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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 ...

17th December, 2010, Friday

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

Top 10 International Health Stories Countdown by Health Key

10. Swine flu fizzles out: Swine flu, or H1N1 virus, started with a bang, but ended 2010 with a whimper, with the World Health Organization declaring the virus in the ‘post–pandemic’ phase. Still, if the swine flu scare left us with anything, it was a heightened awareness of flu prevention practices. And hey, at least this year we only have to get one shot of flu vaccine.

9. Doctor shortage: Experts in 2010 are worried about the shortage of primary care docs. According to the American Medical Colleges, by 2015 the United States will be short about 63,000 physicians and about 33,100 cardiologists, oncologists and emergency–medicine specialists.

8. Prescription drug abuse on the rise: Prescription drug abuse is a rapidly growing problem, at least in part because the drugs are so easy to get. As a result, more and more people are seeking treatment for prescription medication addiction, and prescription drugs are now tying illegal drugs for number of emergency room visits.

7. Obesity & "Let’s Move" campaign: Obesity rates continue to jump every year and 2010 was no exception. America is still losing the battle of the bulge in a big way with obesity rates increasing in 28 states, according to a report from the Trust for America’s Health. The price of being fat is also very expensive. Obesity accounts for 17 percent of all U.S. medical costs each year, according to a study by the National Bureau of Economic Research. First lady Michelle Obama wants to conquer childhood obesity and in early 2010 launched "Let’s Move." The campaign’s goal is to conquer childhood obesity within a generation.

6. FDA limits access to rosiglitazone: The FDA said in September that it would sharply limit access to the diabetes drug rosiglitazone because of concerns that it increases the risk of heart attacks and other cardiovascular problems. The government now requires patients to have a consent form to get the drug and has created new rules for doctors writing prescriptions for it.

5. Health crackdowns: In 2010, the government targeted companies that made misleading claims about their products. In September, the Federal Trade Commission filed a complaint against the pomegranate juice maker Pom Wonderful. The FTC alleged the company made "false and unsubstantiated claims" about the health benefits of its products, which included being able to treat heart disease and erectile dysfunction. The U.S. Food and Drug Administration also warned makers of three mouthwash products. The FDA stated that these companies couldn’t claim their products were effective in preventing gum disease and removing plaque because those benefits hadn’t been proved.

4. The bedbugs are biting: In 2010, cities saw a dramatic surge in the number of bedbug infestations, with local government assessing how to deal with the issue.

3. Concussions: Head injuries were an important issue in 2010. After several players sustained concussions during the first week of the NFL regular season, the National Football League implemented new rules. There are now return–to–play guidelines for players who suffer concussions and each team has to consult with a neurologist whenever there is a head injury. In October, the NFL announced that "headhunters" would be suspended. But head injuries don’t affect only professional athletes. Concussions have increased among child athletes. According to a study in the journal Pediatrics, 40% of the sports–related pediatric concussion patients seen in ERs were between the ages of 8 and 13. This report has called for better guidelines on protecting kids from brain trauma.

2. Salmonella, cadmium prompt recalls: Food and product recalls — including the biggest egg recall in U.S. history — have been in the news throughout 2010. Salmonella prompted the egg recall, but cadmium was to blame for recalls of children’s jewelry and Shrek glasses.

1. Health care reform approved: After decades of debate, medical care reform became a reality this year in the form of new benefits and rights for consumers under the sweeping health overhaul legislation signed into law in March by President Barack Obama.

Dr KK Aggarwal
Editor in Chief
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  SMS of the Day

(By Dr GM Singh)

"Best friends are the siblings God forgot to give us"

    Photo Feature (from the HCFI Photo Gallery)

 Perfect Health Parade 2004

The Heart Care Foundation of India organizes yearly Perfect Health Parade on the 7th of April to earmark World Health Day.

In the photo: A Mobile Exhibition Van in the parade carrying health messages on Obesity and HIV/AIDS

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

IMA protests against Medical Council directions

NEW DELHI: A group of doctors of the Indian Medical Association – the largest non–government organisation of doctors in the country – held a protest dharna at the Medical Council of India (MCI) headquarters in Dwarka here on Tuesday (14–12–2010) against "illegal actions of the Council". "The Council has illegally revoked the licence to practise medicine of the IMA president and the secretary–general and issued show–cause notices to the office–bearers for actions performed by them in their official capacity. This action has been taken in utter disregard of rules and, because of this illegality, has been stayed by the Delhi High Court," said IMA honorary secretary–general Dharam Prakash.

The group is also protesting against the MCI’s plan to introduce another examination which the fresh MBBS graduates will have to pass before being given the licence to practise medicine. "Such examination may be held once in six months. This means the graduates, after getting the MBBS degree, will be sitting idle for variable periods of time after completing the course," the doctors on dharna noted. The group of doctors have demanded that this exit examination scheme should be scrapped and, in its place, necessary changes may be effected in the MBBS curriculum and examination system so as to complete all evaluation within the stipulated five–and–a–half–year period. "Also the MCI has recently diluted the requirements for the faculty strength of forensic medicine departments in medical colleges. This will mean a crippling and even slow death of this specialty," said Dr. Prakash. (Source: The Hindu Dec 15, 2010)

Eight new cases of dengue in Capital

New Delhi: Eight fresh cases of dengue have been reported in the Capital since December 1 despite the onset of winter, leaving medical experts and health officials worried as mosquito breeding normally subsides by mid–November. According to Municipal Corporation of Delhi Health Department, Safdurjung, Ram Manohar Lohia and some other hospitals reported new cases of dengue raising the number of such infected people to 6,229 this year out of which eight persons died. Dr. V.K. Monga, MCD Health Committee Chairman said there were hardly any cases from mid-November last year during the winter spell. "But this time even in December hospitals are reporting dengue cases," he said. (Source: The Hindu Dec 15, 2010)

    International News

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

Study finds americans not nearly as concerned about obesity as they should be

Business Wire recently reported that Americans are not nearly concerned about obesity as they should be. Despite having the highest rate of obesity worldwide, Americans are feeling fine. A survey released December 7 by Health Dialog and commissioned by parent–company Bupa reveals that 91% of Americans "feel well" and 76% "consider themselves healthy." Shocking perhaps, considering 39% of the same Americans rank themselves the least healthy country out of those surveyed and over half (52%) say obesity is the most widespread health problem in the United States. The survey was conducted as part of Bupa Health Pulse 2010, a global study of health attitudes and behaviors of over 12,000 individuals across 12 countries.

(Dr Monica and Brahm Vasudev)

Pfizer recalls severe pulmonary arterial hypertension drug sitaxsentan due to liver damage

Pfizer pulled Thelin (sitaxsentan) off the market and stopped all clinical trials because the drug can cause fatal liver damage.

US Supreme Court to consider generic drugmaker case

The US Supreme Court will consider whether generic–drug makers can be sued for not warning patients about the risk of dangerous side effects, agreeing to hear arguments from units of Mylan Inc. and Teva Pharmaceutical Industries Ltd.

Three–quarters of EDs nationwide struggle with getting enough specialists to take call.

Three–quarters of emergency departments nationwide struggle with getting enough specialists to take call, leading to dangerous delays in care, according to a new study published in Academic Emergency Medicine.

Pregnant women may not need to delay treatment or hasten delivery after breast cancer diagnosis

Pregnant women who are diagnosed with breast cancer should not delay treatment or hasten delivery to avoid exposing the baby to chemotherapy, according to a paper written by the German Breast Group.

Diagnostic may help detect early warning signs of uterine cancer in asymptomatic postmenopausal women

Yearly endometrial cancer screenings are recommended only for women who suffer from Lynch syndrome, a rare condition that puts people at increased risk for certain cancers.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the pros and cons of single vs multiple embryo transfer in IVF? What is the usual practice in Delhi fertility centers regarding the same?

The initial practice of IVF and Embryo Transfer involved the transfer of multiple embryos, usually 3–5. It was soon realized that the number of multiple pregnancies especially higher order i.e. > 3 was increasing. This was associated with pre–term delivery which led to premature babies and developmental delays with occasional mental handicap in the long run. This leads to enormous psychological and financial burden to the person and society in general. A drive was therefore started in the west in those countries where the government is responsible for healthcare, especially the Nordic countries and UK to limit the number of embryos to be transferred. They have in fact suggested transferring a single embryo to further reduce the chance of twin pregnancy. The following steps should be adopted in patients who need anticoagulants and have conceived:This would hold good for a system where

  • The cryopreservation systems are excellent.
  • The government is funding atleast partially for the IVF treatment, as the patient’s would need multiple attempts at transfer to get a viable pregnancy. In India, where the patient has to pay for each cycle, it becomes difficult to justify single embryo transfer. I usually practice transferring between 2–3 embryos. This gives me a good pregnancy rate of 40% vs 25% of single embryo transfer. If the lady has triplets we then offer fetal reduction.

For queries contact: banerjee.kaberi@gmail.com

    Medicine Update

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

Red color of the urine can be due to various causes:

Red blood cells
Other pigments
Myoglobin in myoglobinuria
Porphyrins in porphyria
Drugs and chemicals that may cause a red urine color
Anisindione- is an anticoagulant;Daunomycin or Daunorubicin; Laxtives; Phenolphthalein;Prochlorperazine;Pyridium; Rifampin; Phenazopyridine; Senna; Thorazine; Tranquilizers; Vitamin B; Warfarin; Betanin- in beetroot.

    Medicolegal Update

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

How death was defined by scientist in past?

In the fatal automobile accident of Smith v/s Smith both husband and wife sustained injury. Husband died on the spot and the wife was taken to the hospital where she remained unconscious for 17 days and then died. The petitioner argued that the deaths were simultaneous, since there was no evidence of brain activity after accident. The Inference was that resuscitative efforts were maintaining the body in a state of animation although it could not be shown that life existed. The court did not accept the contention. They quoted Black’s definition of death and stated that "one breathing, though unconsciousness is not dead." The living body depends upon the integrity of three principal interdependent systems circulation, respiration and enervation. Failure of one of them will cause failure of the other two. This leads to the death of the individual. There are two phases of death: (i) Extinction of the personality is immediate sign of vital process: This is Somatic death. (ii) Progressive disintegration of the body tissue: This is molecular death or cellular death that occurs sometimes later.

Calne, in 1970, gave a more practical definition that states when destruction of the brain has been established, the individual has died no matter what the state of the rest of his body, giving four signs for such a diagnosis: (i) Deep, irreversible coma with fixed, dilated pupils and absent cranial nerve reflexes (ii) No spontaneous respiration (iii) absence of electrical brain activity (iv) Cessation of circulation in the retinal vessels.

Rantoul and Smith in 1973 defined death as complete and persistent cessation of respiration and circulation.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of forensic medicine, Peepe Publisher)

    Legal Question of the Day

(Contributed by Dr M C Gupta, Advocate)

How to deal with a patient who needs admission but declines?

Q: I am a consultant physician. It often happens that I advise admission but the patient is not willing. In such a scenario, will my mere note on the prescription suffice that hospitalization was advised but refused by the patient? In such a situation, can I prescribe treatment on an OPD basis?


  1. It will not be sufficient if you merely note on the prescription slip that hospitalization was advised but refused by the patient. That slip remains with the patient. If a case of negligence is later filed against you that the patient was serious but you were careless and did not advise admission, you would be unable to save yourself. This is a practical and real possibility. I have a case with me right now where the medical council held the doctor negligent on this very ground though the doctor says she advised admission several times but the patient was not willing. What you should do is to make a proper note (saying that admission is advised and risk has been explained but the patient is not willing) in your own records to this effect and get the patient or the attendant to sign it.
  2. If such a patient wants to be treated on an OPD basis, it is for you to decide. If there is no grave risk and you have recorded in writing his refusal as above, you may continue to treat. If you think the risk to him (and you) is grave, you would be within your right to withdraw from his treatment after proper notice and consent which should be documented.
    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Can the consent be given by the mother for extension of the surgery when the patient is herself unconscious?

In the model case (Supreme Court of India: Samira Kohli vs. Dr. Prabha Manchanda. Ref: (2008 vol2 SCC @ pg1) the doctor contended that the consent given by the patient’s mother for performing hysterectomy should be considered as valid consent for performing hysterectomy and salpingo–oophorectomy. The patient was neither a minor, nor mentally challenged, nor incapacitated. When a patient is a competent adult, there is no question of someone else giving consent on her behalf. The court observed that "there was no medical emergency during surgery. The patient was only temporarily unconscious, undergoing only a diagnostic procedure by way of laparoscopy. The doctor ought to have waited till the patient regained consciousness, discussed the result of the laparoscopic examination and then taken her consent for the removal of her uterus and ovaries. In the absence of an emergency and as the matter was still at the stage of diagnosis, the question of taking her mother’s consent for radical surgery did not arise. Therefore, such consent by mother cannot be treated as valid or real consent. Further a consent for hysterectomy, is not a consent for bilateral salpingo–oophorectomy."

    Ethical earning

What is reimbursable to a doctor?

A patient who is discharged from hospital is reimbursable for medical practitioner charges for the next two months.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • To help evaluate the body's water and electrolyte balance
  • To investigate hyponatremia and increased or decreased urine production
  • To detect the ingestion of toxins such as methanol
  • To monitor the effectiveness of treatment for conditions affecting osmolality
  • To help determine the cause of chronic diarrhea
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

Is it mandatory to file the return of income?

Ans. Yes, every individual or Hindu Undivided Family (HUF) whose income is in excess of the amount not chargeable to tax is required to file the return.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Sodium chloride 6.80gm + Potassium chloride 0.30 gm + Calcium chloride dihydrate 0.37gm + Magnesium chloride hexahydrate 0.20gm + Sodium acetate trihydrate 3.27gm + L–malic acid 0.67gm in 1000ml solution for infusion
Replacement of extracellular fluid losses in case of isotonic dehydration, especially if acidosis is being imminent or present
    IMSA Update

International Medical Science Academy (IMSA) Update

Cancer prevention

EPIC study, a cohort study of nearly 500,000 European men and women followed for nine years, found only a weak association between increased intake of fruits and vegetables with overall risk of cancer.

(Ref: Boffetta P, Couto E, Wichmann J, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010;102:529).

    IJCP Special

Dr Good Dr Bad

Situation: A patient with albumin in the urine was to go for bypass surgery.
Dr Bad: There is no risk.
Dr Good: There is a risk of kidney injury.
Lesson: A simple urine test for presence of proteins before heart surgery can predict which patients may develop kidney–related complications, according to a study published early online and to appear in an upcoming issue of the Journal of the American Society of Nephrology.

Make Sure

Situation: A child with sore throat and the large lymph nodes developed fever.
Reaction: Oh my God! Why were antibiotics not given in time?
Lesson: Make Sure, that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are Streptococcal unless proved otherwise.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Sympathetic Oneness

A father and son were walking together, enjoying the early morning breeze. They had covered a good distance when the father stopped suddenly and said, "Son, stop!" The son said, "What’s wrong?" The father said, "Nothing in particular, but let’s not walk any farther on this road." "Why not?" asked the son. "Do you see that elderly man coming toward us?" the father asked, pointing down the road. "Yes, I see him," replied the son.

"He’s a friend of mine," said the father. "He borrowed money from me and can’t pay it back. Each time he sees me he tells me he'll borrow the money from someone else and give it to me. This has been going on for a long time, and I don’t want to embarrass him anymore." The son said, "Father, if you don’t want to embarrass him, why don’t you tell him that the money is a gift and you don’t want it back?"

"I‘ve already told him that," said the father. "When I said, ‘I don’t want it back; it’s a gift,’ he got mad. He said, ‘I’m not a beggar. I’m your friend. When I was in need, you gave me money, and when I can, I’ll give it back. I want to remain your friend, not become a beggar.’ Now I don’t want to embarrass him, and I don’t want to be embarrassed myself. So let’s take another road."

The son said, "Father, you are truly good. I’m very proud of you. it’s usually the borrower who tries to avoid the lender. It’s usually the receiver who is embarrassed, not the giver. But you want to spare him embarrassment. What I have learned from you is a sympathetic oneness."

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: "revirdtaes"
Answer for yesterday’s Mind Teaser:
"back seat driver"

Correct answers received from: Dr K Raju, Dr KP Rajalakshmi, Dr Manjesha, Dr Susheela Gupta

Answer for 15th December Mind Teaser: "Home on the range (or home cooking)"
Correct answers received from: Dr Vijay Kansal, Dr Rajiv Kohli  

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr Prabha Sanghi)

What’s the difference between a general practitioner and a specialist?

One treats what you have, the other thinks you have what he treats.

    Readers Responses
  1. Dear Dr. KK, Fibromyalgia is treated very well by Acupuncture, both safely and effectively. Dr.V.K. Agarwal
  2. Dear Dr KK, I fully agree with your observation regarding ‘safe dengue’ this year. I have seen about 10 cases in which patients had severe pain in right hypochondrial region. These patients had marked GB wall edema. It persisted for about 4–5 days, usually beginning on day 2/3 day of illness. Very low platelet count was a hallmark this season with practically near zero mortality. Is it possible to meta–analyze patients who receive platelets versus non platelets receivers, respective cell counts in two groups and mortality in two groups? With regards: Satish Chugh, UCRMC Kalanaur, Rohtak + 91 94160 52467
    Public Forum

(Press Release for use by the newspapers)

Asthma Patients…Check with your Doctor before going for a Holiday

People with emphysema and other serious lung diseases can safely travel by airplane, but they should be evaluated by their doctor before, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

In a study of 500 lung disease patients surveyed after a planned flight, British researchers found that 18 percent suffered some type of respiratory symptom on the plane, most commonly shortness of breath, coughing and chest pain. However, the symptoms were typically moderate, and there were no serious incidents requiring an emergency landing, the researchers report in the European Respiratory Journal. It is therefore advised that patients with serious lung disease check with their doctor before they fly to ensure the doctor is happy with them travelling and that they have enough medication to cover their trip.

Risk of dying from an asthma attack is hereditary

In another study as per Dr. Craig C. Teerlink and associates at the University of Utah in Salt Lake City the risk of dying of asthma was increased by 69 percent for first–degree relatives of people who died from asthma compared to people with no family history of asthma deaths, according to a report in the American Journal of Respiratory and Critical Care Medicine. The risk was also raised by 34 percent for second–degree relatives of asthma death cases (RR = 1.34, p = 0.003), and was even elevated, by 15 percent, among third–degree relatives.

    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, 8 AM to 6 PM.
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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