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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 ...

13th December, 2010, Monday

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

Top 5 Medical News Stories of 2010 relevant to India

  1. New Guidelines for Prostate Cancer Screening: PSA screening can in some cases save lives with early treatment. However, these tests can also pose new dilemmas, as the American Cancer Society (ACS) emphasized on March 3 when it updated its prostate cancer screening guidelines. The test picks up benign disease in addition to cancer, and it can’t distinguish between aggressive and mild forms of the disease. In some cases, PSA screening has led to expensive and invasive treatments in patients who might never have experienced symptoms. So the ACS is calling on physicians to spend more time counseling patients about their options. The PSA controversy intensified when the scientist who discovered PSA in 1970, Richard Ablin, PhD, from the University Of Arizona College Of Medicine in Tucson, said categorically that the test should not be used to screen all men older than 50 years. That’s a direct contradiction of the ACS guidelines.
  2. Revised Diabetes Guidelines highlight A1c: Screening technology popped up in the news again in December 2009 when the American Diabetes Association (ADA) published new clinical practice recommendations. The guidelines promote the use of the hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. A1c measures average blood glucose levels for a period of up to 3 months. Previously it was used only to evaluate diabetic control with time, but because it doesn’t require fasting, A1c testing will encourage more people to get tested, leading to treatments and lifestyle changes that could prevent the worst effects of the disease.
  3. Calcium boosts heart attack risk: Prevention guidelines also made headlines when a large study found that calcium supplements taken without vitamin D may increase the risk for heart attack as much as 30%. Researchers reported the finding online July 29 in BMJ, based on their meta–analysis of 15 randomized trials with up to 11,921 participants. Most guidelines for osteoporosis currently recommend the supplements, despite relatively small benefits in bone health, but senior author Dr. Ian R. Reid, from the University of Auckland in New Zealand, said that in most cases, "discontinuation of calcium would seem appropriate." The study raised many questions, such as why calcium could have this effect during a relatively short period of time. Pending further research, some experts advised eating foods high in calcium, rather than taking supplements.
  4. FDA warns against Quinine for Cramps: What do you do when no one pays attention to your guidelines? Issue them again. That was the approach taken by the US FDA July 8 after it noticed that most of the quinine being prescribed in the United States isn't for the approved indication — uncomplicated malaria — but, rather, for leg cramps. Taking quinine may result in serious and life–threatening hematologic adverse effects.
  5. Task Force Revises Mammography Guidelines: 2010 also may also be remembered as the year of the mammoth mammography muddle. On November 17, 2009, the US Preventive Services Task Force called for an end to routine mammography for women younger than 50 years, citing a lack of evidence for benefits in women that young, sparking outrage from screening advocates. On January 6, 2010, however, the American College of Radiology and the Society of Breast Imaging directly contradicted the task force, recommending routine mammography at age 40 years and older. The debate got further fuel from a Swedish epidemiological study of breast cancer, touted as the largest ever, which found that mammography produced a 26% reduction in mortality from breast cancer in women aged 40 to 49 years. Another study from Norway found that the benefits from mammography screening were modest, however, and an accompanying editorial highlighted the delicate balance between potential benefit and potential harm, concluding that the decision to undergo mammography is "a close call." As 2011 approaches, that controversy looks likely to continue, along with many others that caught readers’ attention this year.
    (Source: Medscape)
Dr KK Aggarwal
Editor in Chief
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  SMS of the Day

(By Dr GM Singh)

Life is only traveled once; today’s moment becomes tomorrow’s memory. Enjoy every moment, good or bad, bcoz the GIFT of LIFE is LIFE itself. Have a nice day.

    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Students demonstrating Karate on Valedictory Day of the 17th MTNL Perfect Health Mela

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

Delhi to get first water gallery

There is water in everything, even in a pair of shoes. At the country’s first ever gallery dedicated to water that is coming up in the city, such unusual details about water, its consumption, wastage and the need for conservation will be put together. In a few days from now Delhi will get its first water museum, "Elixir of Life –– Water and Waste Water Gallery", which has been designed and set up by the Delhi Jal Board in collaboration with the National Science Centre. The gallery will be inaugurated by Chief Minister Sheila Dikshit on December 14 at the National Science Centre. (Source: The Hindu, Dec 10, 2010)

    International News

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

Exercise reduces risk of endometrial cancer by 34 percent

Women who exercise at least 150 minutes per week saw their risk for endometrial cancer fall by more than one–third compared with inactive women, according the results of a population–based, case–control study. Researchers recruited 668 women with endometrial cancer, and 665 women for aged-match controls. They collected information on participants’ demographic features, environmental exposures and lifestyle factors. The study found that compared with women who did not exercise, women who reported exercising 150 minutes per week had a 34% reduced risk of developing endometrial cancer. The mechanism of action is still unknown, but researchers believe the decrease in risk is related to certain sex hormones, insulin production and/or percentage of body fat.

(Dr Monica and Brahm Vasudev)

Healthbeat: How does the shoulder become frozen? (Part 2)

The process usually begins with an injury (such as a fracture) or inflammation of the soft tissues, such as bursitis or tendinitis of the rotator cuff. Inflammation causes pain that is worse with movement and limits the shoulder’s range of motion. When the shoulder becomes immobilized in this way, the connective tissue surrounding the glenohumeral joint — the joint capsule — thickens and contracts, losing its normal capacity to stretch. Trying to avoid the pain caused by moving the shoulder leads to further contraction of the capsule. The humerus has less space to move in, and the joint may lose its lubricating synovial fluid. In advanced cases, bands of scar tissue (adhesions) form between the joint capsule and the head of the humerus. A frozen shoulder may take two to nine months to develop. Although the pain may slowly improve, stiffness continues, and range of motion remains limited.

PPIs may improve HbA1c in Type 2 diabetes

Results from a small retrospective analysis suggest that treatment with the proton pump inhibitor (PPI) esomeprazole improves glycated hemoglobin (HbA1c) levels in patients with Type 2 diabetes. After measuring HbA1c levels in 21 patients with type 2 diabetes who had been treated with the PPI esomeprazole for 11 months and those of 21 diabetic controls not treated with esomeprazole, they found that HbA1c decreased from a mean of 8.6% at baseline to 7.9% at 11 months in the esomeprazole group, a significant difference, and from 9.2% to 9.0% in the control group, a nonsignificant difference. (AMA News)

Diabetes may reduce life span

Diabetes cuts about 8.5 years off the life span of the average 50–year–old compared to a 50–year–old without diabetes, according to a report commissioned by the National Academy on an Aging Society.

Study suggests high blood levels of alpha–carotene may reduce risk of death

A new study published online on Nov. 22 in the Archives of Internal Medicine suggests that people with high blood levels of alpha–carotene –– an antioxidant found in orange fruits and vegetables like carrots, winter squash, oranges and tangerines –– live longer and are less likely to die of heart disease and cancer than people who have little or none of it in their bloodstream.

Novel anti–inflammatory drug may benefit patients with chronic kidney disease

Bardoxolone methyl shows efficacy in the treatment of patients with chronic kidney disease (CKD) and may even have the potential to reverse disease progression, according to University of Texas researchers.

ESRD patients hospitalized on weekends may face increased mortality risk

Patients with end–stage renal disease (ESRD) who are admitted to the hospital on the weekend have higher rates of mortality than those admitted during the week. Medical College of Wisconsin found that the mortality rate among patients admitted on weekends was 17% higher than among those admitted on weekdays.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How does a woman know that there is a problem in her fallopian tubes?

Tubal problem in the form of blockage is usually due to infection. Infection may be symptomatic or silent. The symptoms can be in the form of fever, lower abdominal pain, irregular bleeding, and watery discharge per vagina. Tubal problem can then be confirmed by hysterosalpingography or laparoscopy. However, at times tubal problems may be completely silent because it can damage the inner lining of the tube which has fine hair called cilia.

For queries contact: banerjee.kaberi@gmail.com

    Medicine Update

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

What is functional constipation?

Functional or idiopathic constipation is mainly caused by the painful bowel movement with resultant voluntary withholding of feces to avoid unpleasant defecation. Because of prolonged stasis of stools in the rectum, the fluid is absorbed and hard fecoliths are formed, which are very difficult for the child to bring out so resulting in more pain and the child trying to hold the stools further. Thus a vicious cycle sets in. Eventually, liquid stool from the proximal colon may percolate around hard retained stool and pass per rectum involuntarily (encopresis or fecal soiling). In fact, almost 30–50% children with functional constipation develop encopresis.

Causes of initial painful defecation: Change in routine or diet, stress, illness, child’s postponing defecation because he or she is too busy (morning school), forceful toilet training, exposure to antimotility drugs (antispasmodic, antidiarrheal, antitussive etc).

    Medicolegal Update

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

Facilitate cadaver organ retrieval for transplantation

In India, certain amendments to the Human Organ Transplant Act 1994 are required to enhance cadaver organ retrieval and transplantation to bridge the huge demand–supply gap. The pool of donors, including increasing the supply of organs by widening the definition of ‘near relatives’ by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures. The paired matching should be permitted i.e. if patient A’s donor does not match A, and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant.

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. I am an assistant professor in a government medical college. Another person has now joined the department as an assistant professor. He is still on probation. He is HIV–positive and also has tuberculosis. He also has some psychiatric disorder, maybe schizophrenia, and gets violent at times. He does not do any work. Other departmental faculty colleagues are forced to do his work at the last moment. We spend seven hours in the same room. We are afraid he may transmit tuberculosis to us. He may even bite us in a fit of rage, causing HIV infection. He concealed his infective status while applying for the job. The hospital administration has given 5 memos in last one year for his absenteeism and negligent attitude towards duties. His psychiatric treatment information is also hidden by him from hospital administration.

Are there any special rules or acts for HIV positive employees? What should be done?


  • There are no special privileges for HIV–positive employees.
  • He is on probation. Five memos have been given to him. He has given false information/concealed information about his health. These are sufficient grounds to terminate his services before his probation comes to an end.
  • The above course will be facilitated if the other departmental colleagues give representation to the authorities against him, also requesting that they may be given separate office accommodation because they don’t want to incur the risk of HIV and tuberculosis infection.
  • If the authorities don’t take action against him and don’t give safe office environment to you, you would be entitled to proceed legally against the authorities.
  • Another line of action can be that some other person who applied for the job along with him can proceed legally against the authorities for cancellation of the appointment of this person and for being considered for his own employment in view of the fact that this person’s appointment was illegal (since he had suppressed information/given false information).
   Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Is extended consent implied?

The fact that a patient comes to a doctor for treatment of an ailment implies that he is agreeable to medical examination in the general sense. This is implied consent and would encompass physical examination (not intimate examination), palpation, percussion, auscultation and routine sonography. Implied Consent (Tacit Consent) is the most common variety and is generally accepted in the practice of a family physician or consultant who generally prescribes medicines after noting the history of the patient and physical examination. Implied Consent is consent assessed when the surrounding circumstances lead a reasonable person to believe that consent has been granted even though word of agreement were not direct, express or explicit. (Supreme Court of India: Samira Kohli Vs. Dr.Prabha Manchanda. Ref: 2008 vol2 SCC @ pg1)

    Ethical earning

What is reimbursable to a doctor?

You can bill for telephonic consultation.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Platelet count

Thrombocytopenia (or low platelet count) is divided pathophysiologically into production defects and consumption defects based on examination of the bone marrow aspirate or biopsy for the presence of megakaryocytes.

  • Production defects are seen in Wiskott–Aldritch syndrome, May–Hegglin anomaly, Bernard–Soulier syndrome, Chediak–Higashi anomaly, Fanconi’s syndrome, aplastic anemia, marrow replacement, megaloblastic and severe iron deficiency anemias, uremia, etc.
  • Consumption defects are seen in autoimmune thrombocytopenias (including ITP and systemic lupus), DIC, TTP, congenital hemangiomas, hypersplenism, following massive hemorrhage, and in many severe infections.
Our Contributors
  Docconnect Dr Veena Aggarwal
  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
    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.
One can claim expenses for two to three personal attendants (no names or addresses are asked for). Under Rule 2BB, all labor allowances are exempted.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Chemically Modified Sodium Hyaluronate and Caboxymethylcellulose Absorbable Adhesion Barrier. As an adjunct in abdominal or pelvic surgery for reducing the incidence, extent and severity of postoperative adhesions at the site of placement. 11–Feb–10
    IMSA Update

International Medical Science Academy (IMSA) Update

Outcomes of surgery for severe obesity

In a randomized trial of 50 obese adolescents during the two year follow–up period, the patients in the AGB group (compared adjustable gastric banding) lost 34.6 kg, as compared with 3.0 kg in the supervised lifestyle group. Almost 30% of the patients undergoing AGB required revisional procedures.

(Ref: O'Brien PE, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 2010;303:519).

    IJCP Special

Dr Good Dr Bad

Situation: A patient developed asthma within a year of menopause.
Dr. Bad: It is not asthma.
Dr. Good: It is associated with menopause.
Lesson: The onset of asthma within a year of menopause is a separate asthma phenotype.

Make Sure

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

    Lighter Side of Reading

An Inspirational Story

(By Dr Prachi Garg)

The Wish Fulfilling Tree

A young aspirant was sitting at the foot of a tree in the summer heat. Fortunately or unfortunately, the tree he happened to be sitting under was the Kalpataru tree, the tree that fulfils all desires, but he did not know this.

After a while the heat became scorching and he said, "How I wish somebody would come and fan me!" Right away a young boy came and started fanning him. First he was very surprised. Then he began to think that whatever he wished for would be granted. So he said, "This is a young boy. I don’t want him. Let me have a beautiful girl." Immediately a beautiful girl came and started fanning him. After a while he said, "Now I would like to have food here. I am very hungry." The young girl went and fetched food for him. He ate his fill and then said, "Oh, how beautiful this place is. But I don’t see any animals here. I am in a forest, but how is it that there are no animals? A forest should always be alive with animals. How I wish to see at least one tiger in front of me!" In no time a tiger appeared– only to devour him!

So, as George Bernard Shaw said, "There are two tragedies in life. One is not to get your heart’s desire, the other is to get it." In this story, the young aspirant got it!


Mind Teaser

Read this…………………


Yesterday’s eQuiz: A 53–year–old female with no significant past medical history is admitted with an acute myocardial infarction. She underwent cardiac catheterization and angioplasty. She is discharged home on the usual medications for secondary prevention of coronary artery disease. Two weeks later, she is admitted with altered mental status. Entire workup is negative except for her sodium that is found to be 109 (normal 136–145). Which of the following prescription drugs may have caused this electrolyte disturbance?

1. Aspirin
2. Clopidogrel
3. Lisinopril
4. Metoprolol
5. Simvastatin

Answer for yesterday’s eQuiz: "The correct answer is 3. Lisinopril."

There are several case reports of Lisinopril-induced hyponatremia and even syndrome of inappropriate antidiuretic hormone (SIADH). None of the other medications are known to induce hyponatremia to any significant degree.

Correct answers received from: Dr Meera Rekhari, Dr Chitij Mishra

Answer for 11th December Mind Teaser: "Good afternoon"
Correct answers received from: Dr Aruna Tyagi, Dr  Anupam Sethi Malhotra, Dr Kamlesh Kanodia, Dr U Gaur, Dr Vijay Kansal, Dr T Samraj, Dr Amlendu Yadav, Dr Anurag Jain, Dr S K Bansal, Dr Anjani, Dr Tummala Nalini, Dr Jainendra Upadhyay, Dr Rajiv Kohli, Dr Rashmi Chhibber

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

An anesthesiologist is a doctor who works in the operating room to delay your pain until such time as you get his bill.

    Readers Responses
  1. Sir, It is true that many Nursing homes, small hospitals would definitely suffer due to implemntation of CEA act. Moreover, it would again add for giving one more bribe to some corrupt govt officials who can hold the hospital standstill by threatening to use CEA act provisions. As everybody in doctor community may not be able to fight individually against the act, I think you or the the doctor who takes lead in engaging lawyer for defending our stance against CEA, should be contributed financially for legal expenses. For this, a separate account can be opened up in which every interested doctor can contribute to his / her ability. This will ensure that we all will be participating in the legal process. Please do consider this suggestion & publish for greater response amongst Medical community. Thanks,With regards Dr Jitendra Ingole, MD, Pune.
    Public Forum

(Press Release for use by the newspapers)

Honey Good for Cough

A spoonful of honey can quieten childrens' night time cough and help them –– and their parents –– sleep better, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

When compared to the cough syrup ingredient dextromethorphan or no treatment, honey came out on top. As per a study from Archives of Paediatrics and Adolescent Medicine the results are so strong that one is able to say that honey is better than no treatment and dextromethorphan was not. There is currently no proven effective treatment for cough due to an upper respiratory infection like the common cold. While dextromethorphan is widely used, there is no evidence that it works, and it carries risks.

Honey is used around the world as a home remedy for cough, and might provide a safe, effective alternative to cough medicine. To investigate, the researchers compared buckwheat honey, a honey–flavoured dextromethorphan preparation, and no treatment in 105 children who had sought treatment for night time coughs due to colds. Among the three groups, children given honey had the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality may be soothing to the throat, while its high antioxidant content could also be a factor. Honey also has antimicrobial effects. Honey is not recommended for infants below one year of age.

    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.
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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