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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

19h May, 2010, Wednesday

Why do we need to register with a State Council too?

Dear Colleague

The Medical Council of India (MCI) Act clearly defines that once we are registered with MCI through any state, we can practice anyplace in the country.

However, the Delhi Medical Council (DMC) Act requires registration with DMC if one desires to practice in Delhi. The law needs to be amended as is not sustainable in the court. How can we acquire a driving license for every state? If one is a resident of Delhi and holds a driving license issued by the appropriate authority, he can drive a vehicle throughout India.

After all, even Dr Ketan Desai who was the President of MCI and despite having MCI office in Delhi for all these years, he was not registered in Delhi Medical Council. I have also been told that even our DG Health is not registered with DMC.  More than 90% of army doctors are also not registered with Delhi Medical Council. Then why should other doctors be made to endure this process of re–registration with a State Council. If the state council registration was a must, all of them would have made sure that they were registered with the council.

There have been several DMC judgments wherein the DMC could not take action against the doctors as they were not registered with DMC. Once a person is practicing in Delhi as long as he or she is registered with MCI, the council should be able to discipline him or her and take appropriate action when required. A traffic inspector on the road can issue a ‘challan’ to you irrespective of the state where you got your driving license from.

Dividing the MCI may not be the answer

By an ordinance last week the central government dissolved the MCI and created a seven-member panel of eminent people that have taken over its functioning for the next one year. Uptil now every step is ok but during the next one year period the government is likely to dissolve the MCI and separate two basic functions of MCI — education and licensing. Education may go to the National Commission for Higher Education and Research (NCHER) under Ministry of Human Resource Development (MHRD), and the licensing of medical practitioners under the National Council for Human Resources in Health (NCHRH) under the Ministry of Health and Family Welfare.

The MCI has the following functions

1. licensing new medical colleges
2. ensuring quality education
3. training, maintenance of a list of registered medical practitioners
4. ensuring ethical practices in the profession, etc.

Is creating new institutions the only way of correcting the present crisis only the time will tell? In my view the medical profession requires an overall perspective that only a single entity can provide.

One should remember that the 'health' is already divided with "water supply and sanitation" under the ministry of rural development and 'pharma prising ' under the ministry of chemicals and fertilisers. Now if "education and training" goes to MHRD what will remian with the haelth.

MCI was formed as an independent professional regulator. The health sector requires people with in-depth expertise. Only medical experts can have the necessary understanding to design and implement appropriate regulations. All over the world, it is professionally run medical associations that are in charge of such matters.

The solution, is to create within MCI the necessary tranparent checks and balances that enable organisations to function effectively and credibly.

THe checks should include

1. Auditing its activities
2. Transparency in the grading and registration of educational institutions
3. A regular and free election of key office-bearers

 I hope the new panel will debate before recommending their views to the prime minister. 

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file)

Demonstration of Preventive Procedures

Cardiopulmonary resuscitation (CPR) is an emergency procedure for cardiac arrest. Heart Care Foundation of India has been conducting workshops to inform populace about such basic preventive measures. Cricketer Mr. Chetan Chauhan, was invited in one such workshop as a chief guest. Also in the picture Padma Shri and Dr BC Roy Awardee Dr K K Aggarwal.

Dr k k Aggarwal

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

New guidelines for treatment of HIV infection the 2009 US HIV treatment guidelines recommend initiation of antiretroviral therapy in patients with a CD4 count of less than 500 cells/mL. Raltegravir, an integrase inhibitor, is a new option for therapy in treatment–naive patients. {DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV–1 infected adults and adolescents. www.AIDSinfo.nih.gov. (Accessed on December 1, 2009)}.


Mnemonics of the Day (Dr Prachi Garg)

Carpal Tunnel Syndrome – DOG ARM PIT

  •  Dialysis
  •  Obesity
  •  Gout
  • Amyloid/Acromegaly
  • Rheumatoid arthritis
  • Myxedema
  • Pregnancy/Pill
  • Idiopathic
  • Trauma/Tuberculosis

News and Views

New tests to  determine efficacy of HGH therapy in children with CKD

Using IGFBP3 (insulin–like growth factor binding protein 3) in children with chronic kidney disease may predict growth responses with growth hormone. In a study of 16 children, change in IGFBP3 on the low growth hormone dose was 39% in children with worse kidney function vs 41% in those children who have better kidney function. But, the percent change in IGFBP3 levels observed was 56% in the children with worse kidney function and 42% in those with better kidney function among children who were given high-dose growth hormone. (Annual Meeting of Pediatric Academic Societies)

A new drug may reduce BP and curb appetite

Qnexa, an experimental drug, is a unique formulation that combines phentermine with topiramate, the anti–seizure medication. Phentermine causes rapid suppression of appetite. Topiramate reduces appetite and increases satiety throughout the day. It also reduces BP. In an analysis of three separate studies that involved more than 4000 individuals, highest dose of the drug combination produced considerable weight loss of 10% after one year and also led to significant fall in systolic BP.

Most high BP patients fall short of recommended exercise levels

In a survey of nearly 400,000 individuals, 66.9% on the whole and 60.2% of those with hypertension reported exercise equivalent to 150 minutes of moderate activity per week. In all three BMI categories, hypertensive patients were significantly more likely to report being inactive. Hypertensive patients had 15% less chances to reach the threshold after adjustment for age, gender, race, socioeconomic status, body mass index, smoking status, and disease history. The study findings were presented at the American Society of Hypertension meeting. The 2008 Department of Health and Human Services recommendations are 150 minutes of moderate to intense physical activity, 75 minutes of vigorous activity, or an equivalent combination of the two, per week.

Being vaccinated against pneumonia may not reduce risk of heart attack

A study published in JAMA states that vaccination against pneumonia does not reduce the risk of cardiovascular events (heart attack or stroke) in men older than 45 years.

Quote of the day (Paramjeet Chadha)

A good way to change someone’s attitude is to change your own.
Because, the same sun that melts butter, also hardens clay!
Life is as we think, so think beautifully.

Question of the Day

What are the factors regulating growth? (Dr Shabina Ahmed)

  1. In infancy, it is an extension of intrauterine growth from 20 weeks gestational age to 6 months postnatally. Control is in the brain / hypothalamus, nutrition, but is less dependent on growth hormone.

  2. In childhood, 6 months of later infancy to childhood (prepubertal). The childhood component of growth adds about 70 cms to height. The control is growth hormone.

  3. In school years, adrenal androgen influence growth, particularly in boys (adrenarche).

  4. In adolescence, pubertal growth is regulated by both growth and sex hor–more

Evidence Based Practice: (Dr N P Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital)

Cord–Blood pH an important indicator of perinatal outcome
Low pH in cord blood can signal major adverse neonatal outcomes, including death, seizures, and cerebral palsy, according to a BMJ meta–analysis.
Analysts examined 51 studies, together including almost a half–million infants. They found low cord arterial–blood pH to be associated with higher risks for neonatal mortality (odds ratio, 16.9), hypoxic ischemic encephalopathy (13.8), intraventricular hemorrhage or periventricular leukomalacia (2.9), and cerebral palsy (2.3). The authors say that further studies would be needed to attach longer–term prognostic significance to low pH levels in cord blood. In the meantime, they recommend "increased initial surveillance" in low–pH babies. An editorialist points to both U.K. and U.S. guidelines that "remain valid" and provide specific recommendations on use of cord blood sampling.

eMedinewS Try this it Works: Fecal occult blood testing

To minimize the incidence of false–positive and false–negative results, the following steps are necessary:

  • For 3 days before and during testing, patients should avoid eating red meat, fruits such as cantaloupe, and vegetables such as broccoli, turnips, radishes, and cauliflower. Vitamin C, aspirin, and nonsteroidal anti–inflammatory drugs (NSAIDs) should also be avoided.

  • Two samples of each of three consecutive stools should be tested within 4 to 6 days. Obtaining specimens by digital rectal examination in hospitalized patients has a high false–positive rate and should not be done.

Dr Good Dr Bad

Situation: A patient with DVT came to the hospital.
Dr Bad: Start oral anticoagulants.
Dr Good: Start heparin.
Lesson: Initial therapy with intravenous or full dose subcutaneous heparin is superior to oral anticoagulants alone.

Make Sure

Situation: A patient with severe asthma came to the emergency room, Reaction: Oh my God! why did you give him aspirin? You should have prescribed nimesulide.
Lesson: Make Sure to remember that five percent patients of asthma worsen on aspirin intake.

IMANDB Joke of the Day (Dr. Vandana Shiva)

Two words from Sanskrit that are strikingly same – chita and chinta
One burns the dead and the other burns the living.

Formulae in clinical practice : Nitrogen balance (g)

Formula: Protein intake in g/6.25 – urine urea nitrogen (g) + 2.5

Milestones in Gastroenterology: Maximilian Stoll

In 1777, Maximilian Stoll, an Austrian physician provided the first description of cancer of the gall bladder.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Reticulocyte Count

To help evaluate the bone marrow’s ability to produce red blood cells (RBCs) and to help distinguish between anemia related to blood loss or destruction and anemia related to decreased RBC production; to help monitor bone marrow response and the return of normal marrow function following chemotherapy, bone marrow transplant, or post–treatment follow–up for iron deficiency anemia.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Sertaconazole Nitrate Powder 2% w/w & Lotion 2% w/v

For the topical treatment of the superficial fungal infections of the skin.




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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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Public Forum (Press Release for use by the newspapers)

Heat stroke depends not only on temperature but also on relative humidity

Development of heat stroke and other heat disorders not only depends on the temperature but also on relative humidity. This was stated by Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India. The atmospheric temperature of more than 110°F (>44°C) can cause heat stroke when there is a continuous exposure to sunlight. At a humidity of 40%, a temperature of 110°F behaves like a temperature of 130°F and is classified under high risk red zone.

When the humidity is between 30–40% at the same temperature, persons are likely to suffer from sun stroke, heat stroke and heat exhaustion. However, heat stroke can occur with prolonged exposure and/or physical activity.

Till the temperature is lower than 85°F the chances of heat cramp, heat exhaustion and heat stroke will continue. At this stage only fatigue is possible that too with prolonged exposure and/or with associated physical activity.

Dr. Aggarwal said that if a heat disorder is suspected a person may require fluid resuscitation of upto 4–8 litres which should include lemon water with salt.  The main parameter to differentiate heat stroke and heat exhaustion is that in heat stroke there is no sweating. Absence of sweating with high body temperature should be treated as an emergency to prevent charring of inside organs.

Readers Responses

  1. There is a medical fraternity in India beyond IMA which needs to be represented as well. IMA could certainly be called the most representative body in the country with its 1.70 lakh members but today the body is practically defunct. The Government has rightly chosen eminent doctors in their field who are not remotely connected (hopefully) with the gang that was running the medical establishment in the country. I join the nation in looking up to them for making affordable healthcare, available to the nation. This cannot be done till a realistic model is thought out for private medical colleges, which are unfortunately relying mainly on the revenue generated by selling medical seats in cash. My only concern is how much time will the newly appointed panel members be devoting to the humongous work which needs to be done? I do hope they will work with the same passion in this administrative job as they do in their clinical fields. I wish them the very best and hope they will nurse the ailing medical education system through a robust model and lift the morale of the medical community too which is at its lowest ebb. It is my belief that we can again be very proud of our ethics and deliver health to the nation, keeping our heads high: Dr Ashish Sabharwal

  2. Thanks for sending the emedinews, Dr Shyamsunder Kasapa

  3. hi kk ! personally, i think, we should not write personal,or individual complaints about any doctor or an individual event between two people of our own medical fraternity. Perhaps we ourselves do not know the individual facts and details. This newsletter should not be a judgement base – be it on ground of medical ethics or whatever else. I think the ideology of this newsletter is based on updating a knowledge-base & recent medical trends for our medical community. I feel very strongly on this fact. Let’s keep this communication of yours through this E–Medinews above personal bias and personal likes and dislikes or an isolated medical event. I would also request the doctors not to express their individual views on any other colleague. Kind Regards: Dr. Sanjeev Bagai, Padma Shri, Dr. B.C. Roy Awardee

  4. Five ways of apologising: Dr G M Singh

    1. I am sorry – expressing regeret
    2. I am wrong – accepting responsibility
    3. What can I do to make it right – making restitution
    4. I will not do that again – genuinely repenting
    5. Will you please forgive me? – sure step to bliss

  5. Hello All, There is a 4–day unique training programme in Emergency Medicine, under the leadership of Emergency Department, AIIMS in collaboration with faculty from American Universities, facilitated by INDUS–EM, starting 17th June 2010. Dr Vivek Chhabra

  6. Dear Dr KK Aggarwal, My hearty felicitations to you on starting the First National Daily e medical News paper of India. You are doing yeomen service to the medical profession through this. I go through the contents of the newsletters with great interest. More and more honours and awards await you. At 85+ I continue to learn and am ‘playing’ with the computer to get as much from it as possible and as much as it can offer.! I continue to teach Anatomy. My website gives you a short introduction to my professional standing. With warm regards: S Ramaswamy 26 (125) Chamiers Road, Nandanam Extension, Chennai 600 035.