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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 January, 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

American Diabetes Association Revises Diabetes Guidelines

  • A1c is a faster, easier diagnostic test, reduces undiagnosed patients, better identifies pre diabetes.
  • No fasting is required.
  • A1c of 5% indicates the absence of diabetes.
  • A1C 5.7% to 6.4% indicates pre diabetes.
  • A1C > 6.5% indicates the presence of diabetes.
  • For optimal control: A1C < 7%, prevents nephropathy, neuropathy, retinopathy, and gum disease.
  • Diabetes related to cystic fibrosis: Early diagnosis and aggressive treatment with insulin have narrows the gap in mortality.
  • "Diagnosis of Pre–diabetes" is now named "Categories of Increased Risk for Diabetes."
  • Increased risk for future diabetes: A1c 5.7%– 6.4%, impaired fasting glucose and impaired glucose tolerance levels.
  • Detection and Diagnosis of GDM: Screening– use risk factor analysis and an oral GTT. Women diagnosed with gestational diabetes should be screened for diabetes 6 to 12 weeks postpartum and should have subsequent screening for the development of diabetes or pre diabetes.
  • Diabetes Self–Management Education: improve adherence to standard of care, to educate patients regarding appropriate glycemic targets, and to increase the percentage of patients achieving target A1c levels.
  • Antiplatelet Agents: in moderate– or low–risk patients, aspirin is of questionable benefit for primary prevention of cardiovascular disease. The revised recommendation is to consider aspirin treatment as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk, defined as a 10–year risk greater than 10%. Patients at increased cardiovascular risk include men older than 50 years or women older than 60 years with at least 1 additional major risk factor.
  • Fundus photography may be used as a screening strategy for retinopathy, as described in the section "Retinopathy Screening and Treatment." However, although high–quality fundus photographs detect most clinically significant diabetic retinopathy, they should not act as a substitute for an initial and dilated comprehensive eye examination. Retinal examinations should be carried out annually or at least every 2 to 3 years among low–risk patients with normal eye examination results in the past.
  • "Diabetes Care in the Hospital" now questions the benefit of very tight glycemic control goals in critically ill patients.

eMedinewS Revisitng 2010

eMedinews Revisiting 2010 was Attended by 940 delegates at Maulana Azad Medical College and was viewed on live webcast at www.docconnect.com by 649 electronic delegates.  Out  of 649, 417 viewed it around lunch time. In total 782 people viewed the webcast (including multiple time opening).

Out of 649 webcast viewers, 19% were gynecologists, 14% pediatricians, 6% were family medicine, 5% anesthetist, 4% general surgeons, 3% cardiologist and 49% were others. Maximum viewership was from 10 am to 1 pm in the afternoon with a peak between 12 noon to 1 pm.

Electronic webcast now has become a reality. 649 web viewers was almost like  a full-fledged conference on the web. We thank all our readers and viewers for making it a success and will try to give our eMedinewS readers more and more of webinas.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

  eMedinewS Audio PostCard

  MEDICON 2010, 26 December
53rd Annual Delhi State Medical Conference

Dr Neelam Mohan gives her views on 'How safe is Liver Transplant in Children in India"

Audio PostCard
  SMS of the Day

(By Dr GM Singh)

People only see what they are prepared to see. Ralph Waldo Emerson

    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisitng 2010

The 2nd eMedinews reveisting was also webcast live . The growth illustrates the timeline of the users who viewed the webcast of the conference.

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

PGI to throw open advanced trauma centre next month

After several years of delay, the Advanced Trauma Centre (ATC) at the Post–Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, will finally become operational from the next month. The 100–bed ATC, located near the main entrance of the Institute, will provide specialised trauma care facilities to patients in the region and, more importantly, will ease the burden on the institute’s overcrowded Emergency Department. It will primarily cover four departments — include Orthopaedics, Neurosurgery, Plastic Surgery and General Surgery." (Source: Indian Express, Jan 12, 2011)

Cancer, diabetes programme for whole India

The Indian government plans to extend the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke to all the 650 districts of the country under the 12th Five Year Plan (2012–17). Union Health Minister Ghulam Nabi Azad Wednesday said the programme was already being implemented in 100 most–backward and remote districts spread across 21 states. The implementation in these districts will continue till 2012. "Depending on the success of the programme, all 650 districts in the country will be covered under the 12th plan," Azad said in his inaugural address at the conference of health ministers of the states. The two–day conference will assess the progress under various schemes and draw up an action plan for the rest of the 11th plan (2007–12) and road map for the 12th plan. (Source: The Times of India, Jan 13, 2011)

    International News

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

When will runners and swimmers reach their physical limit?

Running and swimming records are broken again and again at almost every international athletics event. But, can human performance continue to improve indefinitely? Will runners continue to accelerate off the starting blocks and reach the finish line in faster and faster times? Will swimmers always be able to dive into the record books with a quicker kick? Writing in the International Journal of Applied Management Science, researchers from South Korea have analyzed data from sports events over the last one hundred years and have calculated that we could reach the upper limits on elite human performance within a decade. Yu Sang Chang and Seung Jin Baek of the KDI School of Public Policy and Management in Seoul used non–linear regression models to accurately extrapolate the data from 61 running and swimming events. They have found the "time to limit" to be somewhere between 7.5 and 10.5 years. So, we may still see records being broken at the 2012 Olympics in London and perhaps at Rio 2016, but after that…who knows? The researchers believe their discovery of a "time to limit" has a number of policy implications for the local and national sport associations as well as for the international rule–setting federations.

(Dr Monica and Brahm Vasudev)

Sugar–heavy diet may increase heart disease risk in teens

All that added sugar in the diets of typical teens could increase their risk for heart disease, according to a paper in Circulation from the CDC and Atlanta’s Emory University. Earlier they found that adults whose diets contained the most added sugar also had the lowest HDL, or good, cholesterol and the highest LDL, or bad, cholesterol and found the same pattern among teens. Teens who consumed the most added sugar had nine percent higher LDL (‘bad’) cholesterol levels, 10% higher triglyceride levels, lower levels of HDL (‘good’) cholesterol, and showed signs of insulin resistance.

Scientists say they are closer to creating universal flu vaccine

The Atlanta Journal–Constitution reports that after studying patients in Atlanta who were infected by the 2009 H1N1 pandemic flu, scientists now say they are one step closer to creating a universal flu vaccine, according to the paper in the Journal of Experimental Medicine.

Gait speed predicts survival in older adults

Results of a meta–analysis suggest that gait speed is independently associated with survival in community–dwelling older adults. In the study, faster gait speed was associated with increased survival across the full range of gait speeds observed: from less than 0.4 to more than 1.4 m/s. The study is published in the January 5, 2011, issue of JAMA.

FDA Approval

The US FDA has approved a new opioid transmucosal product approved for breakthrough pain in patients with cancer. Abstral (fentanyl) is indicated for the management of breakthrough pain in patients who already receive opioid pain medication around the clock and who need and are able to safely use high doses of an additional opioid medication. Only health care professionals skilled in the use of Schedule II opioids to treat pain should prescribe this drug product.

Retinal changes seen with antimalarial drugs

According to a retrospective study reported in the January issue of Archives of Ophthalmology, the visual consequences of retinopathy associated with antimalarial drug use can be progressive and devastating. Isolated central loss was the most common type of visual field abnormality found in 10 of 16 women who had been treated with hydroxychloroquine or chloroquine. In six of the 10 patients for whom follow–up data were available, retinal disease continued to progress even when the drugs were stopped.

    Infertility Update

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

What is a typical IVF calendar?

The sequence of events depends on the treatment protocol that has been planned for you. Usually OPD–based injections are started on Day 20 of previous menses, further gonadotrophins with follicular monitoring and blood tests start from 2nd day of menses for about 10 days. You may need daycare admission for oocyte retrieval as you will be administered anesthesia. Two days later you will come back for embryo transfer, which is an OPD USG–guided procedure. In a different protocol, stimulation starts from Day 2/3 of period and collection is done around day 15 after 10–12 days of stimulation.

For queries contact: banerjee.kaberi@gmail.com

    Pediatrics Update

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

Sources of lead in the environment

Poorly glazed ceramic dishes and pottery may have lead in the glaze. Lead may also be found in leaded crystal, pewter and brass dishware. Acidic foods stored in improperly glazed containers are the most dangerous. Acidic foods or drinks (such as orange, tomato and other fruit juices, tomato sauces, wines, and vinegar) may cause an increase in the release of lead from these types of tableware. You cannot always tell by looking at a dish whether it contains lead. If any tableware starts to show a dusty or chalky gray residue after washing, discontinue using the item. Purchase dishes with labels that state the item is lead–free or suitable for food use. Chipping, peeling or chalking lead paint is a common source of lead dust and may be a hazard. Lead–based paint may also be found on older toys, furniture and playground equipment.

Lead may get into drinking water from household plumbing. Lead may get into the water when water sits in pipes. The cold–water tap should be flushed for several minutes each morning or after sitting until there is a noticeable change in temperature of the water before any water is consumed.

    Medicolegal Update

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


Disternment means the act of digging up something (especially a corpse) that has been buried.

  • Many early groups placed the corpse in the ground and exhumed it at a later date for religious rituals, a practice still undertaken by some traditional societies.
  • In fourteenth–century France, it became common procedure to dig up the more or less dried–out bones in the older graves in order to make room for new ones.
  • The high death rate from the European plagues coupled with a desire to be buried in already–full church cemeteries led to old bones being exhumed so that new bodies could be placed in the graves.
  • In earlier times, on rare occasions prior to embalming, the body was removed from the ground. This happened when burial professionals or the authorities suspected that the person might have been buried alive.
  • The French philosopher and death expert Philippe discussed necrophiliacs who disinterred dead bodies for sexual purposes and scientists who dug up corpses to conduct scientific experiments.
    Lab Update

Prostate specific antigen (PSA)

Some experts recommend doubling the measured PSA value before interpreting the result for patients on finasteride. Longitudinal results from the Prostate Cancer Prevention Trial suggest that PSA values be corrected by a factor of 2 for the first two years of finasteride therapy, and by 2.5 for longer term use.

    Medi Finance Update

Gift Tax

Direct cross gifts are not allowed, but indirect cross gifts are advisable and a better option, for e.g. Dr X can give gift to Dr Y’s wife and Dr Y’s father can give to Dr X’s wife. Gift can be given to major children, father and mother.

    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name


DCI Approval Date

Sphaeranthus Indicus Extract Tablets 700mg

For the management of psoriasis.


    IMSA Update

International Medical Science Academy (IMSA) Update

MMR vaccine

Monovalent vaccines are no longer available in the United States for measles, mumps or rubella. (AAP News 2009;30:9)

    IJCP Special

Dr Good Dr Bad

Situation: A patient on Mediclaim developed a recurrence of illness after three months.
Dr. Bad: It will not be covered under Mediclaim.
Dr. Good: Yes, it will be covered as it is a fresh illness.
Lesson: Occurrence of the same illness after lapse of 105 days is considered as fresh illness for the purpose of Mediclaim policy.

Make Sure

Situation: During evening round in a renal unit, a doctor comes across a patient complaining of headache.
Reaction: Give him a tablet of Nimesulide.
Lesson: Make sure to remember that nimesulide, a selective COX–2 antagonist has minimal potential for renal toxicity.


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
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Do not blame others

Our Indian culture is great. The rules it provides make everyone lead an ideal life. According to our shastras, it seems, a person who blames others (unnecessarily) gets half of the entire paapam of the person blamed and in addition gives away half of his entire punyam to the person blamed! So there a big loss for the person who blames and a big gain for the person blamed. The following is a small story showing how careful one needs to be while doing Dharma nirnayam and eventually blaming others.

Once a poor brahmana, with hunger, came to a person’s house and asked for bhiksha. The kind woman in the house took pity on him and immediately offered food. She asked the brahmana to sit under the shade of a huge tree in their house and she brought food for him. Before the brahmana cleaned himself, prayed to the God and started eating, a very unfortunate thing happened. There used to live a poisonous snake under the shelter of the tree and vidhi vashah it spilt its poison and it directly fell into the food the brahmana was going to eat. The brahmana unknowing that the food was poisoned, ate it and died.

Now, who needs to be blamed? Is it the woman who gave the food, or the snake or the owner or the braahmana himself. It seems that the person who decides and makes a decision that a particular individual is to be blamed will get the brahma–hatyaa–paatakam.

So did you notice how critical is a dharma–nirneta’s role. How many shastras should he have learnt before taking the seat of dharma–nirneta? How careful and unbiased should his thinking be? Imagine how great is Yamadharmaraaja to be able to do perfect justice for so many people for such huge amount of time. That is why He is called ‘Samavarti’. He has one of his legs in Shri–chandanam and the other in fire. Both are same for Him and thus very unbiased and impartial.

Moral in the story: A lot of thinking needs to be done before putting blame on others.

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: Job I’m Job
Answer for Yesterday’s Mind Teaser: I’m between jobs

Correct answers received from: Dr Satyoban Ghosh, Dr K.P.Rajalakshmi, Dr S.Upadhyaya, Dr (Maj. Gen.) Anil Bairaria, Dr Rashmi Chhibber, Dr K.V.Sarma, Dr Sudipto Samaddar, Dr K.Raju, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Apurva Koirala

Answer for 13th January Mind Teaser: Eye before E, Except after See (‘i’ before ‘e’, except after ‘c’)
Correct answers received from: Dr K.P.Rajalakshmi, Dr Sudipto Samaddar

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr.G.M.Singh)


"So, how did you do?" the boss asked his new salesman after his first day on the road. "All I got were two orders."

"What were they? Anything good?" "Nope," the salesman replied. "They were ‘Get out!’ and ‘Stay out!"

    Readers Responses
  1. According to MCI norms it is necessary to have at least 32 CME credit hours for every doctor every 5 years. Till now nobody including the MCI was bothered about it, and now all of a sudden the Maharashtra Medical Council is asking us to renew our registration and submit the proof of credit hours obtained in last 5 years. I have attended some state/national level conferences and have completed some certificate courses through distance education in last five years, but none of them officially had any accredited credit hours. It’s only now that all organizers are waking up to it and getting these conferences accredited. In such a scenario, what should we do about our previously attended CMEs while renewing our registration this year? Logically State Medical Council should accept it, because the aim ultimately is to upgrade the knowledge. Another point is the expenses which a doctor has to bear while attending conferences. The organizers are making this "credit hours" a money making venture by keeping obnoxious charges for these conferences, since they know that doctors "have to" attend out of compulsion. Some regulation has to be in place for such misuse of rights. Regards:sohonica, sohonica@gmail.com
    Public Forum

(Press Release for use by the newspapers)

Absence of shivering bad sign in winter

Absence of shivering in a patient with hypothermia is a bad sign and should be attended to immediately said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Hypothermia is defined as a core temperature below 35°C (95°F), and can be further classified by severity:

  1. Mild hypothermia: Core temperature 90 to 95°F. Symptoms include confusion, increased heart rate and increased shivering.
  2. Moderate hypothermia: Temperature 82 to 90°F. Symptoms include lethargy, low heart rate, irregular pulse, loss of eye pupillary reflexes and reduced or absent shivering.
  3. Severe hypothermia: Temperature below 82°F. Findings include coma, low blood pressure, irregular pulse, pulmonary edema, and rigidity.

The factors contributing to the development of hypothermia include outdoor exposure, cold water submersion, medical conditions like hypothyroidism, sepsis, toxins like ethanol abuse and drugs like oral anti diabetics, sedative–hypnotics. Risk is highest in the elderly as the ability to autoregulate core temperature is impaired.

The diagnosis is done by the use of a low–reading thermometer as many standard thermometers only read down to a minimum of 93°F. A rectal or esophageal temperature probe is preferred for severe hypothermia.

Lab tests are often necessary to detect presence of lactic acidosis, rhabdomyolysis, bleeding diathesis, and infection. Moderate and severe hypothermia can cause dysrhythmia and prolongation of all electrocardiogram intervals.

The initial treatment of hypothermia is directed toward heat resuscitation, assessment of the extent of injury and rewarming.

Endotracheal intubation is performed in patients with respiratory distress. Patients with moderate or severe hypothermia frequently become hypotensive; aggressive fluid resuscitation is appropriate.

Passive external rewarming is the treatment of choice for mild hypothermia and is a supplemental method in patients with moderate to severe hypothermia.

  1. Remove the wet clothing.
  2. Cover with blankets.
  3. Maintain room temperature at approximately 24°C (75°F).
  4. Do active external rewarming in patients with moderate to severe hypothermia. It consists of combination of warm blankets, radiant heat, or forced warm air applied directly to the patient’s skin.
  5. Rewarm the trunk first BEFORE the extremities to minimize hypotension and acidemia due to arterial vasodilation and core temperature afterdrop.
  6. For severe hypothermia, treat with less invasive rewarming techniques (eg, warmed IV crystalloid), and progressively adding more invasive ones (eg, warmed pleural lavage) as needed.

Rough handling of the moderate or severe hypothermic patient can precipitate arrhythmias, including ventricular fibrillation, that are often unresponsive to defibrillation and medications.

Cardiopulmonary resuscitation (CPR) should continue until the patient is rewarmed to 30 to 32°C (86 to 90°F), at which point renewed attempts at defibrillation and resuscitation with ACLS (Advanced Cardiac Life Support) medications are undertaken.

For patients who fail to rewarm appropriately despite aggressive rewarming measures, treat with empiric broad spectrum antibiotics and a single dose of glucocorticoid. Such patients may also need treatment for hypoglycemia, myxedema coma or other contributing causes.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

IMSA Workshop on Rheumatoid Arthritis

Date: Sunday 16th January, 2011; Venue: Moolchand Medicity; Time: 10–12 Noon


  1. Understanding Biologics: Dr Rohini Handa, Former Head Rheumatology, AIIMS
  2. All what a practitioner should know about rheumatoid arthritis: Dr Harvinder S Luthra, Chief of Rheumatology, Mayo Clinic, Rochester USA

No fee. Register emedinews@gmail.com or sms 9899974439

ANCIPS 2011. 63rd Annual National Conference of Indian Psychiatric Society

January 16–19, 2011
The Ashok Hotel, New Delhi, India

Theme of the conference: "Providing Mental Health Care to All
Organising Committee – ANCIPS 2011 Chairperson Dr. Neelam K. Bohra Vice Chairperson Dr. R.C. Jiloha Organising Secretary Dr. Sunil Mittal Treasurer Dr. J.M. Wadhawan

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