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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

8th July, 2010, Thursday

HbA1C variation by race weakens its exclusive
diabetes diagnostic power

Differences in HbA1c levels are attributed to differences in blood glucose levels because the concentration of blood glucose determines the formation of HbA1c. However, HbA1c level may also be influenced by other physiologic, environmental, genetic, or socioeconomic factors, including race and ethnicity.

Uremia, hyperbilirubinemia, hypertriglyceridemia, chronic alcoholism, chronic ingestion of salicylates, and opiate addiction can falsely increase HbA1c results, whereas vitamin C and vitamin E ingestion have also been reported to falsely lower HbA1c results.

Participants enrolled in the Diabetes Prevention Program who had prediabetes were found to have HbA1c levels that differed between black and white participants with no differences in glucose concentration. Black persons have higher HbA1c levels than white persons across the full spectrum of glycemia, and the differences increase as glucose intolerance worsens. (June 14, 2010, Annals of Internal Medicine)

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)


Promotion of Folk Dance Forms


Folk artists from different states of India performed at the Perfect Health Mela organized by the Heart Care Foundation of India in 2007. The performances were based on the theme ‘Women’s Health & Nutrition‘.

Dr k k Aggarwal

Mr A R Kohli, Former Governor Mizoram and Mr. Anuj Sinha, Scientist ‘G’ & Head RVPSP, DST GOI distributing certificates to the folk artists during Perfect Health Mela 2007. Also in the photo: Padma Shri and Dr BC Roy National Awardee Dr K K Aggarwal, President HCFI


News and Views

Advisory panel votes against approval of drug to treat female sexual desire disorder
(Dr Monica and Brahma Vasudeva)

In June this year, the Federal advisory panel, an adviser to the PDA unanimously voted against recommending approving flibanserin manufactured by Boehringer Ingelheim. But it encouraged the company to continue its research. Flibanserin is being investigated as treatment for female sexual desire disorder.

Conjunctivitis or pink eye (Dr G M Singh)

Conjunctivitis is a common infection that is very contagious. Since more serious medical problems can mimic the redness and itchiness that characterize pink eye, the condition should be evaluated by a doctor.

Diabetes responsible for 10% of vascular deaths

More than one in 10 heart disease deaths may be attributable to diabetes. In a meta–analysis of more than 100 studies, diabetes was associated with a two-fold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

Antihypertensive drugs may protect against Alzheimer’s disease

Researchers at Mount Sinai School of Medicine have found that the drug carvedilol, currently prescribed for the treatment of hypertension, may lessen the degenerative impact of Alzheimer’s disease and promote healthy memory functions. 


Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

What constitue 'Consent and Will' in a charge of Rape?

According to Indian law, a woman cannot be charged with the offense of rape on a man. This is the legal provision in most of the countries of the world except France and some of the erstwhile French colonies, where a woman may also be charged for commission of rape on a man. However, in India, a woman may be charged with having committed an indecent assault on a man.

Rape is unlawful sexual intercourse. The phrases "against her will" and "without her consent" used in the definition of rape u/s 375 IPC have great significance. Will and Consent do not mean the same thing, though consent is dependent on will. Every act done against the will of a person is done without his/her consent but an act done without the consent of a person is not necessarily against his/her will. Sexual intercourse with unconscious woman cannot be said to be against her will but it will be without her consent. A woman may be willing for sexual intercourse but she may not give her consent due to shyness, for fear of detection and social stigma or for fear of being pregnant.

On the other hand, a woman may give consent suppressing her unwillingness due to some other factor e.g. for some other benefit or reason. As per the Section 114–A Indian Evidence Act in a prosecution for a rape under clause (a) or clause (b) or clause (c) or clause (d) or clause (g) of subsection (2) of section 376 of the IPC where sexual intercourse of the accused is proved and the question is whether it was without consent of woman alleged to have been raped and she states in her evidence before the court that she did not consent, the court shall presume that she did not consent. Clause (d) is related to the medical professional/hospital - when a doctor/paramedic takes advantage of his position and rapes a female patient/attendant in the hospital. In such case, the law will presumes that there is absence of consent and the charge is treated as a custodial rape in hospital.


Experts’ Views

Interesting tips in Hepatology & Gastroenterology
(Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi)

Gut and Liver–related issues with obesity

• Nonalcoholic fatty liver disease (NAFLD)
• Cholelithiasis
• Gastroesophageal reflux disease (GERD)
• Irritable bowel syndrome
• Constipation
• Pancreatitis
• Predisposition to GI Cancers (Esophagus, stomach, liver, gallbladder, pancreas, colon, rectum)

Prevalence of GI and liver disease in pediatrics population is as follows: Gallstones (0.6%), NAFLD (15%), GERD (22%), Constipation (25%), Encopresis (15%)

Nonalcoholic fatty liver disease (NAFLD) is a clinicopathologic syndrome encompassing a wide range of fatty liver disease in the absence of significant alcohol intake and other common causes of steatosis. The spectrum of NAFLD includes Steatosis  → Steatosis with nonspecific inflammation → Steatohepatitis (NASH) → NASH with fibrosis → Cirrhosis

The Indian Scenario

Prevalence among general population is 5% 25% and is high among diabetics (3090%) and the obese (15% 20%). Indians have increased predisposition to visceral fat accumulation, leading to higher prevalence of Type 2 DM, NAFLD and Insulin resistance.

NAFLD is being seen as hepatic manifestation of the Metabolic Syndrome or Syndrome X.

Question of the Day (Dr AJ Asirvatham, Madurai)

What is the role of glycemic control in microand macrovascular complications in type 2 diabetes mellitus?

Tight glycemic control has the most important role in the prevention of micro and macrovascular complications of diabetes. In the yester years, the concept of good control was just a good way of living with diabetes and none of them knew the real need, though everyone tried to achieve it. Diabetes Control Complication Trial (DCCT) was the first landmark study to confirm that a tight glycemic control, of mainly the fasting plasma glucose in the intensive treatment group, reduced all the microvascular complications of diabetes compared to the conventional treatment group.

Risk reduction

  • Retinopathy: 76%

  • Nephropathy: 50%

  • Neuropathy: 60%

Disease progression: Retinopathy was slowed in 54%.

The macrovascular complications however did not show any statistically significant benefit.

The Kumamoto study confirmed that cumulative percentages of worsening in retinopathy and nephropathy were significantly lower (p < 0.05). It also showed significant improvement in the neurological test (median nerve conduction velocity (p < 0.05) with tight control of fasting and postprandial glucose in the multiple injection therapy, whereas the conventional insulin therapy group showed significant deterioration in nerve conduction velocity and vibration threshold. The total events of cardiovascular, cerebrovascular and peripheral vascular disease in the conventional insulin injection therapy (CIT) group was twice as much as those in the multiple insulin injection therapy (MIT) group (1.3 vs 0.6 events/100 patient-years). The study concluded that intensive glycemic control can delay the onset and progression of the early stages of micro and macrovascular complications.

The UKPDS established that tight glycemic control in the intensive control group had a risk reduction of:

  • Any diabetes related endpoint by 12%

  • Microvascular endpoints by 25%

  • Myocardial infarction by 16%

  • Cataract extraction 24%

Maths Magic ( Dr Jagjit Singh)

13837 × Your age × 73 = ?

Just try it

U will get an Interesting answer


View Point (MCI)

In this column, eminent Padma Awardees express their thoughts on Medical education.

Today, we present the views of Padma Shri Awardee Dr. Harsh Mahajan

In medical education to achieve uniformity of standards both the government and private medical colleges and hospitals, there has to be common curriculum, similar systems of education and also a common entrance exam which should be on an All-India basis and from which anyone can choose what he wants. Currently, what is happening is that there is a lot of variation in standards between the best and the worst and also, if it is one exam, then a merit list can also be prepared from that exam on a State wise basis because health is a state subject. This will also ensure that corruption in the admission process is reduced.

We also need to develop more practical oriented curriculum which are more suitable to our country and also we can have an accelerated course of three years where we can prepare medical professionals who are not doctors but are able to manage day to day problems, routine problems of patients. This will enable us to send these people to the villages, smaller towns were currently it is all unqualified people, the quacks who are practicing. For super specialty again, the MD, MS system and DNB system need to be integrated to bring uniformity in both courses and again, the admission process as well as the final qualification exam should also be similar so that ultimately it brings about uniformity.


Public Forum (Press Release for use by the newspapers)

Take care of your health in Monsoon

Monsoon is welcomed by all but it brings along a whole lot of diseases. Monsoon reduces the immunity of the body, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

The diseases associated with monsoon are malaria, dengue, Chikungunya, jaundice including gastrointestinal infections like typhoid and cholera. Apart from these, viral infections like cold and cough also make their presence felt. Chikungunya patients, classically, have joint pains that are relieved by flexing the limbs. Dengue, if not adequately managed, can be fatal in one to four percent of cases but chikungunya, through not fatal, can cause chronic debilitating joint pains that may last for years. Management of Dengue involves fluid resuscitation and not platelet resuscitation. Mortality can be reduced if enough fluids are given. The mortality period usually starts when the fever subsides. Inappropriate use of anti fever medicines can precipitate bleeding in dengue patients.

Puddles of water formed due to rain become breeding grounds for mosquitoes. Contamination of drinking water is common. It is important to drink clean and pure water to prevent diarrhea and gastrointestinal infections

Walking in dirty water during rainy season may cause numerous fungal infections, which affect toes, and nails. Diabetic patients especially need to take special care of their feet. Their feet should always be dry and clean. Avoid walking in dirty water. Keep shoes, socks and raincoats, dry and clean.

Precautions should to be taken to prevent dampness and growth of fungus (mold) on and around the house where asthmatic patients live. Avoid fumigation in case of asthmatic patients.

During rains, worms from below the soil come up to the surface and contaminate the surface vegetables. In the presence of weak digestive fire this can cause gastric disturbances. It is due to this reasons that community lunches and marriage are prohibited in this season. One should eat light foods. Consuming barley, rice and wheat is good. Water should be boiled before use. Adding ginger and green in daily diet is helpful. Eating warm food is the rule.


An Inspirational Story

Alexander Fleming

His name was Fleming, and he was a poor Scottish farmer. One day, while trying to eke out a living for his family, he heard a cry for help coming from a nearby bog. He dropped his tools and ran to the bog. There, mired to his waist in black muck, was a terrified boy, screaming and struggling to free himself. Farmer Fleming saved the lad from what could have been a slow and terrifying death.

The next day, a fancy carriage pulled up to the Scotsman's sparse surroundings. An elegantly dressed nobleman stepped out and introduced himself as the father of the boy Farmer Fleming had saved. "I want to repay you," said the nobleman. "You saved my son’s life."

"No, I can’t accept payment for what I did," the Scottish farmer replied, waving off the offer. At that moment, the farmer’s own son came to the door of the family hovel.

"Is that your son?" the nobleman asked. "Yes," the farmer replied proudly. "I’ll make you a deal. Let me take him and give him a good education. If the lad is anything like his father, he’ll grow to a man you can be proud of."

And that he did.

In time, Farmer Fleming’s son graduated from St. Mary’s Hospital Medical School in London, and went on to become known throughout the world as the noted Sir Alexander Fleming, the discoverer of Penicillin.

Years afterward, the nobleman’s son was stricken with pneumonia.

What saved him? Penicillin.

The name of the nobleman? Lord Randolph Churchill.

His son’s name? Sir Winston Churchill.


IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was suspected to have metabolic syndrome.
Dr Bad: Get BMI test done.
Dr Good: Also get your abdominal girth measured.
Lesson: Of the anthropometric parameters commonly used to identify metabolic syndrome, waist:height (WHtR) ratios may be the best. In a study, WHtR exhibited the strongest and most consistent relationship with metabolic syndrome in men, even after adjustment for BMI. (J Diabetes 2009;1:57–64)

Make Sure

Situation: A patient in his immediate post-CABG procedure developed dangerous arrthymias.
Reaction: Oh my God! Why you did not correct his K+ Value of 2.5 pre–operatively?
Lesson: Make sure that pre–operative K+ value of <3.5 is corrected. Cardiac surgery patients who have serum potassium levels below 3.5 mmol.L are at high risk for peri–operative arrhythmia.

Quote of the Day (Dr. Santosh Sahi)

"Do not wait to strike till the iron is hot; but make it hot by striking". William B. Sprague

Milestones in Orthopedics

Giovanni Battista Monteggia (1762–1815) was an Italian surgeon and physician. Monteggia fracture [fracture of the proximal third (upper portion) of the ulna with dislocation of head of radius] is named after him.

Mnemonic of the Day

Plantar extensor but abdominal reflex present
Motor neuron disease
Cerebral diplegia
Hereditary spastic paraparesis


IMSA Update

International Medical Science Academy Update (IMSA)

Changes in UpToDate recommendations for cervical cancer screening

Screening for cervical cancer be initiated no earlier than age 21, regardless of the age of initiation of sexual activity. It is also now suggested that Pap smear screening in average risk women less than 30 years old be initiated at intervals of one to two years, lengthening the screening interval to two to three years after three consecutive negative smears or at age 30, whichever comes first.

1. Sawaya GF. Cervical–cancer screening –– New Guidelines and the Balance between Benefits and Harms. N Engl J Med 2009;361:2503.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Hydroxy ethyl starch 10% Solution for infusion

For the treatment of imminent or manifest hypovolemia and shock.



Medi Finance

Cumulative Bonus

Sum insured under the policy shall be progressively increased by 5% in respect of each claim free year of insurance, subject to maximum accumulation of 10 claim free years of insurance.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

BNP and NT–proBNP

Also known as: Brain natriuretic peptide; proBNP

Formal name: Btype natriuretic peptide; Nterminal pro btype natriuretic peptide

To help diagnose the presence and severity of heart failure


Humor Section


The difference between a neurotic and a psychotic is that, while a psychotic thinks that 2 + 2 equals 5, a neurotic knows the answer is 4, but it worries him

Funny Definitions

Hangnail………………What you hang your coat on

Medical bloopers on medical charts!

He had a left–toe amputation one month ago. He also had a left-knee amputation last year.


Readers Responses

  1. Dear Sir, Regarding Dr. Vinod Varshney’s suggestion to generate (and store) prescription on computer (desktop / laptop), it is imperative that you have appropriate software (preferably customised for your practice) I know from personal experience that it has tremendous advantage, much more than the two enumerated by Dr. Vinod Varshney as I have been using one such software since August 2009. Anybody interested I can give the software developer’s contact. Dr. BB Gupta (drbbgnd29@gmail.com)

Forthcoming Events

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5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

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

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29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

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31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

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