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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 ...

12th November 2010, Friday

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

Lung cancer trial results show mortality benefit with low–dose CT

Twenty percent fewer lung cancer deaths seen among those who were screened with low–dose spiral CT than with chest X–ray

The National Cancer Institute (NCI) released initial results from a large-scale test of screening methods to reduce deaths from lung cancer by detecting cancers at relatively early stages. The National Lung Screening Trial (NLST), a randomized national trial involving more than 53,000 current and former heavy smokers ages 55 to 74, compared the effects of two screening procedures for lung cancer — low–dose helical computed tomography (CT) and standard chest X–ray — on lung cancer mortality and found 20 percent fewer lung cancer deaths among trial participants screened with low-dose helical CT. The NLST was sponsored by NCI, a part of the National Institutes of Health, and conducted by the American College of Radiology Imaging Network (ACRIN) and the Lung Screening Study group. A paper describing the design and protocol of the NLST, "The National Lung Screening Trial: Overview and Study Design" by the NLST research team, was published yesterday by the journal Radiology and is openly available at http://radiology.rsna.org/cgi/content/abstract/radiol.10091808.

Participants were randomly assigned to receive three annual screens with either low-dose helical CT (often referred to as spiral CT) or standard chest X–ray. Helical CT uses X–rays to obtain a multiple–image scan of the entire chest during a 7 to 15 second breath–hold. A standard chest X–ray requires only a sub–-second breath-hold but produces a single image of the whole chest in which anatomic structures overlie one another. Previous efforts to demonstrate that standard chest X–ray examinations can reduce lung cancer mortality have been unsuccessful. (NIH News)  

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

Contributed by Dr G M Singh

"Fear is the lengthened shadow of ignorance."

Arnold Glasow

    Photo Feature (from the HCFI Photo Gallery)

 Anmol 17th MTNL Perfect Health Mela 2010

Anmol, a festival for children with special needs was a major attraction of the 17th MTNL Perfect Health Mela which drew public attendance in large numbers.

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

Road accidents common cause of spinal injuries

Road accidents and falling from a height account for the largest number of spinal cord injuries and associated disabilities in the country, reveals a new epidemiological study conducted at the Indian Spinal Injuries Centre (ISIC) here. As part of the study, records of 1,138 patients treated at ISIC over the past decade were examined and it was found that road traffic accidents and fall from height are the two most common causes of spinal injuries accounting for 43.5 per cent and 38.04 per cent of the total cases respectively. (Source: The Hindu) 

Delhi HC nod to course for non-MBBS to practise in villages

The Delhi High Court today gave the green signal to introduction of a three-year-course for non-MBBS persons to practise medicine in primary health centres in rural areas saying "it's better to be treated by a doctor than by a quack".

The go-ahead came after the Centre told the HC that it has approved the course and Medical Council of India (MCI) would prepare a syllabus for the course soon.
"It is better to be treated by a doctor than a quack", said a division bench of Chief Justice Dipak Misra and Justice Manmohan and gave the nod to the Ministry of Health to go ahead with introduction of new course-Bacholar of Rural Health Care for three years. The Centre's counsel submitted before the bench that to practice in primary health care centres, a person has to qualify the new course and six months internship thereafter. After obtaining an experience of five years, if the person does a bridge course for two years, he will be equivalent to a MBBS doctor.
The counsel further submitted that after approval, the government has asked MCI to prepare the syllabus. Meanwhile, MCI informed the Bench that it will prepare the syllabus within two months, after which the court asked the government to issue a notification six weeks thereafter so as to implement the course from next academic year. The Bench was hearing a PIL, filed by one Meenakshi Gautam, through counsel Prashant Bhushan, seeking to decriminalise the practise of medicine by non-MBBS persons.
The petitioner sought a direction to the government to introduce a short-term course for training healthcare workers so that shortage of doctors in rural areas could be removed.The Indian Medical Council Act, which provides for one-year imprisonment for practising medicine by non-MBBS persons, should be amended, said the petitioner.
According to the Act, only a MBBS qualified person can practice medicine and prescribe a scheduled drug. The Act has obstructed the development of mid-level health practitioners who can deliver family healthcare, the petitioner added.

    International News

(Dr Monica and Brahm Vasudev)

Vitamin D agonist enhances nephropathy Tx

In patients with diabetic nephropathy, adding a vitamin D receptor activator may enhance standard interventions for reducing kidney and cardiovascular outcomes. Patients taking 2 mcg of paricalcitol every day had significantly better improvements in urinary albumin–to–creatinine ratio than those on placebo. (Dr Dick de Zeeuw, of University Medical Center Groningen in the Netherlands in The Lancet)

FDA approves combo drugs for diabetes

A pill combining saxagliptin and extended–release metformin as a once–daily use has won US FDA approval. It comes in three strengths: 5/500; 5/1000 and 2.5/1000. The maximum recommended daily dosages of the two drugs are 5 mg and 2,000 mg, respectively.

Air pollution exposure increases risk of severe COPD

Long term exposure to low–level air pollution may increase the risk of severe chronic obstructive pulmonary disease reports Science daily. While acute exposure of several days to high level air pollution was known to be a risk factor for exacerbation in pre–existing COPD, until now there had been no studies linking long–term air pollution exposure to the development or progression of the disease. (American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine)

Single shot of morphine has long lasting effects on testosterone levels

A single injection of morphine to fight persistent pain in male rats is able to strongly reduce the hormone testosterone in the brain and plasma, according to a new study published in the journal Molecular Pain. (ScienceDaily)

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How is infertility assessed?

If both partners are young and healthy and have been trying to conceive for 12 months to two years without success, a visit to the family doctor could help to highlight potential medical problems earlier rather than later. The doctor may also be able to suggest lifestyle changes to increase the chances of conceiving. Women over the age of 35 should see their family doctor after six months as fertility tests can take some time to complete, and age may affect the treatment options that are open in that case.

A family doctor will take a medical history and give a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy yet. If necessary, they can refer patients to a fertility clinic or a local hospital for more specialized tests. The results of these tests will help determine the best fertility treatment.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What are the other associated aspects in a case of IBD?

Pain management

Few patients require long–term analgesia, and persistent severe pain may indicate poor disease control. Consider engaging the pain management team if control is difficult. An element of functional pain may coexist with that due to disease.

    Medicolegal Update

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

What is medical treatment of chemical contamination and burn?

  • In case of chemical contamination or burn injury of eye, put fluorescein drops in the eye. Burns will stain yellow.
  • If there are yellow stains with fluorescein, put chloramphenicol 1% eye ointment in the eye. Put more ointment into the eye every two hours. Continue until the eye is no longer red and the sclera is white, and then for another 24 hours.
  • If the pain is severe the patient may need an intramuscular injection of morphine.
  • If there is no water nearby dab or gently wipe the skin and hair with cloths or paper.
  • Immediately wash the affected part of the body under cold or lukewarm running water, using soap if you have some. If there is no running water use buckets of water. Do it quickly and use a lot of water. Wear gloves and an apron if needed, to protect you from splashes of chemical. Some chemicals give off vapor: be careful not to breathe it in.
  • Quickly remove any of the patient’s clothes contaminated with chemical or vomit, as well as shoes and wrist watch if necessary. Speed is important. Cut the clothes off if the chemicals are very poisonous or corrosive.
  • If large areas of the body are contaminated with chemical, wash the patient under a shower or a hose. Remember to clean the hair and under the fingernails, in the groin and behind the ears, if necessary.
  • Continue to pour water over the patient for 10 minutes or longer if you can still see chemicals on the skin. If the skin feels sticky or soapy, wash it until the feeling disappears. This may take an hour or more.
  • Make sure the water drains away freely and safely as it will have chemical in it.
  • Do not rub or scrub the skin.
  • Dry the skin gently with a clean, soft towel. If clothing stays stuck to the skin even after water has been poured over it, do not remove it.
  • Remember that many chemicals can pass through the skin very quickly. Look for signs of poisoning.
    Rabies Update

Dr. AK Gupta, APCRI, Author of "RABIES – the worst death"

Does kissing of a rabies patient call for anti–rabies vaccination?

Kissing a rabies patient may transmit disease because there may be contact with the patient’s saliva. Full post–exposure immunization must be given either by Intramuscular (IM) or Intradermal (ID) route.

If there are ulcers in the mouth of the exposed person, then rabies immunoglobulins (RIGs) must be given by IM route.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • To help monitor your diabetes over time, especially if it is not possible to monitor using the A1C test
  • To help determine the effectiveness of changes to your diabetic treatment plan.
    Medi Finance Update

Taxation Tips

An employee can claim medical reimbursement of upto 15,000 exempt from tax. One can claim leave travel expenses for family twice in a block of four years.

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Antidiarrhoeal formulations containing Neomycin or Streptomycin or Dihydrostreptomycin including their respective salts or esters.

    IMSA Update

International Medical Science Academy (IMSA) Update

Nocturnal leg cramps

Quinine, the best–studied drug, is no longer routinely recommended in leg cramps due to the potential for serious side effects and evidence for only modest benefit.

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic with A1C 6% had a BP of 130/88 mmHg.
Dr Bad: Very good control of diabetes.
Dr Good: Very good control but we also need to control BP.
Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL less than 100 mg/dL) and aspirin (75 to 150 mg/day) in patients with or at high risk for cardiovascular disease.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough is mostly due to viral infection.

    Lighter Side of Reading

An Inspirational Story

A Story with Wisdom: The Mouse Trap

A mouse looked through the crack in the wall to see the farmer and his wife open a package. What food might this contain?" The mouse wondered – he was devastated to discover it was a mousetrap. Retreating to the farmyard, the mouse proclaimed the warning. There is a mousetrap in the house! There is a mousetrap in the house!"

The chicken clucked and scratched, raised her head and said, "Mr. Mouse, I can tell this is a grave concern to you, but it is of no consequence to me. I cannot be bothered by it." The mouse turned to the pig and told him, "There is a mousetrap in the house! There is a mousetrap in the house!" The pig sympathized, but said, "I am so very sorry, Mr. Mouse, but there is nothing I can do about it but pray. Be assured you are in my prayers."

The mouse turned to the cow and said "There is a mousetrap in the house! There is a mousetrap in the house!" The cow said, "Wow, Mr. Mouse. I’m sorry for you, but it’s no skin off my nose."

So, the mouse returned to the house, head down and dejected, to face the farmer’s mousetrap alone. That very night a sound was heard throughout the house –– like the sound of a mousetrap catching its prey. The farmer’s wife rushed to see what was caught. In the darkness, she did not see it was a venomous snake whose tail the trap had caught. The snake bit the farmer’s wife. The farmer rushed her to the hospital, and she returned home with a fever. Everyone knows you treat a fever with fresh chicken soup, so the farmer took his hatchet to the farmyard for the soup's main ingredient.

But his wife’s sickness continued, so friends and neighbors came to sit with her around the clock. To feed them, the farmer butchered the pig. The farmer's wife did not get well; she died. So many people came for her funeral; the farmer had the cow slaughtered to provide enough meat for all of them.

The mouse looked upon it all from his crack in the wall with great sadness.

Mind Teaser

Read this…………………

g rosey i

Yesterday's Mind Teaser :

one another
one another
one another
one another
one another
  one another  

Answer for yesterday’s Mind Teaser: "Six of one, a half dozen of another. "
Correct answers received from:
Dr.K. P. Rajalakshmi., Dr Deepti Katyal Uppal

Answer for 10th November Mind Teaser:: "C. Propylene glycol solvent"
Correct answers received from: Dr Anupam

Send your answer to ijcp12@gmail.com

Humor Section
(Joke by Dr G M Singh)

Doctor, Doctor, everyone keeps ignoring me.
Next please!

    Readers Responses
  1. Dear editor, ref. todays newspapers, govt. giving nod to 3 yrs.rural medicine course, because govt. feels a qualified person will be better than a jholachaps! Well I have been looking after a primary health centre in a village within heart of Delhi for past 6yrs and also driving to work as even drivers feel below dignity to enter a village, spoil brats of posh colonies. if a male doctor works in a village He is a Hero. If a ladydoc goes to village she is desperate for work. Without sounding pompous i am happy with my rural job. There are thousands of jholachaps whom I don’t have to compete, but what hurts me levels some of our MD colleagues have stooped. Its below their dignity to work in neighboring village but they have given their visiting cards to all jholachaps to work on 60:40 commission basis. Qualified doctors are willing to work in villages; they are NOT threatened by jholachaps but by their own more qualified folks. At the receiving end is poor vulnerable patient, who may also like to play politics because of confusion within medical fraternity. Regards, Dr(Mrs) Neelamnath.
    Public Forum

(Press Release for use by the newspapers)

Risk factors management in diabetes: Blood sugar control should not be the only aim

Diabetes management is not just lowering blood sugar, it also involves reduction of future heart attack, kidney failure, paralysis, neuropathy and blindness, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.
Each one of us should modify his or her life style with an aim to manage risk factors; diabetics need to follow the same more vigorously. The aim should be at reduction of multiple risk factors in type 2 diabetes to reduce coronary risk. This can be done by reducing dietary fat, doing light-to-moderate exercise, smoking cessation, a tight glycemic control (target A1C <6.5 percent with intensive therapy), a tight blood pressure control (target <120/80 for the last two years), ACE inhibitor therapy regardless of blood pressure, lipid-lowering therapy (target bad LDL cholesterol <70 mg/dL and target fasting serum triglyceride <150 mg/dL.

Dr Aggarwal said the same can be remembered by controlling the ABC of Diabetes.

  • A stand for A1C, which should be kept lower than 6.5%
  • B stands for Blood Pressure, which should be kept lower than 120/80, and
  • C stands for Cholesterol, which should be lower than 100 mg% (Bad LDL)

In spite of evidence that aggressive risk factor reduction lowers the risk of both micro- and macrovascular complications in patients with diabetes, the vast majority of patients do not achieve recommended goals for A1C, blood pressure control, and management of dyslipidemia.
Both men and women with diabetes are at increased risk for developing cardiovascular disease and of dying when it is present. Compared with non diabetics, men and women with diabetes have decreased life expectancy (seven to eight years less). At the time of diagnosis of type 2 diabetes, many patients already have one or more risk factors for macrovascular disease (obesity, hypertension, dyslipidemia, smoking) and many have evidence of overt atherosclerosis (past heart attack, ischemic changes on electrocardiogram, or peripheral vascular disease).
Estimated hazard ratios are 2.3 for serum LDL cholesterol, 0.6 for serum high-density-lipoprotein (HDL) cholesterol, 1.5 for hemoglobin A1C, 1.8 for systolic blood pressure, and 1.4 for smokers.
A substantial reduction in cardiovascular mortality can be achieved by smoking cessation, daily low-dose aspirin for most patients, and aggressive treatment of hypertension and dyslipidemia.
With regard to cardiovascular disease risk reduction among patients with type 2 diabetes, the benefit of tight blood pressure control is shown to be the most important. Also discontinuation of smoking is one of the most important aspects of therapy in diabetic patients who smoke.
A meta-analysis of secondary prevention trials has shown that absolute benefits of aspirin are greatest in patients over age 65 years with diabetes or diastolic hypertension. However aspirin is less effective in reducing cardiovascular events in patients with diabetes compared to the general population.  
As per American Diabetes Association, aspirin (75 to 162 mg/day) is recommended for secondary prevention in diabetics with a history of heart attack, bypass surgery, paralysis, peripheral vascular disease, claudication, or angina. It is also recommended for primary prevention in any diabetic patient with an additional cardiovascular risk factor (eg, age >40 years, cigarette smoking, high blood pressure, obesity, albumin in the urine, abnormal lipid levels, or a family history of coronary heart disease). Aspirin is not recommended for diabetic patients under the age of 30 years and aspirin is contraindicated under the age of 21 years because of an increased risk of Reye's syndrome.
The American Diabetes Association recommends measuring blood pressure at every routine diabetes visit. Early and effective treatment of blood pressure is important, both to prevent cardiovascular disease and to minimize the rate of progression of diabetic kidney disease and diabetic eye disease.
The American Diabetes Association recommends screening for lipid disorders at least annually in diabetic patients, and more often if needed to achieve goals.

  • In individuals without obvious heart disease, the goal LDL is <100 mg/dL, whereas in patients with obvious heart disease a lower LDL goal (<70 mg/dL) is an option.  Triglyceride levels <150 mg/dL and HDL levels >40 mg/dL for men and >50 mg/dL for women are preferable.
  • Adults with low-risk lipid values (LDL <100 mg/dL, HDL >50 mg/dL, and triglycerides <150 mg/dL) may be screened every two years.
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9-12 noon
Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 - 9.30 AM: Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 - 10.00 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00 - 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 -11.00 AM: Kidney Transplant: managing difficult cases: Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
- 12.00 AM: Panel discussion
12.00: Lunch

(Registration free: email to emedinews@gmail.com)

eMedinewS Revisiting 2010

The 2nd eMedinewS  – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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