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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 ...

15th December, 2010, Wednesday

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

eMedinews: Top Ten Health Stories of the Year 2010

The year 2010 saw a lot of ‘hustle and bustle’ in the medical circle. Here are the Top 10 stories as viewed by eMedinewS.

  1. Overhauling of Medical Council of India: The major story of the year was the arrest of MCI President Dr. Ketan Desai, dissolution of the MCI; appointment of six out of seven Board of Governors; subsequent release of Dr. Ketan Desai on bail, common entrance exam for MBBS; reduction in forensic faculty requirement; increase in retirement age to seventy and the suspense behind 7th seat of Board of Governors etc.
  2. Medical Council of India action against Indian Medical Association: MCI took action against the IMA President and Secretary for violation of MCI Ethics on the ground that IMA should not have endorsed Pepsi products. The IMA had to approach High Court to take a stay. The matter is now in the High Court. Is that a start of MCI actions against ethics violations? Will it act against the cut system?
  3. Delhi Bug: A huge controversy arose when British Medical Journal broke a story about NDM1 bug being named after New Delhi. The medical circle in India said that it was unfair and was an attempt to sabotage the medical tourism in India. The new bug is a gram negative bacteria showing resistance to all present antibiotics. New Delhi metallo–beta–lactamase (NDM–1) is an enzyme that makes bacteria resistant to a broad range of beta–lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic–resistant bacterial infections. The gene for NDM–1 is one member of a large gene family that encodes beta–lactamase enzymes called carbapenemases. Bacteria that produce carbapenemases are often referred to in the news media as "superbugs" because infections caused by them are difficult to treat. Such bacteria are usually only susceptible to polymyxins and tigecycline. NDM–1 was first detected in a Klebsiella pneumoniae isolate from a Swedish patient of Indian origin in 2008. It was later detected in bacteria in India, Pakistan, the United Kingdom, the United States, Canada, Japan and Brazil. The most common bacteria that make this enzyme are Gram negative such as Escherichia coli and K. pneumoniae, but the gene for NDM–1 can spread from one strain of bacteria to another by horizontal gene transfer.
  4. H1N1 havoc: H1N1 created great havoc, but ultimately, proved to be a ‘much hyped’ virus with mortality even lower than the regular human flu virus. Most of the hospitals who had started special H1N1 virus wards, now do not have these wards.
  5. Chikungunya epidemic: The latest epidemic in the North India was that of Chikungunya with patients presenting with fever, rash and joint pains. It complicated the pre–existing dengue epidemic in the society.
  6. Dengue with a difference: This year dengue was different than other years, came with more GI symptoms, pancreas involvement, dengue hepatopathy and lot of skin reactions. The platelet count dropped to less than 10000 but most required no platelet transfusion.
  7. Diabetes diagnosis: The year saw a new advancement where A1C is to be used for diagnosis of diabetes and not fasting sugar. An A1C >6.5% means diabetes.
  8. New pill for HIV prevention: A new pill is now available for HIV prevention along with condoms. It is to be used before the act and continues for seven days. In a trial involving nearly 2,500 HIV–negative, but high risk, gay men in six countries, researchers found that a combination antiretroviral pill (tenofovir and emtricitabine) reduced the risk of HIV infection by 44%, compared with placebo. When scientists looked more carefully at the study volunteers who took the medication most faithfully, on a daily basis, they found that the risk of contracting HIV was even lower — 73% lower than the placebo group. More studies will need to confirm the benefit of antiretrovirals in the prevention of HIV, and public health experts warn that even if the results hold up, it would not replace the best method of prophylaxis: safe sex and consistent use of condoms. That’s because the way so–called pre–exposure prophylaxis, or PrEP, works is to load up high–risk people with HIV–disabling antiretroviral drugs before exposure to the virus, which allows the medication to hit HIV as early as possible. But the drugs do not work as a vaccine would, by priming the immune system to actually prevent infection.
  9. National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) started in the country: At last, Govt. of India, Ministry of Health and Family Welfare has started the above program.
  10. New drug for premature ejaculation: The year ended with the launch of an SOS drug for premature ejaculation. This will be breakthrough for the community. Premature ejaculation, the most common sexual problem apart from erectile dysfunction, has been often found to put marriages under strain. While the existing drugs, which are not specific to treat premature ejaculation, need to be taken regularly, the new pill can be popped just a few hours before intercourse. It works by altering levels of serotonin, a chemical in the brain. The drug, dapoxetine, comes from a family of drugs called selective serotonin reuptake inhibitors, which block the reabsorption of the neurotransmitter serotonin.
Dr KK Aggarwal
Editor in Chief
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  A strange coincidence

The coming year 2011 has the same calender as that of 2005.

  SMS of the Day

(By Dr. GM Singh)

"Anger manages everything badly"


    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Yoga is good for physical health. It is also beneficial to mental and emotional health. Students performing Aerobics in ‘Eco–Fest’ School Eco Club festival in 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

Posts Department to hold world philatelic exhibition in Delhi

The Department of Posts will be organising INDIPEX–2011, the world philatelic exhibition, in the Capital from February 12 to 18 next year. As a part of the event, India Post organised a "Letter Writing" and "Design a Stamp" competitions for school children at the India Gate lawns here on Sunday. The theme for the competition was "Save the Tiger". The six best entries at the national level will be printed as the official Government of India stamps and issued on the next Children’s Day –– November 14, 2011. (Source: The Hindu, Dec 13, 2010)

    International News

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

Obesity is a precursor to both heart disease and diabetes

Globally, heart disease is the biggest killer, and diabetes is the fastest–growing chronic condition. Medical evidence has shown that obesity is a precursor to both. "Chronic disease is the leading cause of death and disability globally, representing 60 percent of all deaths. What’s concerning is that many of these diseases are preventable,– said Julien Forder, senior research fellow, the London School of Economics, which published the study. "We know from research that exercise is one of the most effective lifestyle changes you can make to reduce your risk of developing long–term conditions." He said that 30% of cardiovascular disease and 27% of diabetes could be avoided if Americans started to exercise.

(Dr Monica and Brahm Vasudev)

Thought for food reduces actual consumption

A new study by researchers at Carnegie Mellon University, published in Science, shows that when you imagine eating a certain food, it reduces your actual consumption of that food. This landmark discovery changes the decades–old assumption that thinking about something desirable increases cravings for it and its consumption.

Drug combination shows promise for newly diagnosed blood cancer patients, study finds

A new three–drug combination of a novel proteasome inhibitor called carfilzomib, combined with lenalidomide and low–dose dexamethasone used to treat multiple myeloma may be effective as a front–line therapy for newly diagnosed patients, as per a study led by the University of Michigan Comprehensive Cancer Center. This is the first study to look at carfilzomib as a front–line treatment of patients with myeloma, a type of cancer that arises in the plasma cells. Initial results of the phase I study were presented Dec. 6 at the American Society of Hematology Annual Meeting and Exposition.

Aromatase inhibitors may be heartbreakers

Aromatase inhibitors appear to increase the risk of cardiac events among women being treated for breast cancer, an analysis of several studies showed. The relative risk of suffering a cardiovascular event increased 26% (P=0.01); however, that excess risk can be mitigated if a woman is treated with tamoxifen first and then switches to an aromatase inhibitor (Dr Eitan Amir, of the Princess Margaret Hospital in Toronto).

Aortic aneurysm treatable with asthma drugs

Science Daily: A new study from the Swedish medical university Karolinska Institutet shows that asthma drugs are a potential treatment for aortic aneurysm. These drugs, which block cysteinyl–leukotrienes, could reduce the break down of vessel wall tissue and the dilation of the aortic wall, and thus the risk of its rupturing. This could both save lives and reduce the need for complicated and risky surgery. The results are presented in the scientific journal Proceedings of the National Academy of Sciences (PNAS).

    Infertility Update

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

Are there any symptoms a woman/couple may notice that might indicate an inability to conceive?

Women who have extreme pain associated with ovulation or menstruation may be at risk for endometriosis and should seek expert care. Women who are annovulatory (do not ovulate) or who have very irregular cycles may be at risk for polycystic ovarian disease and should seek expert care. Unmanaged, these diseases can cause serious barriers to fertility. However, early treatment and expert management can preserve a woman’s fertility.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What is Disimpaction?

Disimpaction means cleaning of retention from the rectum. This can be achieved by two methods: oral or rectal route. The oral route is preferred over rectal route as the latter is invasive and is likely to add fear and discomfort to the child. Polyethylene glycol (PEG) lavage solution in a large dose is given orally (20–30ml/kg/hr for 4 hours, may be repeated on next day or day after if there is inadequate response on first day) or by naso–gastric tube (25ml/kg/hour) until clear fluid is excreted through anus. Adequate disimpaction means both output (stool) and input (lavage solution) should be of same color.

    Medicolegal Update

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

What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well–known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.

  • Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
  • Section 46 IPC states that death denotes the death of a human being unless the contraryappears from the context.
  • Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. Can a medicolegal expert represent a client in a medical negligence case against another medical practitioner?

  1. A client can be represented in a court only by an advocate except when the court permits a non–advocate to appear on his behalf.
  2. I am a medicolegal expert and I regularly appear for my clients in my capacity as an Advocate.
  3. There is no reason why a court should deny permission to a person to represent another on the ground that he has twin expertise in medicine as well as law.
    Medilaw – Medicolegal Judgement dil

(Dr KK Aggarwal)

Can MCI stay the action of DMC or does one need to go to the High Court?

A: IN THE HIGH COURT OF DELHI: Writ Petition (C) No.1735/2008/3rd March: Dr PB vs DMC, Justice Gita Mittal.

  1. This writ petition has been filed by the petitioner who has submitted that he is a radiologist and has been wrongly found guilty of medical negligence by the DMC vide an order dated 4th February, 2008 in respect of the alleged examination which he never conducted. It is an admitted position that the petitioner has assailed the order passed by the DMC by way of an appeal filed before MCI.
  2. Ms. PMS learned counsel for the MCI submits that it is a fact that the petitioner has filed an appeal. I find that there is also no dispute that the appeal accompanied by an application seeking interim stay, has been filed. However, as on date, no interim order has been passed and the impugned order passed by the DMC dated 4th February, 2008, takes effect from 4th March, 2008. According to the petitioner, the respondent has taken a stand that there is no statutory power with MCI to entertain or pass interim order. This writ petition seeks grant of the interim orders during the pendency of the appeal.
  3. DMC has directed removal of the petitioner’s name from the State Medical Register for a period of three months as well as penalty. It is pointed out that the same would abrogate not only the petitioner’s right to practice medicine in Delhi but also in the entire country and would severely impact his professional reputation.
  4. I have heard the parties who are present. So far as the merits of the petitioner’s appeal is concerned, the same is pending consideration before MCI which would take a considered view after hearing the parties before this court. However, it cannot be denied that removal of the name from the medical register would irreparably impact the petitioner's right as well as the reputation and standing in the medical profession. In case the appeal is decided in favour of the petitioner, there is substance in the petitioner’s contention that restitution may not be possible. The regulations under the appeal which has been filed, are statutory. The petitioner has invoked this statutory remedy in accordance with law. On a consideration of the matter, in order to balance equities and meet the ends of justice, in my view, it would be appropriate if the execution of the order remains stayed till consideration and adjudication upon the appeal filed by the petitioner. Accordingly, this writ petition is allowed. The execution of the DMC order shall remain stayed during the pendency of the appeal which has been filed by the petitioner before the MCI herein, assailing this order.
   Ethical earning   

What is reimbursable to a doctor?

In hospital practice, consultation charge for two visits a day. They are also allowed a third emergency visit.

    Lab Update

(Dr Naveen Dang and Dr Arpan Gandhi)

Serum calcium

Hypocalcemia (or low serum calcium level) must be interpreted in relation to serum albumin concentration (Some laboratories report a "corrected calcium" or "adjusted calcium" which relate the calcium assay to a normal albumin. The normal albumin, and hence the calculation, varies from lab to lab). True decrease in the physiologically active ionized form of Ca++ occurs in many situations:

  • Hypoparathyroidism
  • Vitamin D deficiency
  • Chronic renal failure
  • Magnesium deficiency
  • Prolonged anticonvulsant therapy
  • Acute pancreatitis
  • Massive transfusion
  • Alcoholism

Drugs producing hypocalcemia include most diuretics, estrogens, fluorides, glucose, insulin, excessive laxatives, magnesium salts, methicillin, and phosphates.

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

(Contributed by Dr GM Singh)

What are simple equity funds?

These funds invest a pre–dominant portion of these funds mobilized in equity and equity related products. In most cases about 80%–90% of their investments are in equity shares. These funds have the freedom to invest both in primary and secondary markets for equity. One variation of the simple equity fund is the ELSS (equity linked saving scheme).

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Olopatadine HCl Nasal Spray 0.6% w/w (Additional Indication) For the relief of the symptoms of seasonal allergic rhinitis in patients 6 years of age and older 10–Feb–10
    IMSA Update

International Medical Science Academy (IMSA) Update

Preoperative antisepsis with chlorhexidine–alcohol is superior to providone–iodine

Chlorhexidine should be used preferentially for preoperative antisepsis in clean–contaminated surgery. In a systemic review of six studies involving more than 5000 patients, chlorhexidine reduced postoperative surgical–site infection compared with povidone–iodine (pooled odds ratio 0.68, 95 percent confidence interval 0.50 to 0.94; p = 0.019).

(Ref: Noorani A, et al. Systematic review and meta–analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean–contaminated surgery. Br J Surg 2010 Nov;97(11):1614–20).

    IJCP Special

Dr Good Dr Bad

Situation: A man who was to be married was found to be HIV–positive.
Dr Bad: Keep the report secret.
Dr Good: I will inform the to–be married girl.
Lesson: Sections 269 and 270 of the Indian Penal Code provide as under: "269. Negligent act likely to spread infection of disease dangerous to life – whoever unlawfully or negligently does not act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

Make Sure

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid.
Lesson: Make sure, to evaluate only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Learn from your mistakes

Thomas Edison tried two thousand different materials in search of a filament for the light bulb. When none worked satisfactorily, his assistant complained, "All our work is in vain. We have learned nothing."

Edison replied very confidently, "Oh, we have come a long way and we have learned a lot. We know that there are two thousand elements which we cannot use to make a good light bulb."


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: "b bow w"
Answer for yesterday’s Mind Teaser: Crossbow

Correct answers received from: Dr.K.V.Sarma, Dr.K.P.Rajalakshmi, Dr Vikas Kumar, Dr Sudipto Samaddar, Dr. Rajiv Dhir, Dr.K.Raju, Dr Muthumperumal Thirumalpillai, Dr Joshi Sachin, Dr.K.V.Sarma,

Answer for 13th December Mind Teaser: "Water fall"
Correct answers received from: Dr. T. Samraj, Dr. Anupam Sethi Malhotra, Dr. B.V.Sai Chandran, Dr Anurag Jain 

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Doctor, doctor, my little boy’s swallowed a bullet. What shall I do?
Well, for a start, don’t point him at me.

    Readers Responses
  1. Dear Sir, It is great to read the revisiting editorials. Thanks a lot for your revisiting stories 2010: Dr Anupam
    Public Forum

(Press Release for use by the newspapers)

First cigarette of the day most harmful

Heart patients should avoid smoking and taking coffee early in the morning said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Both smoking and caffeine can acutely raise the blood pressure by as much as 10 mmHg. The rise in blood pressure can be greater in susceptible individuals. The effect is most prominent with the first cigarette of the day in habitual smokers.

In patients with mild high blood pressure, habit of smoking and drinking coffee, elevation of daytime upper systolic blood pressure can be up to 6 mmHg during winters.

Heart patients, therefore, should avoid taking cigarette, coffee, tea, with or without a cigarette early in the morning.

    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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