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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 ...

23rd November 2010, Tuesday

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

Early hemodialysis initiation may be harmful to patients (ACP Internist)

An observational study in Nov issue of Archives of Internal Medicine included more than 20–40 years old 80,000 non diabetic hemodialysis patients with no co–morbidities other than hypertension. The patients were divided by their eGFR (mL/min/1.73 m2) at initiation of dialysis. Among patients with eGFR value below 5, the one–year mortality was 6.8%. In the highest eGFR group (>15) the mortality rate was 20.1%. After adjustment and compared with the lowest eGFR group, patients starting with a eGFR of 5.0 to 9.9 had a 23% increased risk for mortality over two years, while those with an eGFR between 10 and 15 had a 47% increased risk and those with an eGFR over 15 had a 74% risk. The researchers also found the same increased mortality risk even in the healthiest patients, who had serum albumin above 3.5 g/dL.

The possible mechanisms are myocardial ischemia and stunning and changes resulting from fixed systolic dysfunction induced by hemodialysis. Initiation of hemodialysis should not be based on an arbitrary level of eGFR or serum creatinine level unless this measure is accompanied by definitive end–stage renal failure–related indications. Current guidelines recommend that dialysis be started when eGFR falls below 10.5 and the average eGFR and serum creatinine of patients initiating dialysis have increased substantially over the last 15 years. Changing practice guidelines suggest starting dialysis only when patients' symptoms are worse than the side effects of dialysis are likely to be.  

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr. G.M.Singh)

"The greatest conqueror is he who overcomes the enemy without a blow."

Chinese Proverb

    Photo Feature (from the HCFI Photo Gallery)

Anmol 2010

Children with special needs performing on the stage during Anmol – Festival for Children with Special Needs in the recently concluded 17th MTNL Perfect Health Mela

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

New agency to network medical research

The Centre will form an inter agency network which will identify institutions doing medical research across the country and help them establish infrastructure on their campuses. "This will help us promote research in the field of medicine and help produce more PhDs. Currently the number of PhDs in the field of medical research in the country is only a few hundreds which is pathetic, given the size of our country," said T Ramasami, secretary, department of science and technology, Government of India. (Source: The Times of India)

Scheme for adolescent girls launched

Union Home Minister P. Chidambaram on Friday launched a special scheme for the well–being and overall empowerment of adolescent girls. The scheme has been launched as a pilot project in 200 most backward districts. ‘Sabla’ or the ‘Rajiv Gandhi Scheme for Adolescent Girls’ would be launched in 22 districts of Uttar Pradesh, 15 in Madhya Pradesh, 12 each in Bihar and Sikkim, 11 in Maharashtra, and 10 in Rajasthan. To be based on the Integrated Child Development Services platform, the scheme would address the nutritional and special training aspects of girls aged 11–18. (Source: The Hindu)

    International News

(Dr Monica and Brahm Vasudev)

Latex is everywhere

According to the U.S. National Library of Medicine, the following products frequently contain latex:

  • Disposable medical gloves
  • Condoms
  • Balloons and rubber bands
  • The soles of many shoes
  • Infant and toddler pacifiers

Treating heart attack with fat–derived stem cells may be safe in humans

Fat cells obtained from liposuction from a patient’s belly can safely boost heart function after a heart attack, according to a first–of–its–kind study presented at the American Heart Association’s Scientific Sessions 2010. These findings were reported by Eric (HJ) Duckers, M.D., Ph.D., lead author of the small study and head of Molecular Cardiology Laboratory at the Thoraxcenter, Erasmus University Medical Center in Rotterdam, Netherlands. With the patients’ consent, researchers liposuctioned 200–250 cubic centimeters of fat from the abdomen of each, using a system called Celution 800 device (Cytori Tx). They isolated 20 million regenerative stem cells from the fat cells, which took nine to 10 minutes to infuse.

Higher dose of anti–clotting drug no better than standard dose for high risk patients with drug–coated stents

Compared to the standard dose, a high dose of Clopidogrel did not reduce the incidence of death, heart attack or blood clots inside of stents in certain high–risk patients who have had drug–coated stents implanted to open blocked arteries, according to late–breaking clinical trial results reported at the American Heart Association’s Scientific Sessions 2010.

Death of spouse, child may cause higher heart rate, other dangers

The death of a spouse or child can cause elevated heart rate and other potentially harmful heart rhythm changes among the recently bereaved.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

Q. We have been trying for a baby for three years and I was diagnosed as having endometriosis. Will a test–tube baby treatment solve my problem?

A. IVF is the treatment of choice in women with severe or moderate endometriosis. However, depending on the severity of the endometriosis, surgery, intrauterine insemination can also be used.

Q. We were told that we need IVF treatment. What is our chance of achieving a live birth?

A. The overall live birth rate per treatment cycle is in the region of 20–30%.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

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

How and when does Alagille’s present?

Jaundice, a yellow coloring of the white of the eyes and then the skin, is usually the first sign. It mostly occurs before 6 months of age but sometimes is not noticed up to the age of 3 years.

    Medicolegal Update

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

Admission and discharge of a person admitted as a medicolegal case

Issuance of the discharge certificate is the mandatory duty of the treating doctor; failure to do so renders the doctor liable for "negligence" and "deficiency of service

A medicolegal case should be registered as soon as a doctor suspects foul play and the same is applicable on later stage of admission or even if it is brought after several days of the incident.

In some cases, I have found that the patient was admitted in hospital as non MLC but later on after admission of the patient the case required to be converted as MLC and the police was informed. This duty should also be extended in cases of discharged patient. The nearest police station must be informed at the earliest whenever there is an admission, death or discharge of a medicolegal case and a medicolegal register should be maintained with necessary entries of patient details. While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge.

In N. K. Kohli v Bajaj Nursing Home, the Madhya Pradesh State Consumer Disputes Redressal Commission said that "issuance of the discharge certificate is the mandatory duty of the treating doctor and the Nursing Home/ Hospital and the non–issuance of the same amounts to grave negligence and deficiency in service on the part of the doctor and the hospital." If the patient is not serious and can take care of himself, he may be discharged on his own request; after taking in writing from him that he has been explained the possible outcome of such a discharge and that he is going on his own against medical advice. Police have to be informed before the said patient leaves the hospital. Sometimes the patient, registered as a medico–legal case, may abscond from the hospital. The police should be informed immediately, the moment such an instance comes to the notice of the doctor/ hospital staff.

    Interesting Websites to know

Dr Jitendra Ingole, MD Internal Medicine, Asst Professor (Medicine), SKN Medical College, Pune


Westby G. Fisher, MD
Cardiologist, Evanston, Illinois

Frequent topics: Healthcare reform; advances in heart disease treatments and technologies.
Why you should read it: To stay updated on the latest therapies for the leading killer of women and men.
Sample dose: "(A) doctor's time with a patient is finite. For every click on a computerized quality check-box, we're stealing from time...with the patient.... (O)ur governmental overlords have consistently swollen the number of 'quality measures' from 74 in 2007, (to)119 in 2008,(to)153 in 2009, to a whopping 179 in 2010. I figure...we will have about 319 measures by 2014.... And the government will be proud we're providing such 'quality care.' Click. Click. Click."

    Legal Question of the Day

(M C Gupta, MD (Medicine), LL.M., Ex-Professor and Dean, Practicing advocate, mcgupta44@gmail.com)

Q: Are there any likely legal consequences if a doctor takes a photograph of a patient or hospital / faculty staff without permission and displays it during a presentation in a class room or conference or CME program etc.?

A: In certain situations, even taking a photograph of somebody without permission can be a crime in itself. If a photograph of a person taken without permission is displayed publicly without permission, such person would be definitely entitled to take the following legal actions, besides others:

  • Civil suit for defamation/breach of privacy in a civil court asking for monetary compensation.
  • Criminal suit for defamation/breach of privacy in a criminal court asking for punishment/jail to the defendant.
  • Complaint to the medical council for disciplinary action against the doctor for violation of Regulation 7.17 of the Indian Medical Council (Professional conduct, Etiquette and Ethics), if the presentation concerned is published, along with the photograph concerned, in any medical or other journal (which would include the conference proceedings/souvenir etc.).

Regulation 7.17
"7.17 A registered medical practitioner shall not publish photographs or case reports of his/her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Called anti-cyclic citrullinated peptide antibody

  • To help diagnose rheumatoid arthritis (RA) and differentiate it from other types of arthritis
  • To help evaluate the prognosis of a patient with RA
    Medi Finance Update

What is the tax implication in case of repayment of loan taken from a bank for doing post graduate course in medicine (Installment  50,000, Interest  10,000)?

A. Only the interest amount is allowed to be deducted under Section 80E ( 10, 000/–).

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification


    IMSA Update

International Medical Science Academy (IMSA) Update

Autism spectrum disorders

In a cohort of patients with autism spectrum disorders (ASD), chromosomal microarray (CMA) identified significantly more abnormalities than karyotype or fragile X testing. Children diagnosed with ASD should undergo CMA testing in addition to high–resolution karyotype and DNA analysis for fragile X syndrome.

(Ref: Shen, Y, Dies, KA, Holm, IA, et al. Clinical genetic testing for patients with autism spectrum disorders. Pediatrics 2010;125:e727).

    IJCP Special

Dr Good Dr Bad

Situation: A patient on ACE inhibitors wanted to know whether he could take aspirin.
Dr. Bad: No, you cannot take aspirin.
Dr. Good: It can be given if it is a must.
Lesson: Though some evidences suggest that aspirin inhibits the acute affect of ACE inhibitors, most of the evidence do not support an inhibitive affect of aspirin on the long term outcome of ACE inhibitors.

Make Sure

Situation: A patient with suspected heart attack with blood pressure of 40 mm Hg with warm peripheries died.
Reaction: Oh my God! Why was a diagnosis of anaphylaxis not considered?
Lesson: Make sure all patients with warm shock are managed on the lines of sepsis or anaphylaxis. Heart attack will have cold shock.

    Lighter Side of Reading

An Inspirational Story

(Contributed by Major V V Narayanan)

The Art of Giving

When should one give?

We all know the famous incident from Mahabharata. Yudhisthira, asks a beggar seeking alms to come the next day. On this, Bhim rejoices, that Yudhisthira his brother, has conquered death, for he is sure that he will be around tomorrow to give. Yudhisthira gets the message. One does not know really whether one will be there tomorrow to give!

The time to give therefore is now.


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: "cover cop"
Answer for yesterday’s Mind Teaser:
"under cover cop"

Correct answers received from: Dr. K.V.Sarma, Dr Sudipto Samaddar, Dr Avdhesh Shukla, Dr. Rajiv Dhir, Dr S. Upadhyaya, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr.K.Raju, Dr. Anjani,  Dr Rajiv Kohli, Dr Deepti Katyal Uppal, Dr Prabha Sanghi, Dr. Naorem Sharat, Dr. Anupam Sethi Malhotra

Answer for 21st November Mind Teaser: "underwater basket weaving"
Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr.K.Raju,  Dr. Rohini Vaswani

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr GM Singh)

Doctor, Doctor My little boy has just swallowed a roll of film!

Hmmmm…Let’s hope nothing develops.

    Readers Responses
  1. Dear Dr KK, I wish to add some more points to your deliberation on hypothermia.
    a.  Hypothermia can be systemic or localized (e.g. frostnip, frostbite and non freezing injuries). Frostbite and non freezing injuries are best treated by submersing the affected part in water which is maintained at a constant temperature of 40 degrees centigrade, ideally in a whirlpool tank, with ongoing ECG monitoring.
    b. Systemic hypothermia can set in rapidly as in immersion or slowly as in spending time in cold environments.
    c.  Systemic hypothermia in the setting of trauma is to be considered at temperature of ≤36 degrees C and is considered severe if temperature drops below 32 degree C with a trauma setting.
    d.  Active core rewarming techniques are many times needed in severe hypothermia and include warm peritoneal lavage, thoracic or pleural lavage, arteriovenous rewarming and cardio-pulmonary bypass.
    Regards, Dr Vivek Chhabra, Specialty Emergency Physician, James Paget University Hospital, UK.
    Public Forum

(Press Release for use by the newspapers)

November is Diabetes Awareness Month: Diabetes is Preventable

Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India said that diabetes can be prevented. With proper risk factor management it is possible to get rid of both insulin and drugs in type 2 diabetes. Type 1 diabetes requires life–long insulin treatment.

Type 2 diabetes is due to a faulty lifestyle and the resultant insulin resistance can be prevented.

For this, drastic changes in lifestyles need to be done, starting with improved diets and more exercise, to avoid type 2 diabetes in the first place.

Type 2, or what used to be called adult-onset diabetes, occurs when either the body does not produce adequate amounts of the hormone insulin or the cells ignore the insulin. The body needs insulin to transport sugar in the blood to cells for energy. Being overweight, eating an unhealthy diet, and lack of exercise are common contributors to this form of the disease. However, even small steps –– standing more often during the day or walking during a lunch break or eating an apple instead of ice cream –– can help make a difference.

Tips to prevent diabetes

  • Do not eat white refined carbohydrates.
  • Eat less at a time.
  • Work out at least 30 minutes a day.
  • Eat green bitter vegetables in plenty
  • Eat a high fiber diet
  • Do not eat trans fats in food.

These simple messages are being put up and conveyed to the public via playing games at the ongoing India International Trade Fair, where Heart Care Foundation of India has set up stall at the Ministry of Health and Family Welfare Pavilion. The trade fair is being held until the 27th of this month.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant
Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 – 9.30 AM:
Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Medicity
9.30–10.00 AM: Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
10.00–10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30–11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion

1. Dr. (Prof.) S C Tiwari
2. Dr. K K Aggarwal
3. Dr. S V Kotwal
4 .Dr. Ambar Khaira
5. Dr. Saurabh Misra
6  All Speakers

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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