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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

  Editorial ...

6th September, 2010, Monday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

US experience: Over 40% of all doctors get sued during their careers (JAMA)

  • 95 medical liability claims are filed for every 100 physicians
  • 5% of doctors are sued in any given year.
  • General surgeons and obstetricians/gynecologists get sued five times as often as pediatricians and psychiatrists.
  • Nearly half of OB/GYNs are sued by the age of 40.
  • 90% of general surgeons age 55 and over have been sued.
  • 65% of claims were dropped, dismissed or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% went to trial.
  • Physicians win 90% of cases that go to trial.
  • Average defense costs per claim were $ 40,649, ranging from a low of $22,163 among claims that were dropped, dismissed or withdrawn to a high of over $100,000 for tried cases.
  • Median paid claims were $200,000 for settled claims and $375,000 for tried claims.
  • Men were sued twice as much, likely because they are concentrated in high–exposure fields such as surgery compared to women, who concentrate in lower–risk fields. Also, men work on average longer and more hours per week, and they're more likely to be practice owners, who get sued more often.
  • Approximately 45% of solo physicians had been sued, compared to 37% of physicians who provided care in multispecialty groups and 40% of those in hospitals.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Cigarettes are bad for the heart

Actress Meghna Kothari and Singer Rita Ganguly along with Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal, President HCFI in an event organized to propagate the message that cigarettes are harmful to the heart.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Sipuleucel–T (Provenge) vaccine for metastatic prostate cancer

For minimally symptomatic or asymptomatic patients with castration–resistant prostate cancer that is not progressing rapidly, treat with sipuleucel–T before using cytotoxic chemotherapy
(www.fda.gov/ downloads/ BiologicsBloodVaccines/ CellularGeneTherapyProducts/ ApprovedProducts/ UCM210031.pdf)

  National News

Elephant to be declared national heritage animal

It is worshipped and used in religious rituals, but also slogs it out in labour camps; it features prominently in our history and mythology, but is also an icon of modern India. In a bid to give elephant conservation the same momentum of national pride that ‘Save the Tiger' campaigns evoke, the government has decided to declare the jumbo as a national heritage animal. This comes in the wake of last year's move to have the Gangetic dolphin declared as the national aquatic animal, as it symbolises the health of the country's rivers.  (The Hindu).

  International News

A Diagnostic test for TB

The Xpert MTB/RIF TB test, a molecular test, has been devised to diagnose tuberculosis and also detect a drug-resistant form of the disease has been found to be much more specific, sensitive and rapid results than currently available TB diagnostics. In a study of more than 1730 patients with suspected drug–sensitive or multidrug–resistant pulmonary TB, the test successfully identified 98 percent of all confirmed TB cases and 98 percent of patients with rifampin–resistant bacteria in less than 2 hours. The study is published in the New England Journal of Medicine.

A promising malaria drug candidate shows promise, says NIH–sponsored research

NITD609, a chemical that removed malaria–causing parasites from mice, after a single oral dose, may eventually become a new malaria drug if further tests in animals and people uphold the promise of early findings. The compound was developed by an international team of researchers including Elizabeth A. Winzeler, Ph.D., a grantee of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The compound acts on a protein in the malaria parasite, which is not attacked by any existing malaria drug. The study is published in the Sept. 3 issue of Science. NITD609 is one of a new class of chemicals, the spiroindolones.

Lower BP goal benefits African–Americans with chronic kidney disease

The African–American Study of Kidney Disease and Hypertension (AASK) has found that on average, a lower blood pressure goal was no better than the standard blood pressure goal at slowing progression of kidney disease among African–Americans who had chronic kidney disease resulting from high blood pressure. The BP goal nevertheless did benefit those patients who also had proteinuria, which is a sign of kidney damage. AASK is the largest and longest study of chronic kidney disease (CKD) in African–Americans funded by the NIH. The study findings are published in the Sept. 2 issue of the New England Journal of Medicine.

Disclosing medical errors does not increase malpractice claims

The University of Michigan Health System (UMHS) has fully disclosed and offered compensation to patients for medical errors without increasing its total claims and liability costs.

   Liver Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta Medicity

Q. What's New in the management of Hepatitis C?

Ans. Hepatitis C — Accumulating evidence supports the use of combination therapy with pegylated interferon and ribavirin to treat chronic hepatitis C infection in children. In a multicenter trial, this combination yielded 93 percent sustained viral response in patients with genotype 2 or 3, and 53 percent in those with genotype. (J Hepatol 2010; 52:501)

  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Q: Is IVF very expensive?

A. IVF is not as expensive as it is generally perceived to be. The cost of your IVF cycle is decided by the dose of drugs that would be needed for ovarian stimulation. IVF is only as expensive as perhaps a gall stone removal or removal of uterus surgery! There is a myth amongst the public that IVF is hugely exorbitant.

  Diabetes Update: Question of the day

What is honeymoon phase in type 1 diabetes mellitus? (Dr Subhankar Choudhury, Kolkata)

Honeymoon phase is a transient clinical remission period of type 1 diabetes mellitus shortly after its clinical onset; it is characterized by continuation of endogenous insulin secretion, reduced exogenous insulin requirement and good metabolic control. The fall in insulin requirement is likely due to improved β–cell function and improved insulin sensitivity consequent upon improvement of ‘glucotoxicity’ on treatment. Two to 12% patients have been reported to undergo total remission, whereas 18–62% may undergo partial remission requiring one or two intermediate acting insulin only.1,2

It should be remembered that this natural remission is always temporary because of inexorable progression of β–cell damage in type 1 diabetes, ending with a gradual or abrupt increase in insulin requirement. The duration of remission depends on age of onset and antibody status of the patient. Older age,3 less severe initial presentation and low or absent ICA3 or IA-24 are predictors of longer remission. The average duration of remission is mostly <3 years as destruction of β–cell is usually complete within this time, especially those with HLA–DR3 and DR4 genotype.5 In 15% older patients β–cell function may be preserved upto 10 years.6

DCCT data indicate that strict control of blood glucose may prolong β–cell destruction. Patients at honeymoon phase should be prescribed minimal maintenance dose of insulin to ensure compliance of the patients. Patients and their guardians should be given explained about this phenomenon, especially so as not to raise undue expectation of cure. There is renewed interest in the phase of partial remission in recently diagnosed diabetes because of the potential for pharmacological and immune intervention to preserve beta-cell function.7


  1. Pinkey JH, Bingley PJ, Sawtell PA, et al. Presentation and progress of childhood diabetes mellitus: A prospective population–based study. Diabetologia 1994;37(1):70–4.
  2. Agner T, Damm P, Binder C. Remission in IDDM: Prospective study of basal C-peptide and insulin dose in 268 consecutive patients. Diabetes Care 1987;10(2):164–9.
  3. Ortqvist E, Falorni A, Scheynius A, Persson B, et al. Age governs gender–dependent islet cell autoreactivity and predicts the clinical course in childhood IDDM. Acta Paediatr 1997;86(11):1166–71.
  4. Sabbah E, Savola K, Kulmala P, et al. Diabetes associated autoantibodies in relation to clinical characteristics and natural course in children with newly diagnosed type 1 diabetes. JCEM 1999;84(5):1534–9.
  5. Knip M, Ilonen J, Mustonen A, Åkerblom HK. Evidence of an accelerated B–cell destruction in HLA–Dw3/Dw4 heterozygous children with type 1 (insulin–dependent) diabetes. Diabetologia 1986;29(6):347–3.
  6. Madsbad S, Bottazzo GF, Cudworth AG, Dean B, Faber OK, Binder C. Islet–cell antibodies and beta cell function in insulin–dependent diabetics. Diabetologia 1980;18(1):45–7.
  7. Muhammad BJ, Swift PG, Raymond NT, Botha JL. Partial remission phase of diabetes in children younger than age 10 years. Arch Dis Child 1999;80:367–9.
  Medico Legal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is the right to refuse medical interventions? Theresa Marie "Terri" Schiavo case of the United States

This consistent refusal to intervene on behalf of Schiavo’s parents’ desire to continue nutrition and hydration is a reaffirmation of the right to refuse medical care even for mentally incapacitated patients and that artificial nutrition and hydration are medical treatments. In theory, the right of patients to refuse medical therapy can be limited by four state interests in: Preservation of life, Prevention of suicide, Protection of third parties such as children and Preserving the integrity of the medical profession. In practice, these interests almost never override the right of competent patients and incompetent terminally ill patients who have left explicit advance directives.

  Medi Finance Update

Financial Tips

The aim in life should not be to save money but also to invest it properly. How much is enough is a question which differs from individual to individual. The earlier you start investing and saving, better are the returns in the long run.

  Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Dicyclomine 2.5mg + Dried Aluminimum Hydroxide 200mg + Light Magnesium Oxide100mg + Simethicone 20mg per 5ml suspension.

For the treatment of the symptoms of functional gastrointestinal disorders like irritable bowel syndrome, functional dyspepsia, peptic ulcers., GERD which includes smooth muscle spasm, flatulence, abdominal distension, hyperacidity, gastric distress, bloating etc


  Lab Calculator

Mean Corpuscular Hemoglobin Concentration

MCHC (g/dL) = Hemoglobin (in g/dL) / HCT (in %) x 100

Reference values are 32–34 g/dL

Interpretation: Low MCHC suggests iron deficiency anemia; high MCHC suggests spherocytosis, dehydration, sickle cell anemia or unstable hemoglobin

  IJCP Special

Dr Good Dr Bad

Situation: A 30–year–old male with suspected migraine came with runny nose.
Dr.Bad: It cannot be migraine.
Dr.Good: It can be migraine.
Lesson: Migraine can also cause nasal stuffiness and runny nose, or teary eyes in 10–20% of individuals.

Make Sure

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients with Rheumatoid Arthritis are started with specific treatments within 3 months of diagnosis.

Quote of the Day

Eleanor Roosevelt …"Great minds discuss ideas; Average minds discuss events; Small minds discuss people."
(Contributed by Dr Prachi Garg)

Hypertension Alert

  1. Malignant hypertension most often occurs in patients with long–standing uncontrolled hypertension, many of whom have discontinued antihypertensive therapy.
  2. Underlying kidney artery stenosis is also commonly present.
  Mind Teaser

Read this………………

k k
c c
u u
t t
s s
word word word word

The answer for yesterday’s Mind Teaser : "Red in the face"

Correct answers received from: Dr Kalpana Mohan, Dr Simran Singh, Dr.Susheela Gupta, Dr. Anupam sethi malhotra, Dr Virender Prakash Gautam, Dr Mukesh Bhandari, Meera Rekhari, DR SUKANTA SEN, Dr.Satish Gunawant, Dr Anurag Jain, Dr Virender Prakash Gautam; D.T.C.D., M.D.

Correct Answer for 4th September Puzzle is One foot in the grave

Correct answers received for 4th September Puzzle: Dr.Satish Gunawant

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Contributed by Dr G M Singh)

A blonde walks into a bank in New York City and asks for the Loan officer.

She says she’s going to Europe on business for two weeks and needs to borrow $5,000.

The bank officer says the bank will need some kind Of security for the loan, so the blonde hands over the keys to a new Mercedes Benz SL 500.

The car is parked on the street in front of the bank, she has the title and everything checks out. The bank agrees to accept the car collateral for the loan.

The bank’s president and its officers all enjoy a good laugh at The blond for using a $110,000 Benz as collateral against a $5,000 loan. An employee of the bank then proceeds to drive the Benz into the bank's underground garage and parks it there. Two weeks later, the blonde returns, repays the $5,000 and the interest, which comes to $15.41.

The loan officer says, "Miss, we are very happy to have had your business, and this transaction has worked out very nicely, but we are a little puzzled. While you were away, we checked you out and found that you are a multimillionaire.

What puzzles us is, why would you bother to borrow $5,000?"

The blonde replies, "Where else in New York City can I park my Car for two weeks for only $15.41 and expect it to be there when I return?"

Finally… a smart blonde joke.

Funny One Liner
Father: A banker provided by nature.

  An Inspirational Story

A School Teacher scolded a boy for not paying attention to his mathematics and for not being able to solve simple problems. She told him that he would not become anybody in life. His mother however believed in him and coached him in Math.

We all know this boy as Albert Einsten.

  Readers Responses
  1. "Happy B´day Dr. Sahab ! Never noticed you were born on Teachers´ Day ! No wonder, you are one of the Best Teachers I have ever seen !!!" : Rajesh Kumar Bhatia
  2. "Dr. sahib.. Janamdin kee hardik subhkamna....cheers with buttermilk...have a great day": Rajeev Tyagi
  3. "HAPPY BIRTHDAY  sir !! may u keep shining....GOD  bless u": Megha Chaudhary
  4. "Wish u a happy and long life":    Rakesh Gupta
  5. "Happy Birthday sir.............May God Bless u...................": Dr.Gifty Arora
  6. "Happy birthday sir... may god bless u ... enjoy". :   R Mayur Jain
  7. "Happy bday boy": Dr V K Monga
  8. "HAPPY BIRTHDAY": Seema Chakraborty
  9. "Happy b'day sir...." :       Priyanka Kain
  10. Dearest Brother KK: Many Happy Returns of the Day. All GREAT Teachers are 5th Sept born......and all good disciples too......(27th).. God bless. Dr.N.K.Bhatia
  11. "Happy birthday": Ajay Vadhvani
  12. Happy Birthday & happy teachers to our respected guru Dr. KK Aggarwal: Dr. Virendra Kumar & Dr Anita
  13. "Happy birthday Krishan chachu : May God bless you": Pankhuri Aggarwal
  14. "Happy birthday KK": Ashwani Mehta
  16. Many happy returns of the day dear KK. : Krishan Arora
  17. "Happy Birthday sir": Himanshu vats
  18. Dear Dr Aggatwal happy teachers day,  Yes you are a good teacher for all of us through your emedinews . All the best. Vivek kumar
  19. Anil Singhal: "Happy Birthday to you Sir"
  20. Many Many happy Returns. May the agenda  of  passing on the knowledge continue forever.: Madhu Phull
  21. Happy birthday Jij !! May god shower his choisest blessings on you. All the best: Gunjan Sanghi
  22. Dear Dr Aggarwal,   Lot of filth and rubbish is reported everyday in daily newspaper, when a case is reported in news paper regarding doctors mistake..Sometime it is so ill logical and irrational, for example in a serious pt injection given patient died, some injection has to be last one in a seriously ill pt., Malignancy pt opened and closed due to advanced disease, Pt party making big fus over such pts. Idea is, this high time to take journalism and press reporting as a full time profession by few of us and write the right things in papers. Vivek Kumar
  23. Happy Birthday, doc saab. You're the best, and you deserve the best!:    Shubhra Krishan
  24. KK Uncle, Many Many happy returns! Hope you can get away from your tedious lifestyle and enjoy your BIG day! Rajat Bhatnagar
  25. Dear Dr Aggarwal, Wishing you a very happy birthday and happiness always. These four teachings for healthcare workers from Bhagwat Geeta are very relevant and should be part of NABH healthcare standards. Please send these to Quality Council of India. Gayatri Mahindroo
  26. "HappY BirthdaY!!!" : Ajay Kumar Gupta
  27. Happy birthday to Dr. KK Aggarwal sir, you are a born teacher, hence god has chosen the teacher,s day for your birth. Best wishes from Charu and PN Aggarwal
  28. "Happy Birthday": Anil Bansal
  29. "Happy b'day, sir! And happy teacher's day as well.": Jainendra Upadhyay
  30. "Happy birthday sir.. nd happy  teachers day": Priyanka Nim
  31. "Happy Birthday, doc saab. You're the best, and you deserve the best!-------no doubt,secret of so much energy? Natraj Kamboj
  32. Many Many happy returns of the day: Aniamma Pugazhenthi
  33. "Respected & Dearest Dr. Sahab, Many-many Happy Returns of the Day!!!!"   :     Pawan Jain"
  34. "Happy birthday....and Happpy Teachers Day sir......"      Manju Leo
  35. "SIR JI MANY MANY HAPPY RETURNS OF D DAY....HAPPY BIRTHDAY............" Jagdish Bhatia
  36. Many happy returns of the day sir, rgds Anoop
  37. MAny  many happy returns of d day sir......." Ayonika Dey
  38. Many-many happy Returns of the day sir..... Ajay Mittal
  39. "Many Many Happy Returns of the Day Sir!!! May u continue doing the great work of uniting the different schools of medicine & thus impart knowledge to all!! Thank u so much for all ur efforts....HAPPY TEACHER'S DAY AS WELL!! :)" Mayank
  40. "Happy b day sir!!!!!!!!!!!!!!!! may god bles u in multitudes!"         Mini
  41. Wish u many happy returns of the day...i met u at FICCI function. it was a gr8 program...hope u remember me? Poonam Kej
  42. "Many-many happy Returns of the day sir....." Sukhvinder KAur
  43. "Wish you Many Happy returns of the day sir." Devender Solanki
  44. "Happy birthday sir: Narendra Deo
  45. Sir, This is in context to release, “doctors have to register in all states they practice." Such a step is going to add to bureaucratic oppression towards doctors & increase their troubles. Already it is mandatory for doctors practicing in Delhi to register with DMC. Initial fees of Rs 100/- increased to Rs 1000/-. This has added hassles to qualified doctor by making the financial axe fall on him!!!! Doctors from other states can’t apply for jobs in Delhi till they are registered with DMC. However quacks, who show no concern as regards registration, are same in Delhi!!!! This just added problems to qualified doctors!!!! Now let us consider the other problem. Corporate sector will be in a hot soup too.
    Consultants from corporate hospitals like Apollo, Ganga Ram, Medanta, Escorts visit periphery dists & villages in different states. They will be predisposed to higher risks from bureaucracy from different dists. Consumer courts, civil hospital interference will increase in other states too!!!!!! Quality of pt care too shall decrease due to restriction in practices & good docs will not be able to go to other states.  CME will lose weight, as for registration every state shall give due weightage to its own faculty CME, rather than a good CME of some other state. Such unequivocal, unthoughtful legal steps have already deteriorated the things for us professionals. I think it is we professionals who are creating obstacles for ourselves & moving forward on a path where our medical standards will go back by 50 years.
    A Delhi doc will be a Delhi doc, a Punjab doc will be a Punjab doc, a Maharashtra doc will be Maharashtra doc, and Bengali doc will be Bengali doc & so on. Critically this is a drastic step making medicine too regional, communal!!!! Is this secular free India? A Think Tank thinks ten times before taking such steps. When it comes to number of docs in a state, the MCI, in the past, has not been able to keep track even of expired/demised docs - we all know this. Now they are planning a new problem rather than solutions!!!!
  46. Narendra Deo: "Happy birthday sir.."  
  Public Forum

(Press Release for use by the newspapers)

When Constipation May be a Serious Problem

While most instances of constipation may not be serious, some cases of infrequent or difficult bowel movements need evaluation by a doctor said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

Heart Care Foundation of India offers this list of warning signs:

  1. You’re constipated for the first time
  2. Constipation occurs for you very infrequently.
  3. You’ve been treating constipation at home with more fiber, fluids and exercise for at least three weeks, but have no improvement.
  4. You have abdominal pain.
  5. You have bloody stools.
  6. You have unexplained weight loss.
  Conference Calendar

Knowledge to Action: The Next Generation of Evidence Based Practice

Date: September 12–15, 2010

Venue: Chicago Sheraton Hotel and Towers, Chicago, USA

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday– BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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