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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 …

11th February, 2011, Friday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Drugs to strengthen bones ‘prolong life’

Bisphosphonate taken to lessen the risk of fractures caused by osteoporosis could bring an unexpected extra five years of life. Sydney experts observed that death rates among those taking bisphosphonate were cut by two–thirds, compared with patients taking vitamin D supplements or hormone treatment. The study published in the Journal of Clinical Endocrinology and Metabolism suggest the drugs could extend life by ensuring that toxic metals remain locked up in the patients' bones, instead of allowing them to be released into the bloodstream.

In a group of women over 75 with osteoporotic fractures one would expect 50 percent to die over a five years. In the study such women who took bisphosphonates, the death rate dropped to 10 percent.

Bone is normally in a constant cycle of being formed and broken down. Osteoporosis occurs when the rate of breakdown exceeds the rate of new bone formation. Bisphosphonates slow the rate of breakdown.

Bisphosphonate drugs have been checked in recent years for an increase of a rare condition called osteonecrosis of the jaw.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  2nd eMedinewS Revisiting 2010

Revisiting the Year 2010 with Dr KK Aggarwal Alternatives to warfarin

Audio PostCard
  Quote of the Day

(By Dr GM Singh)

"Whether you think you can or think you can’t, you’re right. "

Henry Ford

    Photo Feature (From HCFI File)

2nd eMedinewS Revisiting 2010

Awardee Doctors in the 2nd eMedinewS Revisiting 2010 held at Maulana Azad Medical College on 9th January 2011.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Toll–free number for health queries

NEW DELHI: Not sure what’s causing that screaming stomachache every two hours? Or which doctor is the best for that eye infection of yours and what his fees would be? Need to know which diagnostic centre is closest to your house, equipped with that fancy MRI scanner? Or which pharmacy has the medicines you are looking for? Dial just one single toll free number – 33006666 – from anywhere. This round–the–clock service, available from Monday, has been launched by a private company as a one–stop information platform on everything about healthcare, be it medicines, diseases, procedures or health news.

The primary information database includes doctors, specialists, chemists, radiology or pathology labs, clinics, nursing homes, hospitals, ambulances, blood banks and medical equipment providers. It will also help you evaluate, compare and select doctors on fees and location of their clinic. Created over the past two years, healthline 24x7 – a service that is free and 24×7×365 – will empower people with reliable, relevant and in–depth health information. It will function in the metros as a starter. Within the next nine months, it will be available in over 30 towns across India. Additionally, it will also offer tele–consultation – 80% of ailments do not require a face–to–face interaction with the doctor. Therefore, a consumer in Hubli can call Healthline24×7 and get the appropriate health advice from a doctor in Mumbai or Delhi or Jaipur and get the medicines home delivered. Pankaj Vaish, president, Religare Technologies, which has launched the helpline, said that over the next few years, they expect to touch at least 12 billion Indian lives and connect them with one million providers. Questions like side–effects of medicines, alternate medicines and cost comparison will also be answered. (Source: The Times of India, Feb 7, 2011)

    International News

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

February is Heart Health Month. Today’s tip

We all need a little fat in our diet (25%–35% of our daily calories). But the type of fat matters. Unsaturated fats (found in canola, olive, and safflower oils) help lower LDL "bad" cholesterol and may help raise HDL "good" cholesterol. Saturated fats (found in butter and palm oil) and trans fats raise LDL cholesterol. Even good fats have calories, so eat in moderation.

(Dr Monica and Brahm Vasudev)

Shingles may recur among healthy adults

According to a study published in the February issue of the Mayo Clinic Proceedings, shingles, usually thought of as a once–in–a–lifetime (miserable) experience, may recur among healthy adults, and not just among the immunocompromised.

High endotoxin activity levels associated with increased risk for type 2 diabetes

According to a study published Jan. 26 in the journal Diabetes Care, high levels of endotoxin activity are independently associated with an increased risk for type 2 diabetes.

Three lifestyle changes may significantly reduce cancer rates

Approximately 340,000 cancer cases in the US could be prevented each year if more Americans ate a healthy diet, got regular exercise and limited their alcohol intake, according to the World Cancer Research Fund.

Study links early introduction of solid foods to risk of early childhood obesity

A prospective prebirth cohort study states that early introduction of solid foods is associated with a risk for early childhood obesity. The study is published online February 7 in the journal Pediatrics. According to the authors, introduction of solid foods prior to 4 months of age is associated with increased body fat or weight in childhood or with greater weight gain during infancy, which itself predicts later adiposity.

    IMT Update

IMT (intima media thickness) is a strong predictor of future MI. All sites (common carotid artery, carotid bifurcation, internal carotid artery) have the same ability to predict future MI. (Ref: Iglesias del Sol A, et al. Carotid intima–media thickness at different sites: relation to incident myocardial infarction. The Rotterdam Study. Eur Heart J 2002;23(12):934–40)

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are some less common causes of infertility?

Although still considered "uncommon" by many practitioners, there is increasing evidence that many cases of "unexplained" infertility are actually the result of an immune system malfunction. There are many variances of immune problems, ranging from antisperm antibodies to an outright rejection of a developing fetus. The good news is that greatly improved testing is now available to screen for these problems, and new treatment protocols are netting unprecedented success rates.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

Myths of asthma

If my child has asthma, he or she should not be allowed to play like other kids and shouldn't take gym class or play sports.

Not true. All kids need to play and exercise to be healthy. Kids with asthma can play, take gym class and play sports, but may need to take medication before they play. Kids with asthma that is not under control may not be able to keep up with their peers, tire out before other kids or may develop symptoms when they play.

For queries contact: drneelam@yahoo.com

    Medicolegal Update

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

Exhumation of corpse – America

In America corpses are exhumed when there is a need to identify a body or to establish cause of death like in the case of suspected homicide.

  • President Zachary Taylor was exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
  • Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
  • In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
  • Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
  • California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. On what grounds can the CEA 2010, be challenged?

Ans. The main grounds are as follows:

  • The Act has been made under Article 47 of the Constitution but there is no relation between this Article and the purpose of the Act.
  • The Act places unreasonable restrictions up on the fundamental right of the medical practitioners to practice their profession within the meaning of Article 19(1)(g).
  • The Act defines and provides adjudication for ‘emergency medical condition’ and ‘stabilisation’, which are medical concepts that should not be interfered by the courts.
  • The Act mandates giving emergency medical treatment without providing for a mechanism for compensation for the services rendered.
  • Solo practitioners are not, cannot and should not be treated as an establishment. They are already covered by the MCI Regulations. There is no parallel Act for other professionals who are covered by their own professional councils.
  • Medical treatment, including emergency treatment and standards for the same cannot be different for civil and defence establishments. There is no rational basis for exempting the armed forces from the purview of the Act.
  • The Act provides for a dismally low representation of modern medicine/allopathic doctors in the National and State Councils.
  • There is no provision for representation of the private sector in the National Council as envisaged in Sec 3 of the Act.
  • The District Registering Authority, having vast discretionary powers to impose heavy punishment, must have a legal expert as a member to avoid administrative arbitrariness.
  • Section 12 (1) (ii) of the Act takes away the freedom of the owner of the establishment to employ the number and type of personnel as he may think appropriate and thereby violates his fundamental right to run his establishment as he deems appropriate.
  • Too much power has been vested in the District Authority under various sections including Section 49.

"e–patient" … The Impatient Patient

Dr. Parveen Bhatia: MS, FRCS (Eng.), FICS, FIAGES (Hon.), FMAS, FIMSA, Chairman, Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, Consultant Laparoscopic & Bariatric Surgeon & Medical Director, Global Hospital & Endosurgery Institute, New Delhi

Dr. Pulkit Nandwani: MD, DMAS (WALS), DMAS (CICE, France), Associate Consultant Gynaecologist and Laparoscopic surgeon, Bhatia Global Hospital & Endosurgery Institute, New Delhi

The Future

Patients’ use of the Internet for health information will continue to evolve, empowering both physician and patient and, ultimately, shaping a new orientation to health care based on communication, education and shared knowledge. It is clear that patients viewed seeking information from the Internet as fundamentally different from gaining information from a face to face encounter with their doctor. This was attributed to factors such as access to a full medical history and the humanity of dealing with a person face to face. There is a continuing and strong awareness of the value of medical expertise. Therefore, doctors need not feel challenged or threatened when patients bring health information from the Internet to a consultation, rather they should see it as an attempt on the part of the patient to work with the doctor and respond positively.

The Internet and related technologies promise great changes in the doctor–patient relationship. However, active direction from physicians is imperative for this new dynamic to positively impact our ability to provide quality care.

The e patient is here to stay and if not by themselves, health care providers will be dragged to the internet by their patients. Hence, as David Blumenthal, of Massachusetts General Hospital puts it; let’s prove to the our patients that we are as good at surfing the web as listening to the heart or at appendicectomy.

Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Rabies Update

Dr A K Gupta, Author of "RABIES – the worst death"

What are most dangerous sites of bites/exposure in man?

Theoretically, the richly innervated areas like head, neck, face, hands and genitals are the most dangerous sites of bite in man. But in reality, it is often the wounds on legs, which are ignored/neglected, that cause rabies.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Laboratory testing for alcoholism

  • Gamma–glutamyl transferase (GGT): A liver enzyme that is increased by heavy alcohol intake and by many other conditions that affect the liver.
  • Mean corpuscular volume (MCV): Measures the size of red blood cells; usually measured as part of a Complete Blood Count (CBC) test; the MCV may increase over time in those who are heavy drinkers but may also be affected by many other conditions.
  • Comprehensive Metabolic Panel (CMP) or liver panel: Groups of tests used to evaluate organ and liver function. Magnesium, can be low in those who are alcoholic due to insufficient dietary intake.
  • Folate test: With alcohol abuse, less B12 and folate are absorbed and more are excreted from the kidneys.
  • Toxicology screen or blood alcohol level (ethanol test): To determine if a person has been drinking alcohol recently, but do not diagnose alcoholism.
    Medi Finance Update

To what extent can payment be made by cheque, cash, etc?

As per Section 40 A (3), in case payment is made in excess of Rs. 20,000 other than by cross cheque or bank draft (cross), then of such expense shall be disallowed.

    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
DCI Approval Date
Dicyclomine 2.5mg + Dried Aluminium Hydroxide 200mg + Light Magnesium Oxide 100mg + Simethicone 20mg per 5ml suspension.
For the treatment of the symptoms of functional gastrointestinal disorders like irritable bowel syndrome, functional dyspepsia, peptic ulcers, GERD which includes smooth muscle spasm, flatulence, abdominal distension, hyperacidity, gastric distress, bloating etc.
    IMSA Update

International Medical Science Academy (IMSA) Update

Agomelatine and Depression

Agomelatine, the first melatonergic antidepressant, is beneficial for depressed patients with sleep disturbance. It has both melatonergic and serotonergic action.

    IJCP Special

Dr Good Dr Bad

Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in ventricles or cisterns.

Make Sure

Situation: An 18–year– old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr. Prabha Sanghi)

A young woman went to her mother and told her about her life and how things were so hard for her. She did not know how she was going to make it and wanted to give up, She was tired of fighting and struggling. It seemed as one problem was solved, a new one arose. Her mother took her to the kitchen. She filled three pots with water and placed each on a high fire. Soon the pots came to boil. In the first she placed carrots, in the second she placed eggs, and in the last she placed ground coffee beans. She let them sit and boil without saying a word.

In about twenty minutes she turned off the burners. She fished the carrots out and placed them in a bowl. She pulled the eggs out and placed them in a bowl. Then she ladled the coffee out and placed it in a bowl. Turning to her daughter, she asked, ‘Tell me what you see.’ ‘Carrots, eggs, and coffee,’ she replied.

Her mother brought her closer and asked her to feel the carrots.. She did and noted that they were soft. The mother then asked the daughter to take an egg and break it. After pulling off the shell, she observed the hard boiled egg. Finally, the mother asked the daughter to sip the coffee. The daughter smiled as she tasted its rich aroma. The daughter then asked, ‘What does it mean, mother?’

Her mother explained that each of these objects had faced the same adversity: boiling water. Each reacted differently. The carrot went in strong, hard, and unrelenting. However, after being subjected to the boiling water, it softened and became weak. The egg had been fragile. Its thin outer shell had protected its liquid interior, but after sitting through the boiling water, its inside became hardened. The ground coffee beans were unique, however. After they were in the boiling water, they had changed the water.

‘Which are you?’ she asked her daughter. ‘When adversity knocks on your door, how do you respond? Are you a carrot, an egg or a coffee bean?

Think of this: Which am I?

Am I the carrot that seems strong, but with pain and adversity do I wilt and become soft and lose my strength?

Am I the egg that starts with a malleable heart, but changes with the heat? Did I have a fluid spirit, but after a death, a breakup, a financial hardship or some other trial, have I become hardened and stiff? Does my shell look the same, but on the inside am I bitter and tough witha stiff spirit and hardened heart?

Or am I like the coffee bean? The bean actually changes the hot water, the very circumstance that brings the pain. When the water gets hot, it releases the fragrance and flavor. If you are like the bean, when things are at their worst, you get better and change the situation around you. When the hour is the darkest and trials are their greatest do you elevate yourself to another level?

How do you handle adversity? Are you a carrot, an egg or a coffee bean? The happiest of people don’t necessarily have the best of everything; they just make the most of everything that comes along their way. The brightest future will always be based on a forgotten past; you can’t go forward in life until you let go of your past failures and heartaches

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: a chance n
Answer for yesterday’s Mind Teaser:
An outside chance

Correct answers received from: Dr K.P.Rajalakshmi, Dr K.V.Sarma, Dr Rawat Purushottam Singh

Answer for 9th February Mind Teaser: Potatoes
Correct answers received from: Dr Rajiv Dhir, Dr Neelam Nath, Dr Chandresh Jardosh, Dr Anita Rajorhia, Dr Joginder Pal Manocha, Dr Sudipto Samaddar, Dr Neelam Nath, Dr K.P.Rajalakshmi, Dr K.Raju, Dr Aditya Rattan, Dr Vijay Kansal

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr Chandresh Jardosh)

History of Telecommunication

After having dug to a depth of 10 feet last year, Italian scientists found traces of copper wire dating back 100 years and came to the conclusion, that their ancestors already had a telephone network more than 100 years ago.

Not to be outdone by the Italian’s, in the weeks that followed, a Chinese archaeologist dug to a depth of 20 feet, and shortly after, a story in the China Daily read: ‘Chinese archaeologists, finding traces of 200 year old copper wire, have concluded their ancestors already had an advanced high–tech communications network a hundred years earlier than the Italian’s.

One week later, the Punjab Times, a local newspaper in India, reported the following: After digging as deep as 30 feet in his pasture near Amritsar, in the Indian state of Punjab, Dugdeep Singh, a self–taught archaeologist, reported that he found absolutely nothing. Dugdeep has therefore concluded that 300 years ago, India had already gone wireless.

— — — — — — — — — —

Knowledge is amusing

Coca–Cola was originally green.

— — — — — — — — — —

    Readers Responses
  1. The description of ‘trip to ICU’ by dr. kishore shah is absolutely fantastic. it took me back to ‘adventures of tom sawyer’, it reminded so much of mark twain. hats off to his hilarious attitude even during a major illness like MI. Dr Anupam
    Public Forum

(Press Release for use by the newspapers)

Give your Valentine a healthy heart checkup

On the occasion of Valentine’s Day falling on 14th February, Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee, Senior Consultant Moolchand Medcity and President Heart Care Foundation of India, said that the best gift one can give to his or her Valentine is a healthy heart check–up.

One cannot give or accept heart attack as a gift. One has to act for more than 10 years against the laws of nature to get heart blockages. The process of heart blockage starts during adolescence when the person is either in high school or early college life, the time when Valentine’s Day is celebrated by most people.

To detect future chances of heart blockages at that age, the only test available is to measure the wall thickness of the neck artery using a high resolution colour Doppler ultrasound. Neck artery thickness is non–invasive marker of early pre–clinical blockages in the heart arteries.

Special facilities are being created for neck artery measurement in Moolchand Medcity which is organizing a month–long campaign on this subject in the month of February 2011.

Dr. Aggarwal said that in women with chest pain and normal neck artery morphology one may practically rule out need for coronary angiography and carotid wall thickness of less than 0.55 mm and thoracic aorta wall thickness of less than 3 mm practically rules out underlying heart blockages.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Fetal and Paedatric Echocardiography Pre and perinatal management of heart disease

13th February 2011, Sunday, Moolchand Medcity, 8AM –10AM

  1. Fetal Echocardiography–How to get it right: Dr Vandana Chaddha
  2. Fetal Cardiac Spectrum– abnormal cases with interactive session: Dr Vandana Chaddha
  3. Neonatal Cardiac Cases– Hits and misses inetractive session: Dr Savitri Srivastava
  4. Intima Media Thickness and Plaque Volume, New Marker for Atherosclerosis Regression in Children: Dr KK Aggarwal

Delhi Medical Council Inaugural CME on Managing Common Emergencies
Date: Sunday, 20 Feb., 2011
Programme – 1.00PM – 4.00PM
1.00 PM 1.30PM Lunch
1.30 PM 1.45PM Inauguration
1.45 PM 4.00PM Scientific Programme

Topics Time Speakers Chairpersons
RTA, Emerging Epidemic
1:45 PM – 2.05 PM
Dr MC Misra
Dr BK Dhaon, Dr Praveen Bhatia, Dr Chander Prakash
Acute Febrile Illness
2.05 PM – 2.25 PM
Dr N.P Singh
Dr OP Kalra, Dr SP Byotra,
Dr B Gupta
Haematuria – Red Alarm
2.25 PM – 2.45 PM
Dr Anil Goyal
Dr P.N Dogra, Dr. Rajeev Sood
Managing PPH – Saving Lives
2.45 PM – 3.05 PM
Dr Reva Tripathi
Dr Sharda Jain
Panel Discussion of Update of Lt. Side chest pain 3.05 PM – 3.50 PM Dr Purshottam Lal,
Dr Naresh Gupta
Dr PS Gupta, Dr K.K Aggarwal, Dr Ashok Seth

Vote of Thanks: 3.50 PM – 4.00 PM

Followed by Tea

Please Note: Prior Registration is Mandatory (No Registration Charges)

For Registration e–mail to delhimedbalcouncil@gmail.com, SMS to Secretary – 9868116494 & Organizing Chairman – 9811101454

Organization: President: Dr Arun Aggarwal, Vice President: Dr Vinay Aggarwal, Secretary: Dr Girish Tyagi, Organizing Chairman: Dr Anil Goyal, CME Committee Members: Dr Anil Bansal, Dr Manoj Singh, Dr NP Singh, Dr Praveen Bhatia.

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