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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


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  Editorial …

11th July 2011, Monday

Indians have the highest rates of diabetes in India and abroad

Regardless of where you live, in India or in the United States, you have the highest chances of getting diabetes, if you were born an Indian.

The same is also true for heart disease. The CADI study has already shown earlier that Indians settled in US are 17 times more likely to get a heart attack than the US natives.

And now a new study published in the June 29 in the journal Diabetes Care has shown that people who immigrated to the United States from India have the highest rate of type 2 diabetes. The study by Leena Gupta and colleagues analyzed data provided by the city’s Department of Health and Mental Hygiene of 54,000 people and concluded that 13.6 percent of South Asians born outside of the US had diabetes. In the study, South Asians who were born abroad and had normal body mass index (18.5 to 25) had a rate of diabetes 2.5 times as high as other foreign–born Asians and a five times increased rate than that among US–born non–Hispanic whites.

When the authors adopted WHO BMI categories tailored for specific regions and races to define who was overweight and obese, foreign–born South Asians had a higher rate of diabetes at lower BMI levels than all other racial and ethnic groups.

The study also showed that people from India, Pakistan, Bangladesh, Sri Lanka, Nepal and Bhutan have the highest rate of diabetes of any ethnic group in New York. It is nearly double that of other foreign–born Asians. Hence, it is important for South Asians to be screened for diabetes, regardless of their body weight.

Diabetes has been increasing in India over the last few decades because of consumption of more calories, not exercising regularly and a shift of diet from high complex carbohydrates to high refined carbohydrates.

Dr KK Aggarwal
Group Editor in Chief
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India have the highest rates of diabetes
in India and Abroad

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on Medicolegal Issue

A National Conference on Insight on Medicolegal Issue was organized at Auditorium, Chinmaya Mission, New Delhi. In the photo: Justice A K Sikri, Hon’ble Judge Delhi High Court, Justice Vipin Sanghi, Hon’ble Judge Delhi High Court, Dr. H S Rissam, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, Dr. A K Aggarwal, Dr NV Kamat, Dr Ashok Seth, Dr Vinod Khetarpal.

Dr K K Aggarwal
    National News

Now, chewing tobacco outstrips smoking in India

NEW DELHI: Now, more adults in India are chewing tobacco than smoking it. The World Health Organization’s latest figures, released on Friday, said while 33% adult Indian males and 18.4% adult Indian females use smokeless tobacco, the corresponding figure for those taking a puff stands at 24.3% and 2.9% males and females, respectively. Among the youth, 19% males and 8.3% females use some form of tobacco. The WHO’s report on the "global tobacco epidemic" finds that tobacco will kill nearly six million people this year worldwide. More than five million will be users and those addicted to tobacco but have since given up. And, the rest will perish for being exposed to tobacco smoke. WHO says tobacco could kill eight million a year by 2030. Tobacco use is one of the biggest contributors to the non–communicable diseases epidemic, including heart disease, stroke, cancers and respiratory diseases, and accounts for 63% of all deaths. (Source: TOI, Jul 9, 2011)

20 rabies deaths in 6 mths, health workers worried

CHENNAI: At least 20 people have died of rabies at the Government General Hospital in the city in the last six months. Last month, three died of the virus, spread through dog bites. The increasing number of such deaths is worrying public health workers, who are coming together on July 9 to debate the topic, ‘Why should anyone die of rabies in the 21 century?’ The conference, organised by the Association for Prevention and Control of Rabies in India, will discuss strategies to eliminate rabies by 2020. (Source: TOI, Jul 7, 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

(Dr Monica and Brahm Vasudev)

FDA approves Tdap booster for seniors

The tetanus toxoid/reduced diphtheria toxoid/acellular pertussis single–dose booster vaccine (Tdap; Boostrix, GlaxoSmithKline Biologicals) received approval today from the US Food and Drug Administration (FDA) for adults aged 65 years and older. The vaccine is already licensed for individuals aged 10 to 64 years. Given as a single–dose booster shot, the vaccine is the first approved to prevent all 3 diseases in seniors. Before today’s decision, only vaccines for preventing tetanus and diphtheria were approved in this age group. (Source: Medscape)

Germany approves genetic testing of human embryos

Germany’s parliament agreed in a conscience vote on Thursday to allow the limited use of genetic testing of human embryos. Preimplantation genetic diagnosis (PGD) –– in which a cell or two are extracted from a developing embryo to test for genetic disorders –– has divided governments around the world, with many people opposing it on religious and ethical grounds, or arguing that it would let parents choose a "designer baby." The new law will allow screening embryos of parents who have a predisposition to severe genetic disorders, where a pregnancy would be likely to result in either stillbirth or miscarriage. (Source: Medscape)

Lab–grown trachea implanted in patient

A 36–year–old cancer patient is the recipient of the first–ever bioartificial trachea grown on a synthetic substrate using the patient’s own stem cells, researchers at the Karolinska Institute announced. The surgery was performed on June 9 at Karolinska University Hospital in Huddinge, Stockholm, by Paolo Macchiarini, MD –– leader of a team that three years ago implanted the first bioartificial trachea engineered on a human substrate. Researchers say that a successful implantation using a synthetic scaffold represents a small jump for the field of regenerative medicine. (Source: Medspage Today)

Allergies start in baby’s first month

Signs of future allergic sensitivity show up as early as the first month of life, Danish researchers found. Neonatal levels of the urinary marker eosinophil protein–X predicted allergic sensitization, nasal eosinophilia, and eczema during the early school years in a prospective study by Hans Bisgaard, MD, DMSc, of the University of Copenhagen, and colleagues. These findings suggested that the allergic disease process is well underway before any symptoms develop, the group noted online in the American Journal of Respiratory and Critical Care Medicine. (Source: Medspage Today)

Lidocaine for local anesthesia

A meta–analysis of 23 trials in children and adults found that patients receiving subcutaneous lidocaine that was buffered by adding sodium bicarbonate reported significantly less pain than those who received unbuffered lidocaine (Cepeda MS, Tzortzopoulou A, Thackrey M, et al. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010;CD006581).

    Fitness Update

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

Fit into your Fifties

The average 50–something is fitter and healthier now than they were in their mid-20s, a report revealed yesterday (Sun).

Mature adults are reaping the benefits of better diets, more exercise and increased free time to focus on their health. It also emerged they spend more time outdoors and exercise more frequently than they did when they were younger. The lifestyle study was carried out among 1,500 adults aged 50 and upwards by Engage Mutual.

Current predictions for life expectancy state that men age 65 could expect to live another 17 years and women at 65 could expect to live another 20 years. These kinds of predictions make taking action on health and fitness in our later years just as important as when we are younger. The report found around one in five over 50s feel more energetic and enjoy more of a zest for life than they did in their 20s. And more than 70 per cent of the ‘fit at 50s’ do more exercise than they did when they were young. A similar number now pay more attention to their diet, with a dramatic decrease occurring in the number of take–aways and ready meals being consumed.

Almost seven out of ten of those who felt healthier put their new–found motivation down to a better awareness of the importance of a healthy lifestyle. The research also showed the fit over 50s eats far more fruit and veg now than they did in their early years. Only a fifth of them said they would have consumed the recommended amount of fruit and veg a day while in their 20s, compared to an impressive 75 per cent today. Eight out of ten people also claim to pay more attention to what they are buying in the supermarket now, taking into account all the ingredients. Of the people who feel fitter than in their twenties, the average exercise frequency was four times a week with walking, swimming, cycling or attending a fitness classes the mostly common practices.

One in four said exercise now made up an integral part of their social life. When questioned about why they exercise now, 29 per cent said it was because they want to be fit and energetic for the sake of the grandchildren. For more than half, it was gaining weight that prompted their lifestyle change, while 17 per cent suffered a worrying health scare. Four out of ten people said they were looking forward to an active and enjoyable retirement. Incredibly, more than half said they felt they looked younger than their age.

    Twitter of the Day

@DrKKAggarwal: #AJOG Acetaminophen intake during pregnancy may increase risk for childhood asthma, Mothers who use… http://fb.me/16qkMLxNc

@DeepakChopra: In every moment of our existence, we are in that field of all possibilities where we have access to an infinity of choices.

    Spiritual Update

Science behind Hanuman Chalisa

Nava Nidhi

Kanakdhara Siddhi: One can acquire immense and unlimited wealth through this Siddhi.

    An Inspirational Story

(Dinesh Singh)

One day a man was walking along the beach when he noticed a boy picking something up and gently throwing it into the ocean. Approaching the boy, he asked, "What are you doing?"

The youth replied, "Throwing starfish back into the ocean. The surf is up and the tide is going out. If I don’t throw them back, they’ll die." "Son," the man said, "don’t you realize there are miles and miles of beach and hundreds of starfish? You can’t make a difference!"

After listening politely, the boy bent down, picked up another starfish, and threw it back into the surf. Then, smiling at the man, he said…"I made a difference for that one."

    Pediatric Update

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

What are the risk factors for bronchiolitis?

Risk factors for bronchiolitis include birth to a young mother, being born in the first half of the RSV season, tobacco exposure, lower maternal socioeconomic status, low birth weight, male gender, crowding, prematurity, chronic lung disease/congenital heart disease, and lack of breast feeding.

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    Did You Know

(Dr Uday Kakroo)

Intelligent people have more zinc and copper in their hair.

    Contrary Proverbs

(Mr Vipin Sanghi)

Don't cross your bridges before you come to them. BUT Forewarned is forearmed.

    Legal Question of the Day

(Dr MC Gupta, Advocate)

Q. We pathologists are finding it almost impossible to work honestly and respectfully and maintain scientific standards properly and make reasonable earning because of the following:

  • Numerous small pathology labs run by DMLT technicians are operating in our city. They get work from clinicians for obvious considerations. Some technicians are doing it in their own name while some have put the name of some MBBS doctor on the report format.
  • The pathlabs in some nursing homes are run by these technicians.

What action can we take?


  1. Running a pathological laboratory amounts to practice of medicine as held by various high courts. Practice of medicine without having a medical qualification is an offence under various laws and amounts to quackery against which the IMA has been fighting. A feasible approach is that the IMA or an association of pathologists or both together should engage an advocate to study the problem and initiate practically feasible legal actions.
  2. Some of the possible legal actions are as follows:

    a. Complaint to medical council for quackery;
    b. Complaints to the concerned council (Bharatiya Chikitsa Council; Homeopathy council; paramedical council etc.)
    c. Complaint to consumer court for deficiency and negligence in service, invoking quackery;
    d. Complaint to police for quackery.
    e. Complaint under Clinical Establishment Act, if applicable in the state.
    f. Complaint to the medical council against another physician licenced by the council under Regulation 1.7 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, for unethical conduct of the following types:

    i) Associating with quacks by referring cases to them and by relying on reports given by them. (Those who practice pathology without having a medical qualification are quacks.)

    ii) Mechanical signing of illegal pathlab reports by pathologists;

    iii) Running a pathlab without having a qualification in pathology.

    g. Direct complaint to the DM or SDM under Section 133 (1)(b), CrPC. The SDM Jalgaon, Maharashtra, sealed illegal Pathlabs under section 133 CrPC on a complaint dated 11–1–2010. A final order against the illegal labs was passed by the SDM on 13–5–2011. Similar action can be taken in other states.
    h. A writ petition or a PIL in the High Court. If pathologists in MP, MR and Gujarat can go to HC, there is no reason other than complacence why those in other states cannot do so.
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    IJCP Special

Dr Good Dr Bad

Situation: A patient with dengue with platelet count of 25000 mm3 came with mild bleeding.
Dr. Bad: Start platelet transfusion immediately.
Dr. Good: No platelet transfusion is required.
Lesson: Platelet transfusions have not been shown to be effective at preventing or controlling hemorrhage but should be warranted in patients with platelet count of <10000 mm3 and active bleeding (CAB International, Wallingford 1997. p.133).

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on sulfa?
Lasson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

    SMS of the Day

(Dr GM Singh)

Compromising does not means you are wrong and some one is right, it only means that you value your relationship much more than any one else.

    GP Pearls

(Dr Pawan Gupta)

Pharmacological treatment of asthma

Mild intermittent asthma: Inhaled short–acting beta 2 agonists (salbutamol and terbutaline)

Mild persistent asthma: Add low–dose inhaled corticosteroids.

Moderate persistent: Select one of the following options–

  • Low dose inhaled corticosteroids + long–acting beta 2 agonist (salmeterol and formoterol)
  • Higher dose inhaled corticosteroids
  • Low dose inhaled corticosteroids + leukotriene antagonists (montelukast and zafirlukast)
  • Low dose inhaled corticosteroids + oral theophylline.

Severe persistent asthma: High dose inhaled corticosteroids + one or more of the following:–

  • Long–acting beta agonists
  • Leukotriene antagonist
  • Oral theophylline
  • Oral beta agonist

Add oral corticosteroids if control still not achieved.(prednisolone) Consider corticosteroids sparing agent

(Postgrad Med J 2003;79:259–67)

    Medicolegal Update

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

What are Harvard criteria of death?

The Harvard Criteria, listed the following guidelines for identifying irreversible coma:

  • Unreceptivity and unresponsivity: Total unawareness to externally applied stimuli and inner need; no complete unresponsiveness to even the most intense painful stimuli.
  • No movements or breathing: No sign of spontaneous movements and spontaneous respiration and no response to pain, touch, sound, or light.
  • No reflexes: The pupils of the eyes are fixed and dilated and do not respond to a direct source of bright light. No response to harmful stimuli; tendon reflexes absent. Corneal and pharyngeal reflexes are also absent.
  • Flat electroencephalogram (EEG): This shows lack of electrical activity in the cerebral cortex. Has confirmatory value.

These four tests should be repeated 24 hours after the initial test.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of forensic medicine, Peepee Publisher)

    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: The most common type of total anomalous pulmonary venous connection is:

1. Supracardiac
2. Infracardiac
3. Mixed
4. Cardiac

Answer for Yesterday’s Mind Teaser: supracardiac TAPVC

Correct answers received from: Dr. Pramod M Kulkarni, Dr Jainendra Upadhyay, Dr Y. J. Vasavada, Dr Anil Bairaria, Dr Rakesh Bhasin

Answer for 9th July june Mind Teaser: Broken Heart
Correct answers received from: Dr Anil Bairaria, Dr Suneera Charitable, Dr Prabha Sanghi, Dr K V Sarma, Dr Amit Kochar, Dr Jainendra Upadhyay, Dr B N Ganagdhar, Dr Rakesh Bhasin, Dr Shubha Laxmi Margekar, Dr .S.Doraisami, Dr Sudipto Samaddar, Dr.Sandhya, Dr Pramod M Kulkarni, Dr S K Bansal, Dr U Gaur, Dr Rashmi Chhibber, Dr Vijay Kansal, Dr Shashi Saini

Send your answer to ijcp12@gmail.com

    Medi Finance Update

(Dr GM Singh)

What is financial planning?

Financial planning is a process whereby you will have a road map of your personal and financial life, which will help you to meet all your life's expenses – both the expected – and the unexpected.

   Laugh a While

(Dr. Anupam Sethi Malhotra)

Awesome answers in IAS(Indian Administrative Service) Examination

Q.. If you throw a red stone into the blue sea what it will become?
A. It will become Wet or Sink as simple as that. (UPSC IAS Rank 2)

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Methylcobalamin 750mcg + Pregabalin 75/150mg + Vitamin B 61.5mg + Folic acid 0.75mg + Benfothiamine 7.5mg capsules
For the treatment of painful diabetic neuropathy in adults only
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Medical accident is not medical negligence

Sunday 10th July: Inaugurating, a daylong national conference on "Insight on Medicolegal Issues", Hon’ble Justice A K Sikri, Hon’ble Judge Delhi High Court said that a better and continuous patient–doctor relationship can reduce most of the litigations occurring in the field of medical care.

Addressing a gather of over 300 doctors, Hon’ble Justice Vipin Sanghi, Hon’ble Judge Delhi High Court, said that a medical professional is not supposed to possess and provide maximum degree of knowledge skills and care. He is only expected to provide and possess an average degree of care, knowledge and skills.

Dr. H S Rissam, Member, Board of Directors, Medical Council of India, in his address said that most important thing a doctor must maintain is proper records of the patient and take informed consent for undertaking any treatment.

Padma Shri & Dr. B.C. Roy Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that medical accidents are not synonymous with medical negligence. Medical accidents are now classified as sentinel events or events which are unexpected and end up in complications or untoward effects. Quoting a recent US Study, Dr. Aggarwal said that wrong site surgical operations are the third most common sentinel events all over the world. All sentinel events will end up into a claim. These events may or may not be medical negligence.

Dr. A K Aggarwal, President Delhi Medical Council said that there are a number of ‘never events’ which should not happen while treatment is given. Citing an example, he said that leaving a surgical instrument or a sponge inside the abdomen will fall under ‘never events’ and is not pardonable. In the US, insurance companies have started refusing to pay for the treatment of such events.

The faculty included eminent doctors and advocates. Senior advocates who spoke on the occasion were Mr. Mukul Rohtagi, Mr. Ajay Agrawal, Ms Priya, Ms Meenakshi Lekhi, Mr. M C Gupta,
Mr. Sidhartha Luthra and Ms Indu Malhotra.

The medical faculty included Dr. Ranjit Roy Chaudhury, Dr. H S Risam, Dr. Navin Dang, Dr. Neelam Mohan, Dr. N P Singh, Dr. Sanjiv Malik, Dr. Anupam Sibal, Dr. Ajay Gambhir, Dr. Vijay Aggarwal, Dr. Girish Tyagi and Dr. Sudhir Gupta etc.

The proceedings of the conference can be accessed on www.emedinews.in.

    Readers Responses
  1. Dear sir, it was really a great pleasure to read the gists of medicolegal conference via facebook. Thanks a lot. Regards: Dr Anupam
    Forthcoming Events

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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