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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

16h July, 2010, Friday

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

10.3% tax on cashless mediclaim 

After the governmentowned insurance companies restricted cashless mediclaim facility, patients now also have to contend a service tax of 10.3% on every claim made using the cashless facility. The introduction of the preferred provider network (PPN) by the public sector insurance companies had the instant impact of bringing cashless transactions to a virtual standstill in the metros, the service tax move had gone practically unnoticed, though both moves were introduced on July 1. The tax is discriminatory as only patients who claim cashless facility will have to pay the service tax while the patients who go in for reimbursement won't have to pay extra. The service charge component will be paid by TPAs (Third Party Administrators) to hospitals after every cashless transaction. The hospitals will forward this sum to the union government. But ultimately the patient will pay. Consider that a patient with a cover of Rs 1 lakh has been allowed a claim of the full sum. Now, the TPA has to pay 10.3% of the claim as a service tax. As it cannot pay the hospital about 110% of the original policy sum that the patient purchased, it would have no option but to pay 90% of the original claim plus 10% as service tax.(TOI)

Stop Press: As per the sources the insurance companies have reversed the order of restricting cashless facilities. It will now be decided from case to case basis. The service tax however will stay.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)


On the occassion of World Environment Day

HCFI and the Federation of NCR doctors flagging off a Tableau–cum-mobile exhibition on the occasion of World Environment Day, June 5, 2006

Dr k k Aggarwal In the photo Union Minister of Environment and Forest, A Raja, flagging of the Tableau. Also in the picture Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President HCFI


News and Views

India... Quick Bytes

  1. In the year 2008, a survey was done by Ministry of Health in 10 states covering one district each. The incidence was of diabetes 9.95%, hypertension 7.14%, cardiovascular disease 4.91% and CVA 0.45%.

  2. Cabinet has approved Rs. 500 crores for National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDS).

  3. MCI contemplating reducing MD course: One of the suggestions, which MCI is seriously considering is to have two types of postgraduation courses. In one, you can exit at two years as a specialist and in the other, you have to complete the third year to go into research and academics.

  4. DNB to start 3-year course in family medicine for service doctors. National Board of Examination is planning to start a 3-year DNB in family medicine for service doctors. It is possible that most doctors posted in rural areas may opt for it.
  5. Bail plea of ex-MCI president rejected in corruption case
    A Delhi court today rejected an anticipatory bail plea of former Medical Council of India (MCI) president Ketan Desai in a fresh corruption case lodged against him in Chennai. The bail application is dismissed as it devoid of merits, special CBI judge OP Saini said, allowing the plea of the agency that the probe in the case was at an initial stage and release of the accused would affect the investigation. The court had earlier rejected the CBI's contention that it was not empowered to hear the anticipatory bail application as the corruption case was lodged in Chennai. Being a special court to deal with cases lodged under the Prevention of Corruption Act, it was very much competent to hear the plea, the judge had said.
    6. Dr Rakesh Verma
    The CBI enquiry is on. He attended his work today and met many well wishers. He is insistant that he is innosent and has been framed. He has accounts of each and ebvery iunvestment. The hispital has neve received any stent fron the government supply.
    7. Two more city doctors under CBI scanner
    It was heard that two more city govt hospital doctors were iunder MCI scanner linked to recognistion of meducalk collged as inspectors.

News and Views (Dr Brahm and Monica Vasudeva)

1. Scientists continuing to survey the microbiome by gathering DNA

In 2008, Dr. Alexander Khoruts, of the University of Minnesota, took on a patient suffering from Clostridium difficile and eventually conducted a transplant in which the patient received some of her husband’s bacteria. The procedure is known as bacteriotherapy or fecal transplantation. They also took a genetic survey of the bacteria in her intestines before and after. While there were no normal bacteria in the gut flora before, two weeks after transplant, the transplanted bacteria had gained foothold. The microbiome has a significant role in maintaining health. But it still remains a mystery.Scientists are now surveying the microbiome by gathering DNA. The Human Microbiome Project is one such initiative that is working to characterize the human microbiota and also analyzing its role in health as well as disease.

2. Genetic testing following sudden cardiac death expanding

Physicians are now turning to a test that can help pinpoint mutations that have been linked to sudden deathassociated cardiac disorders. Once identified, the immediate family can also be advised to undergo testing. Geneticist Robert Marion, of the MontefioreEinstein Center for CardioGenetics, which assists families touched by sudden cardiac death, said, "We are using information from the dead to guide treatment for the living."

3. Extra cranial capacity may afford some cognitive reserve in dementia patients

A study published July 13 in the journal Neurology, for patients examined the head circumferences of 270 participants with Alzheimer’s disease in the MIRAGE ( MultiInstitutional Research in Alzheimer’s Genetic Epidemiology) study found that extra cranial capacity affords patients some cognitive reserve, resulting in better brain function at any given level of cerebral atrophy.

4. Early screening, treatment for Alzheimer’s would decrease time spent in long–term care

Screening people for Alzheimer’s disease and treating them early would add a year to the time they spend in less–severe stages of the condition. This was stated in a study presented at the International Conference on Alzheimer’s Disease, .


Legal Column

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

Disaster mortuary operational response team (DOMRT)

DMORTs are federal teams of professionals including forensic anthropologists, odontologists, and pathologists that respond to mass death scenes such as airplane crashes, earthquakes, terrorist attacks.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Nutrient Needs of Adolescent

Adolescents need extra nutrients to support growth spurt.

  • Girl: Growth spurt begins at 10 to 12 years, peaks at 14 years and stops at 15–16 years

  • Boys: Growth spurt begins at 12–13 years, peaks at 15 years and stops at 19 years.

Rapidly growing athletic body needs 4000 calories/day. An inactive girl requires<2000 calories per day

Question of the Day

Does diabetes mellitus affect fertility and cause miscarriage? (Prof. V Seshiah Chennai)

Women with type 1 diabetes may have amenorrhea or oligomenorrhea which are attributed to the abnormalities in the pulsatility of the hypothalamic gonadotrophic releasing hormone release. Also, some of them may have increased evidence of autoimmune premature ovarian failure or autoimmune polyglandular syndrome. All these factors can cause infertility in type 1 diabetic women. Women with type 2 diabetes have increased frequency of PCOS. Poor glycemic control during first trimester of pregnancy is associated with an increased risk of fetal morbidity and mortality. Maternal diabetes affects placenta both functionally and structurally. Hyperglycemia inhibits trophoblast proliferation which results in early intrauterine growth delay. This may cause fetal loss through early spontaneous miscarriage and major fetal malformations.


Public Forum (Press Release for use by the newspapers)

Travel more than doubles risk of blood clots

Long distance travelers periodically should move around and stretch their legs, and drink plenty of water to stay hydrated, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Long–distance travel can lead to potentially fatal blood clots in some people –– showing that the risk grows with the length of the trip. Certain people are at increased risk of blood clots, including cancer patients, people who have recently had major surgery such as a joint replacement, and women on birth control pills.

In general, travel is associated with a nearly three-fold increase in the risk of venous thromboembolism (blood clots that form in the veins), often in the legs. If such a clot dislodges and travels to the lungs, it can cause a potentially fatal condition called pulmonary embolism.

A combination of factors including dehydration and hours of sitting in cramped conditions explains why some people develop blood clots.

A review, published in the Annals of Internal Medicine, analyzed 14 studies involving more than 4,000 cases of venous thromboembolism and found that travelers had a nearly three–fold higher risk of blood clots than non–travelers. The risk climbed along with the duration of the trip –– rising 18 percent for every two hours of any type of travel, and by 26 percent for every two hours of air travel.

But there is no reason for panic, because the absolute risk to any one traveler is still low.  People who travel long distances should be aware of the risk of blood clots and learn to recognize the symptoms. Symptoms of a blood clot in the leg include pain, warmth, swelling and redness in the limb. If the clot travels to the lungs, it may cause sudden shortness of breath, chest pain or a cough that produces blood.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Lab Tests for Infertility for women

Luteinizing hormone (LH), Folliclestimulating hormone (FSH), Prolactin, Estradiol, Progesterone and Estrogen.The changes in pituitary or thyroid function can also affect the menstrual cycle and ovulation. TSH and/or T4 and steroids (testosterone and DHEAS) are also informative.


An Inspirational Story

Believe what you feel

On this day, Morrie says that he has an exercise for us to try. We are to stand, facing away from our classmates, and fall backward, relying on another student to catch us. Most of us are uncomfortable with this, and we cannot let go for more than a few inches before stopping ourselves. We laugh in embarrassment.

Finally, one student, a thin, quiet, darkhaired girl whom I notice almost always wears bulky, white fisherman sweaters, crosses her arms over her chest, closes her eyes, leans back, and does not flinch, like one of those Lipton tea commercials where the model splashes into the pool…

For a moment, I am sure she is going to thump on the floor. At the last instant, her assigned partner grabs her head and shoulders and yanks her up harshly.

"Whoa!" several students yell. Some clap. Morrie finally smiles. "You see", he says to the girl, "you closed your eyes, That was the difference. Sometimes you cannot believe what you see, you have to believe what you feel. And if you are ever going to have other people trust you, you must feel that you can trust them too even when you're in the dark. Even when you're falling".

Source: "Tuesdays With Morrie" by Mitch Albom


IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have A1C 6.7%.
Dr Bad: Get GTT done.
Dr Good: You have diabetes.
Lesson: An International Expert Committee issued a consensus report in June 2009, recommending that a hemoglobin A1C level ≥6.5% be used to diagnose diabetes.

Make Sure

Situation: A patient of acute MI died after he was given sublingual sorbitrate.
Reaction: Oh my God! why was history of Viagra not taken?
Lesson: Make sure before giving a sorbitrate to ask about intake of Viagra and like drugs as the combination can be fatal.

Quote of the Day (Dr. Santosh Sahi)

"If you are in hurry you will never get there." Chaz Lee

Are you fit to fly?

Brain Disorders

  1. A paralytic attack within the past two weeks is a contraindication to air travel.

  2. Patients with migraines have reported travel in airplanes or trains as triggers of their headaches. The cause is unclear, and may relate to the stress of travel, sleep deprivation, high altitude, or other environmental stressors. Migraineurs, as with other patients, should be advised to maintain their prophylactic medicines and to carry rescue medication with them.

  3. Epilepsy is generally not a contraindication to flying; however, patients with frequent, severe seizures should not fly until their epilepsy is better controlled.

Myths about Aging

Myth: Sex ends when you age.

Milestones in Gabapentin

Complex Regional Pain Syndrome: In 1995, Mellick et al reported role of Gabapentin in the management of Complex Regional Pain Syndrome type one (CRPS I) or Reflex Sympathetic Dystrophy (RSD) as it was earlier known.

Mnemonics of the Day (Varesh Nagrath)

Causes of clubbing: CLUBBING PP

C Congenital cyanotic heart disease
LLiver cirrhosis, especially alcoholic & primary biliary cirrhosis
UUlcerative colitis/ Crohn's disease
BBronchogenic carcinoma/Metastatic lung cancer /Mesothelioma
BBronchiectasis /Lung abscess/Cystic fibrosis
IInfective endocarditis
NNot known /Idiopathic
GGraves’ disease
P-Parental (Hereditary)
P-Polyposis coli


International Medical Science Academy Update (IMSA)

Cardiac involvement is often clinically silent in patients with sarcoidosis although sudden death is a leading cause of mortality in this population.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Azithromycin SR Granules for oral suspension 2000mg

For the treatment for mild to moderate susceptible infections including RTI, uncomplicated skin/ skin structure, non gonococcal urethritis, cervicitis



Medi Finance

Q : If a doctor receives an Xray machine as gift, is he liable to pay tax on the same?

Ans. Yes, in this case the instrument will be considered as an asset to the doctor’s practice.


Humor Section

Jokes (Dr Maj Prachi Garg)

Once Dr Jhatka was out walking. He was wearing glove only on one hand.
So a man asked him why he did so.
He replied that the weather forecast had announced that on one hand it would be cold and on the other hand it would be hot.

Medical bloopers on medical charts!

Morbid…………………………A higher offer than I bid


Readers Responses

  1. Dear KK, I appreciate response from S/L Ahooja. Let me be straight and precise, if he can clarify, whether a TA officer can prefix or use this kind of decoration? and that too when he mentions this TA service under "Extra–Curriculur" in his CV? and having been in civilian service all his life.Thanks S/L Ahooja: Dr K K Arora.

  2. Dr. K.K. Aggarwal, Thanks for ONLINE EMEDINEWS Daily Wednesday 7/7/2010. Its is a great effort and will be helpful. Add one column on spirituality and medicine, sending one inspirational story and some jokes wives. Will continue to support: Dr Jagdish C Sobti, Past Hony Gen Secretary (IMA).

  3. Dear Dr. Aggarwal, I am a regular reader of your e–newspaper and greatly appreciate it. I have a query. I have a great deal of confusion about the role of alcohol in the health of the heart. Today’s note by Dr. G.M. Singh talks of eating healthy for the heart and definitely includes alcohol. Could you please clarify this matter? Knowing the addiction potential of alcohol and the known damage it does to the liver, should doctors be recommending it like this – at a higher level than even fruits and vegetables? I don’t think I could get a more reliable response from anyone other than yourself. I would be very greatful if you would respond to my query. Regards: Dr. Malini Kapoor.
    eMedinewS Responds: If u do not drink, do not start. Its not a prescription. If u drink restrict it to < 80 ml/day. 6 gram of alcohol is the only safe limit. 10 gram is 30 ml whiskey. Because of the high prevalence of metabolic syndrome among Indians, any amount of alcohol will harm the liver.

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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