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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; Member 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


9th June, 2010, Wednesday

MCI stops internships in private non–medical college hospitals

Dear Colleague

In a meeting between the officials of the MCI and the officials of the Ministry of Health & Family Welfare, Govt. of India held on 19.08.2009, it was suggested that henceforth internship should only be permitted in teaching hospitals affiliated to medical colleges.

The same was referred to the MCI General Body Council by the MCI Executive Council on 1.12.09. The MCI General Body Council in its meeting held on 11.3.10 endorsed the decision that henceforth internship should only be permitted in teaching hospitals affiliated to medical colleges.

The same is being communicated to the existing private hospitals not affiliated to medical colleges where internships are at present on. It seems that the present MCI board of governors has also agreed to this decision. Redaers response is invited so that one knows that it is not a retrograde step?

ESI New Rule, with effect from 1st May 2010( attention establishment owners)

In the Employees’ State Insurance (Central) Rules, 1950, in Rule 50, for the words" ten thousand", wherever they occur, the words "fifteen thousand" shall be substituted.

As per the new rule now employee with salary (basic+HRA) upto 15000 (earlier 10,000) will be come under ESI act. They will be covered under ESI health insurance and their ESI contribution will be deducted.

Deduction percentage

Employee deduction: 1.75% (Basic + HRA)
Employer deduction: 4.75% (Basic + HRA)

Total deduction 6.5%

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Walk for Health

Walking is an eco–friendly method, it is safe, simple, does not require practice, and the health benefits are many. Heart Care foundation of India has used 'Walk for Health' as a module for health awareness. Groups of students or adults participate in the walk. They hold placards and banner with health messages. They impart health awareness throughout the route of their walk. Sportspersons are usually involved to flag off such campaigns as they are role models for many and themselves follow a regular fitness regime.

Dr k k Aggarwal
Cricketer Manoj Prabhakar flags off the 'Walk for Health'. Also in the picture: Padmashri Awardee Dr K K Aggarwal and Dr H K Chopra.

International Medical Science Academy Update (IMSA): New FDA Drug Update

Sibutramine

Sibutramine, a reuptake inhibitor of norepinephrine, serotonin and dopamine, is used for the medical treatment of obesity. Based on results from an ongoing placebo–controlled trial in which sibutramine was associated with a higher risk of heart attack and stroke, US FDA recommended that sibutramine NOT be used in patients with cardiovascular disease, and the European Medicines Agency recommended suspension of marketing of the drug in the European Union.

References

  1. Caterson I, Coutinho W, Finer N, et al. Early response to sibutramine in patients not meeting current label criteria: preliminary analysis of SCOUT lead-in period. Obesity (Silver Spring) 2009; Oct 8 (Epub ahead of print).
  2. http:// www.fda.gov /Safety/MedWatch /SafetyInformation/ Safety Alerts for Human Medical Products/ ucm 198221.htm Accessed January 25, 2010.
  3. http:// www.ema.europa.eu/ pdfs/ human/ referral/ sibutramine/ 3940810en. pdf Accessed January 25, 2010.

Mnemonic of the Day (Dr Prachi)

Neurological focal deficits (10 S's)

Sugar (hypo, hyper)
Stroke
Seizure (Todd’s paralysis)
Subdural hematoma
Subarachnoid hemorrhage
Space–occupying lesion (tumor, AVM, aneurysm, abscess)
Spinal cord syndromes
Somatoform (conversion reaction)
Sclerosis (MS)
Some migraines

News and Views (Dr Monica and Brahm Vasudeva)

1. Researchers say rate of fatal medication errors at teaching hospitals spikes in July

A report by UC San Diego researchers in the Journal of General Internal Medicine has found that July is the worst month to check into a teaching hospital because of the arrival of new residents.

2. H1N1 vaccine is as safe as seasonal flu shot

A CDC analysis has shown that the Swine flu vaccine no more increases the chances of Guillain–Barre syndrome than the seasonal flu vaccine. The association between swine flu vaccine and Guillain–Barre syndrome was increased in 1976, when dozens of cases broke out during a swine flu vaccination campaign, prompting the federal government to shut down the effort.

3. Rosiglitazone, metformin low–dose combination may reduce progression to type 2 diabetes

A study published online June 3 in The Lancet finds that a combination of low doses of rosiglitazone and metformin can reduce the progression to type 2 diabetes by two–thirds in people who are at high risk of developing the disease. This benefit is greater than with either of the drugs used alone, and the combination is well–tolerated with fewer side effects.

4. Thoracoabdominal calcifications may herald cardiovascular mortality

Thoracoabdominal calcifications may predict mortality due to cardiovascular diseases in diabetic women and nondiabetic men and women but not in diabetic men. High hs-CRP levels (=of 3 mg/dL) plus presence of thoracoabdominal calcifications facilitate the prediction of CVD and total mortality in women but not in men.

Conference Calendar

Advanced Cardiac Life Support (ACLS) Provider Course American Heart Association (AHA) Accredited
Target Audience – All Healthcare Personnel
Date: June 11–12, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the day

"Great speakers are not born, they’re trained." Dale Carnegie (1921)

Question of the Day

How to evaluate and treat a patient with angina–like pain due to esophagus? (Dr. Shobna Bhatia, Mumbai)

At least one–third of patients referred to a cardiologist or admitted to a coronary care unit because of angina–like chest pain will have cardiac causes excluded. In most, an alternative etiology is not apparent. Lack of a specific diagnosis may lead to ongoing anxiety, changes in lifestyle and frequent medical consultations if the patient continues to worry that serious heart disease may be present. Such patients should be evaluated for esophageal disease, although the cost–effectiveness of this approach is not known.

Initial investigations include a barium esophagogram and/or upper GI endoscopy to screen for gross esophageal dysmotility and esophagitis. Frequently esophageal motility studies are usually required to establish an esophageal cause for the pain. In many of these patients, abnormalities of esophageal motility can be documented, suggesting that esophageal dysfunction may be responsible for the pain. Of more diagnostic importance, however, is the demonstration that "provoking" the esophagus with acid perfusion, balloon distention or cholinergic stimulation reproduces the patient’s pain.

Both pH and esophageal pressure can be monitored over 24 hours. This method is probably more sensitive and specific than conventional tests, but the equipment is expensive and the test is of limited value in patients with infrequent pain attacks. Management of angina–like chest pain of esophageal origin should be directed at the specific pathophysiological process. If the pain is triggered by GER, then antireflux treatment may be quite helpful. If the pain is due to esophageal spasm, smooth–muscle relaxants such as nitrates, calcium channel blockers, hydralazine and anticholinergics should help, although few controlled clinical trials have demonstrated any significant benefit. Tricyclic antidepressants in relatively low dosage have been shown to be beneficial and should be tried in patients with incapacitating symptoms when other forms of treatment have failed. These are most likely to be useful in patients with abnormal visceral nociception, or the so–called irritable esophagus. Many of these patients will have a significant functional overlay with many other somatic complaints. Simple re–assurance is probably the most important part of treatment. Symptoms usually improve once the patient is given a positive diagnosis and no longer fears that underlying heart disease is the cause.

Liver Fact

An elevated Gamma GT with otherwise normal SGOT and SGPT does not require further investigations.

eMedinewS Try this it Works

Freeze and tweeze the ticks

A simple procedure for removing a tick and all of its body parts is to apply liquid nitrogen for 20 seconds. Then use a tweezer to lift the tick from the skin.

Dr Good Dr Bad

Situation: A diabetic with cancer came for chemotherapy.
Dr Bad: Diabetics have good response to chemotherapy.
Dr Good: Diabetics have bad response to chemotherapy.
Lesson: Diabetes is associated with an increase in mortality and poor response rates to cancer chemotherapy. (Int J Diab Dev Ctries 2007;27:122–8.)

Make Sure

Situation: A patient on gentamicin developed polyuria on 7th day. He developed renal failure on 9th day.
Reaction: Oh my God! Why was gentamicin toxicity not suspected when the urine output increased?
Lesson: Make sure that all patients on gentamicin are looked for toxicity.The firts indication is increased output.

IMADNB Joke of the Day (Dr Tarun)

An excellent old gentleman grew hard of hearing, and was beset with apprehension lest he become totally deaf. One day, as he rested on a park bench, another elderly citizen seated himself alongside. The apprehensive old gentleman saw that the newcomer was talking rapidly, but his ears caught no faintest sound of the other’s voice. He listened intently–in vain. He cupped a hand to his ear, but there was only silence. At last, in despair, he spoke his thought aloud:

"It’s come at last! I know you’ve been talking all this while, but I haven’t heard a single word."

The answer, given with a grin, was explicit and satisfying to the worried deaf man:

"I hain’t been talkin’–jest a–chewin’."

Formulae in Clinical Practice

Room Air A–a Gradient

Formula: {150 – (PaCO2/0.8) – PaO2}

Milestones in Gastroenterology

1843–1913: Reginald H. Fitz

Fitz contributed greatly to treatment of the perforated appendix and coined the term appendicitis. He also described many clinical and pathological features of acute pancreatitis. He defined a triad of essential characteristic symptoms for appendicitis as sudden localized pain, fever and circumscribed swelling.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Pediatric Allergy Screen, Serum

Testing for IgE antibodies may be useful to establish the diagnosis of an allergic disease and to define the allergens responsible for eliciting signs and symptoms, to confirm sensitization to particular allergens prior to beginning immunotherapy, and to investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Chlorthalidone Tablet 6.25mg

For the treatment of mild to moderate hypertension.

03.10.09

 

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eMedinewS–revisiting 2010

The second 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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Public Forum (Press Release for use by the newspapers)

Forty percent have metabolic syndrome

Forty percent of adults over age 40 have metabolic syndrome, a constellation of obesity leading to dyslipidemia; hypertension, and insulin resistance and, thus a, 10-year risk of a first heart attack event of about 17 percent. All patents with metabolic syndrome should be considered for aspirin prophylaxis. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Current criteria define the metabolic syndrome as the presence of any three of the following five traits:

  • Abdominal obesity, defined as a waist circumference in men >35 inches and in women >32 inches.

  • Serum triglycerides 150 mg/dL or drug treatment for elevated triglycerides

  • Serum HDL cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL-C
  • Blood pressure 130/85 mmHg or drug treatment for elevated blood pressure

  • Fasting plasma glucose (FPG) 110 mg/dL or drug treatment for elevated blood glucose.

Metabolic syndrome is an important risk factor for subsequent development of type 2 diabetes and/or CVD.

Thus, the key clinical implication of a diagnosis of metabolic syndrome is identification of a patient who needs aggressive lifestyle modification focused on weight reduction and increased physical activity.

13th June 2010: IMSA workshop with Dr KK Aggarwal, Moolchand Medcity 8-10am

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

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 day-long 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

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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. My Dear Dr. Aggarwal, I read with interest ur mail regarding Nutrient– Dense Foods. There are certain foods which are not available in India, whereas for other foods in English they may not be understood well and the name of the various fruits/foods may perhaps be mentioned in Hindi. Being the Chairman of Indian Association of Age Management and with the help of my associate members, I am working on Healthy Ageing. With my own philosophy I have treated nearly 550 patients. My patients are so happy that I get their messages to send them the medicines at their place of residence by courier. You may not agree with my philosophy that "it is not the age which leads to decline of hormones, rather it is the decline of hormones which leads to ageing."
    Hence all my patients (beyond the age of 65 and having Orthopaedic problems) are investigated for the deficiency of hormones and accordingly according to the deficiency the hormones are replaced. I may mention that with my treatment many of my patients who were recommended for Total knee Replacement, never required the replacement.

    Lastly I may write that hormonal treatment is last on my list. Rather lifestyle, diet, exercise play the major role in my treatment: Prof. V.P. Bansal, MBBS, MS Orth (Punjab), MCh Orth (Liverpool), DPMR (Mumbai)

  2. Dear Dr K K, how will the Govt ensure that the doctors trained for rural purpose will not migrate to urban area; in the present scenario when the Govt has no control on unqualified people / quacks. My suggestion is that Govt should get a bond filled from each medical student entering the Govt medical college for a big amount (20 to 25 lac) if he does not serve the rural area for a minimum of 2 years. Incentive as higher pay scale to be given to doctors working in rural area: Dr V K Goyal, IMA – EDB – 949

  3. Issue of infections in traumatized patients

    Respected Sir, Recently the issues of infections in trauma patients with special reference to growing medico–surgical concern have been discussed and many important aspects are highlighted. All of us would agree that the concept of trauma care, establishment of trauma centers and availability of efficient antibiotics have changed the outcome of trauma patients remarkably. However, there is need to study our patients’ population in detail, including injury patterns and the incidence of infections, details of antibiotic prescriptions including outcomes in further details. With the help of the institutions and experts who deal with trauma care, we can find out pattern of infections in trauma cases and can develop guidelines to find out the indications for prophylactic and therapeutic agents according to our patient population where the resources and finances are major limiting factors. While developing the guidelines we need to develop the strategies to propagate the message so it should reach to the most peripheral health personnel who are involved in the patient care.

    Reference
  1. Mathur P. Infections in traumatised patients: A growing medico–surgical concern. Indian J Med Microbiol 2008;26:212–6