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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 ...

18th December, 2010, Saturday

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

2010: Seven International Medical Stories that mattered

  1. Revolutionary tuberculosis tests. World Health Organization endorsed a molecular diagnostic test for TB that is accurate nearly ninety–nine per cent of the time and produces results in two hours or less.
  2. Cholera epidemic in Haiti. More than two thousand are dead so far, and the Centers for Disease Control says a hundred thousand have been infected.
  3. Health–care reform. On March 23rd, President Obama signed legislation into law that will guarantee health insurance for thirty million people who currently lack it.
  4. Polio strikes the Republic of Congo. More than two hundred people have died from polio this year in the Republic of Congo—where there had not been a case reported in the past five years.
  5. Pertussis epidemic in California. The state is in the midst of the worst pertussis (whooping cough) outbreak in fifty years.
  6. Supplements: Calcium boosts heart–attack risk, and Vitamin D is not the fountain of youth. One large study found that calcium supplements taken without vitamin D may increase the risk of heart attack by as much as 30 percent.
  7. Bedbugs. Bedbugs are a threat to the future of humanity. In fact, bedbugs do not make anyone sick. They are a terrible nuisance that, for the first time in years, seems to be attacking a more prosperous group of people.
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr GM Singh)

"When in doubt, tell the truth."

Mark Twain

    Photo Feature (from the HCFI Photo Gallery)

HCFI Field campaigns

The Heart Care Foundation of India uses mobile Exhibition Vans to propagate health messages to the general public in its field campaigns. In the Photo: A mobile Exhibition Van carrying a one–liner health tip "Eat seasonal and locally grown fruits and vegetables"

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

1 in 10 people in Tamil Nadu is diabetic

One out of 10 people in Tamil Nadu is diabetic, and every two persons in a group of 25 are in the pre–diabetic stage. These statistics from phase 1 of the Indian Council of Medical Research’s INDIAB (India–diabetes) nationwide study have confirmed some of the worst fears of medical experts and policy makers, and come as warning signals to the public at large. Nearly, 80% of people have abnormal lipid profile, which means high amount of fat and bad cholesterol, coupled with low levels of good cholesterol. About 28% are hypertensive and 20% have high cholesterol. The Madras Diabetes Research Foundation launched the study, the largest in the country and supported by ICMR, to determine the prevalence of type–2 diabetes mellitus and hypertension in India, compare the urban–rural divide, estimate the risk for heart diseases and the effects of treatment. The study, in three phases, will cover people above the age of 20 in urban and rural areas of 28 states and two union territories, besides New Delhi. Phase 1 of the study covered 4,000 people each in Chandigarh, Jharkhand, Maharashtra and Tamil Nadu. (Source: The Times of India, Dec 14, 2010)

New laptop tracker launched

Bhubaneswar: Quick Heal Technologies Private Limited, a leading anti–virus solution provider, here on Sunday launched Laptop Tracker, a service by which one could trace stolen or lost laptop computers. Quick Heal’s Vice–President (Corporate Communication) M. J. Srikant said the technology would provide law enforcement agencies with a sure–fire method of tracking and recovering lost laptops. "What we have done is that the company has provided website interface to individual user, law enforcement agencies and its own customers. If a laptop is lost, one could register with the website – www.trackmylaptop.net. On request of law enforcement agencies, we would give location of the lost laptop if it is used," said Mr. Srikant. He said the company had already launched the programme at Indore and Jaipur and would go to every State Capital. (Source: The Hindu, Dec 13, 2010)

    International News

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

Health over procedure

Doctors at Boston’s Beth Israel Deaconess Medical Center have agreed to a new global budget without monetary incentives for procedures. Medical Director Rich Parker points out the patients’ health is the goal, not the volume of procedures: "More care is not always better care and, in some cases, it’s worse care," Parker said. "We’ve all heard of situations where somebody got a procedure that caused a complication and in retrospect questions were asked, ‘Did they really need that procedure?’ So all of this extra doing is not necessarily benign." Beth Israel is not the first hospital to adopt such a model but they are the biggest. This move, although it has generally flown under the radar of national media outlets, could have huge implications on the way doctors prescribe exercise and dietary changes.

(Dr GM Singh)

Trimethoprim–sulfamethoxazole may increase hemorrhage risk in patients taking warfarin

Older patients receiving warfarin are at increased risk for upper gastrointestinal hemorrhage if they also take trimethoprim–sulfamethoxazole, according to study in Archives of Internal Medicine. Researchers examined Ontario healthcare databases to find people aged 66 years or older treated with warfarin for at least 180 days. They compared the antibiotic use of nearly 2200 of these patients who were hospitalized with upper gastrointestinal hemorrhage with that of 21,000 age– and sex–matched controls. Patients were nearly four times more likely to be admitted for hemorrhage if they had recently filled a prescription for trimethoprim–sulfamethoxazole. Ciprofloxacin use was also associated with increased hemorrhage risk, but other antibiotics were not. The authors say their observations "suggest that clinicians should consider antibiotics other than (trimethoprim–sulfamethoxazole) in patients receiving warfarin. If alternatives are inappropriate, close monitoring of anticoagulation control is necessary, and temporary reductions in the dosage of warfarin may be required."

(Dr Monica and Brahm Vasudev)

Research provides more clues about Alzheimer’s

Preliminary research on Alzheimer’s disease suggests a protein that accumulates in the brain at very high levels in Alzheimer’s patients is not being overproduced; it’s just not being cleared efficiently from the brain. The research was published in Science.

CDC data show few adults get vaccinations

There are several vaccines that adults need to protect against serious diseases, including shingles, pneumonia, hepatitis and cervical cancer. And, although rates of adult immunization have inched up in recent years, they are still far below what they should be, according to new data from the Centers for Disease Control and Prevention. Dual anti–HER2 attack before surgery may boost complete response rates in HER2–positive breast cancer.

    Infertility Update

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

How do you know that a lady has an ovarian problem?

An ovarian problem can be due to many factors. In a polycystic ovarian syndrome (PCOS), the lady is usually overweight and has delayed periods. She has numerous maturing eggs; due to hormonal imbalance they are unable to mature regularly. In endometriosis, though the exact cause is not known, it has been postulated that some of the blood flow is slow and damages the tube and ovarian tissue. This leads to cyst formation and egg damage. The lady would present with pain, abdominal pain during periods, and pain during intercourse or irregular menstrual period. Ovarian pain may be due to lack of good quantity of eggs. A girl is born with a fixed number of eggs and by the time she reaches menopause, there are no eggs remaining on her reserve. About 10–15 years before menopause, she enters a phase called reduced ovarian reserve, where though she is menstruating regularly, the quantity of the eggs is poor with less or no chance of conception. Some time this happens many years prior to menopause, it is then called premature ovarian failure.

For queries contact: banerjee.kaberi@gmail.com

    Medicine Update

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

Causes of red color of the urine

Hematuria: Presence of red blood cells (erythrocytes) in the urine. Hemoglobinuria is used synonymously, although more precisely it refers only to hemoglobin in the urine.

Blood that you can see is called gross hematuria. Urinary blood that is visible only under a microscope is known as microscopic hematuria.

    Medicolegal Update

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

What is any hurt which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days?

A grievous injury

The 8th clause of Indian Penal Code 320 defines such hurts, which cause the victim to be in severe bodily pain for a period of 20 days as

  • Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days
  • Ordinary pursuits means the patient cannot be able to go toilet, to brush the mouth, bath cannot eat himself, cannot walk and to carry on such daily pursuits require mandatory help of other person for 20 days
  • The length of time during which an injured person is in pain, disease or is not able to pursue his ordinary daily routine work must be meticulously and satisfactorily observed by the doctor himself before certifiying the injury as a grievous injury.
  • It is employed not only in cases where violence has been used but also in cases where hurt has been caused without any assault, e.g., by administration of drugs, the digging of pitfalls. The setting of traps etc. the extent of hurt and the intention of the offender are considered for giving punishment.
  • It is difficult for a doctor to prove that an injured person was in severe bodily pain for 20 days but it is easier to prove that he was unable to follow his ordinary profession/pursuits due to the hurt.
  • A mere stay of 20 days in the hospital doesn’t make an injury grievous unless the person was in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days. Certifying doctor must rule out and document the feigned illness in medicolegal report.
    Rabies Update

Dr. AK Gupta, APCRI, Author of "RABIES – the worst death"

What are the myths about rabies in India?

The following myths about rabies are very prevalent in India.

  • Some herbal extracts and concoctions will cure rabies.
  • In rural areas, people also resort to witchcraft, magic or religious practices.
  • Washing of wound can cause hydrophobia.
  • Dietary changes can cure, i.e., shift from vegetarianism to non–vegetarianism or vice versa; stopping consumption of white things etc.
  • A single dose vaccine will prevent rabies.
  • Vaccines are more effective if taken on empty stomach.
  • One should not take bath; eat meat and eggs during vaccination.
  • Gems and stones have magical properties against rabies.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q: What should a doctor do when:

1. A victim of sexual assault/ rape victim voluntarily comes for treatment to the hospital after the incidence but she (or her guardian) does not want that the matter may be reported to the police?

2. A child is brought for treatment by the mother and the doctor suspects that the child is a victim of sexual abuse by a near relative but the mother does not want to report the matter to the police?


  • When a patient comes to a doctor, the latter is bound by the principle that anything regarding the patient that comes to his knowledge during the course of professional services is privileged information for divulgence of which, without permission or legal necessity, he would be liable in law. However, it is likely that some time in future, the police may ask the doctor about the particular incident. Hence, it is important that the doctor should keep the record of the patient in sufficient detail in safe custody because it may be a potential court case/medico–legal case.
  • The legal necessity mentioned above would include, for e.g. demand by an authorised investigating agency; court orders; and specific legal provisions etc. The most important legal provision is section 39, CrPC.
  • Section 39 of the Code of Criminal Procedure, 1973, titled "Public to give information of certain Offences", lists various sections of the Indian Penal Code, 1860, and reads:

    "( 1 ) Every person, aware of the Commission of , or of the intention of any other person to commit any offence punishable under any of the following sections of the Indian Penal Code ( 45 of 1860 ), namely:




    shall , in the absence of any reasonable excuse, the burden of proving which excuse shall lie upon the person so aware, forthwith give information to the nearest Magistrate or Police officer of such Commission or Intention."
  • The offences of sexual assault mentioned in the question do not fall within the purview of Section 39 CrPC.
    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

What is the definition of laprotomy?

It is a surgical incision into the abdominal cavity, for diagnosis or in preparation for surgery. In one case the doctor contended that the term ‘laparotomy’ used in the consent form is equal to or same as hysterectomy. The Supreme Court observed that (Samira Kohli Vs. Dr.Prabha Manchanda. Ref: (2008 vol2 SCC @ pg1) the doctor’s contention that ‘Laparotomy’ refers to and includes hystectomy and bilateral salpingo–oopherectomy cannot be accepted. Laparotomy is opening up of the abdomen which is quite different from hysterectomy. Hysterectomy is a procedure which involves surgical removal of uterus. The two procedures are totally different and consent for each procedure has to be obtained separately. Laparotomy is usually exploratory and once the internal organs are exposed and examined and the disease or ailment is diagnosed, the problem may be addressed and fixed during the course of such laparotomy (as for example, removal of cysts and fulguration of endometric area as stated by doctor herself as a conservative form of treatment).

Laparotomy is never understood as referring to removal of any organ. In medical circles, it is well recognized that a catch all clause giving the surgeon permission to do anything necessary does not give roving authority to remove whatever he fancies may be for the good of the patient. For example, a surgeon cannot construe consent to termination of pregnancy as consent to sterilize the patient.

    Ethical earning

What is reimbursable to a doctor?

Epley maneuver in vertigo can be billed separately.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum gastrin

  • To detect an overproduction of gastrin
  • To help diagnose Zollinger–Ellison syndrome
  • To monitor for recurrence of a gastrin–producing tumor (gastrinoma)
Our Contributors
  Docconnect Dr Veena Aggarwal
  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

Q. What will be the consequence for non–compliance of provisions of Income Tax Act?

Ans. Doctor will be liable to penalties. But if he gives reasonable cause for the default made, then he may not be liable to penalties.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Olopatadine 5mg + Ambroxol 30mg tablets

For the management of cough in adult patients only


    IMSA Update

International Medical Science Academy (IMSA) Update

Valproic acid monotherapy in pregnancy and major congenital malformations

A case–control study using the European Surveillance of Congenital Anomalies database (registering a combined total of 98,075 major congenital malformations) confirmed that valproic acid is associated with an increased risk for several congenital malformations compared to no AED use and compared to other AED use.

(Ref: Jentink J, Loane MA, Dolk H, et al. Valproic acid monotherapy in pregnancy and major congenital malformations. New Engl J Med 2010;362:2185–93)

    IJCP Special

Dr Good Dr Bad

Situation: A 65–year–old patient on levofloxacin developed tendon rupture.
Dr bad: It’s not related.
Dr Good: It’s related.
Lesson: A federal court jury ordered Johnson & Johnson to pay damages of $1.8 million in the case of an 82–year–old man who sued over claims the antibiotic levofloxacin caused him severe tendon injuries. In 2008, the US FDA required makers of related drugs in the class fluoroquinolones to include warnings on the risk of tendon ruptures. The risk is higher in patients older than 60, those taking steroids, and recipients of kidney, heart or lung transplants.

Make Sure

Situation: A patient missed his second dose of Hepatitis B vaccine and developed Hepatitis B.
Reaction: Oh my God! Why was the vaccine not given between 1–2 months?
Lesson: Make sure that all patients who missed their second dose of vaccine at one month are given the same upto second month (1–2 months).

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Flood of Compassion–Heart

Gambhirananda was a man of few words. Sometimes people used to misunderstand him, thinking he was indifferent to the world, because he used to hide his compassionate heart. But when necessity demanded, he helped people, cured them and illumined them unreservedly and unconditionally. Gambhirananda was fond of animals – both ferocious animals and tame household pets. Ferocious animals even roamed among the Master’s attendants. These animals were very fond of Gambhirananda, and he gave them much affection and love.

One night, a disciple was sleeping beside the Master’s room when some noise from inside the room woke him up. He quietly opened the door of the Master’s room and saw the Master feeding quite a few mice with small pieces of bread. He was offering them the bread with great affection. When Gambhirananda saw the disciple, he was a little bit embarrassed to be seen feeding mice at that hour, but the disciple was very moved. The Master quite often showed tremendous indifference to seekers outwardly, but here the disciple saw that his compassionate heart cried even for poor little mice.

Commentary: It is almost impossible to fathom a spiritual Master’s compassion–height and justice–light. His justice–light is admired and adored by the brave. His compassion–height is loved and adored by the hopeless and helpless. But his compassion–height and justice–light together prepare the seeker for an integral understanding of God the Creator Supreme and God the Creation Manifested.

— — — — — — — — — —


Read this…………………

Which of the following is NOT an effective strategy for primary prevention of stroke?

  • Dosing with vitamin K antagonists on the basis of pharmacogenetics
  • An angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker for diabetics with hypertension.
  • Physical activity (150 minutes of moderate exercise per week)
  • Treat blood pressure to below 130/80 mm of Hg
  • Aspirin for primary stroke prevention

Contributed by Ashish Verma MD

Yesterday’s Mind Teaser: "dice dice"
Answer for Yesterday’s Mind Teaser: "Paradise"

Correct answers received from: Dr KP Rajalakshmi, Dr Sudipto Samaddar, Dr Muthumperumal Thirumalpillai

Answer for 16th December Mind Teaser: "back seat driver"
Correct answers received from: Dr B V Sai Chandran, Dr K Raju, Dr Maneesh Gupta, Dr Vijay Kansal

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr GM Singh)

You might have seen the Dev Anand mega hit film, ‘Guide’. A famous song of this film is "Gata Rahe Mere Dil."

In this song, Waheeda Rehman wears a pink saree and throughout the song wears the same dress. So when we have a trend of heroines changing clothes every sequence, the big question is why does Waheeda Rehman not change her saree throughout the entire song? The answer is pretty simple. Coz in the first stanza of the song, Dev Anand sings –– Oh Mere Humrahi Meri Bah Thamen Chalna, Badle Duniya "Saree" Tum Na Badalna

    Readers Responses
  1. Sir, as you rightly said, dengue this year saw platelet count dipping markedly. I think there are some of the future implications with Dengue also. These are as follows: A large part of the community has been affected because of dengue. First episode of dengue may be mild; however if the person happens to get second infection later, the episode will likely to be met with complications such as bleeding. What is the morale then for society? Prevent, prevent and prevent. Use Mosquito nets, wear protective long sleeves clothing. This advice needs to be propagated widely. Even many doctors amongst Medical community/Medical students are not serious enough about the prevention of dengue by these simple measures. And when complications start occurring, they run everywhere searching the "best" hospital or "best" physician etc. So, let’s begin with ourselves: Using preventive measures against mosquito bites. Regards and best wishes, Dr Jitendra Ingole, MD, Asst Professor, Internal Medicine
    Public Forum

(Press Release for use by the newspapers)

Smoker’s Cough Strong Predictor of Lung Disease

People who develop chronic cough and phlegm (sputum production) are at significantly high risk of developing Chronic Obstructive Artery Disease (COAD), said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

COAD, also called as Chronic Obstructive Pulmonary Disease (COPD), is the fourth leading cause of death. It is a combination of chronic bronchitis and emphysema where the lungs get enlarged and weak. The main cause of COAD is smoking.

Quoting a study published in the American Journal of Respiratory and Critical Care Medicine, Dr. Aggarwal said that the presence of chronic cough and phlegm in smokers is not an innocent symptom but is an early marker of airflow obstruction. In the study, people who developed chronic cough and phlegm had a four–fold higher risk of developing COAD. Until now it was thought that only 15% of smokers develop COAD but the current literature suggests that the lifetime risk of COAD in smokers is upto 50%. If not managed properly, COAD leads to heart involvement resulting into right heart failure with increased morbidity and mortality.

Quitting smoking can reverse the process in the early stages. In late stages, quitting will stop further progression of the disease.

    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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