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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


10th June, 2010, Thursday

High Court directs AIIMS to frame policy for opening a pharmacy by any charitable organisation

Dear Colleague

In a Double Bench judgement dated May 17, 2010 by Justice Sanjay Kishan Kaul and Justice Valmiki J Mehta, the High Court has directed the All India Institute of Medical Sciences to frame a proper policy for the purpose of making available space/spaces for charitable purposes within a maximum period of 3 months from the date of the order and to implement the same within the same period of time.

The judgment came after Helpline Pharmacy, a charitable pharmacy group, approached High Court that no space had been allotted by All India Institute of Meedical Sciences for any charitable institution to open a charitable pharmacy for giving free/subsidized medicines to the poor patients of AIIMS. The petitioner wanted to get a space allotted to itself for the said purpose. This issue has been pending for quite some time. The petitioner is a charitable organisation which is willing to give free or subsidized medicines.

The court was of the view that there can really be no dispute about the advisability or requirement of having a space/spaces allotted to charitable institution/organizations for giving free/subsidized medicines to poor patients who visit AIIMS. The court observed that if a space can be allotted for existing barber shops, tailor shops and beauty parlours, certainly, a space/spaces can be allotted for such charitable purposes.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)


Health Messages signed by Famous Public Figures

Heart Care Foundation of India (HCFI) believes that public figures are crucial for getting the Health message across to people and inspiring them to act accordingly. HCFI has frequently released relevant Health Messages signed by famous public figures such as politicians, who are able to reach out to a wider audience due to their following.

In the photo: Shri Arun Jaitley, Politician, putting his signature to a health message from HCFI. Also in the photo: Padmashri Awardee Dr K K Aggarwal and Dr. H. K. Chopra

Dr k k Aggarwal

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

Propofol

The safety of propofol administration by nonanesthesiologist nurses and physicians for endoscopy was addressed in a study of 646,080 endoscopic procedures There were only four deaths, and bag–mask ventilation was required in 0.1 % of upper endoscopies and 0.01 % of colonoscopies (1). In a position statement, the use of nonanesthesiologist–administered propofol for gastrointestinal endoscopy in healthy, low–risk patients was endorsed by the American Association for the Study of Liver Diseases, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy (2).
In addition, a randomized study found that the incidence of postoperative delirium was 50 percent lower in patients receiving light versus heavy propofol sedation during hip fracture repair performed under spinal anesthesia (3
).

References

  1. Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist–directed administration of propofol: a worldwide safety experience. Gastroenterology 2009;137:1229.

  2. Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. Gastroenterology 2009;137:2161.

  3. Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 2010;85:18.

Mnemonic of the Day (Dr Varesh Nagrath, M.D.)

Causes of Urethral Syndrome (Dysuria present but routine urine culture is sterile).

(FAST MANS DCH)

Fungal
Anaerobes
Sexual intercourse: urethral congestion
Tuberculosis

Menopause (postmenopausal atrophic vaginitis)
Allergy to toilet preprations
Nongonococcal urethritis
Surgery (post surgery)

Diverticula
Chlamydia
Herpes simplex–labialis or genitalis

News and Views (Dr Monica and Brahm Vasudeva)

Catheter ablation in atrial fibrillation with may prevent premature death, strokes, and dementia

A study presented at the Heart Rhythm Society’s annual scientific meeting reports that treating atrial fibrillation with catheter ablation can prevent premature death, strokes and dementia for some patients.

Kidney disease has high mortality in hospitalized ACS patients

Kidney disease is frequent in hospitalized patients with non–ST–segment elevation acute coronary syndrome (NSTE ACS) and is a powerful predictor of subsequent mortality in this population group. More than 10,000 patients with ACS were evaluated in a study; of these, more than 4000 had kidney disease. Kidney disease was independently associated with a 2.11–fold increased in–hospital mortality risk, and a 1.95–fold increased 30-day mortality risk. The study is published in the May 24 issue of the Archives of Internal Medicine.

Sex differences noted in presentation, diagnosis of chest pain in primary care

Chest pain in women is more likely to be due to psychogenic cause; while in men, CHD, trauma, and pneumonia/pleurisy are more likely to be the causes. A history of vascular disease, pain worse with exercise and increasing age are associated with CHD in both men and women, but duration of pain is different between the sexes.

Signs that a Head Injury Is Serious (Dr G M Singh)

Any head injury should be taken seriously, but certain warning signs indicate that the injury needs immediate medical attention.
a doctor’s evaluation is required if you notice the following:

  • Any symptom that begins to worsen, including sleepiness, nausea or a headache.
  • Nausea that doesn’t subside.
  • Behavioral changes, such as acting confused or irritable.
  • Enlarged eye pupils, or pupils that are a different size in each eye.
  • Difficulty talking or walking.
  • Any bloody or unusual discharge from the nose or ears.
  • Seizures or vomiting.
  • Weakness or numbness in the legs or arms.

Interesting Tips in Hepatology & Gastroenterology

Welcome to a new daily column on Hepatology & Gastroenterology by Dr Neelam Mohan. Watch out for this space…

Introducing our Columnist

Dr Nilam
  • Dr Neelam Mohan is a Consultant in Pediatric Gastroenterology, Hepatology, Therapeutic Endoscopist & Liver Transplant Physician, Centre for Child Health at Sir Ganga Ram Hospital, New Delhi.

  • She trained in Pediatric Gastroenterology & Hepatology from AIIMS, New Delhi and then did a fellowship in Pediatric Gastroenterology and Hepatology from Birmingham Children’s Hospital, UK, a major pediatric liver transplantation Centre.

Achievements

– Dr Neelam Mohan has set up the Pediatric Gastroenterology & Hepatology Unit at Sir Ganga Ram Hospital, Delhi, which is the busiest Liver transplant center in the country. Credited with several firsts in the field of pediatric liver transplantation in India.

– Her centre is the first private centre in the country providing certified fellowship in Pediatric Gastroenterology and Hepatology.

– She is the first in India to perform Percutaneous Endoscopy Gastrostomy for enteral feeding in newborns & young children.

– Several presentations (272 in which 54 are international) and publications (90 in which 32 are international)

– Vice President of Delhi IAP

Conference Calendar

CME on Transfusion Medicine – "Current Trends in Transfusion Medicine" Date: June 19, 2010
Venue: Physiology Lecture Hall, Sion Hospital (LTMMC & LTMGH), Mumbai, Maharashtra

Quote of the day (Dr Santosh Sahi)

"For true success ask yourself these four questions; Why? Why not?, Why not me? Why not now?" James Allen

Question of the Day

How important a risk factor is hypertriglyceridemia in our country and how should one approach such a patient? (Dr Hemant Malhotra, Ahmedabad)

Hypertriglyceridemia (TG > 150 mg/dl) has been considered to confer increased risk for CAD. Indians tend to develop centralized adiposity (preferential deposition of fat on the trunk and intra–abdominally) with higher insulin resistance and hyperinsulinemia. Syndrome X or metabolic syndrome is characterized by increased insulin resistance, diabetes, hypertension, dyslipidemia (high fasting TG and low HDL cholesterol and high platelet activator inhibitor type 1 (PAI–I.) Some studies have suggested that hypertriglyceridemia is an independent risk factor for CAD. Minor elevations in TG levels (150–299 mg/dl) usually are caused by obesity, sedentary lifestyle, smoking, excess alcohol intake and high carbohydrate diets. In other patients, secondary causes such as diabetes, renal failure, Cushing’s disease, nephrotic syndrome or medication (e.g., protease inhibitors, corticosteroids, retinoids, oral estrogens) may be responsible and genetic causes may be pertinent to others.

The therapy for this group of patients involves identification and treatment of secondary cause (if present), change in medications and lifestyle changes. Very high TG levels (>500 mg/dl) usually result from genetic defects of lipoprotein metabolism; these patients are at risk for acute pancreatitis.

Early and active treatment is required to prevent this condition like
(a) Dietary measures (low fat diet <15% calories from fat).
(b) Fibrates, niacin, statins in high doses. Intermediate rise in TG levels (200–499 mg/dl) is often a result of a combination of poor lifestyle, secondary causes and genetic factors. These patients often have other markers of increased atherogenic risk such as increased LDL, low HDL or elevated VLDL remnants.

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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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Liver Fact

Gamma GT may be high in patients taking anti–epilepsy drugs.

eMedinewS Try this it Works

Local anesthetics for abscess?

Local anesthetics are unreliable when used in the acidic environment of an abscess. Use a double–buffered solution of 2 mL of bicarbonate with 8 mL of lidocaine. It works.

Dr Good Dr Bad

Situation: A diabetic anemia patient was advised serum adiponectin test.
Dr Bad: This test is of no significance.
Dr Good: Go and get this test done.
Lesson: Anemia is associated with marked elevation of serum high–molecular–weight (HMW) adiponectin levels in diabetic patients who have chronic kidney disease (CKD), and this elevation is independent of renal function. Hb had the strongest independent influence on HMW adiponectin in a study. Diabetic patients of both sexes with anemia and CKD had the highest serum levels of HMW adiponectin among the groups studied. (Transl Res 2009;154(4):175–82).

Make Sure

Situation: A patient developed cardiac arrest after the nurse gave IV Chloro to the patient.
Reaction: Oh my God! Why was IV chloroquine given? The order was for IV chloromycetin.
Lesson: Make sure that when giving instructions on phone about drugs, abbreviations are not used.

IMADNB Joke of the Day (Dr Tarun Gupta)

The mother catechized her young son just before the hour for the arrival of the music teacher.

"Have you washed your hands very carefully?""Yes, mother."

"And have you washed your face thoroughly?" "Yes, mother."

"And were you particular to wash behind your ears?"

"On her side I did, mother."

Formulae in Clinical Practice

Prediction of height potential

1. For girls, 13 cm is subtracted from the father’s height and averaged with the mother’s height.  For boys, 13 cm is added to the mother’s height and averaged with the father’s height. For both girls and boys, 8.5 cm on either side of this calculated value (target height) represents the 3rd to 97th percentiles for anticipated adult height.

2. The 13 cm represents the average difference in height of men and women; thus, the child grows, on average, to the midparental height percentile.

3. In general, the rule of "fives" for length or height should suffice to estimate normal growth.Rule of "Fives": Children should grow at a rate of at least 5 cm per year from age four years until the onset of puberty.

Milestones in Dermatology

Marjolin’s Ulcer

In 1828, Jean Nicolas Marjolin, the French surgeon first described the occurrence of ulcerating lesions within scar tissues. Marjolin's ulcer is commonly seen in chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis and post radiotherapy scars.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

B–type natriuretic peptide {brain natriuretic peptide (BNP)}

A 32–amino acid–ringed peptide secreted by the heart to regulate blood pressure and fluid balance. BNP is stored in and secreted predominantly from membrane granules in the heart ventricles, and is continuously released from the heart in response to both ventricle volume expansion and pressure overload.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Caffeine (as Citrate) 10mg / ml Injection

For the short term treatment of apnoea of prematurity of infants between 28 and < 33 weeks gestational age.

16.05.09



Public Forum (Press Release for use by the newspapers)

Fasting good for health

Fasting has been identified as a preventive measure for various physical and mental diseases, according to Heart Care Foundation of India. Regular weekly fast may act as a safety valve against ill health. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

He said that denying the system its usual food intake for a day, every week would induce growth hormones and promote metabolism. But fasting should not be a casual affair to be observed only on certain religious occasions; it should rather be a weekly discipline, undertaken regularly on a particular day each week.

The spiritual benefits being apart, the fast tends to create immunity in the system against diseases. The day’s rest to the digestive system as a result of the fast would cause release of certain chemicals in the body which would keep ailments away.

The fast is also prone to usher quietitude of mind. Pollution of the physical and mental environment hatred, anger, jealousy and all negative thoughts which enhance the chances of damage to health are taken care of by the resting digestive system.

People were, however, cautioned not to precede and/or proceed the fast with heavy meals. The fast would lose its health benefits if the stomach is loaded with heavy food before or after the fast. They accumulate more calories by eating such food compared to what they lose by fasting. While one chapatti contains 40 calories, most sweets have 200 to 300 calories per 40 grams. The higher caloric content of sweets and the ‘puri–kachori’ also raise cholesterol in the blood, increasing the chances of a heart attack.

People were also advised to count their calories on monthly basis rather than on daily basis.

MCI News


MCI board preparing vision document (source the hindu)

The Board of Governors said its mandate was not only to assess medical institutions but also suggest options to improve medical education and bring about time-bound changes.

“We want to propose a purposive system in medical education and governance to ensure absolute transparency with student as our ultimate target,” board chairman S.K. Sarin said. “The number of students opting for medicine as profession has declined, and this is a matter of serious concern. We need to give confidence to the students that medical education is accessible to all.” The board members were evolving a vision document and setting up working groups for the purpose.


1. The board would try to simplify the regulations so as to reduce litigation.
2. Just two weeks into the job, the six-member board has set up 43 teams of assessors to evaluate the facilities in colleges, whose applications are pending for starting new colleges or expanding the existing ones or increasing the number of seats.
3. To make the process more credible and transparent, the assessors, earlier known as inspectors, have been drawn from seven most reputed institutions of the country. The process of selection and assigning the States is computer-generated.
4. The teams are told to use their wisdom during verification, but without going into trivial things. Their reports should be made available to the board by June 16.
5. There were 87 proposals pending when the board took over on May 15. These had been cleared by the previous executive committee, but were not forwarded to the Health Ministry. All these institutions were asked to apply afresh but the board received only 79 applications, including from the Gyan Sagar Medical College in Punjab.
6. MCI is flooded with emails, phone calls and complaints, and the present board has tried to address these sympathetically but without allowing illegal things to happen.

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

13th June Sunday IMSA workshop with dr KK Aggarwal at Moolchand Hospital

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.


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Readers Responses

  1. Internship is a most important programe, it has to given in a organised hospital viz teaching: Dr P D Nigam

  2. Sir: As per news it is not clear whether internship shall not be allowed in all non teaching hospitals or only in private non teaching hospital as initial suggestions from MOH is to allow internship only in teaching hospitals affiliated to medical colleges. In Delhi many non pvt. hospitals like ESI, Hindu Rao and Kasturba Hospital are now recognised for internship training. Before commenting on merits or demerits it is important to know the reasons for this decision: Dr K K Kanodia

    eMedineS Responds: As per the order, all hospitals not affiliated with medical colleges will not have an internship program.

  3. Vitamin B12 helps maintain healthy blood and aids in making important proteins. People who don’t get enough B12 can have memory problems or confusion, and are at greater risk of developing anemia. Dietary sources of vitamin B12: Poultry, Seafood and fish, Meat, Eggs, Cheese, yogurt and milk and Foods that are fortified with vitamin B12, such as certain breakfast cereals: Dr. G M Singh.

  4. As usual I say thanks kk: Dr K P Singh

  5. To the Editor eMedinewS, Dear Sir, This refers to the editorial "Ghulam Nabi Azad writes to Dr. Sarin" (June 8). It is strange to find the central health minister, Ghulam Nabi Azad, sending a cautionary letter to the newly formed Board of Governors, suggesting that "touts" may approach the Board members for obtaining clearance for spurious medical colleges to allow them teach medical course to produce new doctors.

    The "Board" was created last month by the government with six independent medical doctors in order to continue the important functions of the MCI. The primary purpose of the medical council is to protect health and safety of the public by ensuring proper standard of practice of medicine and by taking appropriate disciplinary actions against the negligent medicos.

    The MCI must maintain high and uniform standard for medical education in India by permitting only the bonafide medical colleges to offer medical education to produce qualified new physicians. The MCI must also take quick action to disbar the errant doctors for protection of the innocent patients from falling prey to negligent therapy.

    Azad’s cautionary letter to the Board underscores the pervasive nature of corruption that has riddled through our healthcare system today.

    Azad’s warning for the Board members about "touts" approaching them on behalf of spurious medical colleges further corroborates the ominous fact that rampant corruption has rotted the Indian healthcare system to its very core. But one must wonder, instead of prompting the Board with a cautionary letter, why did the health minister not openly name and attack the "touts" who might be trying to manipulate the Board members to obtain undue favors for dubious medical colleges? One also wonders whether Azad ever issued similar caution about possible "touts" to the previous MCI leaders.

    Ordinary people of India must hope that the new medical Board of six "eminent" doctors will live up to their reputation and be able to clean up the filthy muddle of our healthcare system that was created by their medical colleagues and past leaders of the medical council. But they will undoubtedly have a daunting job in their hands for more reasons than one. The Board has been given only a temporary custody of the MCI for one year. Before the end of the year, the government would establish a new medical council to run the health care system. How the new council would be different than the old one remains unknown for now. A "doctor–only" medical council is unlikely to solve the inherent problems that caused the fiasco in the now disbanded MCI. Thank you. Dr Kunal Saha, PhD; HIV/AIDS Consultant, President, "People for Better Treatment" (PBT)

eMedinewS Responds

  1. The letter is welcome as the medical fraternity felt that MCI new board works under directions from the health ministry. This confusion needed to be clarified.

  2. MCI can only take disciplinary action against professional misconduct. Medical errors need to be covered under professional indemnity insurance by civil courts and not by MCI or criminal courts.

  3. Medical negligence is a criminal negligence and needs to be covered under the IPC Act.

  4. MCI body can help pin point the medical errors, but committing an error is not a crime. If it was insurance compaies would not have insured doctors against it.

  5. The Delhi Medical Council Disciplinary Body is already an example where the disciplinary body is a mox of of doctors and non doctors mix.
  • Allopathy explantion of acupuncture (Dr. Raman Kapur): A biological molecule that may help explain the effects of acupuncture has been identified by scientists. The chemical, adenosine, is a natural compound known for pain–killing and anti–inflammatory properties. It also influences the heart and plays a role in regulating sleep. Researchers found that adenosine is very active in tissues affected by acupuncture, the ancient Chinese treatment that involves inserting needles into sensitive points of the body. The scientists performed acupuncture on mice suffering chronic inflammatory pain in one paw. Each animal received a 30–minute treatment with fine needles inserted into a known acupuncture point near the knee. Acupuncture reduced discomfort by two–thirds in mice with normal levels of adenosine. However, it had no effect on "knock out" mice genetically prevented from responding to adenosine, the researchers found.

    During and immediately after acupuncture treatment, adenosine levels in the tissues near the needles were boosted 24–fold. Maiken Nedergaard, from the University of Rochester Medical Centre in New York state, said: "Acupuncture has been a mainstay of medical treatment in certain parts of the world for 4,000 years, but because it has not been understood completely, many people have remained sceptical. In this work, we provide information about one physical mechanism through which acupuncture reduces pain in the body."

  • How come, Dr Desai so far has not been removed from Karnataka Medical Council and World Medical Association? He is currently the President of Karnataka Medical Council and President Elect of World Medical Association: Dr S Gupta

    eMedinews Responds: Till a person is convicted, he/she is eligible to contest an election, become an elected Member of Parliament, become a minister of a State or the Centre and even become a magistrate or a judge. Recently, Mumbai High Court has held that a candidate who has been selected for the post of magistrate or a judge cannot be denied the appointment just because he or she is facing a prosecution. The decision was taken by a Double Bench consisting of Justice S A Bobade and Justice P.D. Kode. In the case of Dr. Desai also, unless he is convicted or himself offers to resign he cannot be removed from the elecetd posts of President, Karnataka Medical Council. In the case of Medical Council of India, he tendered his resignation of his own. He was suspended from B.J. Medical College as a Professor as there is a government rule, which states that any government servant who has been in Police Custody for more than 48 hours can be suspended (not terminated) from the  post.