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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 ...

22nd December, 2010, Wednesday

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

Medscape Top 10 in Psychiatry 2010

  1. A new diagnostic entity in DSM–5?
  2. Child Psychiatry
    • Is bipolar disorder overdiagnosed in children and adolescents: a virtual debate
    • can a child’s birthday predict ADHD?
  3. Senate approves last–minute delay for medicare pay cuts
  4. Psychologist’s prescribing: a threat or a promise?
  5. Pharmacotherapy for borderline personality disorder
  6. FDA warns of aseptic meningitis risk with lamotrigine
  7. Unintentional drug poisoning deaths: a national epidemic
  8. Effectiveness of second–generation antipsychotics
  9. House enacts historic Healthcare Reform Bill
  10. What is bizarre in bizarre delusions? a critical review
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr. GM Singh)

"The greatest inspiration is often born of desperation"

Comer Cotrell

    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela

Children with special needs performing in the Anmol Festival.

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

India loses Rs 24,000 cr annually due to lack of toilets, hygiene: World Bank

The Indian economy loses nearly $54 billion (around Rs 24,000 crore) annually due to lack of toilets and poor hygiene, a World Bank study said on Monday. In a study ‘Economic Impact of Inadequate Sanitation in India’, conducted by its South Asia Water and Sanitation unit, the multilateral body said premature deaths, treatment for the sick and loss of productivity and revenue from tourism were the main factors behind the significant economic loss. "For decades, we have been aware of the significant impacts of inadequate sanitation in India," Christopher Juan Costain, the World Bank’s head for South Asia’s water and sanitation programme, told reporters. The cost of treatment for diseases due to poor hygiene was estimated at $38.5 billion (over Rs 17,000 crore). (Source: The Times of India, Dec 21, 2010)

    International News

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

Deceitful appearances

The Montreal Gazette points out overweight people who exercise may be healthier than skinny people who do not. The idea, the newspaper reports, dates back to 1999. In the ‘99 study, 22,000 men were put through a treadmill test. Overweight men who performed well on the treadmill test lived longer than lean men who performed poorly. We all know weight loss is an important goal for health club members. However, let this serve as a healthy reminder that cardiovascular health – rather than weight loss – may be the key to longevity.

(Dr Monica and Brahm Vasudev)

Somatotropin safe enough for now

The European Medicines Agency will pursue a review of growth hormone safety. The announcement came after the agency’s Committee for Medicinal Products for Human Use reviewed more details of a French registry study that suggested increased death rates among adults who had taken somatotropin agents as children for growth hormone deficiency or idiopathic or gestational short stature.

FDA declines to approve ticagrelor

The novel antiplatelet drug ticagrelor has failed to win FDA approval. AstraZeneca announced late Thursday that it had received a complete response letter from the FDA, requesting additional analyses of data from the product's pivotal clinical trial, called PLATO.

Visceral adiposity may contribute to the risk for estrogen receptor–negative breast cancer

Visceral adiposity may contribute to the risk for estrogen receptor–negative breast cancer in premenopausal women. The hazard ratio for this type of breast cancer for women in the highest quintile of waist circumference was 2.75 compared with those in the lowest quintile, according to Karin B. Michels from Harvard University in Boston. (Journal of the National Cancer Institute)

    Infertility Update

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

What is Intrauterine insemination

The IUI procedure consists of washing an ejaculated semen specimen to remove prostaglandins, concentrating the sperm in a small volume of culture media, and injecting the sperm suspension directly into the upper uterine cavity using a small catheter threaded through the cervix. The insemination is timed to take place just prior to ovulation, typically using home urine luteinizing hormone (LH) measurement. In couples with mild male infertility, IUI does improve pregnancy rates in couples when compared to intracervical insemination or timed natural cycles.

For queries contact: banerjee.kaberi@gmail.com

    Medicine Update

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

How do we diagnose Galactosemia?

Diagnosis is made by demonstration of reduced or absent activity of the enzyme galactose–1–phosphate uridyl transferase (GAL–1–PUT) which is central to galactose metabolism. This test is invalid if the child has received a blood transfusion within previous 2 months. Parents’ samples should be sent instead for carrier testing.

    Medicolegal Update

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

Errors in diagnosis of Death?

  • Generally, there is no difficulty in the diagnosis of somatic death by the doctors. However, in some cases the heart sounds and breath sounds diminish greatly. Errors occur if proper clinical examination is not done or hurriedly done in patients with kidney failure and Cheyne–stokes respiration etc. Nevertheless, there are occasions when the distinction between death and suspended animation poses a real difficulty.
  • Suspended animation is a death like state in which vital functions of the body are at such a low pitch that they cannot be determined by ordinary methods of clinical examination.
  • Practitioners of yoga can induce this death like state voluntarily.
  • It can be involuntarily due to: (i) Severe shock following accident. (ii) Electrical shock. (iii) Poisoning (barbiturate). (iv) Drowning. (v) Epilepsy (vi) Sunstroke (vii) Cholera, and (viii) Hysteria.
  • Suspended animation lasts for seconds to hours and by ordinary clinical methods, distinction is not possible. However. methods like ECG and EEG can be used to reach a diagnosis.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publisher)

    ENT Update

Dr. Aru Handa MS, DNB (Department Co–coordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

What are the symptoms of unsafe type of ear infection?

Patients with unsafe chronic suppurative otitis media (CSOM) have scanty, persistent foul–smelling discharge which may or may not be blood stained. Hearing loss may be variable depending on the extent and site of the disease. Patients may present late because of scanty discharge and minimum hearing loss thus delaying the diagnosis.

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q: Some forensic medicine faculty members have written to the Health Minister protesting against the move to allow professors to work till the age of 70 years on the ground that this would lead to unemployment in the specialty because young aspirants would not be able to get appointed as lecturers. What are your comments from a legal perspective?
There is no point writing to the Health Minister on the above lines because of the following reasons:

  • The retirement age of the faculty in universities is determined as per rules made by the HRD Ministry/UGC.
  • The proposal to increase the retirement age emanates from the university teachers themselves.
  • There is an acute shortage of senior faculty in higher education everywhere, including the fields of medicine, engineering, management and law etc. The proposal will help meeting this shortage.
  • Even otherwise, when judges can be appointed for life in the USA and politicians can hold the office of MP and minister till their nineties, there is no reason why professors should be denied the opportunity to continue in service till the age of 70 years.
  • There is no legal guarantee that everybody who gets an MD degree would get a faculty job.
  • Everybody enjoys a constitutional freedom under Article 19(g) "to practice any profession or to carry on any occupation, trade or business". Everybody who gets an MD degree need not and cannot become a lecturer. There is no question of the younger generation being deprived of any legitimate job opportunities. Nothing prevents a doctor from being self employed/starting his own practice.

The letters written by the forensic medicine specialists to the health minister show that they have very poor knowledge of law and the constitution even though they claim to be great legal experts by virtue of having the degree of MD in Forensic medicine and Toxicology.

    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Indian context: is Bolam test applicable?

In India, Bolam test has broadly been accepted as the general rule.

  • The skill of Medical practitioners differs from doctor to doctor.
  • The nature of the profession is such that there may be more than one course of treatment, which may be advisable for treating a patient.
  • Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution.
  • Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the Medical profession and the court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.
  • In cases where the doctors act carelessly and in a manner, which is not expected of a Medical practitioner, then in such a case an action in torts would be maintainable.
  • A doctor will be liable for negligence in respect of diagnosis and treatment in spite of a body of professional opinion approving his conduct where it has not been established to the court’s satisfaction that such opinion relied on is reasonable or responsible. Thus, if it can be demonstrated that the professional opinion is not capable of withstanding the logical analysis, the court would be entitled to hold that the body of opinion is not reasonable or responsible.
  • The approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties. In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services.
  • The American view, as illustrated in the popular case of Canterbury does not find mention in the cases which relied on the bolam test as explained above.

Ref – Achutrao Haribhau Khodwa v. State of Maharastra MANU/SC/0600/1996, In Vinitha Ashok v. Lakshmi Hospital MANU/SC/0583/2001, this Court after referring to Bolam, Sidaway and Achutrao, clarified: In Indian Medical Association v. V.P. Shantha MANU/SC/0836/1995, this Court held: Neither Achutrao nor Vinitha Ashok referred to the American view expressed in.

   Ethical earning   

What is reimbursable to a doctor?

One can charge separately for plaster removal.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests for Pancreatitis

Serum Amylase: Increases from 2 to 12 hours after symptoms and peaks at 12 to 72 hours. It may rise to 5 to 10 times the normal level and will usually return to normal within a week.

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

Q. Is there any provision if a doctor fails to file the return within the time limit?

Ans. A doctor can file a belated return within a year from the assessment year or before the assessment is completed, whichever is earlier.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Olopatadine Hcl Nasal Spray 0.6% w/w (Additional Indication) For the relief of the symptoms of seasonal allergic rhinitis in patients 6 years of age and older.
    IMSA Update

International Medical Science Academy (IMSA) Update

Ankylosing spondylitis and interleukins

The increased serum IL–17 and IL–23 levels in ankylosing spondylitis (AS) patients found in a preliminary suggest that these two cytokines may play critical roles in the pathogenesis of AS.

(Ref: Mei Y, et al. Increased serum IL–17 and IL–23 in the patient with ankylosing spondylitis. Clin Rheumatol. 2010 Dec 17. Epub ahead of print)

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady died.
Dr Bad: Declare her dead.
Dr Good: Deliver the infant within 5 minutes.
Lesson: "Five minute rule", the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within five minutes of maternal cardiac arrest.

Make Sure

Situation: A rape victim became pregnant.
Reaction: Oh my God! Why was emergency contraceptive not given to her?
Lesson: Make sure that all victims of rape are given an emergency contraceptive.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The Horse that wanted more beauty

A cosmic god had a horse. The horse was beautiful and also it had many good qualities. But it wanted to be more perfect in every way. It especially wanted to become beauty unparalleled. One day the horse said to the cosmic god, "O Lord, you have given me beauty. You have given me other good qualities. I am so grateful to you. But how I wish you could make me more beautiful. I would be extremely, extremely grateful if you could make me more beautiful." The cosmic god said, "I am more than ready to make you more beautiful. Tell me in what way you want to be changed."

The horse said, "It seems to me that I am not well proportioned. My neck is too short. If you can make my neck a little longer, my upper body will be infinitely more beautiful. And if you can make my legs much longer and thinner, then I will look infinitely more beautiful in my lower body." The cosmic god said, "Amenl" Then immediately he made a camel appear in place of the horse. The horse was so disheartened that it started to cry, "O Lord, I wanted to become more beautiful. In what way is this kind of outer form more beautiful?" The cosmic god said, "This is exactly what you asked for. You have become a camel."

The horse cried, "Oh no, I do not want to become a camell I wish to remain a horse. As a horse, everybody appreciated my good qualities. Nobody will appreciate me as a camel."

The cosmic god said, "Never try to achieve or receive more than I have given you. If you want to lead a desire–life, then at every moment you will want more and more. But you have no idea what the outcome will be. If you cry for a longer neck and legs, this is what will happen. Each thing in my creation has its own good qualities. The camel is not as beautiful as you are, but it carries heavy loads and has a tremendous sense of responsibility.


Mind Teaser

Read this…………………

To rn

Yesterday’s Mind Teaser: "sleeping Job"
Answer for yesterday’s Mind Teaser: Sleeping on the job.

Correct answers received from: Dr KP Rajalakshmi, Dr Sudipto Samaddar, Dr Alok Gupta, Dr Rohini Vaswani, Dr.G.Padmanabhan, Dr. Anupam Sethi Malhotra, Dr Muthumperumal Thirumalpillai, Dr. Rajiv Dhir, Dr T Samraj, Dr.Asim Kumar Sen, Dr.K.Raju, Dr.K.V.Sarma, Dr.Harimohan Goel

Answer for 20th December Mind Teaser: "dont underestimate me"
Correct answers received from: Dr (LtCol) Gopal Agarwal, Dr Avdhesh Shukla, Dr U Gaur, Dr Rashmi Chhibber, Dr S Upadhyaya, Dr Neelam Nath, Dr Anurag Jain, Dr Vijay Kansal, Dr Arvind Khanijo, Dr KP Rajalakshmi, Dr.Satish Gunawant, Dr.Asim Kumar Sen, Dr.Satish Gunawant, Dr Sudipto Samaddar, Dr.S.K.Bansal, Dr Shirish Singhal, Dr Joshi sachin  

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr Chandresh Jardosh)

Installing Husband!

A woman writes to the IT Technical support……

Dear Tech Support,

Last year I upgraded from Boyfriend 5.0 to Husband 1.0 and I noticed a distinct slowdown in the overall system performance, particularly in the flower and jewellery applications, which operated flawlessly under Boyfriend 5.0. In addition, Husband 1.0 uninstalled many other valuable programs, such as Romance 9.5 and Personal Attention 6.5,and then installed undesirable programs such as NEWS 5.0, MONEY 3.0and CRICKET 4.1.

Conversation 8.0 no longer runs, and Housecleaning 2.6 simply crashes the system.

Please note that I have tried running Nagging 5.3 to fix these problems, but to no avail. What can I do?




DEAR Madam,

First, keep in mind, Boyfriend 5.0 is an Entertainment Package, while Husband 1.0 is an operating system.

Please enter command: I thoughtyoulovedme. html and try to downloadTears 6.2 and do not forget to install the Guilt 3.0 update. If that application works as designed, Husband1.0 should then automatically run the applications Jewellery 2.0 and Flowers 3.5.

However, remember, overuse of the above application can causeHusband1.0 to default to Silence 2.5 or Beer 6.1. Please note that Beer 6.1 is a very bad program that will download the Snoring Loudly Beta.

Whatever you do, DO NOT in any circumstances install Mother–In–Law 1.0 (it runs a virus in the background that will eventually seize control of all your system resources.) In addition, please do not attempt to reinstall the Boyfriend 5.0program. These are unsupported applications and will crashHusband 1.0.

In summary, Husband 1.0 is a great program, but it does have limited memory and cannot learn new applications quickly. You might consider buying additional software to improve memory and performance.

We recommend: Cooking 3.0 and Good Looks 7.7.

Good Luck Madam

    Readers Responses
  1. Sir, I really thank you for your regular magazine with balanced proportion of medical information. I find it interesting and informative especially the columns – Medicolegal Update, Legal question of the day and Medilaw as most of us are not aware of these facts. In fact, even in my busiest daily schedule I feel like spending some time on this magazine routinely. It is quite recommendable to all the doctors. Dr. B.V. Sai Chandran, MCh, DNB, Asst. Professor, Dept. of Cardiothoracic & Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry (U.T.) – 605006
    Public Forum

(Press Release for use by the newspapers)

Women above 65 should take extra care of their health

Women aged 65 and above should routinely take low–dose aspirin to prevent heart attack and paralysis, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

  1. All women should exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate–intensity activity on most, or preferably all, days of the week.
  2. A heart–healthy diet should be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
  3. Saturated fats should be reduced to less than 7 percent of calories.
  4. Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL. Otherwise, high–risk women are still encouraged to lower their LDL to less than 100 mg/dL.
  5. Women aged 65 and over should consider taking low–dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group.
  6. Women under 65 should not be taking aspirin routinely, as it has been shown only to have a benefit for stroke prevention.
  7. The upper dose of aspirin for high–risk women is 325 mg per day.
  8. Neither hormone replacement therapy, selective estrogen receptor modulators or antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
  9. Folic acid should also not be used to prevent cardiovascular disease.
  10. Women should eat oily fish or some other source of omega–3 fatty acids at least twice a week.
  11. Women should not only quit smoking but should use counseling, nicotine replacement or other forms of smoking cessation therapy.
    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.

The one–day conference will revisit and cover all the new advances in the year 2010. There will also be a webcast of the event. The eminent speakers will be Padma Bhushan 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, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

2nd eMedinewS Doctor of the Year Award

Dear Colleague, The Second eMedinews Doctor of the Year Award function will be held on 9th January, 2010 at Maulana Azad Medical College at 4 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2010, send his/her biodata: Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee.

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