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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 ...

14th November 2010, Sunday

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

Today is World Diabetes day

Every year, World Diabetes Day is celebrated on November 14 to mark the birthday of Dr. Frederick Grant Banting who, along with Charles Best (a medical student at that time) discovered insulin in 1922. It was first started in the year 1991 by the International Diabetes Federation (IDF) and the WHO due to the rising incidence of diabetes and its various complications.

The World Diabetes Day theme for the period 2009–2013 is ‘Diabetes Education and Prevention.’ The campaign slogan for 2010 is ‘Let’s take control of diabetes. Now.’

Some salient facts about diabetes:  

  • Morbidity from diabetes involves both macrovascular (atherosclerosis) and microvascular disease (retinopathy, nephropathy, and neuropathy).
  • Diabetic interventions can limit end organ damage.
  • Prevention of cardiovascular morbidity is the major priority.
  • Diabetes is considered CAD equivalent in predicting the risk of future cardiac events.
  • Smoking cessation is essential for patients who smoke.
  • Cardiovascular morbidity can 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.
  • Blood sugar control can minimize risks for retinopathy, nephropathy and neuropathy in both type 1 and type 2 diabetes, and cardiovascular disease in type 1 diabetes.
  • A1C goal is <7% for most patients
  • A1C goal is <6% for individual patients with type 1 diabetes and during pregnancy.
  • A1C goal is >7% for some type 2 patients with comorbidities or with a limited lifespan. (Source: Uptodate)
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(Contributed by Dr. G.M. Singh)

"The saddest thing I can imagine is to get used to luxury."

Charlie Chaplin

    Photo Feature (from the HCFI Photo Gallery)

 Medico Masti 17th MTNL Perfect Health Mela

Students from different colleges participated in the Medico Masti – An Inter College Youth Fest.

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

Manipal Hospital launches nutrition guide

Commemorating World Diabetes and Children’s Day, the department of nutrition and diabetics and department of pediatrics, Manipal Hospital, launched a comprehensive nutrition guide consisting of three books for children, ‘Good nutrition for your baby,’ ‘Kids Nutrizone’ and 'Managing your Diabetes, the Carbohydrate Counting Way', on Thursday. (Source: Indian Express)

    International News

(Contributed Dr GM Singh)

Clinical decision rules to identify patients at high risk for subarachnoid hemorrhage

One of three rules might eliminate unnecessary evaluation of patients with acute headache.

Because subarachnoid hemorrhage (SAH) is a potentially devastating cause of acute headache, many patients with acute headache undergo extensive testing (e.g., computed tomography (CT), lumbar puncture) to rule it out. In this 5–year multicenter prospective Canadian study that involved nearly 2000 neurologically intact adults who presented with acute (peaking within 1 hour) nontraumatic headache, investigators sought to identify clinical characteristics that predicted SAH. Overall, 130 patients had SAH. Sixteen clinical characteristics were associated significantly with SAH and were used to create three possible clinical decision rules:

  • Rule 1: age >40, complaint of neck pain or stiffness, witnessed loss of consciousness, onset of headache with exertion
  • Rule 2: arrival by ambulance, age >45, vomiting at least once, diastolic blood pressure >100 mm Hg
  • Rule 3: arrival by ambulance, systolic blood pressure >160 mm Hg, complaint of neck pain or stiffness, age 45–55

For each rule, patients are investigated for SAH if one or more clinical characteristics in the rule are present. Retrospectively, each of the three rules had 100% sensitivity, and their specificities were between 28% and 39%.

Although these decision rules are promising, they must be validated in other populations before they are used routinely; indeed, the authors note that a prospective validation study is under way. But, in the meantime, the findings provide guidance: Patients who present with nontraumatic headaches that peak within 1 hour and who have any of the clinical characteristics mentioned in the rules above should be assessed carefully for SAH. As the authors note, validated rules "could allow clinicians to be more selective and accurate when investigating patients with headache" and lower use of CT and lumbar puncture.

(Dr Monica and Brahm Vasudev)

Basic lifestyle factors play key role in controlling diabetes and preventing complications

For patients with type 2 diabetes, basic lifestyle factors, like diet and exercise, can play a key role in controlling the disorder and preventing serious complications, such as blindness, nerve disorders, and kidney failure.

Misconceptions about diabetes abound

Despite the fact that many people think that complications such as blindness, loss of limbs, and kidney failure are inevitable, they are not. With proper medication and medical care, regular blood sugar checks and good habits such as staying active and eating right, there’s a good chance you’ll avoid other health complications.

Britain’s longest surviving kidney transplant patient celebrates anniversary of 1968 surgery

Pensioner Mrs Anne Whiteman has made medical history by becoming Britain's longest surviving kidney transplant patient. When she underwent her transplant in 1968, she was one of the first in the country to have such an operation. At that time the surgeons told her the kidney would only last for ten years. However, on Oct. 31, Mrs. Whiteman, 67, celebrated the 42nd anniversary of the transplant.

    Infertility Update

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

What are some less common treatments for infertility?

Immunotherapy with IntraVenous ImmunoGlobulin (IvIg) is a less common treatment that is becoming more recognized and utilized.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

How is hepatobiliary disease diagnosed in cystic fibrosis?

Hepatobiliary disease in patients with cystic fibrosis is unpredictable and clinically difficult to detect because of the lack of a single reliable test, the inability to clinically recognize developing fibrotic liver lesions, and the lack of clinical symptoms until portal hypertension develops. The detection of CF liver disease depends on a combination of diagnostic tests, including clinical examination (for evidence of hepatosplenomegaly) and assessment of parenchymal or biliary epithelial damage (serum ALT/GGT).

    Medicolegal Update

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

Advice of the Royal College of Surgeons London introduced in India

In 1842, a Council of Education, which introduced many changes in the course curriculum and system of medical examinations, replaced the Committee of Public Instruction. The new courses of study, based on the advice of the Royal college of Surgeons London were introduced in 1844, and were ultimately recognized by them, by the London University and the Society of Apothecaries in 1846. After the foundation of the University of Calcutta in 1857 and its Faculty of Medicine for the award of medical degrees, the courses of study were revised to a certain extent of practice of medicine and surgery. The University conferred three medical degrees, Licentiate in Medicine and Surgery (LMS), Bachelor in Medicine (MB), and Doctor of Medicine (MD).

    MCI Act

1.3 Maintenance of medical records

1.3.1 Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard Performa laid down by the Medical Council of India and attached as Appendix 3.

1.3.2. If any request is made for medical records either by the patients / authorized attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the
period of 72 hours.

1.3.4 Efforts shall be made to computerize medical records for quick retrieval.

Appendix-3: Format for Medical Record

Name of the patient :
Age :
Sex :
Address :
Occupation :
Date of 1st visit :
Clinical note (summary) of the case:
Prov. Diagnosis :
Investigations advised with reports:
Diagnosis after investigation:
Advice :
Follow up
Signature in full ………………………….
Name of Treating Physician

    Lab Update

(Dr. K Raghu, Senior Consultant Hematologist, Coimbatore)

Hematology Tips

Anemia is very common in our country. Always try to get a causative diagnosis in anemia. Red cell indices using a cell counter, reticulocyte count and a blood smear reported by a trained person either a pathologist or a medical technologist are three basic tests in anemia. If there are no facilities for these tests, one is justified in giving a therapeutic trial of iron and folic acid for a short time and investigate the non responders.

    Medi Finance Update

To what extent can a doctor deposit an amount to PPF?

Ans. Upto Rs. 70,000 in a financial year.

    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

Liquid Oral antidiarrhoeals or any other dosage form for pediatric use containing halogenated hydroxyquinolines

    IMSA Update

International Medical Science Academy (IMSA) Update

Glycemic control in Type 2 diabetes

In Asian patients with type 2 diabetes, postprandial glucose 24 and 4 h after meals was a predominant contributor to excess hyperglycaemia in well–controlled patients and was equally important as fasting glucose or preprandial glucose in moderately to poorly controlled patients with mean HbA1c up to 10%.

(Ref: Wang JS, et al. Contribution of postprandial glucose to excess hyperglycaemia in Asian type 2 diabetic patients using continuous glucose monitoring. Diabetes Metab Res Rev 2010 Nov 10. (Epub ahead of print)

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic came with A1C 7.5%.
Dr Bad: Its ok.
Dr Good: You need better control.
Lesson: A1C goal is <7 % for most patients.

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh by God! Why was additional insulin given?
Lesson: Make sure that insulin dose is correct. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

    Lighter Side of Reading

An Inspirational Story

I wanted to change the world

When I was a young man, I wanted to change the world.
I found it was difficult to change the world, so I tried to change my nation.
When I found I couldn’t change the nation, I began to focus on my town. I couldn’t change the town and as an older man, I tried to change my family.
Now, as an old man, I realize the only thing I can change is myself, and suddenly I realize that if long ago I had changed myself, I could have made an impact on my family. My family and I could have made an impact on our town. Their impact could have changed the nation and I could indeed have changed the world.

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterdays Mind Teaser: "ALLworld "

Answer for yesterday’s eQuiz: "It’s a small world after all."
Correct answers received from: Dr Vishanji Karani, Dr. A. K. Gupta, Dr.K.V.Sarma, Dr.G.Padmanabhan

Answer for 12th November Mind Teaser: "Ring around the rosey"
Correct answers received from: Dr. Rochlani, Dr Rashmi Chhibber, Dr Vijay Kansal, Dr Muthumperumal Thirumalpillai.

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a while
(Contributed  by Dr G M Singh)

A little girl asked her mother: "How did the human race appear?" The mother answered: "God made Adam and Eve and they had children, and so was all mankind made."
Two days later the girl asked her father the same question. The father answered: "Many years ago there were monkeys from which the human race evolved."
The confused girl returned to her mother and said: "Mom, how is it possible that you told me the human race was created by God and Dad said they developed from monkeys?"
The mother answered: "Well, dear, it is very simple. I told you about my side of the family and your father told you about his."

    Readers Responses
  1. Dear Readers, please check the flaws in the new MCI amendments.
    1. Is there any institute in India offering Biotechnology course, along with Physics and Chemistry at the level of Higher Secondary (or Plus two)? If not, then what was the logic of including Biotechnology as an alternative to Biology??
    2. Is there any Medical College in India, offering pre–medical course? If not, then where was the need to add the sentence "Pre–medical course may be conducted either at the Medical College or a science college"?
    3. Requirement of faculty positions (Asst Prof and Assoc Prof) has been decreased while requirement of Tutors/Registrars/Sr Residents have been increased in many clinical streams. Any logic??
    4. Notices issued regarding DNB courses and increasing SR/Registrars/Tutors etc are un–dated and un–numbered. Why??
      Dr Rajiv Mahajan, Associate Professor (Pharmacology), AIMSR, Bathinda, Editor in Chief, IJABMR (www.ijabmr.org), GS, BMSA (www.bmsa.co.in)
  2. 14 November 2010 (World Diabetes Day): World Diabetes Day (WDD) is celebrated every year on November 14. The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. The day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922. With regards: Dr Sukanta Sen, Index Medical College, Indore.
    Public Forum

(Press Release for use by the newspapers)

Concentrate with Concentration

Speaking at the 13th Varishth Nagrik Awaz function organized by Hindi Bhawan, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal said that yoga is not just simply Aasans but involves eight limbs of discipline practice incorporating Aasans, Pranayams, withdrawal of senses, intention, concentration and contemplation. He said that 20 minutes of deeper relaxation can produce the same benefits which are seen with seven hours of deep sleeping.

He said that Pranayam in allopathic language can be equated to parasympathetic lifestyle which reduces the wear and tear of the body and helps in healing.

Addressing another gathering organized by Yoga Sansthan at Rohini, Dr. KK Aggarwal said that lifestyle disorders can be regressed. By proper lifestyle management, one can reduce intake of drugs for diabetes and high blood pressure by 30%. He said that it is possible to regress even coronary blockages over a period of time in patients with stable angina. One should not plan interventional procedure until a meditation or lifestyle management has failed.

Delivering another lecture in Law Asia organized at India Habitat Centre which was attended by over 100 lawyers, Dr. Aggarwal said that medical tourism is booming in India but is facing a lot of initial hurdles.

Non–uniformity of services in various hospitals is one of the main hurdles. Dr. Aggarwal said that if India has to become a super power then they have to attract patients from all over the world. The doctors and nurses in hospitals should be paid well if they have to provide better services to foreigners at reasonable cost.

    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

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant
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
11.00 – 12.00 AM: Panel discussion
12.00 Noon: 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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