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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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 …

10th June 2011, Friday                                eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

How long can Baba Ramdev continue his fast?

There is a rough ‘Formula of 3’ which says that one cannot live for 3 minutes without air, 3 days without water and 3 weeks without food. But this formula is applicable for healthy muscular people. When you fast you can stay healthy for long if you have good muscle mass and have adequate fat contents.

Minus points with Baba Ramdev: He has a thin muscle mass, his body fat content is low and moreover, he is fasting in summer.

Minus points with Baba Ramdev: He has access to AC environment, is a Yogi, who are known to fast for long by reducing the metabolic needs of their body.

Some salient points about fasting

  • Fasting is willingly abstaining from some or all food, drink, or both, for a period of time.
  • An absolute fast is abstinence from all food and liquid for a defined period.
  • Partially restrictive fast is limited to particular foods or substance.
  • The fast may also be intermittent in nature.
  • Fasting may also refer to the metabolic status of a person who has not eaten overnight, and to the metabolic state achieved after complete digestion and absorption of a meal.
  • A person is assumed to be fasting after 8–12 hours.
  • Metabolic changes toward the fasting state begin after absorption of a meal (typically 3–5 hours after a meal); "post–absorptive state" is synonymous with this usage, in contrast to the "post–prandial" state of ongoing digestion.
  • A diagnostic fast refers to prolonged fasting (from 8–72 hours depending on age)
  • The longest known fast for a human is 132 days (without food).
  • Snakes have been observed to go without food for up to 2 years.
  • Glucose is the body’s primary fuel source and is essential for the functioning of brain. When denied glucose for more than 4–8 hours, the body turns to the liver for glycogen, a storage form of glucose, to be used for fuel.
  • A process called glycogenolysis converts glycogen into a usable form of fuel. At this point, the body also uses small amounts of protein to supplement this fuel. This fuel will last for up to 12 hours before the body needs to turn to glycogen stored in muscles, lasting for a few more days.
  • If glucose is still denied at this point, muscle wasting is prevented by temporarily switching to fat as the fuel source, i.e. fat is converted into ketone through catabolism. Ketones, while not sugars, can be used by the brain as a fuel source as long as glucose is denied.
  • The body continues to use fat for as long as there is fat to consume.
  • The body will generally indicate to the fasting person as to when fat levels are running extremely low (less than 7% and 10% of body weight for males and females, respectively) with an increased urge for food. Fasts are usually broken long before this point.
  • If the fast is not broken, starvation begins to occur, as the body begins to use protein for fuel.
  • Health complications associated with fast–induced starvation include electrolyte imbalances, thinning hair, lanugo, cardiac arrhythmia and renal failure. Death can occur if fasting is pursued to the point of complete starvation.
  • Hypovolemia refers to any condition in which the extracellular fluid volume is reduced.
  • It can be produced by salt and water loss (as with vomiting, diarrhea, diuretics, bleeding, or third space sequestration) or by water loss alone (i.e., dehydration).
  • Salt and water loss comes primarily from the extracellular fluid whereas pure water loss (i.e., dehydration) comes from the total body water, only about 40 % of which is extracellular. Thus, for dehydration to produce the same degree of extracellular volume depletion as salt and water loss, 2.5 times as much fluid would have to be lost.
  • Patients with dehydration are always hypernatremic whereas those with salt and water loss typically have a plasma sodium concentration that is normal or even reduced (due to free water replacement of part of the deficit).

Dr KK Aggarwal
Editor in Chief

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  Changing Practice – Evidence which has changed practice in last one year

Carboplatin dosing

For most patients, carboplatin dosing uses the Calvert formula, which is based upon desired exposure (area under the curve (AUC) of concentration X time) and the glomerular filtration rate (GFR). When the GFR is estimated based upon measured serum creatinine, we suggest limiting the maximal GFR to 125 mL/min for this calculation. (October 8, 2010)

(Ref: Rustin GJ, van der Berg ME, Griffin CL, et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet 2010;376:1155).

  eMedinewS Audio PostCard

Rheumatoid arthritis Update

Dr Harvinder S Luthra Speaks on
‘Biologics and tuberculosis’

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

Winners of eMedinewS Excellence Awards on the dias at the 2nd eMedinewS Revisiting 2010.

Dr K K Aggarwal
    National News

Picasso of India passes away

Eminent Indian painter Maqbool Fida Husain, popularly known as "M F Husain" died yesterday in London. He was 95. He was admitted after being in "indifferent health" for the last one and a half months.

Country’s national bird may be extinct soon

JODHPUR: Unabated killing of peacocks is gradually pushing the national bird on the brink of extinction and lack of stringent measures to put a check on their poaching is making the situation worse. After repeated instances of killing in Bundi previous month, 23 more peacocks were killed in Bhilwara and Ajmer last week, where poachers used the poison laced grains as bait. Wildlife activists and environmentalists attribute this mass killing of peacock for its meat and attractive feathers. "People from nomadic tribes kill them as they believe that peacock meat has extraordinary healing powers," forest ranger Purushottam Purohit said. But many peacocks are killed for their beautiful feathers. Currently, the Wildlife Protection Act 1972 prohibits killing of peacocks and export of tail feathers or articles made from them. But the Act allows domestic trade in feathers or articles under the assumption that these are naturally shed. Source: http://timesofindia.indiatimes.com/city/jaipur/Countrys-national-bird-may-be-extinct-soon/articleshow/8766918.cms, June 8, 2011)

Desert National Park may get newer areas

JAIPUR: The Desert National Park (DNP), one of the largest sanctuaries of the country spread over the twin districts of Jaisalmer and Barmer may get newer territories. A high–powered committee constituted by the ministry of Environment and Forest for the rationalisation’ of the park is seriously contemplating on it. According to sources in the ministry, "Areas near the grasslands of Ramgarh in Jaisalmer may be added to the DNP. Areas like Shahgarh, Ghotaru, Asutor that are now outside the premises of the park may get added to it. But a final decision is yet to be taken."
(Source: http://timesofindia.indiatimes.com/city/jaipur/Desert-National-Park-may-get-newer-areas/articleshow/8766913.cms, June 8, 2011)

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Fit Facts & Tips: Safe physical activity

To do physical activity safely and reduce the risk of injuries and other adverse events, people should:

  • Understand the risks and yet be confident that physical activity is safe for almost everyone.
  • Choose to do types of physical activity that are appropriate for their current fitness level and health goals, because some activities are safer than others.
  • Increase physical activity gradually over time whenever more activity is necessary to meet guidelines or health goals. Inactive people should "start low and go slow" by gradually increasing how often and how long activities are done.
  • Protect themselves by using appropriate gear and sports equipment, looking for safe environments, following rules and policies, and making sensible choices about when, where, and how to be active.
  • Be under the care of a health–care provider if they have chronic conditions or symptoms. People with chronic conditions and symptoms should consult their health–care provider about the types and amounts of activity appropriate for them.

(Dr GM Singh)

Stress statements

  • Too many changes, too quickly can be a cause of stress.
  • Stress can be caused by pleasant and unpleasant events.
  • The cause of stress may not be always apparent.
  • Usually stress is a result build up of ‘related and unrelated events’.
  • Often your stress is more apparent to others than to yourself.
  • Reactions to stress can be emotional, physical and behavioral.
  • There is no magical formula for a stress–free life but there are easy techniques for minimizing stress.

(Dr Monica and Brahm Vasudev)

ASCO: New drug protects against clots in Ca patients

An experimental anticoagulant reduced the risk of dangerous blood clots by 64% in patients undergoing chemotherapy, researchers said at the American Society of Clinical Oncology annual meeting. (Source: Medpage Today)

SYNTAX score useful in unstable coronary disease

SYNTAX scores, typically used to triage patients to percutaneous or surgical coronary intervention, may also be predictive of future events in patients with non–ST–segment elevation acute coronary syndromes undergoing PCI. The scoring system is based on results from the landmark SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial to help determine when surgery is a better option than stenting. (Source: Medpage Today)

Published PARTNER results confirm TAVI option

At one year there were no significant survival differences among high–risk patients who underwent transcatheter aortic valve replacement (TAVI) compared with those who had surgical repair, but there were significant differences in adverse events at 30 days, according to results of the PARTNER trial. (Source: Medpage Today)

Flu poses extra risk for asthmatic kids

Children with asthma who need inpatient care for influenza face a substantial risk of serious complications, researchers reported. The risk of some of those complications, including pneumonia and the need for intensive care, was even higher during the 2009 H1N1 pandemic, according to Fatimah Dawood, MD, of the Centers for Disease Control and Prevention in Atlanta, and colleagues. (Source: Medpage Today)

   Twitter of the Day

@DrKKAggarwal: Dr K K Aggarwal on Giving and Accepting Gifts.

@SanjivChopra: Enthusiasm will benefit my future more than spring rain nourishes the wheat. Og Mandino

    Spiritual Update

Hanuman Chalisa

Jo Yah Padhe Hanumana Chalisa
Hoy Siddhi Sakhi Gaurisa

Meaning: One who repeats this song with the glories of lord Hanumana obtains all the spiritual perfections.

Spiritual Significance: With Japa Meditation and repetitive breathing pranayama–based meditation, one can obtain all spiritual perfections like spontaneous fulfillment of desires, achieving fearless state, acquiring the powers of telepathy and reverse telepathy and creating a non violent atmosphere.

    An Inspirational Story

(Dr Anupam Sethi Malhotra)

The stonecutter

There was once a stonecutter who was dissatisfied with himself and with his position in life. One day, he passed a wealthy merchant’s house and through the open gateway saw many fine possessions and important visitors. "How powerful that merchant must be!" thought the stonecutter. He became very envious, and wished that he could be like the merchant. Then he would no longer have to live the life of a mere stonecutter.

To his great surprise, he suddenly became the merchant, enjoying more luxuries and power than he had ever dreamed of, envied and detested by those less wealthy than himself. But soon a high official passed by, carried in a sedan chair, accompanied by attendants, and escorted by soldiers beating gongs. Everyone, no matter how wealthy, had to bow low before the procession. "How powerful that official is!" he thought. "I wish that I could be a high official!"

Then he became the high official, carried everywhere in his embroidered sedan chair, feared and hated by the people all around, who had to bow down before him as he passed. It was a hot summer day, and the official felt very uncomfortable in the sticky sedan chair. He looked up at the sun. It shone proudly in the sky, unaffected by his presence. "How powerful the sun is!" he thought. "I wish that I could be the sun!"

Then he became the sun, shining fiercely down on everyone, scorching the fields, cursed by the farmers and laborers. But a huge black cloud moved between him and the earth, so that his light could no longer shine on everything below. "How powerful that storm cloud is!" he thought. "I wish that I could be a cloud!"

Then he became the cloud, flooding the fields and villages, shouted at by everyone. But soon he found that he was being pushed away by some great force, and realized that it was the wind. "How powerful it is!" he thought. "I wish that I could be the wind!"

Then he became the wind, blowing tiles off the roofs of houses, uprooting trees, hated and feared by all below him. But after a while, he ran up against something that would not move, no matter how forcefully he blew against it –– a huge, towering stone. "How powerful that stone is!" he thought. "I wish that I could be a stone!"

Then he became the stone, more powerful than anything else on earth. But as he stood there, he heard the sound of a hammer pounding a chisel into the solid rock and felt himself being changed. "What could be more powerful than I, the stone?" he thought. He looked down and saw far below him the figure of a stonecutter.

(Benjamin Hoff from The Tao Of Pooh)

Lesson: We don’t know the extent of our own personal power. And, sometimes, the most insignificant seeming people among us are those most able to effect great change.

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    Hepatology Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

Useful tests for diffentiating the causes of hepatomegaly

  • Febrile agglutinins (typhoid fever, brucellosis)
  • Monospot test (infectious mononucleosis)
  • Serum iron and iron–binding capacity (hemochromatosis)
  • Serum copper and ceruloplasmin (Wilson disease)
  • ANA analysis (lupoid hepatitis, collagen disease)
  • Stool for occult blood (metastatic malignancy)
  • Stool for ova and parasites (amebic abscess, cysticercosis and other parasites)
  • Bone marrow examination (hemolytic anemias, leukemia, myeloid metaplasia)
  • GI series and barium enema (metastatic neoplasm)
  • Sonogram (hepatic cyst, gallstones, abscess)
  • Laparoscopy (cirrhosis, metastatic neoplasm)
  • Liver biopsy (cirrhosis, hepatitis, metastatic carcinoma)
  • Serum alpha–fetoprotein (hepatoma)
  • Mitochondrial antibody titer (biliary cirrhosis)
    Infertility Update

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

What are the complementary and alternative treatments for infertility?

Complementary or alternative female infertility treatments have been scientifically tested, with results published in peer–reviewed medical journals. A 2000 Harvard Medical School study examined the effects of group psychological intervention on infertile women (trying to conceive duration of one to two years). The two intervention groups—a support group and a cognitive behavior group—had statistically significant higher pregnancy rates than the control group.

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant diabetic came with A1c 7%.
Dr Bad: Very good control.
Dr Good: You need further control.
Lesson: The A1C goal is <6 % for individual patients with type 1 diabetes and during pregnancy.

Make Sure

Situation: A female patient C/O lower abdominal pain, fever and had uterine tenderness on bimanual palpation.
Reaction: You should do cervical swabs and consider starting antibiotics.
Lesson: Make Sure to remember that a woman with such symptoms may have endometritis that requires prompt diagnosis and may respond to doxycycline and metronidazole.

  SMS of the Day

(Dr GM Singh)

H. pylori infection, chronic gastritis, and intestinal metaplasia were each inversely associated with Barrett esophageal metaplasia in a study.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is Fracture of bone–Grievous injury?

The Certification of grievous injury on the basis of fracture of bone is done by doctors in accordance with Section 320 IPC, which lists the injuries that are called grievous injury

  • The medical dictionary meaning of the word ‘fracture’ is breaking of a part, especially the bone or break or rupture in the bone or in continuity of a bone This definition is appropriate for the radiologist or orthopedician, but not for the purpose of certifying an injury as grievous since in many cases in legal scrutiny it has been found that the fracture reported by radiologists were tentative, superficial, fabricated or self-inflicted, hardly 1 mm deep cut in the bone or mere a ponding effect on bone with no medical or surgical complication.
  • It is important for the doctor to understand that a tentative fracture medically/clinically non-significant/uncomplicated/invented by modern scan methods cannot be certified as grievous injury.
  • A mere superficial cut and scratch on bone may not be grievous because the meaning of grievous is.. threatening great harm; "a dangerous operation"; "a grave situation"; "a grave illness"; "grievous bodily harm"; "a serious wound"; "a serious turn of events"; "a severe case of wound or a life–threatening disease
  • It must be remembered that the cutting of a bone does not necessarily involve a fracture of that bone. In a criminal revision at the Patna High Court, in which one individual received an incised wound, 3" × 3 ¼" × 1", on the lower part of the left leg cutting the bone underneath, it was held that where the evidence was merely that the bone had been cut and there was nothing whatever to indicate the extent of the cut, whether deep or a mere scratch upon the surface, it was impossible to infer from that evidence alone that grievous hurt had been caused within the meaning of the definition of section 320, IPC.
  • The supreme court in its judgment, in one case, had clarified that until and unless such a cut on bone does not extend deep up to the medullary cavity it will not constitute a grievous hurt within the definition of fracture under section 320(7) of Indian Penal Code.
  • In case of hurt it is the Court that judges finally whether the injury is simple or grievous. The duty of the medical witness is only to describe the facts and not classify a hurt. The entry made in the wound certificate as simple or grievous is only meant to guide the investigating officer.
  Vitamins—Open Secrets revealed

(Dr Jitendra Ingole, MD Internal Medicine)

Nutritional supplementation during acute illness

A study was conducted by Salah G et al. (Published in The American Journal of Medicine Volume 119, Issue 8, Pages 693–699, August 2006) on above mentioned topic. The study tested whether nutritional support of older patients during acute illness leads to a clinical benefit.

Methods: In this randomized, double–blind, placebo–controlled study, we randomly assigned 445 hospitalized patients aged 65 to 92 years to receive either a normal hospital diet plus 400 mL oral nutritional supplements (223 subjects) or a normal hospital diet plus a placebo (222 subjects) daily for 6 weeks. The composition of the supplement was such as to provide 995 kcal of energy and 100% of the Reference Nutrient Intakes for vitamins and minerals for a healthy older person. Patients had three assessments: at baseline, at 6 weeks, and at 6 months post–randomization. Outcome measures were 6 months of disability, non–elective readmission and length of hospital stay, discharge destination, morbidity, and mortality.

Results: Randomization to the supplement group led to a significant improvement in nutritional status. Over 6 months, 65 patients (29%) in the supplements group were readmitted to the hospital compared with 89 patients (40%) in the placebo group (adjusted hazard ratio 0.68 (95% confidence interval 0.49–0.94)). The mean length of hospital stay was 9.4 days in the supplements group compared with 10.1 days in the placebo group. Thirty–two people (14%) died in the supplement group compared with 19 people (9%) in the placebo group at 6 months (adjusted hazard ratio 1.65 (95% confidence interval, 0.93–2.92)).

Conclusion: Oral nutritional supplementation of acutely ill patients improved nutritional status and led to a statistically significant reduction in the number of non–elective readmissions.

    Mind Teaser

Read this…………………

Urinary concentrating ability of the kidney is increased by:

1. ECF volume contraction
2. Increase in RBF
3. Reduction of medullary hyperosmolarity
4. Increase in GFR

Yesterday’s Mind Teaser:
A previously healthy 23–year–old woman residing in Washington DC is admitted to the hospital with a 2–day history of cough, substernal chest pain, fever (40°C), headache, chills, rigors, myalgias, coryza, and sore throat. On chest ×–ray, she has patchy, nodular infiltrates and a pleural effusion. The sputum reveals numerous gram–negative coccobacilli. Despite empiric treatment with a beta–lactam antibiotic, she continues to deteriorate over the next 48 hours. On the second hospital day, three of her co–workers are admitted to the hospital with similar symptoms. The possibility of a deliberate epidemic is considered, and the differential diagnosis is broadened to include inhalational anthrax, pneumonic plague, and inhalation tularemia.

Which of the following communications to the public health system is most appropriate?

A. Immediately inform the Centers for Disease Control and Prevention (CDC)
B. Confirm the diagnosis and inform the CDC
C. Immediately inform the local or state public health organization
D. Confirm the diagnosis and inform the local or state public health organization

Answer for yesterday’s Mind Teaser:
C. Immediately inform the local or state public health organization

Correct answers received from: Dr Rakesh Bhasin, Dr Muthumperumal Thirumalpillai, Doraisami Sundaram, Dr BB Aggarwal, Dr Neelam Nath, Dr Jainendra Upadhyay, Dr Anil Bairaria, Dr Deepali Chatterjee.

Answer for 8th June Mind Teaser: Neither, a peacock does not lay eggs. Peahens do!
Correct answers received from: Dr Rajiv Kohli, Dr Jainendra Upadhyay, Dr Anupam Sethi Malhotra,
Dr Rakesh Bhasin, Dr Amol Hartalkar, Dr Bhavuk Garg, Dr Shashi Saini, Dr SK Bansal, Dr YJ Vasavada.

Send your answer to ijcp12@gmail.com

    Medi Finance Update

No tax return for salary and interest income up to Rs 5 lakh

"No income–tax returns is required for salaried persons whose annual taxable income including salary and interest is up to Rs 5 lakh. We would shortly notify this," a Central Board of Direct Taxes official said. However, he said this would not cover income from other sources like house property, capital gains and gains from profession and business. The scheme would be applicable from assessment year 2011–12 onwards. This means that the salaried persons eligible under the scheme would not have to file returns for the financial year 2010–11 in 2011–12 (assessment year).Under the scheme, those salaried persons who want to claim tax refund, would have to file income tax return. As per the Memorandum to the Finance Bill 2011, the government will be issuing a notification exempting "classes of persons" from the requirement of furnishing income tax returns. Under the scheme, the salaried person wants exemption from filing IT return, has to disclose about the incomes like dividend and interest to his employer for tax deduction. In the scenario, the Form 16 issued to salaried employees will be treated as Income Tax Return. At present, it is obligatory for all salaried persons to file income tax return under the Income Tax Act, 1961.The idea behind the move is that in cases where there are no other sources of income, filing of a return is a duplication of existing information.
(Source: http://articles.timesofindia.indiatimes.com/2011-06-07/india-business/29629330_1_requirement-of-furnishing-income-income-from-other-sources-salary-and-interest-income, June 7, 2011)

    Laugh a While

(Dr GM Singh)

Little Johnny knows his numbers

The math teacher saw that little Johnny wasn’t paying attention in class. She called on him and said, "Johnny! What are 2 and 4 and 28 and 44?" Little Johnny quickly replied, "NBC, CBS, HBO and the Cartoon Network!"

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Fluconazole For Oral suspension 50/200 mg per 5ml (Pack Size: 35ml)
For the treatment of systemic candidiasis, mucosal candidiasis, prevention of fungal infections in patients with malignancy.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Understanding Laparoscopic Sleeve Gastrectomy

Complications of LSG: Staple line leaks

Staple line leaks are the most devastating complication of LSG. The incidence of gastric leak in several reports ranges from 0.7% to 5%. A leak occurs when intraluminal pressure exceeds the strength of the tissue and the staple line. Postoperative leak after LSG typically appears just below the gastroesophageal junction and it is related with the high pressure that is created after the vertical tubulization of the stomach, with tissue ischemia and mechanical deficiencies at the site of stapling, resulting in significant morbidity, sepsis, organ failure, and maybe death. Because ischemic leaks are known to occur 5–7 days postoperatively, when wound healing is between the inflammatory and fibrotic phases, the most common causes of the vast majority of leaks, which occur within 48 hours, are mechanical.

    IMSA Update

International Medical Science Academy (IMSA) Update

The diabetic foot

The epidermal plantar skin becomes thinner and plantar soft tissues stiffen in people with diabetes, particularly in persons who have neuropathy or ulceration, which increases the risk of tissue breakdown and ulceration formation. (Ref: Chao CY, Zheng YP, Cheing GL. Epidermal thickness and biomechanical properties of plantar tissues in diabetic foot. Ultrasound Med Biol. 2011 Jun 1. Epub ahead of print)

    Public Forum

(Press Release for use by the newspapers)

Diabetes can be delayed by 14 years

A defined Diet and Exercise Programme in people at high risk of diabetes, if followed for six years, can delay the onset of diabetes for 14 years as per a report published in "The Lancet".

Commenting on the findings of the study, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India, said that 577 adults with high blood sugar levels at risk of diabetes from 33 clinics in China were included in the trial called China DA Quing Diabetes Prevention Outcome Study. The study participants were randomly assigned to any of the three life–style interventions. One group on diet, second on exercise, and the third on combination. They were compared with the control group without any diet or exercise programme.

The interventions included reducing the amount of food, sugar and alcohol and putting more vegetables and increasing the level of physical activities.

Dr AK Gaur, Sr Consultant, Cardiologist, Moolchand Medcity said that the lifestyle interventions reduced the incidence of diabetes by 51% over the six years of the programme and over the whole 20 years period, the incidence of diabetes was reduced by 43% in those people who have been in diet and exercise programme.

    Readers Responses
  1. My query is for respected Dr Sudhir Gupta. Sir, please elaborate the timing of rigor mortis in summer and winter in northern part of India: 1) In how many hours does rigor mortis start to appear and completes during summer and winter? 2) For how many hours does the body remain in state of rigor mortis in summer and winter? 3) In how many hours does rigor mortis disappear during summer and winter? Sir I am asking this question because there are different ranges given in different books, and I can easily follow timing given by you without any doubt. Please do reply this question. Thanks Dr Sundeep Nigam

    Dr Sudhir Gupta responds: Rigor mortis means stiffening/shortening of muscles after death which is appreciated in body joints due to the rigidity and flexion of joints. It gives good idea about the time of death particularly in the initial phase of after death. During the summer season if the whole body is in the state of primary relaxation then the death is within the last one hour. If the rigor mortis is present in the face alone then the death has occurred about one hour back. If it is present in the upper limb and chest only and not in the abdomen, then death might have occurred about three hours back. However, if it is present all over the body, then time since death is 4–18 hours back. In winters, the above timings are more or less/roughly doubled. The rigor mortis stays in the body for similar period as above and further take similar period to pass off. The application of formula 12–12–12 hours should be applied with due care to calculate time since death along with other parameters, history by IO and eye witness statement in inquest paper because of large variations. The reliable eye evidence of when seen alive last must be the nucleus in determining the time since death unless until contrary is proved.
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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    Forthcoming Events

National Conference on "Insight on Medico Legal Issues"
Date: Sunday, 10th July, 2011
Venue: Auditorium, Chinmaya Mission, 89, Lodhi Road, New Delhi – 110003

eMedinewS and Heart Care Foundation of India are jointly organizing the first-ever National Conference on "Insight on Medico Legal Issues" to commemorate "Doctors’ Day".
The one–day conference will provide total insight into all the medicolegal and ethical issues concerning the practicing doctors. Both medical and legal experts will interact with the delegates on important issues.
You are requested to kindly register in advance as seats are limited. There will be no registration fee. You can register by sending your request at rekhapapola@gmail.com or at 9899974439.


Session: Ethical Issues in Medical Research (8 am–8.30am)
Chairpersons: Dr T K Joshi
Moderators: Dr K K Aggarwal and Dr Girish Tyagi

Topic: Rights of a patient in medical trial, Speaker: Ajay Agrawal (Sr Advocate), Time: 8 am–8.10 am
Topic: Ethical Issues in a medical trial, Speaker: Dr Ranjit Roy Chaudhury, Time: 8.10 am–8.20 am
Topic: Statutory permits required for conducting trials, Speaker: Ms Priya Hingorani (Sr Advocate), Time: 8.20 am–8.30 am

Session: Medical ethics and organ donations (8.30 am–9.00 am)
Chairpersons: Dr N V Kamat and Dr Anil Bansal
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic: Ethical issues in IVF practice, Time: 8.30 am–8.37 am
Topic: 100% voluntary blood donation, Speaker: Dr N K Bhatia, Time: 8.37 am–8.44 am
Topic: Need for do not resuscitate laws in India, Speaker: Dr Rajesh Chawla, Time: 8.44 am–8.51am
Topic: Ethical issues in organ transplantation, Speaker: Dr Neelam Mohan Time: 8.51 am–8.58 am

Session: Handling cases of death (9 am–9.30 am)
Chairpersons: Mr S K Saggar, Dr Arvind Chopra and Dr Ambrish Mithal
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic: How to declare the death?Time: 9.00 am-9.10 am
Topic: Spiritual considerations in a dying patient, Speaker: Dr S C Tewari, Time: 9.10 am-9.20 am
Topic: Medico legal and ethical issues in post mortem, Speaker: Dr G.K. Sharma, Time: Time: 9.20 am-9.30 am

Session: Medical Insurance (9.30 am –10 am)
Chairpersons: Mr Vibhu Talwar, Dr H K Chopra and Dr Vinod Khetrapal Moderator: Dr K K Aggarwal
Topic: Indemnity Insurance Time: 9.30 am–9.40 am
Topic: Engaging a lawyer Speaker: Ms Meenakshi Lekhi (Sr Advocate) Time: 9.40 am–9.50 am
Topic: Understanding various court procedures Speaker: Maninder Acharya (Sr Advocate) Time: 9.50 am–10.00 am

Session: How to handle medico legal cases? (10 am–10.30 am)
Chairpersons: Dr Anil Goyal and Dr Rajiv Ahuja
Moderators: Dr K K Aggarwal and Dr. Girish Tyagi
Topic: When to do the MLC? Speaker: Dr M C Gupta (Advocate), Time: 10.00 am–10.10 am
Topic: Checklist of MLC case Speaker: Dr Sudhir Gupta Time: 10.10 am–10.20 am
Topic: Medicolegal record keeping Speaker: Mr Siddarth Luthra (Sr Advocate) Time: 10.20 am–10.30 am

Session: Medical Consent (10.30 am–11 am)
Chairpersons: Dr Vinay Aggarwal and Dr P K Dave
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic: Types of consent Speaker: Ms Indu Malhotra (Sr Advocate) Time: 10.30 am–10.40 am
Topic Ideal consent Speaker: Dr Manoj Singh Time: 10.40 am–10.50 am

Session: Fallacies in acts applicable to medical profession (11 am–11.30 am)
Chairpersons: Dr Anup Sarya, Dr Sanjiv Malik and Dr Anupam Sibbal
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic: MTP, PNDT Act, Speaker: Dr Kaberi Banerjee, Time: 11.00-11.10 am
Topic: Organ Transplant Act, Speaker: Dr Sandeep Guleria Time: 11.10-11.20 am
Topic: State Medical Councils and Medical Council of India, Speaker: Dr DK Diwan, Time: 11.20–11.30 am

Session: Inauguration: 11.30 am to 12.00 noon
Invited Guests: Justice Vipin Sanghi, Dr KK Talwar, Dr Shiv Sarin and Dr A K Agarwal

Session: Professional misconduct and professional ethics (12.00 am–1.00 pm)
Chairpersons: Dr A K Agarwal, Dr D S Rana and Dr H S Rissam
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic: Doctor–pharma relationship Time: 12.00–12.10 pm
Topic: Advertisement and medical practice Speaker: Dr P Lal, Time: 12.10 pm–12.20 pm
Topic: Rights of a patient Speaker: Dr Navin Dang Time: 12.20 pm–12.30 pm
Topic: Rights of a doctor Speaker: Dr Ajay Gambhi, Time: 12.30 pm–12.40 pm
Topic: Kickbacks, touts and commercialization in medical practice Speaker: Dr Ashok Seth Time: 12.40 pm–12.50 pm
Topic: Complaints of a doctor against doctor Time: 12.50 pm–01.00 pm

Session: When it is not negligence? (1.00 pm to 2.00 pm)
Chairpersons: Dr Prem Kakkar and Dr S K Sama
Moderators: Dr K K Aggarwal and Dr. Girish Tyagi
Topic: What is medical negligence? Speaker: Dr Girish Tyagi, Time: 1.00 pm–1.10 pm
Topic: Medical accidents Speaker: Dr Vijay Aggarwal Time: 1.10 pm–1.20 pm
Topic: Professional Misconduct Speaker: Mr Mukul Rohatgi (Sr Advocate) Time: 1.20 pm–1.30 pm
Topic: How to defend a complaint? Speaker: Dr K K Aggarwal Time: 1.30 pm–1.40 pm
Topic: Out of court settlement Time: 1.40 pm–1.50 pm
Topic: Compensation Vs Cancellation of License Speaker: Dr O P Kalra, Time: 1.50 pm–2.00 pm


September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta