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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; 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

17th May, Monday, 2010

 New MCI Panel: Big task ahead 

Dear Colleague

The job of the government should be to open and promote education by opening new colleges whether they are medical, engineering or otherwise. To run a college, obviously, certain infrastructure requirements and standard operating procedures need to be defined. That is what the job of a university is.

In terms of a medical college, the job of Medical Council of India is to inspect these colleges for the first five years so that they are able to sustain, maintain standard and provide services expected from them.

The job of Medical Council of India therefore should be to assist these medical colleges in doing what is expected from them, pointing deficiencies and helping in removing those deficiencies. If a medical college is found short of a faculty because of non-availability, it should be the duty of the Council to help them sourcing that faculty. Similarly, if a medial college has not been able to fulfill infrastructural facilities, it is again the duty of the council to help them procuring those infrastructure facilities. The council should behave with a motherly attitude and assist the college in fulfilling all its requiremen
This is what American approach is where there is no question of de-recognition. The councils there are recognizing bodies and not aiming at de-recognition.

In India, the medical council uptill now has been behaving like a de-recognising body and the inspectors are being treated and feared like Gods on the days of inspection. By hook or by crook, the medical colleges try to arrange temporary or permanent infrastructure facilities so that their inspection can be cleared without any hindrances. No medical college owner will dare to ask the inspectors if they have some real deficiencies and how to overcome them. Once the deficiencies are found, for fear of de-recognition, money exchanges hands and the inspection is cleared. This way, the standard of medical education and the services in the hospital can never be improved. The cost borne to the inspection team invariably passes on to the students in the form of capitation fee.

Today, the Central Government education ministery has already taken a decision of passing every school student upto 10th class without exams. The same thing should be done by the Medical Council of India. For the first four years of inspection, they should assist the collegs in fulfilling their deficiencies and a real exam like inspection could take place in only in fifth year and an action taken if even at fifth year they are not being able to fulfill the criteria which they were supposed to fulfill.

I am sure the new MCI panel under Dr S Sarin, Dr Rai Chaudhary etc will take this into consideration.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file) Health awareness modules

International Dance forms with wider reach

Russian Dancers have a magnetic ability to attract crowd. Besides being fun, dancing has many positive health benefits; Heart Care Foundation of India received wide acclaim when this module was used during a press conference for Perfect Health Parade 2004.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

The diagnosis of diabetes mellitus can be established by a hemoglobin A1C level > 6.5%, as recommended by an International Expert Committee consensus report and confirmed by the American Diabetes Association.


DMC Update

Can a criminal complaint be looked into by the council?

No. As per DMC order DMC/14/DC/Comp. 288/2/2006 dated 10th March, 2006; DMC wrote to Director General of Civil Aviation; "With reference to your letter dated 4.1.2006 on the subject noted above, it is observed that since the allegation leveled in the complaint, if established, are punishable under the Indian Penal Code; you may, therefore, seek redressal under the criminal justice system".

News and Views

Medical costs of cancer have nearly doubled over the past two decades

Total treatment costs of cancer have nearly doubled in the past two decades, so finds a new analysis published in the journal Cancer. The cost of treatment has shifted from inpatient treatment to outpatient care. The shares of costs that are paid for by private health insurance and Medicaid have also increased.

Gender difference in risk factors of opioid misuse

Women with chronic pain who misuse opioids do so because of emotional issues and psychological distress, while men who misuse these drugs have greater chances of having social and behavioral problems, or having legal difficulties.

Erythropoiesis–stimulating drugs may increase cardiovascular risks in chronic kidney disease patients

A meta–analysis reports that treatment with erythropoiesis–stimulating agents that target higher levels of hemoglobin augments risk of hypertension, stroke and thrombosis in patients with chronic kidney disease. (May 3, 2010, Annals of Internal Medicine)

For your desk (Dr G M Singh)

INR greater than 3.0 but under 6.0 (target INR 2.5)
Reduce or stop warfarin, restart when INR <5.0
INR greater than 4.0 but below 6.0 (target INR 3.5)
Reduce or stop warfarin, restart when INR <5.0
INR greater than 6.0 but below 8.0 with no bleeding or minor bleed
Stop warfarin and restart when INR <5.0
INR greater than 8.0 with no bleeding or minor bleeding Admit to hospital for vit K 0.5mg or GP for IV vit K 0.5mg or oral vit K 0.5–2.5mg for partial reversal Major bleeding Stop warfarin; admit to hospital for urgent reversal (prothrombin complex concentrate/FFP) and iv vitamin K 5–10mg Source: British Journal of Haematology 1998;101:374–87

Quote of the Day (Paramjeet Chadha)

Never make the same mistake twice,
There are so many new ones,
Try a different one each day.

Question of the Day

What is latent autoimmune diabetes in adults? Prof. Dr Sidhartha Das Cuttack

Latent autoimmune diabetes in adults (LADA) was first described in 1993. LADA refers to adult persons developing type 1 diabetes mellitus in the later part of life, as late as seventh decade, consequent to slowly evolving autoimmune destruction of β–cells. The current classification of diabetes mellitus no longer depends only on clinical characteristics but based on etiopathogenesis. Therefore, LADA, although an adult onset type of diabetes mellitus is classified under type 1 diabetes mellitus. Such patients can be diagnosed by estimation of antibodies to GAD 65. Patients with LADA may not be insulin–dependent to start with but have lower levels of circulating insulin and poor C–peptide reserve as compared to age matched patients with type 2 diabetes mellitus. While classical type 1 diabetic subjects are associated with HLA DR–DQ2 and DR–DQ8, patients with LADA are more often associated with DR3–DQ2. Due to presence of some residual β–cells activity patients with LADA may not present with ketoacidosis. Treatment with oral hypoglycemic agents, especially sulfonylureas and meglinitides may be effective in earlier stages of LADA but sooner or later they have to be on insulin therapy.

eMedinewS Try this it Works: Auscultation for pleural effusions

Percussing the sternum with one or two fingers while listening with the diaphragm of the stethoscope over the posterior hemithorax can more easily allow the listener to hear dullness replace tympany when the level of the effusion is reached. This allows greater confidence when performing the thoracentesis.

Dr Good Dr Bad

Situation: A patient came with acute heart attack.
Dr Bad: Chew 300 mg aspirin.
Dr Good: Chew 300 mg aspirin and 600 mg clopidogrel.
Lesson: For all patients with ST–elevation MI, start dual antiplatelet therapy with chewable aspirin (300 mg) and clopidogrel (600 mg) or prasugrel (60mg) as soon as possible after presentation.

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did not you give him nimesulide?
Lesson: Make sure to remember that nimesulide is safe in acid peptic disease. So can be prescribed if a painkiller is required.

Evidence Based Practice (Dr N P Singh - Nanu)

N Engl J Med. 2010 Mar 24: Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur.

Background A number of recent case reports and series have identified a subgroup of atypical fractures of the femoral shaft associated with bisphosphonate use. A population–based study did not support this association. Such a relationship has not been examined in randomized trials.
The present study performed secondary analyses using the results of three large, randomized bisphosphonate trials: the Fracture Intervention Trial (FIT), the FIT Long–Term Extension (FLEX) trial, and the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Pivotal Fracture Trial (PFT). The authors reviewed fracture records and radiographs (when available) from all hip and femur fractures to identify those below the lesser trochanter and above the distal metaphyseal flare (subtrochanteric and diaphyseal femur fractures) and to assess atypical features. They  calculated the relative hazards for subtrochanteric and diaphyseal fractures for each study. 

The authors reviewed 284 records for hip or femur fractures among 14,195 women in these trials. A total of 12 fractures in 10 patients were classified as occurring in the subtrochanteric or diaphyseal femur, a combined rate of 2.3 per 10,000 patient-years. As compared with placebo, the relative hazard was 1.03 {95% confidence interval (CI), 0.06 to 16.46) for alendronate use in the FIT trial, 1.50 (95% CI, 0.25 to 9.00) for zoledronic acid use in the HORIZON–PFT trial, and 1.33 (95% CI, 0.12 to 14.67) for continued alendronate use in the FLEX trial. Although increases in risk were not significant, confidence intervals were wide.

Conclusions The occurrence of fracture of the subtrochanteric or diaphyseal femur was very rare, even among women who had been treated with bisphosphonates for as long as 10 years. There was no significant increase in risk associated with bisphosphonate use, but the study was underpowered for definitive conclusions.

IMANDB Joke of the Day (Dr Tarun Gupta)


"I suppose I must admit that I do have my faults," the husband remarked in a tone that was far from humble. "Yes," the wife snapped, "and in your opinion your faults are better than other folks’ virtues."

Formulae in clinical practice

Blood Oxygen Concentration

Formula: (Hemoglobin × oxygen saturation) × 1.34

Myth of the Day: Dr Gurinder Mohan Singh

Myth: It’s best not to wear glasses all the time. Taking a break from glasses or contact lenses allows your eyes to rest.

Fact: If you need glasses for distance or reading, use them. Attempting to read without reading glasses will simply strain your eyes and tire them out. Using your glasses won't worsen your vision or lead to any eye disease.

Milestones in Cardiology

1903: Willem Einthoven Willem Einthoven, a Dutch physiologist, developed the electrocardiograph.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

CCP: Called anti–cyclic citrullinated peptide antibody.
To help diagnose rheumatoid arthritis (RA) and differentiate it from other types of arthritis; sometimes to help evaluate the prognosis of a patient with RA.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI 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



Public Forum (Press Release for use by the newspapers)

No Antibiotics are required for viral disorders

With every change of season, viral nasal and throat congestion cases rises. The patients typically presents with high grade fever, nasal discharge, sore throat and body ache, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Dr. Aggarwal said that no antibiotics are required for viral disorders. Symptoms that suggest a viral etiology for sore throat include congestion, cough, nasal discharge and diarrhea. One needs to be concerned especially in children and rule out group A beta hemolytic strepto bacterial infection which accounts for upto 30% of pharyngitis cases in children and 10% in adults. If untreated they can lick the joints and bite the heart and cause valvular heart disease. A sore throat which needs antibiotics is the one which is associated with red angry looking tonsils, pain in the throat while swallowing food, painful enlargement of lymph node at the angle of the mouth and absence of cough, nasal discharge, sneezing and eye inflammation.

Readers Responses

  1. Is there a limit to the number of drugs that can run through a single syringe driver – whilst of course keeping any drug incompatibilities in mind? Our district nurses seem to restrict it to a maximum of three drugs – is this essential?
    A: The issues that dictate how many drugs can be run via a single syringe driver are the compatibility and volumes of the individual drugs, and the clinical governance issues around drawing up and mixing multiple drugs.  Some PCTs advise a maximum of three drugs to reduce the risk of error, but four or five different drugs can be infused without compatibility problems. Drugs that do not mix well with other drugs are cyclizine and dexamethasone and the drugs less commonly prescribed in the community ketamine and ketorolac. Dr G M SINGH

  2. Fantastic service… Regards, Ganeshan C, General Manager Marketing, Micro Labs BB, +919845199478

  3. Are there any age limits to treating hypertension? A: There is no age at which antihypertensive should not be considered. HYVET (Hypertension in the Very Elderly Trial) has produced conclusive evidence that very elderly patients achieve excellent benefit from therapies to lower BP. It demonstrated, for the first time, the major benefits of treating raised BP in people over the age of 80, with reductions in heart failure and stroke as well as a decrease in mortality. (DR.G.M.SINGH)

  4. Respected Sir, As always its a great daily experience of going through the epaper! Sir, it would be really helpful if some tips on management of "chronic" complications of diabetics are also incorporated. Yours sincerely. Prashant emedinews responds: Will do that.

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eMedinewS–Padma Con 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 .


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