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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

22nd May, 2010, Saturday

Dear Colleague

India need more medical colleges

The total registered allopathic doctors in the country are 7,58,866 but this is not an exact figure as names of doctors who have died, still continue to appear in the register. For every 10000 population, there are 5.97 doctors and 7.9 nurses.

India is short of 6–8 lakh doctors, 10–12 lakh nurses and 2-3 lakh dentists as per the Planning Commission statistics. In its 271 medical colleges, India produces only 31,000 allopathic doctors every year and around 150000 postgraduates every year. This year, Ministry has decided to upgrade only 19 medical colleges with super–specialty facilities.

The shortage of doctors is evident when we look at the doctor–patient ratio. The present ratio is 1:1722 as a whole in the country. The ideal ratio should be 1:500. However as per WHO, the doctor–patient ratio should be 1:250 (one doctor for every 250 patients). The sitaution is worse in the rural areas where for every 34,000 rural population, there is only one doctor.

The above statistics only indicate the need for more medical colleges in India. BRMS or Bachelor of Rural Medicine and Surgery as envisaged by the previous Medical Council of India is not the answer.

The Government is planning to spend Rs. 10,000 crore over the next 2–3 years to establish seven medical institutes on the lines of AIIMS. The same money, in fact, should be used by the Government in opening more medical colleges all over the country.

It is always said that doctors do not want to go to rural areas. If the government wants to solve this problem, they can put in a condition that for the next ten years new medical colleges would be opened only in rural areas. Here is another suggestion. A senior resident in Govt. Hospital is paid
Rs. 60–70 thousand per month as salary. If this salary can be increased to Rs. 1 lakh and made income–tax free for rural areas, it will be enough and good incentive for any senior resident who has completed three years in a government hospital to go and serve in rural areas for another two years. He will save around Rs. 20 lakh income–tax free money, can come back and start practice anywhere he wants.

As per WHO, for every 1000 population, there should be 5 beds in an hospital and, at present in the country, the figure is less than 2 per 1000 population. It is true that 75% of human resources, 68% of hospitals and 37% of total bed capacity is in private sector. Private hospitals have 12,22,000 beds compared to only 5 lakh beds in the government hospitals.

The need, therefore, is to open more medical colleges, postgraduate courses and hospital beds so that the gap is not filled up by quacks.

A new synthetic cell now (MIRACLE)

Craig Venter world renowned geneticist at the J. Craig Venter Institute for the first time has created life using a computer and making the first ever synthetic cell. Three years ago, Dr. Venter was able to show that the natural DNA from one bacterium can be inserted into another and that it would take over host cell’s operations. In the year 2009, his team synthesized a piece of DNA over 108000 bases.

As per a report published in Science, his team found that a synthetic DNA takes over a bacteria cell just as prenatural DNA did, making the cell generate the proteins specified by the new DNA genetic information in preference to those of its own genome. The bacteria used was microplasma mycoides.

Venter said that the creation of the synthetic cell began on a computer. His team assembled it and transplanted it into a recipient cell, converted that to a new species. He said that they built the DNA chromosome from scratch from 4 bottles of chemical chromosomes over 1 million letters long and they did the final assembly in the yeast that people are familiar with making beer and bread. The new bacteria replicated over 1 billion times.

However, many scientists have cautioned the new species is not a truly synthetic life as its genome was inserted into an existing cell. Nevertheless, the results were hailed as a turning point in the relationship between man and nature.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file)

World No Tobacco Day

All Religious Gurus united together under one roof to end the tobacco menace (L to R): Dr R P Vashist (Govt of Delhi), Dr AK Merchant (Bahai), Swami Shantatmanandaji (Ramakrishna Mission), Maulana Moazzam Ahmed Naib Shahi Imam (Islam), Padmashri Awardee Dr K K Aggarwal (Heart Care Foundation of India), Sister Asha (Brahmakumaris), Rev Ezekiel Isaac Malker (Judah Hyam Syngogue) and Father Dominique Emanuel (Christianity)

Dr k k Aggarwal

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

Newborn screening for Severe Combined Immunodeficiency (SCID)

In January 2010, the United States Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) recommended adding a screening test for SCID and related T–cell disorders to mandatory newborn screening conducted by state public health programs.

(Patel NC, Hertel PM, Estes MK, et al. Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010;362:314)


Dr Ketan Desai Update

Former Medical Council of India President, Dr. Ketan Desai starting Friday is being grilled by the Enforcement Directorate. The ED that booked Dr. Desai under the Prevention of Money Landering Act was earlier granted permission by the Court to quiz him. (UNI)

Mnemonics of the Day (Dr Prachi Garg)

Causes of Middle Mediastinal Mass - HABIT5

  • Hernia / Hematoma 
  • Aneurysm 
  • Bronchogenic carcinoma / duplication cyst
  • Inflammation (sarcoidosissis, histiocytosis, coccidio, TB) 
  • Tumor 5 (lung, lymphoma, leukemia, leiomyoma, lymph nodes)

News and Views (Dr Monica and Brahm Vasudeva)

1. New research informs on how to better use oxygen to treat very premature babies

Surfactant has been customarily used for premature babies i.e. those born before 27 weeks of gestation, or more than three months early. But serious complications like infections and lung injuries can occur because of such interventions. A new study reported in the New England Journal of Medicine recommends using a kinder, gentler type of oxygen therapy first, which is safe, before adopting more invasive methods to help them breathe

2. Researchers see increase in children hospitalized with MRSA

According to a study published in the journal Pediatrics, the number of children hospitalized with dangerous drug–resistant staph infections has increased 10–fold in recent years.

3. Study on link between cell phone use and brain cancer inconclusive

A major international study investigating the association between use of mobile phones and two forms of brain cancer has proved inconclusive.

Eradication of smallpox linked to spread of HIV infection

A study published in the journal BMC Immunology says that the global eradication of small pox may have unintentionally helped spread of HIV infection. The smallpox vaccine was gradually withdrawn following the worldwide eradication of the disease and HIV has been spreading exponentially since then, researchers note. In their study, they observed significantly lower HIV replication rates of HIV in blood cells from vaccinated individuals, compared with those from unvaccinated controls. The vaccine reduced replication of the virus by 5–folds. The small pox vaccine may protect against the Human immunodeficiency virus (HIV) by producing long–term alterations in the immune system, possibly including the expression of a receptor called CCR5 on the surface of white blood cells, which is used by the smallpox virus and HIV. However, according to the researchers, it is too early to recommend the smallpox vaccine to combat HIV.

Quote of the day (B.K. Sapna)

In order to live in peace, try not depend on anyone and at the same help others become independent, free and responsible for their lives. In the same way, ensure you do not cause anyone sorrow, and do not allow others to be a source of hurt for you.

Question of the Day

How should lipid–lowering therapy be monitored?

Monitoring of effect: Fasting lipid profile to measure total cholesterol, TG, HDL, LDL and VLDL cholesterol should be done at least once, four to six weeks after initiating the therapy. The target for LDL cholesterol is <100 mg/dl for patients with CHD or diabetes or in high–risk subjects and <130 mg/dl for patients without these factors. If LDL or TG are above optimum level, the therapy should be modified by either increasing the dose of statin or adding one more drug (preferably a fibrate for elevated triglyceride or ezetimibe for elevated LDL cholesterol). Next measurement should be done after another four to six weeks. If the cholesterol and LDL cholesterol is found to be very low (much below the desired range), the dose can be reduced to see whether a lower dose will be effective for that patient. Once the patient is well controlled, monitoring once in three to six months is adequate. Frequent monitoring has the advantage of ensuring compliance to drugs, diet and exercise therapy.

Monitoring of side effects: SGOT, SGPT and CPK should be measured at least once after three months of initiating the therapy in asymptomatic patients and earlier in the presence of myalgia. Due attention should be given to the presence of associated disease conditions or drug therapy, which can increase the chances of myopathy. If the patient is hospitalized for any acute illness or for any surgery, it is preferable to stop statins in order to avoid the chances of myopathy.

No Tobacco Day 31st May

Religions and Smoking

Bahai Faith: As per Bahai Faith, true health extends beyond physical wellbeing. Bahai’s teachings discourage the tobacco use as unclean and unhealthy. It also emphasise on scientific investigations of reality as there are enough scientific evidence linking smoking with various diseases. Bahai Faith discourages smoking at any level.

eMedinewS Try this it Works: Bitter meds for toddlers

The best way to minimize spillage is to divide the total dose into 6 or 7 portions and give them with a dropper.

Dr Good Dr Bad

Situation: A high risk patient for diabetes was advised PFT test.
Dr Bad: You do not need this test.
Dr Good: Go get this test done.
Lesson: Men who are predisposed to develop diabetes have decreased lung function many years prior to the diagnosis, compared with men who do not develop diabetes. This decrement in lung function remains after the development of diabetes. In the Normative Aging Study, diabetic patients had lower FEV1 and forced vital capacity (FVC) at all time points. (Respir Med 2005;99(12):1583–90)

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh My God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lasson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients

IMANDB Joke of the Day (Dr Prachi Garg)

See how time changes

Ten years ago when I used to return home my dog used to greet me by barking and my wife by kissing. Now they have exchanged their roles.

Formulae in clinical practice

Arterial Oxygen Content (CaO2)

Formula: CaO2 = (1.39 × SaO2%/100 × Hb) + (0.0031 × PaO2)

Normal value: 18–21 ml/dl

Milestones in Urology

1792-1867: Jean Civiale was a French surgeon and urologist, who invented a surgical instrument, the lithotrite in 1823 and performed transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen (lithotomy).

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)


To determine lithium levels in the blood in order to maintain a therapeutic level or to detect lithium toxicity.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Ramipril MR capsule 10mg

For the treatment of hypertension/ cardiac failure and myocardial infarction



Public Forum (Press Release for use by the newspapers)

Expanding waistline associated with lower urinary tract symptoms in older men

Until now the phrase ‘longer the waistline, shorter the lifeline’ was linked to high blood pressure, diabetes and heart attack in both men and women. Abnormal waist size was traditionally considered as one component of metabolic syndrome which signifies an elevated risk for cardiovascular risk. But new data has shown that an expanding waistline in older men is also associated with worsening lower urinary tract symptoms and poor sexual functions.

Quoting Dr Kaplan of American Urologists Association, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, said that prostate volume, PSA level, voiding symptom score, erectile dysfunction and ejaculatory dysfunction increase as waist size increases, indicating that increasing waist circumference is associated with worsening male health.

Dr. Aggarwal said that waist circumference in Asian males should be less than 35 inches and in women lower than 32 inches.

Readers Responses

  1. Dear Dr Aggarwal, Great Medinews bulletin. Lots of new and current information. Keep it up. Regards: Rakesh Thakur

  2. I want to share my suffering with everyone. Ii had a car accident on March 2007, there by I had trauma in my right hip joint. Since that time i have constant pain in the groin region. Not even a single orthopedic surgeon could diagnose it as they took it very lightly. Second time i again suffered from great trauma at the same place in 2008 March. The pain got worst i got MRI done in September 2009. The report said AVN? and traumatic osteoarthritis. i was kept on the line of treatment of Sciatica for 8 months without any relief. I got my digital X–Ray done in March 2010 which showed AVN and end stage of necrosis which require Hip joint replacement. Had i been diagnosed early i would have avoided heavy wt. lifting and staircases i would have saved my Hip joint transplant. We the medical fraternity must update our knowledge, be compassionate and leave our ego to diagnose our cases properly. Despite giving proper history of trauma and pain in groin no one could diagnose it in time as a case of AVN. Thanks Sneh Jain: snehlata_jainus@yahoo.com:

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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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