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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 December, 2010, Saturday

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

Revisiting 2010

Initial chemotherapy for metastatic pancreatic cancer

One should use Folfirinox rather than gemcitabine for patients with metastatic pancreatic cancer who have a good ECOG performance status and a serum total bilirubin level that is <1.5 times the upper limit of normal.

In a preliminary report presented at the 2010 ASCO meeting, Folfirinox was associated with significantly higher objective response rates (31 vs 9%), median progression–free survival, and overall survival (11.1 vs 6.8 months). These benefits were achieved at the cost of significantly more toxicity. For patients who are willing to sacrifice some survival benefit for a less toxic regimen, gemcitabine alone or gemcitabine plus capecitabine is a reasonable option. One should give gemcitabine monotherapy rather than Folfirinox for patients with an ECOG performance status other than 0 to 1.

Reference

  1. Conroy T, Desseigne F, Ychou Y, et al. Randomized phase III trial comparing FOLFIRINOX (F: 5FU/leucovorin (LV), irinotecan (I), and oxaliplatin (O) versus gemcitabine (G) as first–line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial (abstract 4010). J Clin Oncol 2010; 28:303s. (Abstract available online at: http://www.asco.org/ ASCOv2/ Meetings/ Abstracts?&vmview=abst_detail_view&confID=74&abstractID=41562,accessed August 18, 2010).
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr GM Singh)

"Someone has defined genius as intensity of purpose; the ability to do; the patience to wait…put these together and you have genius and you have achievement."

Leo J Muir

 
    Photo Feature (from the HCFI Photo Gallery)

HCFI Anti–smoking campaign


The Heart Care Foundation of India carried out an anti-smoking campaign using a Mobile Exhibition Van in Delhi during the Annual Perfect Health Parade, organized on the day of World Health Day.

 
Photo Feature
 
    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

Delhi to be centre of tiger campaign soon

"Tigers everywhere", is the latest initiative to promote tiger population in the country, through lifesize tiger figures and paintings. Delhi would be the centre of this campaign and full–sized felines will dot public spaces of the capital soon. Even if the tigers are dwindling from the forests, the concrete jungles are all set to welcome their caricatures. The initiative known as the "ArTiger" brings together artists, corporate houses and conservationists at over 50 public locations here, including the two Dilli Haats, the India Habitat Centre, ISBT, airport and malls. Aimed at drawing public attention and raising funds for conservation of big cats, the initiative has been inspired by London’s ‘Elephant Parade’ said Swapan Seth, managing partner of Henry S Clark Art house and one of the brains behind the initiative.(Source: The Pioneer, Dec 06, 2010)

 
    International News

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

Resistance training improves blood flow better than aerobic training

New research from Appalachian State University gives even more reason to make resistance training part of your daily workout. During the study, researchers compared blood vessel responses to two types of moderate–intensity workouts: three sets of 10 repetitions of eight resistance exercises and 30 minutes of aerobic cycling. They found that resistance exercise produced a greater increase in blood flow to the limbs and led to a longer–lasting decrease in blood pressure post–workout, than aerobic exercise. Researchers found that resistance training mildly increases arterial stiffness and greatly increases blood flow to the limbs. In contrast, aerobic exercise decreases arterial stiffness but does not greatly increase blood flow to the limbs, the study found. If done together, researchers say, both forms of exercise could have many favorable benefits for cardiovascular health. The study appears in the November issue of Journal of Strength and Conditioning Research.

(Dr Monica and Brahm Vasudev)

Annual mammograms may reduce mastectomy risk for women in their 40s

For women in their 40s, a new study suggests that annual mammograms may reduce the risk of having a mastectomy. This latest recommendation is based on "a British study of 971 women between 40 and 50 years old who had been diagnosed with breast cancer.

People with type 2 diabetes urged to exercise 150 minutes per week

People with type 2 diabetes should get 150 minutes of aerobic exercise a week, according to a new recommendation. Diabetics should not let more than two days pass between exercise (sessions) because frequent activity is key to keeping blood glucose levels from rising. Combining physical activity and modest weight loss can lower the risk of developing type 2 diabetes by up to 58% in high–risk populations.

Urine test may help detect preeclampsia during early stages of pregnancy

A simple measurement of key proteins in spot urine samples can detect preeclampsia in women during the early stages of pregnancy, according to a study presented at Renal Week 2010: American Society of Nephrology 43rd Annual Meeting.

Esomeprazole may improve HbA1c levels in patients with type 2 diabetes

According to an analysis published in the December issue of the journal Diabetes Research and Clinical Practice, treatment with esomeprazole improves glycated hemoglobin levels in patients with type 2 diabetes.

 
    Infertility Update

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

Who can be a sperm donor?

A young healthy male can be a sperm donor. He has to be screened and given clearance for certain medical illnesses and sexually transmitted diseases. The ICMR guidelines encourage anonymous donation through sperm bank. International anonymity is not a major criterion.

Who can be an egg donor?

Egg donation can be achieved through professional donors, egg sharing and known donors. ICMR guidelines suggest that donors should be anonymous.

For queries contact: banerjee.kaberi@gmail.com

 
    Medicine Update

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

What is constipation?

Constipation is defined as a delay (<3 stools/week) or difficulty (due to consistency) in defecation present for two or more weeks and sufficient enough to cause significant distress to the patient. In the West, 3% of children visiting pediatrician are due to constipation and one in four (25%) Pediatric Gastroenterology consultations are due to constipation. There is no such prevalence data from our country but it is quite common especially among toddlers and preschool children.

 
    Medicolegal Update

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

Dilemmas in legal inquiry over antemortem and a postmortem injury

Injuries, other than antemortem in nature, may appear due to various other reasons and sources such as deliberate mutilation of a body by a murderer, predation by wild animals, or handling in transportation leading to cause confusion over the manner and cause of death. It is important to distinguish between antemortem, perimortem and postmortem injuries.

  • One major difference between an ante mortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed.
  • After death, the body usually does not bleed. However, there are exceptions. For e.g. when a person drowns, the body usually floats face downwards resulting in the head becoming congested with blood. If the cadaver receives a head injury by being buffeted around in the water and colliding with boats or propellers, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood.
  • It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration (cuts or scrapes) to the head and scalp which may be very hard to interpret.
  • After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some post–mortem bruising which may need to be distinguished from antemortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as lividity. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante–mortem bruising.

Recent research has focused on improved techniques for distinguishing between an antemortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Chinese scientists have found that tissue from antemortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help the pathologist classify injuries more accurately.

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Can IMA back out of the agreement?

A: IMA can back out from the MoU with Pepsi & Dabur, under Section 23 of the Contract Act, without paying compensation. There is no contractual obligation for IMA now. If IMA is not particular about receiving the last installment of 75 lakh rupees, we can pull out of the MoU. Whether we are ready for that is the moot question.

ENDORSING PEPSI, DABUR PRODUCTS Show–cause notices to 61 IMA members Aditi Tandon, Tribune News Service, New Delhi, December 6 In the dock for endorsing Pepsi and Dabur products in lieu of money, the office–bearers of the Indian Medical Association (IMA) continue to be in trouble. After recommending the removal of the names of serving president and secretary of the IMA from the medical register for six months for "professional misconduct" in the matter, the Medical Council of India (MCI) has now issued show–cause notices to 61 office–bearers of the association who were parties to this continued endorsement of products for commercial reasons –– something the MCI has described as a violation of the Indian Medical Council (Professional Misconduct, Etiquettes and Ethics) Regulations 2002).

In doing so, the MCI has approved the recommendations made earlier by the council’s Ethics Committee, which gave the directions in October. Among the latest lot to receive show–cause notices for professional misconduct are all the 61 executive committee members of the IMA, whose president G Samaram and secretary Dharam Prakash are already facing the prospect of the removal of names from the medical register. The latter has already approached the court against the order and got relief.

The MCI’s latest order directs the 61 doctors in question to personally appear before the council on December 8 or send their lawyers or written stands on the matter as to "why they should not be censured for unethical behaviour".

The MCI has further directed the IMA to stop the endorsement of Pepsi and Dabur products and recall brochures and ads in a reasonable time period or face similar action as faced by top two officials of the IMA. Importantly, the IMA has refused to present to the MCI copies of the MoUs they signed with the two companies for the endorsement of their products.

Taking a serious note of this refusal, the Ethics Committee, whose decision the MCI has approved, said, "The IMA by refusing to place the MoU before the MCI on the pretext of the agreement being between itself and the companies has shown professional misconduct."

The Tribune was the first to report that strict censure was on the cards for the IMA office–bearers who agreed to receive Rs 2.25 crore for three years of the contract with Pepsi and Dabur –– Rs 52 lakh a year from Pepsi and Rs 23 lakh a year from Dabur. They agreed to endorse Quaker Oats, Tropicana (Pepsi) and Odomos (Dabur).

The complaint was filed with the MCI by Dr KV Babu, member of the Kerala State Medical Association.

 
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    Legal Column

(Dr KK Aggarwal)

Doctor Faces Suits over Cardiac Stents

Editorial excerpts reproduced (Story by Gardiner Harris, December 5, 2010, NYT)

"Word quickly reached top executives at Abbott Laboratories that a Baltimore (USA) cardiologist, Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008. Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow–smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore". The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February. Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance. The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, concludes that Dr. Midei "may have implanted 585 stents which were medically unnecessary" from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures. The report also describes the close relationship between Dr. Midei and Abbott Labs, which paid consulting fees to the cardiologist after he left the hospital.

The case has turned into a legal quagmire for Dr. Midei and St. Joseph, which have been sued by hundreds of patients who claim they received unnecessary implants. "What was going on in Baltimore is going on right now in every city in America," said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. "We’re spending a fortune as a country on procedures that people don’t need." Last month, St. Joseph agreed to pay a $22 million fine to settle charges that it paid illegal kickbacks to Dr. Midei’s medical practice, MidAtlantic Cardiovascular Associates, in exchange for patient referrals; the hospital did not admit wrongdoing. St. Joseph said in a statement Friday that it now conducts monthly random reviews of stent cases "to assure such a situation cannot occur again."

The case has had wide repercussions. Over the past year, St. Joseph has told hundreds of Dr. Midei’s patients that they did not need the expensive and potentially dangerous stents that the doctor inserted because their arteries were not as obstructed as he had claimed. Now, state health officials are investigating other local cardiologists who inserted a suspiciously high number of stents, which are tiny wire mesh devices inserted to prop open clogged arteries in the heart. After reports about the Midei case and the wider state investigation, the number of stent procedures performed at St. Joseph and other area hospitals plunged, raising doubts about the appropriateness of much of the region’s cardiac care.

A landmark 2007 study published in The New England Journal of Medicine showed that many patients given stents would fare just as well without them. Dr. Christopher J. White, president–elect of the Society for Cardiovascular Angiography and Interventions, said that inappropriate stenting was a problem, but a rare one. The federal Medicare program spent $3.5 billion last year on stent procedures. Prosecutors, malpractice lawyers and state medical boards are only now waking up to the issue. The Texas Medical Board last month accused a widely known cardiologist in Austin of inserting unnecessary stents. In September, federal prosecutors accused a cardiologist in Salisbury, Md., of performing unnecessary stent surgeries, and last year a Louisiana doctor was sentenced to 10 years in prison for inserting unneeded stents. Jay Miller, another Baltimore lawyer, said he was devoting his entire practice to unnecessary stent cases. "And I don’t think this is limited to just a few Maryland hospitals," Mr. Miller said. But far from questioning cardiologists who perform an unusually high number of stent procedures, many hospital executives celebrate these doctors because of the revenue they bring, which can be more than $10,000 per procedure.

Dr. Midei’s fall was as rapid as it was dramatic. He had been one of the most sought–after clinicians in his region. Trained at Johns Hopkins University, he was a co–founder of MidAtlantic, a practice with dozens of cardiologists that controlled much of the cardiac business in Baltimore’s private hospitals. Dr. Midei was one of the practice’s stars. When MidAtlantic negotiated a $25 million merger with Union Hospital in 2007, the deal was contingent on his continued employment. St. Joseph was so concerned about losing Dr. Midei’s business that the hospital offered a $1.2 million salary if he would leave MidAtlantic and join the hospital’s staff. When Dr. Midei agreed, the merger with Union collapsed, MidAtlantic sued, and the practice’s former chief executive vowed in a deposition to "spend the rest of my life trying to destroy him personally and professionally." In the June deposition, Dr. Midei estimated that in 2005 — before research revealed that many stents were unnecessary — he performed about 800 stent procedures. Instead of dropping in subsequent years, however, the number of stents Dr. Midei inserted rose to as many as 1,200 annually, he estimated. In a 2007 internal document, Abbott Laboratories ranked Dr. Midei’s use of stents behind only five other cardiologists in the Northeast, including those at hospitals four and five times St. Joseph’s size. That sort of increase in volume was an obvious red flag, said Dr. William E. Boden, clinical chief of the division of cardiovascular medicine at the University of Buffalo and an author of the 2007 stent study. "For him to have this brisk increase over those years is really unusual," Dr. Boden said.

In stable patients, stents should be used only if X–rays show that most of the artery is blocked, and the patient has symptoms like frequent chest pain. Stent procedures can, in rare cases, cause bleeding, stroke or a heart attack. Once a stent is placed, it can result in a life–threatening clot that emerges weeks to months later. Stent patients must spend a year or more taking blood–thinning medications, which have their own risks.

In April 2009, a patient of Dr. Midei’s who was also a St. Joseph employee complained that he had received an unneeded stent and that many other patients had as well. The hospital engaged a panel of experts who reviewed 1,878 cases from January 2007 to May 2009 and found that 585 patients might have received unnecessary stents. When asked to review the cases himself, Dr. Midei found far less blockage than he had initially, according to the Maryland Board of Physicians. The hospital suspended his privileges and eventually sent letters to all 585 patients. Hundreds of lawsuits against Dr. Midei and St. Joseph followed, including from patients treated well before January 2007. Abbott responded to the controversy by hiring Dr. Midei as a consultant. "It’s the right thing to do because he helped us so many times over the years," an Abbott executive wrote in a January e–mail cited in the Senate report. The company sent Dr. Midei to Japan, but news of the controversy made his duties impossible, and he flew home. Edward Chaid, 68, a semiretired general contractor from Timonium, Md., is among those who have sued. Five years ago, Mr. Chaid decided to get his first physical examination in decades. Just to be safe, his doctor sent him for a cardiac stress test at MidAtlantic, which revealed a small "squiggle" of concern, Mr. Chaid said. He was sent to Dr. Midei to get his arteries X–rayed, and he emerged from the procedure with two stents. "Dr. Midei said: ‘You sure are lucky. You had 90 percent blockage.’ And the nurse said, ‘Oh yeah, you were blocked in your widow–maker.’ And I said: ‘Thank God. I guess I’m really lucky you got it when you did,’" Mr. Chaid said in an interview. Five years later, another doctor concluded that Mr. Chaid’s blockage had been minimal. "I was really shocked," Mr. Chaid said. "I’m from a generation where doctors are thought very highly of." But Mr. Snyder, Dr. Midei’s lawyer, said that his client’s care had been entirely appropriate, that doctors often interpret X–rays differently and that St. Joseph was using him as a scapegoat. A Web site created by friends of Dr. Midei lists dozens of testimonials like this one: "Plain and simple, Dr. Midei saved my life."

 
    Ethical earning

What is reimbursable to a doctor?

The emergency visit – You can charge more than the regular visit.

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Polycythemia

Polycythemia is defined as an increase in total body erythrocyte mass. As opposed to the situation with anemias, the physician may directly measure RBC mass using radiolabeling by 51chromium, so as to differentiate polycythemia (absolute erythrocytosis, as seen in polycythemia vera, chronic hypoxia, smoker’s polycythemia, Ectopic erythropoietin production, methemoglobinemia, and high O2 affinity hemoglobins) from relative erythrocytosis (as seen in stress polycythemia and dehydration)

 
    Medi Finance Update

How to read a balance sheet

Current Assets Ratio

Current asset ratio is arrived at by dividing the current assets by current liabilities plus current loans (excluding long term loans). It is considered best if it is above 1.33.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Rivaroxaban film coated Tablets 10mg

For the prevention of venous thromboembolism in patients (VTE) in adult patients undergoing hip or knee replacement surgery.

30–Jan–10

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Pediatric migraine

In children, red ear syndrome is a highly specific sign for migraine. According to the univariate statistical analysis, RES showed a statistically significant association with male gender, throbbing quality of the pain, vomiting and phonophobia.

(Ref: Raieli V, et al. Prevalence of red ear syndrome in juvenile primary headaches. Cephalalgia 2010 Dec 1. Epub ahead of print)

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with an eGFR value of 15.
Dr. Bad: You need immediate dialysis.
Dr. Good: Hold on till proper investigations are done.
Lesson: A study published on December 6th in Canadian Medical Association Journal shows that starting dialysis too soon can be associated with high mortality.

Make Sure

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis?
Lesson: Make sure all rape victims are counseled for HIV post exposure ART prophylaxis.

 
    Lighter Side of Reading

An Inspirational Story

The Sanyasi in America

About Swami Vivekananda’s stay in America by Sri Chinmoy

Swami Vivekananda, a great Indian hero, and a great spiritual renunciate or sanyasi, came to America to preach spiritual philosophy and to offer India’s message to the nation. After addressing the World’s Parliament of Religions held in Chicago in 1893, he became famous overnight.

This lofty spiritual figure had many friends and admirers. One day, some of these friends and admirers came to his house to ask him questions about Indian philosophy and spirituality. They were moved by his answers. By the time they departed, it was nearly midnight. After they had gone, the man thought of India, his poor India, especially Mother Bengal. He said to himself, "I am going to bed. But tonight there are thousands and thousands of people without beds who will be lying in the street, poverty stricken. Here I have got a cozy and most comfortable bed. But once upon a time, I was a renunciate. Even now I am a renunciate. I used to roam in the street with no food, with nothing. Still, from time to time, I have no food or clothes. I'm in a destitute condition.

"God blesses me with riches, and my friends keep me in their homes. They’ve even given me this beautiful apartment. Indeed, I’m living in great luxury. In a few minutes, I'll go to sleep in a comfortable bed, and yet many of my fellow brothers and sisters in Bengal will be sleeping in the street. "My heart bleeds for them. I have not fulfilled my task. I must help my poor Indian brothers. I must save their lives; I have to enlighten them, to awaken their consciousness. There is so much to do! Alas, what am I doing here? I need rest, but I won’t sleep on the couch. I'll sleep on the floor."

He unwrapped his turban and laid it out on the floor for bedding. Early the following morning when the owner of the apartment, who was his friend, came to invite him to breakfast, he saw this great Indian hero lying on the floor. He said, "What is the matter?" The Indian replied, "Thousands and thousands of my brothers and sisters spend the night in the streets. How can I sleep in a comfortable bed? I can’t, unless and until I have done something for them. It is my duty to serve God in the poor and needy. So the life of comfort is not for me. The life of selfless service, the life of dedicated, devoted service, is for me. Service is my goal, service is my perfection in life."

— — — — — — — — — —

Mind Teaser

Read this…………………

noon good

Yesterday’s Mind Teaser: "Land Time"
Answer for Yesterday’s Mind Teaser: "The land before time"

Correct answers received from: Dr KV Sarma, Dr KP Rajalakshmi, Dr Sudipto Samaddar, Dr Neelam Nath, Dr Vikas Kumar, Dr Joshi Sachin

Answer for 9th December Mind Teaser: "A step above the rest"
Correct answers received from: Dr. Manjesha, Dr Vijay Kansal, Dr Anurag Jain, Dr Sudipto Samaddar, Dr. K P Rajalakshmi, Dr Chandresh Jardosh, Dr Shirish Singhal, Dr.K.V.Sarma, Dr. T. Samraj

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr GM Singh)

Doctor, doctor, I keep thinking I’m a spoon.
Sit there and don’t stir.

 
    Readers Responses
  1. Dear Sir, the article under ‘An Inspirational Story – Value your spouse’ was one of the most touching stories I have ever read. Kindly continue to publish such stories. Thank you very much. Dr. Manjesha, Manjesh Hospital, Kalluvathukkal, Kerala.

 
    Public Forum

(Press Release for use by the newspapers)

Avoid Smoking in Winter

Smoking can not only precipitate heart attack, paralysis and increase blood pressure but can also increase the risk of erectile dysfunction in men. Men who smoke 20 cigarettes a day are 40 percent more likely to struggle with erectile dysfunction than men who do not smoke, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Nicotine present in smoke can constrict the blood supply to various organs. As per a study published in the journal Tobacco Control, in men aged 16–59 years, the risk of erectile dysfunction is almost double in smokers than in non smokers. Apart from smoking, obesity, heavy alcohol consumption and misuse of Viagra like drugs can also disturb men’s sexual health. Uncontrolled diabetes, blood pressure, which is common in winter season also add to the same.

Depression is also common in winter adding to the agony. For those who want to quit smoking winter is the best time to do so.

 
    Classifieds – Situation Vacant

Wanted a Senior Resident in Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta, The Medicity, Gurgaon, Delhi (NCR). Those interested please contact: Dr. Neelam Mohan (9811043475), or Secretary to Dr. Neelam Mohan – Amit (9818200582).

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on Sunday, January 9th 2011, 8 AM to 6 PM.
The one day conference will revisit and cover all the new advances in the year 2010. There will also be a web–cast of the event. The eminent speakers will be Padmabhushan Dr Naresh Trehan (cardiac surgery); Padma Shri Dr KK Aggarwal (revisiting 2010); Dr Neelam Mohan (liver transplant); Dr N K Bhatia (transfusion medicine); Dr Ambrish Mithal (diabetes); Dr Anoop Gupta (Male infertility); Dr Kaberi Banerjee (Female infertility) and many more.

There will be no registration fee.
Delegate bags, gifts, certificates, breakfast and lunch will be provided.
Kindly register at www.emedinews.in

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