Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
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; Member 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


Dear Colleague

15th March 2010, Monday

The Rishis knew how to prevent metabolic syndrome

Metabolic syndrome is  characterized by pot belly obesity, hyperinsulinemia, insulin resistance, high triglyceride levels and low good HDL cholesterol. A metabolic syndrome patient is susceptible to develop diabetes, hypertension and premature atherosclerosis.

Today India is facing an epidemic of metabolic syndrome. Being an Indian is now considered a risk factor for metabolic syndrome. Than why metabolic syndrome was not present in the society in ancient vedic times. The reason probably lies with our Rishis and Munis who created preventive rituals, which we have stopped following. They included observing weekly fast, an extra monthly fast on full moon and additional nine days fast each before winter and summer during navratras.

A typical fast includes not eating grains on the day of fast. The grains prohibited were wheat flour and white rice. The permissible grains were ‘singhara’ flour and/or ‘kutu’ flour. In medical language, the fast can be described as eating less quantity (one meal a day) and avoiding carbohydrates all together or only eating non refined carbohydrates with low glycemic index. This is what we as medical professionals are advocating today to all our patients to prevent or treat metabolic syndrome. Both ‘kutu’ and ‘singhara’ flour have low glycemic index. The typical fast also include consuming fruits, leaves or drinking milk. All these foods are metabolic syndrome–friendly.

Eating less is also depicted in the spiritual practice as ‘bhog’. We offer ‘bhog’ to God and not feed God, thereby emphasizing the need for eating less.

Dr KK Aggarwal
Chief Editor

News and Views (by Dr Monica Vasudeva)

Carotid stenting linked to higher stroke, MI rate than endarterectomy

Patients at risk for having a stroke are more likely to benefit from surgery to strip fatty plaque out of the arteries in the neck than from a stent, according to research published in online in The Lancet Neurology.

Prophylactic mastectomy of healthy breast may boost survival in some women

According to research appearing in the Journal of the National Cancer Institute, in women under 50 with Stage 1 or Stage 2 breast cancer that was estrogen receptor negative, researchers found that prophylactic removal of a healthy breast boosted their odds of being breast–cancer free after five years by 4.8 percentage points.

Medical imaging device makers to add new safeguards to CT scanners

Medical imaging industry said top machine makers will add new safeguards in an effort to prevent patients mistakenly receiving too much radiation from CAT scans. The safety controls will include dosing checks to alert machine operators whenever the machine’s settings exceed recommended levels.

Regular exercise can significantly reduce symptoms of anxiety

In a study appearing in the Feb. 22 edition of the Archives of Internal Medicine, researchers analyzed the results of 40 randomized clinical trials involving nearly 3,000 patients with a variety of medical conditions. They found that, on average, patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise.

CREST Triual results

Loyola University Medical Center enrolled patients in a landmark trial that compared traditional surgery with less-invasive stenting to clear dangerously clogged carotid arteries. The study found that the safety and efficacy of both procedures are roughly equal. The nine–year Carotid Revascularization Endarterectomy vs. Stenting Trial is known as CREST. The trial, conducted throughout the United States and Canada, is one of the largest randomized stroke prevention trials ever.

Video Games for Elderly Depression

Research at the Sam and Rose Stein Institute for Research on aging at the University of California, San Diegosuggests a novel route to improving the symptoms of subsyndromal depression in seniors through the regular use of exergames, entertaining video games that combine game play with exercise. The researchers found that use of exergames significantly improved mood and mental health–related quality of life in older adults with SSD.

Eye care snippets : Errors of Refraction (Narendra Kumar)

Hypermetropia : It is a form of refractive error in which parallel rays of light do not focus on the retina when the eye is at rest but are brought to a focus some distance behind the retina. The condition of hypermetropia is very common. Most common cause of this refractive error is shortening of the anteroposterior axis of the eye. Hypermetropia can be due to unduly flattened cornea too. In hypermetropia, the formation of a clear image is not possible until the converging power of the eye is increased. This can be done in two ways:  By the eye itself: by increasing the converging power of the crystalline lens in the act of accommodation or by placing a convex lens in the form of spectacles in front of the eye.  

Conference Calendar

Heart Saver First Aid (HSFA) Provider Course American Heart Association (AHA) Accredited – (Target Audience – General Public). Date: March 18, 2010. Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

What’s New : Smoking drug warning

The US FDA has asked for identical boxed warnings on bupropion and varenicline about the risk of serious neuropsychiatric symptoms (eg, behavior changes, agitation, depressed mood, suicidal thoughts, and attempted suicide) and noted the overlap with typical symptoms of nicotine withdrawal.  www.fda.gov/ Drugs/Drug Safety/ Post market DrugSafety Information for Patientsand Providers /Drug Safety Informationfor Heathcare Professionals/ucm169986.htm (Accessed on July 7, 2009).

Cancer Alert : Breast cancer screening

The value of a clinical breast examination (CBE) as an adjunct to mammography in screening for breast cancer was evaluated in a study that compared a cohort of 290,000 women who underwent screening with both CBE and mammography, and 58,000 women who had mammography alone. CBE plus mammography had greater sensitivity but, for each additional cancer detected by CBE, there were 55 additional false positive screens. (Chiarelli AM, Majpruz V, Brown P, et al. The contribution of clinical breast examination to the accuracy of breast screening. J Natl Cancer Inst 2009;101:1236.)

Quote of the Day

We have to pray with our eyes on God, not on the difficulties. (Oswald Chambers)

Diabetes Fact

Metformin has been shown to modestly enhance GLP–1 secretion, making it an attractive option for combination therapy with DPP–4 inhibitors

Public Forum (Press Release:

Drugs as Good as Angioplasty for Stable Heart Disease

Aggressive drug therapy is just as good as angioplasty for patients with stable heart blockages, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

There has been a belief amongst cardiologists that all patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery.

Patients with stable heart disease make up about three–quarters of all the patients who undergo angioplasty and receive stents.

Quoting the results of 7 "Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial", Dr. Aggarwal said that optimal drug therapy, when combined with lifestyle changes, has equal results as that of angioplasty and optimal medical therapy combined.

The study published issue of the New England Journal of Medicine randomly assigned 2,300 patients with stable but significant heart disease to one of two treatment regimens. The first group received drug therapy alone, while the second group received the drug therapy plus angioplasty.

Follow up showed that 19% in the angioplasty group had died or had a heart attack, compared to 18.5% in the group that only received drug treatment.

The only benefit of angioplasty, was that it reduced chest pain over the long–term compared with drug therapy alone.

About 30% of the patients who received drug therapy alone did eventually undergo angioplasty because their symptoms couldn't be managed with drugs alone.

In addition, about 21% of the patients who received stents needed to have another procedure. Although angioplasty was better at relieving symptoms, it wasn’t better in preventing death or heart attack.

Drug therapy for patients with stable heart disease should be tried as first–line treatment. Angioplasty should be reserved for patients who have continuing symptoms.


Question of the day: How do you manage a case of multiple disseminated intra–abdominal hydatidosis with spontaneous intrabiliary rupture?

Echinococcal infection constitutes most of the cystic lesions of liver and only 5–10% are distributed along the peripheral arterial system. The most common complication of hydatid cyst is spontaneous rupture into the biliary tract.

Hydatid disease (liquid tumor) is a zoonosis caused by larval or cyst stage of Echinococcus granulosus. human beings act as an accidental and abortive intermediate host. Hydatid cysts occur at all ages, in both sexes and anywhere in the body.

In unilocular variety, cysts are usually superficial, grow slowly by expansion and internal pressure of cyst may reach upto 300–900 mm of water. Daughter and even grand daughter cysts develop by restructuring and fragmentation of the germinal layer.

Intraperitoneal rupture results in explosive showering of viable reproductive elements, which initiates secondary echinococcosis of the peritoneum. Splenic localization is usually due to retrograde invasion via valveless hepato–portal circulation during bouts of increased intra–abdominal pressure.

Endoscopic sphincterotomy, including removal of daughter cysts and hydatid debris (for rupture cyst in CBD) and PAIR technique (for non–communicating hydatidcysts) with antihelminthic chemoprophylaxis is the mainstay of treatment. During the follow–up period, ultrasonography and laboratory investigations are mandatory to assess effective and complete response to treatment.

Ultrasonography and CT are complementary tools for diagnosis of hepatic echinococcosis, with endoscopic retrograde cholangiography being the "gold standard" in confirming rupture into the biliary system. Laboratory results are usually nonspecific. Anti–helminthic treatment,should be continued for 1 year. The traditional treatment of biliary cystic fistula is surgery and recently endoscopic sphincterotomy.

Suggested reading

  1. McGreevy PB and Nelson GS. Larval cestode infections. In: Hunter’s Tropical Medicine Strickland GT (Ed.), WB Saunders, Toronto, Canada 1984:771.

  2. Zargar SA, Khuroo MS, Khan BA, et al. Intrabiliary rupture of hepatic hydatid cyst: Sonographic and cholangiographic appearances. Gastrointest Radiol 1922;17(1):41–5.

  3. Akkis H, Akinoglu A, Colakoglu S, et al. O. Endoscopic management of biliary hydatid disease. Can J Surg 1996;39(4):287–92.

  4. Filice C, Brunetti E. Use of PAIR in human cystic echinococcosis. Acta Tropica1997;64:95–107.
eMedinewS Try this it Works: Warts and calluses

Often a plantar callus is difficult to distinguish clinically from a plantar verruca. Both may look like hyperkeratotic lesions and are painful on ambulation.

It is possible to tell the two apart by palpation. A plantar callus is painful on direct palpation, while a verruca is usually painful on lateral (side–to–side) palpation. Treatment is more likely to be successful if the lesions are differentiated.

Dr Good Dr Bad

Situation: A diabetic A1C status worsened in winter
Dr Bad: It has nothing to do with winter.
Dr Good: Diabetes may worsen in winter.
Lesson: A prospective study of glycemic control during holiday time in type 2 diabetic patients demonstrated an influence of winter holidays on the glycemic control of these. The poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1C gain during the winter holidays are likely to contribute to the substantial increase in A1C that occurs every year among type 2 diabetic individuals. (Source: Diabetes Care 2004;27(2):326–30.)

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully.
Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.

Medi Finance : (BUDGET 2010–2011): INDIRECT TAXES- SERVICE TAX

• No change in Rates
• New services shall be included for Service Tax. Such services shall be introduced later on

Punjab & Sind Bank
Central Bank of India
¤JCP Group

Laughter the best medicine: Actual medical record

Patient has left his white blood cells at another hospital.

Formulae in Critical Care

Conversion of lbs into kg
Formula: Weight in kg = Weight in Ibs × 0.45

Milestones in Ortho: PERCIVAL POTT (1714–1788)

Best known for the fracture that bears his name, Pott’s fracture, as he was the first to give a good description of this ankle fracture.

Mistakes in Clinical Practice

Give specific instructions. "Use as directed" is not appropriate.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

Transabdominal USG in BPH should be done to determine size of prostate gland and its effects on bladder and kidneys. USG should be done with full bladder and also after voiding to know postvoid residual urine.

Lab test (Dr Navin Dang)

Levels of total cholesterol, LDL and apolipoprotein B, increase significantly in women at the time of menopause thus increasing the risk factors for coronary heart disease.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Ezetimibe 10 mg + Fenofibrate 145 mg Film coated tablets

For the treatment of combined hyperlipidemia in patients with normal hepatic and renal function


(Advertorial section)



Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second eMedinewS–revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April) . Over 300 registrations done already.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Doctor Pharma Relationship: What the media has reported

Stiffer rap for gift-taking docs (Sanchita Sharma, Hindustan Times)

Doctors found accepting gifts, travel, hospitality or money from pharmaceutical companies risk being banned from practicing medicine for one year or more, besides being fined Rs 1 lakh or more. Faced with widespread protests from doctors and the pharmaceutical industry, the Medical Council of India (MCI) — India’s apex body controlling medical education and practice — has further clarified amendments made to the Medical Ethics Regulations in December. And in doing so, it has made punishment stringent. The MCI has proposed punishment based on the value of gift or favour accepted. “India is the first country in the world to categorise punishment provisions depending on the magnitude of the transgression. While gifts valued above Rs 1,000 but below Rs 5,000 will draw censure, those over Rs 1 lakh will result in the doctor’s name being struck off the Indian Medical Register or State Medical Register for more than one year,” said Dr Ketan Desai, president, MCI. The proposals were sent to the health ministry on Friday for approval and are likely to be accepted without changes. “Pharma and companies selling medical devices are luring doctors to push their products. This law, if implemented, will be serve as a deterrent,” said Dr Naresh Trehan, chairman, Medanta, the Medicity. The travel ban includes sponsored travel to attend conferences, workshops or continuing medical education programmes as a delegate. While doctors can work as consultants, researchers and treating doctors with pharma companies, they can’t endorse any drug or product of the industry publicly. Breaking the law will result in censure for the first offence, and getting the medical licence revoked for subsequent ones.

Doctors to be penalized for pharma freebies (TOI): Rema Nagarajan , TNN

The Medical Council of India (MCI) has prescribed a bitter pill that all doctors must now swallow. Doctors found accepting gifts from pharmaceutical companies will face punishment ranging from a fine to at least one year of licence-suspension. More serious violations such as endorsing a pharmaceutical product could result in permanent removal of the doctor's name from the medical register, effectively ending the doctor's career.

To add shame to pain, the Council plans to publish on its website the doctor's name, that of the pharma company, nature of offense and punishment. The proposals were finalised by the MCI at a meeting on Friday and sent to the health ministry for its approval. "Even if the name of a doctor is restored on the medical register after the period of punishment, the record that such a case had happened and that the doctor was punished would be available on the website for the public to scrutinize," said MCI president Dr Ketan Desai.

The MCI first moved against pharma freebies for medicos in January, banning doctors from accepting gifts, travel facilities or hospitality of any kind from the drug industry. The latest move fixes the quantum of punishment for violations. For gifts worth Rs 1,000-Rs 5,000, doctors will only be censured. That would mean that gifts worth up to Rs 1,000 would be acceptable but those up to Rs 5,000 would attract censure. The council has been holding meetings since January to reach a consensus on the quantum of punishment, something that was proving difficult as members could not come to an agreement.


1. Gifts/Travel/Expenses/Cash Hospitality: upto 5000 (censure); upto 10,000 (3 months suspension); upto 50,000 ( 6 months suspension); Upto 1 lac (1 year suspension), over 1 lac (more than 1 year suspension).

2. Violation of regulation regarding pharma sponsored medical research ( First time censure, therefater removal from medical register for period dependent on violation)
3. Violation of regulation regarding affiliation with pharma company (first time censure, therefater removal from medical register for period dependent on violation)

4. Violation of professional autonomy while dealing with pharma company ( Firt time censure, therefter removal from medical register)

5. Any public endorsemenbt of drug/product (firts time censure, therefater removal from medical regsiter)


 Dr Sanjiv Chopra Faculty Dean at Harvard to talk in Delhi on Leadership
On 20th March Saturday 2.30pm Venue DMA Hall Daryaganj or MAMC Auditorium (to be confirmed ) 

Title of Talk:  Leadership for the 21st Century:  The Ten Tenets of Leadership

Learning Objectives:

1. Discuss the qualities of great leaders.
2. Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
3. Emphasize that we can all lead and can do so at many different levels.
4. Explore what made or makes many leaders – historical and contemporary – so effective

Leadership Talk Description

In this talk Dr. Sanjiv Chopra  will discuss historic figures such as Mahatma Gandhi, Florence Nightingale, and Winston Churchill, as well as contemporary leaders, and examine what makes them effective.  What are some of the qualities and attributes of the great leaders?  What is leadership, and can it be taught or is it something you’re born with?  It’s a subject I’ve been fascinated with. He will assert that great leaders listen will, they have empathy, they dream big, they’re resilient, they have a sense of purpose.  The possess humility and humor, they also have integrity and great people skills.

Dr. Sanjiv Chopra will examine whether Adolf Hitler, who was certainly a charismatic figure and fiery orator, was a great leader. He  will discuss 10 Tenets of Leadership, and I believe anyone who follows these tenets will be on the path to becoming a better leader. Leaders occur in all walks of life, and one can lead at many different levels.

About Sanjiv Chopra, M.D., MACP

Dr. Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Dr. Chopra has scores of publications.  He has four books to his credit.  His books have been translated into several languages including Portuguese, Japanese, Italian and Czech.

Dr. Chopra is  Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world (subscribed to by an estimated 300,000 physicians worldwide).

Dr. Chopra has received a number of teaching awards:

1. The George W. Thorn Award presented by the Brigham and Women’s Hospital Housestaff, Harvard Medical School in 1985 for his outstanding contribution to clinical education
2. In 1991 he received the highest accolade from the 1991 graduating class of Harvard Medical School, the Excellence in Teaching Award.
3. In 1995 Dr. Chopra was the recipient of the Robert S. Stone Award, a prestigious award given to a faculty member who is an outstanding clinician and teacher and is chosen by colleagues, housestaff and students from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
4. In 2003 he was honored by being chosen as the recipient of the American Gastroenterological Association’s Distinguished Educator Award.
5. In 2009 Dr. Chopra was elected as a Master of the American College of Physicians, a singular honor bestowed to only a select few individuals for being “citizen physicians, educational innovators, scientific thinkers and humanists who inspire those around him or her and sets the standards for quality in medicine.”

Dr. Chopra has been invited to lecture in numerous countries abroad.

Dr. Chopra serves as the Course Director of several CME courses including seven annual Current Clinical Issues in Primary Care  (PriMed) conferences held in collaboration with UCLA, Johns Hopkins, Baylor College of Medicine, University of Miami, Northwestern University and Columbia Presbyterian College of Physicians and Surgeons.   In addition to directing these conferences, he delivers several lectures, moderates a number of sessions and has served as a Keynote speaker on several occasions.  Each of the PriMed conferences are attended by 4,000 – 8,000 clinicians.

Dr. Chopra has had a life long passion in educating clinicians and lay people.  He has conducted scores of workshops on Success and Life Principles.  He has given a number of Keynote addresses on the topic of Leadership – “Leadership for the 21st Century:  The Ten Tenets of Leadership” to wide acclaim in the United States and several countries abroad.

Readers Responses

  1. Dear Sir, thanks for starting a very informative e–medical newspaper. Please consider adding colours at least at headlines to make the information more readable and prominent. regards. Dr Sushil Kumar, Consultant Surgical Oncology, Incharge Cancer Alert Programme, Max Cancer Centre, Saket,New Delhi

  2. Hearty congrats sir for padma award. thro this e medinews ur a doing a wonderful yeomen service to medical fraternity. Dr Ravi Wankhedkar, Consulting Surgeon & Coloproctologist, Member–Maharashtra Medicasl Council Chairman–IMA AMS Maharashtra, Chairman–IMA Rural Health Comt, Maharashtra, Hon Asso Prof of Surgery,SBH Govt Med Clg, Dhule