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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; 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

15th July, 2010, Thursday

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

Fish poisoning are rarely fatal

  1. Ciguatera (pronounced as seegwhaterra) poisoning occurs when you eat a fish that has eaten a certain poisonous food. This poison is not eliminated even when the fish is either cooked or frozen. The first symptoms include abdominal cramps, nausea, vomiting and diarrhea. Symptoms can then progress to headache, muscleaches and skin that is itchy, numb or tingly. One may notice a change in the ability to feel hot or cold temperatures. For example, one may think something feels hot when it is actually cold. The symptoms can last for 1 to 2 weeks and can come back any time one eats an affected fish. To avoid ciguatera poisoning, don’t eat fish that commonly carry the poison. These fish include amberjack, grouper, snapper, sturgeon, king mackerel, barracuda and moray eel. The poison is more concentrated in the fish’s internal organs of the fish, so one should never eat those parts of a fish.

  2. Scombroid poisoning is a foodborne illness caused by bacterial overgrowth in improperly stored fish (stored at temperatures above 20°C for as little as two to three hours). Although associated with fresh fish, scombroid poisoning can also occur with canned fish if the fish is handled improperly. The bacteria are most commonly halophilic Vibrio species, Proteus, Klebsiella, Clostridium, E coli, Salmonella and Shigella species. Histidine that is present in the muscle of dark meat fish is broken down by the enzyme decarboxylate producing high levels of histamine. Toxins are not broken down by cooking, freezing, or subsequent refrigeration. Fish contaminated with scombroid may smell and appear fresh, although patients often report that the fish tastes "peppery," "salty," or "bubbly." Symptoms usually develop 20 to 30 minutes after eating and include flushing of the face, nausea, vomiting, hives and abdominal pain. These symptoms are similar to other allergic reactions. However, getting scombroid poisoning does not mean one is allergic to fish. The symptoms last for 24 hours or less and can come back if one eats fish that has not been refrigerated properly. To avoid poisoning, don’t eat any fish that has not been refrigerated properly. Be especially careful when you eat fish such as tuna, sardines, mackerel, mahimahi or anchovies.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

2nd Meeting of the Padma Awardees

Eminent Padma awardee Doctors met for the second time at Conference hall of hotel ‘The Lalit’ on July 3, 2010. The doctors discussed various problems in the medical education system as it exists today.

Dr k k Aggarwal


News and Views

India Quick Bytes……

  1. National Program for prevention of diabetes, stroke, cancer and cardiovascular disease. The cabinet has approved 500 crore for the next two years.

  2. National Board of Exams is considering 2–3 years DNB in family medicine for service doctors. Many PHC doctors would like to avail the opportunity.

  3. Chlorine gas poisoning in Mumbai: Chlorine gas leak in the early morning today from a scrapyard in the Mumbai Port Trust (MPT) premises has left at least 103 people sick. Reports are here that many of them were students. According to the recent reports, around 500 people have been evacuated while thirteen people are critically ill and have been admitted to JJ Hospital.Chlorine is a respiratory irritant gas and can cause acute lung injury. First aid remains is similar to that for a gas exposure. Put a wet cloth over the nose till you can come out of the exposure.

  4. CBI Raid:  The CBI carried out searches at residential and official premises of Dr Rakesh Verma, Head of Cardiology Department Safdarjung Hospital and claimed to have recovered "incriminating" documents showing properties worth Rs 10 crores in his and his family members' name. The CBI carried out searches at the office, residence and six other places in Delhi, Greater Noida and Ghaziabad and found voluminous incriminating documents pertaining to possession of properties in his name, in the name of his family members and relatives. The properties allegedly owned are at posh Sainik Farm, Patparganj, BK Road, Mansarovar Garden in Delhi, Kaushambi in Ghaziabad, Knowledge Park and Gautam Budh Nagar in Greater Noida and Bhondsi in Gurgaon. These properties include a medical college in the Knowledge Park. The CBI has registered a case against him under sections 13(2) to read with 13(1)(e) of the Prevention of Corruption Act. He has not been arrested yet. (PTI)

  5. MCI News: MCI approval to Gian Sagar Medical College, 77 others

    The MCI has given approval to 78 medical colleges for the current academic year including Gian Sagar Medical College of Patiala, for whose recognition then MCI director Ketan Desai had allegedly demanded a bribe of Rs two crore. In other decisions, out of the 100 medical colleges it reviewed in June, the council's Board of Governors decided to disapprove the scheme submitted for the establishment of 19 new medical colleges. Thirteen colleges were not given permission to increase seats and other issues. Gian Sagar College was given permission for renewal of running 100 seats for the academic year 2010-11.

Eat well to help your heart (Dr G M Singh)

1. "Good" fats and oils
2. Fish and omega3s
3. Grains and oats
4. Beans and lentils
5. Alcohol
6. Plant sterols and stanols
7. Fruits

CDC says thousands of hospital infections could be prevented (Dr Brahm and Monica Vasudeva)

As per CDC estimates, 80,000 patients per year develop catheter-related bloodstream infections (CRBSIs). These infections that can occur when tubes are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. The CDC has estimated that 30,000 patients die as a result…accounting for nearly a third of annual deaths due to hospitalacquired infections in the United States.

Mergers of for–profit, non–profit hospitals re-ignite debate (AMA News)

Cashpoor nonprofit hospitals, unable to borrow money for needed improvements in facilities and equipment, are eagerly seeking for-profit suitors. Meanwhile, forprofit hospital companies and investment firms eyeing the improving economy and the expected influx of millions more insured Americans as a result of the new federal health overhaul law see opportunity in the nonprofit sector. However, the transactions are also re-igniting a longrunning debate: Are the deals good for patients, or do they result in an overemphasis on profits that poses a threat to the quality of care?

Researchers halt testosterone gel trial after high number of heart attacks

A federally financed study to see if testosterone gel helps frail elderly men build muscle and strength was abruptly discontined late last year after participants taking it suffered a disproportionate number of heart attacks and other serious cardiac problems. One patient died as due to what was apparently a heart attack. The Times says that researchers were taken aback by the high rate of adverse heart problems. The FDA has approved it for use only in men with hypogonadism, whose sex glands produce extremely low amounts of testosterone or none at all because of an underlying disorder, yet, offlabel use has increased in recent years.


Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Is it necessary fto disclose all information to patient? What is 'Therapeutic Privilege?

The patient has a right to full information, concerning diagnosis, treatment , prognosis, alternative treatments and its possible complications. 'Informed' means the consent of a patient to the performance of the health care services provided by a registered medical practitioner. There are 2 exceptions: No disclosure is required, if the patient indicates a preference not to be informed; or if the physician or surgeon believes that the patient is so anxiety prone or disturbed that the information would not be processed rationally or that it would probably cause significant psychological harm or it will cause adverse effect on patient's health. This exception to the legal duty of full disclosure to patient  is called the ‘therapeutic privilege’ of a doctor.


Experts’ Views

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

Hepatology Tip of the Day

SGOT is more than SGPT in dengue hemorrhagic fever. It can help in differential diagnosis.

Question of the Day

How do you determine that a baby is jaundiced ? (Dr Anjali Kulkarni)

Jaundice is a clinical sign. The American Academy of Pediatrics irecommends measurement of an infant’s total serum bilirubin if jaundice is clinically significant. The ability of the clinician to diagnose "clinically significant" jaundice varies widely and in some cases may be erroneous. A TSB level that is "clinically significant" depends on the actual TSB level as well as the infant’s age, in hours. Nevertheless, newborns whose TSB levels exceed 12 mg/dl are always identified as "jaundiced"


Public Forum (Press Release for use by the newspapers)

Poly Diet and Poly Drugs

New Delhi, Thursday: Traditional Vedic sciences has been advocating tpoly diet i.e. mixing a combination of all seven colours and six tastes. said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Each colour provide a different vitamin and each taste has a different function in the body. Combining them together provides a perfect balanced diet. Allopathy is also now promoting the concept of multiple drugs for a single disease. Today, for obesity, lipids, blood pressure, diabetes, tuberculosis, malaria, HIV, rheumatoid arthritis, etc., it is advised to combine multiple drugs in low doses than to give high dose of a single drug.

Giving a single drug for infections like tuberculosis, HIV and malaria can produce drug resistance and giving a single drug for non–communicable diseases like blood pressure, diabetes and high cholesterol may not adequately control the disease and achieve the required goals and targets.

Most patients with diabetes and hypertension of over 10 years’ duration may require a combination of three to four drugs. Even preparing home cooked vegetables in a traditional Indian way requires more that 10 ingredients. Therefore, one should not count the number of drugs while taking treatment.


An Inspirational Story (Dr Sarvesh Goel)

On the first day, as President Abraham Lincoln entered to give his inaugural address, just in the middle, one man stood up. He was a rich aristocrat. He said, "Mr. Lincoln, you should not forget that your father used to make shoes for my family." And the whole Senate laughed; they thought they had made a fool of Abraham Lincoln.

Lincoln looked at the man and said, "Sir I know that my father used to make shoes in your house for your family, and there will be many others here… Because the way he made shoes; nobody else can. He was a creator. His shoes were not just shoes; he poured his whole soul in it. I want to ask you, have you any complaint? Because I know how to make shoes myself. If you have any complaint I can make another pair of shoes. But as far as I know, nobody has ever complained about my father’s shoes. He was a genius, a great creator and I am proud of my father".

The whole Senate was struck dumb. They could not understand what kind of man Abraham Lincoln was. He was proud because his father did the job so well that not even a single complaint had ever been heard.

"No one can hurt you without your consent."  "It is not what happens to us that hurts us. It is our response that hurts us."


IJCP Special

Dr Good Dr Bad

Situation: A patient on treatment for thyrotoxicosis developed high blood sugar level.
Dr Bad: You have diabetes.
Dr Good: It may be due to thyroid status.
Lesson: Hyperthyroidism can interfere with glucose metabolism and is associated with both increased sensitivity of pancreatic beta cells to glucose, resulting in increased insulin secretion, and antagonism to the peripheral action of insulin. The latter effect usually predominates, leading to impaired glucose tolerance in untreated patients (Diab Rev 1993;1:343.)

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics. Reaction: Oh my God! Antibiotics were not required!
Lesson: Make sure not to prescribe antibiotics to a patient with fever and cough as most cases are due to viral infection.

Quote of the Day (Dr. Santosh Sahi)

"If you learn only methods, you will be tied to your methods, but if you learn principles you can devise your own methods." Ralph Waldo Emerson

Who can fly?

  1. The US Air Carrier Access Act of 1986 requires that persons with disabilities are able to fly without being discriminated against. As a result, more people with chronic medical conditions now travel on commercial flights.

  2. As a general rule, patients with unstable medical conditions should not fly on a commercial aircraft.

  3. The Aerospace Medical Association recommends assessing fitness to fly by seeing whether a patient can walk 50 yards at a normal pace, or climb one flight of stairs without becoming symptomatic.

Myths about Aging

If you didn’t exercise in your 20s, 30s and 40s, it’s too late to start in your 50s, 60s or 70s.

Milestones in Cardiology

Werner Forssmann (19041979) was a German physician. He performed the first human cardiac catheterization in 1929.

Mnemonics of the Day ( Dr Varesh Nagrath)

Thick nerves

Charcot Marie Tooth disease
Diabetes (DejerineSottas syndrome)
E Idiopathic
Refsum’s disease


International Medical Science Academy Update (IMSA)

Heart failure due to myocardial iron overload is a major cause of death in patients with thallasemia major.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Cetirizine 10 mg + Ambroxol 75 mg SR Tablet

For symptomatic relief of productive cough associated with allergic rhinitis, when both anti–histamine and mucolytic agents are desired



Medi Finance

Q. Can a doctor change the method of depreciation as he likes or is it mandatory to follow a Specific one?

A. It is mandatory to charge depreciation according to written down value method and there is no option for change of method.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Tests to diagnose Hashimoto’s thyroiditis

Antithyroid peroxidase antibody (antiTPO) in addition to thyroid function tests (TSH, T4, T3). Anti-TPO test detects autoantibodies against a protein found in thyroid cells. These antibodies are not normally present, so a high value usually indicates autoimmune damage to the thyroid due to disorders such as Hashimoto’s thyroiditis and Graves’ disease.


Humor Section

Jokes (Dr Maj Prachi Garg)

Dr Jhatka comes back to his car & finds a note saying ‘Parking Fine’

He writes a note and sticks it to a pole ‘Thanks for the compliment.’

Medical bloopers on medical charts!

The patient’s past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.


Readers Responses

  1. Dear Dr Aggarwal: At the outset I appreciate your efforts for bringing out emedinews regularly. I have sent my compliments in the past too. I will request you to kindly bring an update on External Counter Pulsation in your next issue or at your convenience: Dr Gaurav Garg

    eMedinewS Responds: Enhanced external counter pulsation (EECP) is a technique that increases arterial blood pressure and retrograde aortic blood flow during diastole (diastolic augmentation). Cuffs are wrapped around the patient’s legs and, using compressed air, sequential pressure (300 mmHg) is applied (from the lower legs to lower and upper thighs) in early diastole to propel blood back to the heart. The 2002 ACC/AHA guidelines on chronic stable angina concluded that more clinical trial data are required before EECP can be recommended and this conclusion was not changed in the 2007 focused update. EECP has met with only limited acceptance in practice. EECP is for patients with Canadian Cardiovascular Society class III or IV angina who, in the opinion of a cardiologist or cardiovascular surgeon, are not readily amenable to percutaneous coronary intervention or coronary artery bypass graft surgery because the patient is inoperable or at high risk for complications, or the coronary anatomy is not suitable for revascularization.

  2. Dear Dr. Aggarwal, Being in the field of Public Health all along my professional life I did not have any chance to meet you in Delhi. At the moment I am in my village Tapovan on the outskirts of Dharamsala Kangra, Himachal. I will be back in Delhi around mid–Oct. Persons like you are role models for professionals. I thank you for keeping me on Email through which I am knowing the developments. In this village, I do not have the luxury of having a morning Newspaper. So I keep myself abreast through E mail News. Regards: Dr. J.P.Gupta, President, Delhi Branch IPHA, Formerly Director, National Institute of Health & Family Welfare, New Delhi

  3. Dear Dr. Aggarwal, Thanks for exhaustive daily mails. It is very nice of you to take so much trouble preparing it daily. May I make a suggestion kindly make it shorter. I suggest just one fourth the present size more people will read and benefit. Sorry treading on your territory but in support of my suggestion, I would say:They say, the less you speak the more you are heard. Mr. Rusi Mody when he was ChairmanManaging Director Tata Steel would NEVER read any letter if it was more than 1 page. Hope my suggestion will not be misunderstood. Sushil Dhawan.

  4. Dear Dr Aggarwal, I have been reading emedinews almost from the begining. I must congratulate you for this mammoth job. All the best: GKRth

  5. Dear Dr KK Aggarwal, I enjoy reading eMedinews everyday; kudos on your great effort. In your edition of 13 July, in the otherwise very well written piece on DVT, the following statement has been made: "It is usually advised to take an anticoagulant indefinitely". The statement does not accurately reflect the modern management of DVT: Prof (Col) Kumud Rai, Max Heart & Vascular Institute.

    • The initial treatment of DVT (when an underlying cause is present) is 3–6 months of anticoagulation.

    • The initial treatment of DVT (when no underlying cause is present) is 6 – 12 months of anticoagulation.

    • Longer term anticoagulation (minimum 5 years; perhaps lifelong) is only recommended if there is (a) Recurrent DVT/PE (no underlying cause) (b) DVT/PE due to Thrombophilia (procoagulant state).

Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

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