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Dr KK Aggarwal

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

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

  Editorial ...

10th September, 2010, Friday

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

Why unnecessary imaging procedures are done

In addition to increasing costs, over utilization of imaging investigations exposes the public to unnecessary radiations. August 2009 summit on medical imaging called by the American Board of Radiology Foundation also discussed and showed concern on this subject.

  1. The major factor for over imaging is fee–for–service model, which reimburses on a per–procedure basis, yielding more revenue for both physician and institution the more procedures are done.
  2. Another cost–driver is the practice of self–referral. When the doctor benefits financially from the service, referrals increase. Such referrals present a conflict of interest and are banned by Medicare in the US and should be banned by mediclaim in India or by the public sector.
  3. Defensive medicine also contributes to over investigations.
  4. Another reason is patient demand for imaging studies that they’ve read or heard about
  5. Doctors should also ask patients about imaging studies they’ve previously had done, so as not to duplicate work unnecessarily. Greater sharing with electronic records could answer this question.
  6. There is also a need for accreditation of imaging facilities.

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

Book Release function

"Women of the World: Roll Call of Honor" was released at a function held at Acharya Sushil Muni Ashram on 5th September 2010.
In the photo:Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, Dr Mohini Giri, Sardar Buta Singh, Dr Naresh Trehan, Chairman and Managing Director, Medanta –The Medicity and Acharya Dr Sadhvi Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Maintenance rituximab in follicular lymphoma

For patients with newly diagnosed follicular lymphoma who have had at least a partial response to initial therapy, go for maintenance rituximab rather than observation. (J Clin Oncol 2010;28:574s)

  National News

IMA Election

Emedinews requests all its readers to support Padma Shri and Dr. B C Roy National Awardee Dr. K.K. Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela, who is contesting for the post of Vice President of the National Indian Medical Association. Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well-known for his work in the field of public health and academics

Call for universal access to quality TB treatment

A two–day workshop of the Zonal Task Force on Revised National Tuberculosis Control Programme concluded with a call to provide universal access to quality diagnosis and treatment of all tuberculosis patients in the community. By 2015, at least 90 % of all TB patients in the country, including HIV–associated and Drug Resistant TB, should be identified. Initial screening of all smear–positive patients for Drug Resistant TB should be made and HIV counselling and testing for all patients should be done, according to a summary of the proceedings of the workshop, held at SRM Medical College Hospital and Research Institute in Kattankulathur. The workshop had elaborate discussions on TB control–related programmes at the national level. It also examined the trends in the four southern States of Tamil Nadu, Andhra Pradesh, Kerala and Karnataka and the Union Territory of Puducherry. (The Hindu)

  International News

(Dr Monica and Brahm Vasudeva)

Forceps delivery linked to later pelvic organ prolapse

An Australian study reports that use of forceps during delivery is associated with muscle damage that can lead to pelvic organ prolapse later on. Analysis of data from a prospective study, forceps use was associated with almost 4–folds risk of avulsion of the levator ani muscles. Forceps delivery was associated with an increased risk of avulsion, with an odds ratio of 3.83 and a 95% confidence interval from 1.34 to 10.94 (p=0.01). In contrast, epidurals appeared to reduce the risk of related but lesser damage to the levator muscles. The study is reported online in the British Journal of Obstetrics and Gynaecology.

ACOG issues guidelines for antibiotic prophylaxis for cesarean delivery

The American College of Obstetricians and Gynecologists (ACOG) has issued recommendations about timing of administration of antibiotics for cesarean delivery. According to the ACOG Committee, preoperative administration is more effective than giving antibiotic after clamping the umbilical cord, as is the usual practice. The guidelines published in the September issue of Obstetrics & Gynecology state that:

  • Prophylaxis should be started within 60 minutes of the start of cesarean delivery to allow a sufficient serum level to be established by the time of skin incision. Exceptions would be patients already on appropriate antibiotics and emergency cases, which should get antibiotics at the earliest.
  • Therapeutic levels need to be maintained throughout the operation, so the same dose should be re-administered at intervals one or two times the drug’s half–life
  • First–generation cephalosporins and other narrow–spectrum antibiotics effective against gram–positive and gram–negative bacteria including some anaerobic bacteria are usually antibiotics of choice for prophylaxis for cesarean. Clindamycin with gentamicin would be a reasonable alternative for women with a significant allergy to beta–lactam antibiotics.

Vertebroplasty more effective than medical therapy for spine fractures

Caroline Klazen, MD, of St. Elisabeth Hospital in Tilburg, the Netherlands, and coauthors report that vertebroplasty reduced pain more than medical therapy in patients with acute osteoporotic vertebral compression fractures. The study showed that patients who underwent vertebroplasty had considerably greater decrease in the 10–point visual analog scale score at both one month and 12 months than those under conservative management. The decline in pain in the vertebroplasty group from baseline were 5.2 and 5.7 points at both time points, which exceeded the 3–point reduction required to be considered clinically significant. In the control group, these values were 2.7 and 3.7 at both time points. The study findings are reported online in The Lancet.

New criteria for rheumatoid arthritis emphasize early diagnosis

The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have jointly developed new classification criteria for rheumatoid arthritis (RA). According to Tuhina Neogi, MD, PhD, of Boston University, and colleagues, the new diagnostic criteria for RA requires that at least one joint to be swollen – signaling the presence of synovitis – excluding joints that are classically involved in osteoarthritis (e.g., distal interphalangeal joints) and that symptoms are not better explained by another diagnosis.
Four additional criteria, as follows, essential for determining the probability of a diagnosis of RA were also identified:

  • Pattern and extent of joint involvement
  • Acute phase response
  • Serologic findings
  • Duration of signs and symptoms of synovitis

Earlier RA classification criteria, published in 1987, could differentiate between RA and other inflammatory arthritides but could not identify patients likely to benefit from early intervention. The recommendations are published in the September 2010 issue of Arthritis & Rheumatism.

Cat scratch disease

Cat scratch disease (CSD) is an infectious condition that starts with a scratch or bite of the skin caused during contact with pets or other animals. The causative organism is Bartonella henselae. A pustule develops in the area of the scratch, and about three weeks later lymphadenopathy appears. In the beginning, the lymph nodes are firm; later they appear soft and fluctuant.
After diagnosis, no treatment is needed; CSD is self-limiting. It lasts for 4 to 6 months and heals. However, the diagnosis should always be made because the clinical picture mimics lymphoma, tuberculosis, and other granulomatous diseases.
(Contributed by Dr. GM Singh

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Appropriate complementary feeding promotes growth and prevents stunting among children 6–24 months. The period of complementary feeding is when other foods or liquids are provided along with breastmilk. Rates of malnutrition usually peak at this time with consequences that persist throughout life. Stunting is seldom reversed in later childhood and adolescence. Inadequate feeding of girl children also affects nutrient stores, subsequent reproductive health, and the to local conditions. Risk of maternal mortality.

1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/ WHO, 2003.
3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.

  Infertility Update

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

Q: Is infertility more common in any particular group? For example, IT industry, BPO sector, highly competitive and career minded people or any other group.

A. People in the cities are definitely more prone to it as the stressful life style and long working hours do not allow them to have contact at the right time with the desired frequency. Most cases are from people working in the BPO industry.

  ENT Update

Dr. Aru Handa MS, DNB, Dept. Co-ordinator and Senior Consultant Deptt. of ENT, Moolchand Medcity

What is the treatment of Otomycosis?

  • Ear cleaning and dry mopping is very essential before starting antifungal therapy as most of the antifungals are fungistatic and not fungicidal.
  • Topical antifungal drops ( cotimazole/fluconazole) after ear cleaning.
  • Oral antifungals have a role in patients not responding or allergic to topical ear drops.
  • Managing underlying otitis media if any.
  Pediatrics Update: Question of the day

What is the normal expected growth of a newborn baby during the first month? (Dr Tanmay Amladi)

The baby should gain about 750–1000gm. The length and head circumference will increase by 2–3cm in the first month. Preterm infants may show some delay in this gain.

  Medicolegal Update

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

What is the right to refuse medical interventions?

Nancy Beth Cruzan automobile accident case

Although mentally incapacitated patients have the same right, the Supreme Court allowed states to impose restrictions on how explicit and specific the patient’s prior wishes had to be.After this court ruling, some of Cruzan’s friends provided evidence that she had previously expressed wishes that she would want artificial feedings discontinued in such a scenario. As a result of this testimony, her feedings were terminated. Mentally competent patients need not be terminally ill to exercise this right to refuse interventions; they have the right regardless of health status. In addition, the right applies equally to withholding proposed treatments and to discontinuing initiated treatments. Of note, this right to refuse medical care does not imply a correlative right to demand treatment.

  Medi Finance Update

Asset Allocation Funds

  • Asset allocation funds are similar to balanced funds in that they invest in all of the asset classes.
  • Asset allocation funds differ from balanced funds because the fund manager isn’t restricted to the percentage of the money they can put in a specific type of investment (stocks, bonds, and so on).
  • A tactical asset allocation fund is one where the manager frequently makes decisions about the best asset allocation, sometimes every few months.
  • The manager of a strategic asset allocation fund will generally revise the fund’s asset allocation once a year.
  • Asset allocation funds provide a ‘one stop shopping’ approach to asset allocation.
  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Vitamin B1, Vitamin B6 and Vitamin B12 for human use

Jan 1,2001

GSR 702(E)

  Lab Update

Low platelet counts and bleeding

  • In idiopathic thrombocytopenic purpura, minimal bleeding after trauma is uncommon unless the platelet count is less than 60,000/microL.
  • Self–limited bleeding, spontaneous bleeding requiring special attention (eg, nasal packing for epistaxis), and severe life threatening bleeding does not occur until platelet counts are <40,000, <12,000, and <6000/microL, respectively
  IJCP Special

Dr Good Dr Bad

Situation: A migraine patient wanted to know whether he should maintain a headache diary.
Dr.Bad: No, it is not required.
Dr.Good: You must keep a headache diary.
Lesson: People who have frequent or severe headaches may benefit from keeping a headache diary over the course of one month. This can be used to determine what triggers the migraines and what makes them better.

Make Sure

Situation: A known epileptic child died of a seizure while swimming.
Reaction: Oh my God! Why was he allowed to swim?
Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

Quote of the Day

"The greed of gain has no time or limit to its capaciousness. Its one object is to produce and consume. It has pity neither for beautiful nature nor for living human beings. It is ruthlessly ready without a moment’s hesitation to crush beauty and life out of them, molding them into money." – Rabindranath Tagore
(Contributed by Dr. G.M. Singh)

Did you know?

Amazing English Language
Read the following sentence carefully:
"I do not know where family doctors acquired illegibly perplexing handwriting nevertheless, extraordinary pharmaceutical intellectuality counterbalancing indecipherability, transcendentalizes intercommunication's incomprehensi- bleness".

Do you notice something amazing about this sentence?
This is a sentence where the first word has one letter, the second has two letters, third has three………the 8th has 8 letters and the 20th word has 20 letters!!

Mnemonic of the Day
(Contributed by Dr Varesh Nagrath)

Features of Inflammatory low backache

Insiduous Onset
Pain at night, improvement on getting up
Age <40 yrs
Improvement with exercise
No improvement with rest

Hypertension Alert

High BP may have no symptoms. Symptoms appear only when any of the organ is damaged.

  Mind Teaser

Read this…………………

A murderer is condemned to death. He has to choose between three rooms. The first is full of raging fires, the second is full of assassins with loaded guns, and the third is full of lions that haven’t eaten in 3 years.

Which room is safest for him?

(Contributed by Dr. Jagjit Singh)

The answer for yesterday’s Mind Teaser: "Scrambled eggs"

Correct Answer received from: Dr.Susheela Gupta, Dr Simran Singh, Dr. Dinesh Kumar S, Dr.K.V.Sarma, Dr Muthumperumal Thirumalpillai, Dr Rawat Purushottam Singh, Dr Sukanta Sen, Dr. Nagendra Gupta, Dr Aanchal Agarwal, Dr.A.K.Saxena, Dr Virender Prakash Gautam, Dr. Anupam Sethi Malhotra

Send your answer to ijcp12@gmail.com

  Humor Section

Grandparents’ Answering Machine

Good morning… At present we are not at home but, please leave your message after you hear the beep. Beeeeepppp…
If you are one of our children, dial 1 and then select the option from 1 to 5 in order of "arrival" so we know who it is.
If you need us to stay with the children, press 2
If you want to borrow the car, press 3
If you want us to wash your clothes and ironing, press 4
If you want the grandchildren to sleep here tonight, press 5
If you want us to pick up the kids at school, press 6
If you want us to prepare a meal for Sunday or to have it delivered to your home, press 7
If you want to come to eat here, press 8
If you need money, dial 9
If you are going to invite us to dinner, or, taking us to the theater start talking we are listening !!!!!!!!!!!"
(Contributed by Dr Suresh Jaiswal)

Funny But True Facts
Experience: The name men give to their mistakes.
(Dr GM Singh)

  An Inspirational Story

The World Is A Puzzle

There was a man who had a little boy that he loved very much. Everyday after work the man would come home and play with the little boy. He would always spend all of his extra time playing with the little boy. One night, while the man was at work, he realized that he had extra work to do for the evening, and that he wouldn’t be able to play with his little boy. But, he wanted to be able to give the boy something to keep him busy. So, looking around his office, he saw a magazine with a large map of the world on the cover. He got an idea. He removed the map, and then patiently tore it up into small pieces. Then he put all the pieces in his coat pocket.

When he got home, the little boy came running to him and was ready to play. The man explained that he had extra work to do and couldn’t play just now, but he led the little boy into the dining room, and taking out all the pieces of the map, he spread them on the table. He explained that it was a map of the world, and that by the time he could put it back together, his extra work would be finished, and they could both play. Surely this would keep the child busy for hours, he thought. About half an hour later the boy came to the man and said, "Okay, it’s finished. Can we play now?" The man was surprised, saying, "That’s impossible. Let’s go see." And sure enough, there was the picture of the world, all put together, every piece in its place.

The man said, "That’s amazing! How did you do that?" The boy said, "It was simple. On the back of the page was a picture of a man. When I put the man together the whole world fell into place."

  Readers Response
  1. I wish to comment about the column “Vaccine Update" printed in 5th September 2010 ebulletin. Pneumococcal conjugate vaccine now covers 13 pneumococcal strains and is protects against nearly 75% of pneumococcal infections in < 5 children. It is recommended by many countries including USA in routine immunization program. It is especially recommended for high risk NICU graduates (VLBW babies, BPD patients etc.) Dr Pankaj Garg
  Public Forum

(Press Release for use by the newspapers)

Pre–Hypertension Triples the Risk of Heart Attack

A person with pre–hypertension, systolic blood pressure between 120–140 mmHg and diastolic pressure between 80–90 mmHg, is more than three times likely to have a heart attack and 1.7 times more likely to have heart disease than a person whose blood pressure is lower than 120/80 mmHg.

Systolic blood pressure is the pressure against the artery wall when the heart beats and diastolic blood pressure is the pressure when the heart is at rest between the heart beats. Normal blood pressure is lower than 120/80 mmHg and hypertension is a blood pressure more than 140/90 mmHg or higher.

Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela said that research has shown that if pre–hypertension is aggressively treated, 45% of all heart attacks can be prevented. Lifestyle modifications such as weight control, regular physical activity and changes in diet are recommended for people with pre–hypertension. The importance of pre–hypertension has been listed as one of the top 10 recent advances in cardiology. Dr. Aggarwal said that every effort should be made to lower the blood pressure below 120/80 mmHg.

  Conference Calendar

Annual Conference of the International Medical Sciences Academy

Date: September 10-11, 2010
Venue: The Royal Society of Medicine, London, England

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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

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

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

eMedinews Revisiting 2010

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

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