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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

24th MAy, 2010, Monday

The pharma doctors clause in the Medical Council of India needs revision.

Dear Colleague

The clause 6.8 in the Medical Council of India prohibits doctors practically to have any relationship with the pharma industry. The new act even prohibits young doctors receiving educational grant for updating their knowledge from the pharma or related healthcare industry.

The original Medical Council of India Act was made at a time when doctors were not treated under Consumer Protection Act but once it has been made clear that doctors are under Consumer Protection Act, the whole MCI Act may have to be restudied and rewritten.

Under the Consumer Protection Act, a patient is a consumer and hence a doctor can be equated to a shopkeeper and the clinic a shop. When the patient has the right to file a case like a consumer then doctor also should have all the rights of a shop owner.

How can advertisement and promotional activities be not allowed then? A shopkeeper is allowed to choose a particular product from amongst the competitive market and be paid incentives for the same.

I am conscious that many of you reading this may feel offended as none of us wants to be compared with a shopkeeper and our clinic with a shop. But this is the only way we can pursue the policy makers either to withdraw Consumer Protection Act from the medical profession or allow all promotional and marketing avenues for the medical professionals. After all, all medical establishments are allowed advertisement and promotional activities. Most of the hospitals in any city have a full fledged marketing department to market doctor's services, pay commissions officially by cheque and advertise openly.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file)

Kaun Banega Healthy Crorepati 

Replication of famous game shows is a sucessful module that is tested through time by Heart Care Foundation of India (HCFI). Dr. K. K. Aggarwal introduced this concept and consequently many poppular game shows have been replicated and used by HCFI for health awareness. In the photo Ex-CBI Director Mr. Joginder Singh, can be seen playing “Kaun Banega Healthy Crorepati” with Dr. K. K. Aggarwal

Dr k k Aggarwal

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

Changes in UpToDate recommendations for cervical cancer screening

Screening for cervical cancer to be initiated no earlier than age 21, regardless of the age of initiation of sexual activity. We also now suggest that Pap smear screening in average risk women less than 30 years old be initiated at intervals of one to two years, lengthening the screening interval to two to three years after three consecutive negative smears or at age 30, whichever comes first.
(Sawaya GF. Cervical-cancer screening -- New Guidelines and the Balance between Benefits and Harms. N Engl J Med 2009; 361:2503.)


Mnemonics of the Day (Dr Prachi Garg)

Macrocytic Anaemia - Remember the sentence 'Macrocytic Anemia Leaves Big Fat Reticulocytes'

  • Myxoedema
  • Alcohol
  • Liver disease
  • B12 deficiency
  • Folate deficiency
  • Reticulocytosis

News and Views (Dr Monica and Brahm Vasudeva)

1. Study finds association between malathion and ADHD in children

Children with higher malathion levels in their urine appear to be at a greater risk of attention-deficit/hyperactivity disorder (AD/HD), according to a study published in the journal Pediatrics.

2. Migraines may be linked to increased risk for cardiovascular events

Recent research has linked migraines with other health problems and they may even increase the chances of strokes, heart attacks, and other serious illnesses.

3. High-fat meals - latest in the list of asthma triggers

An Australian study has found that high-fat meals may increase inflammation and reduce lung function in patients with asthma. The typical triggers include exercise, allergies, and smoking, which can bring on an asthma attack by increasing airway inflammation.

Nonalcoholic fatty liver disease found in obese youth

A cross-sectional analysis has found nonalcoholic fatty liver disease (NAFLD) nearly 1 in 5 of 156 obese children and young adults aged 5-20 years. More than half of the males aged 16-20 years had NAFLD. The study findings were presented at the annual meeting of the American Association of Clinical Endocrinologists. This was the first study to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in obese children by sex and age. The results point out that liver function tests should be considered in obese children with dyslipidemia and/or insulin resistance

Quote of the day (Dr Santish Sahi)

Your sense of humour is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health. (Paul E. Mc Ghee)

Question of the Day

What is the First Aid in bronchial asthma? Dr (Mrs) Kiran Vinayek, Dr Vikram Vinayek

Bronchial Asthma ia an inflammatory disorder characterised by fluctuating levels of breathlessness and bronchospasm.It has a diurnal variation.its incidence ranges from 0-30% in children. It is more common in boys than girls. Its prevalence is increasing due to increasing urbanization and increase in air pollution. The increasing distribution is also attributed to presence of house dust mites dermatophagoides and increasing affluence. It is more prevalent in developed countries. Asthmatics can swim in heated indoor pools but heavy exercise like mountain climbing in cold climate is not advisable. Asthmatics do not visit their family physician in time due to the fluctuating nature of disease they think it has improved and hence do not seek medical advice. But it is well established that a full blown attack of asthma (status asthmaticus) is fatal and lethal. Bronchoscopy is contraindicated in acute severe asthma.
Peak flow meter recordings and diary maintenance is a must for all asthmatics. Three readings should be taken and the patient should be asked to inhale deeply and exhaled as fast and as hard as possible. The green zone indicates mild asthma that is well controlled, The yellow zone indicates moderate asthma that can be controlled with medicines and the red zone indicates uncontrolled, acute severe asthma i.e. peak expiratory flow rate less than 100 lit/min. First aid of asthma is high flow oxygen and nebulized salbutamol and is treatment of choice. Even in a well-equipped intensive care unit, a full blown attack of asthma may be fatal and thus the family doctor should not be held liable in the case of an eventuality.

May 31, 2010 : World No Tobacco Day

Religions and Smoking

Christianity: Orthodox Christianity welcomes the tobacco free initiative in the hope that its efforts against tobacco will engage the holistic problem and the need to cure the human person. Tobacco is seen in relation to the problem of life as a whole.

eMedinewS Try this it Works

LDL values cannot be accurately calculated when the triglycerides rise above 400. It is important to keep in mind that is higher the triglycerides, lower is the calculated LDL. Thus, be aware that the LDL may be falsely low in the nonfasting state, rather than elevated as is sometimes assumed.

Dr Good Dr Bad

Situation: A diabetic patient on aspirin was to undergo cataract surgery.
Dr Bad: Discontinue aspirin.
Dr Good: Continue aspirin.
Lesson: The 2008 Anticoagulation guidelines from the American College of Chest Physicians (ACCP) recommend that patients on aspirin and who are undergoing cataract removal continue aspirin around the time of the procedure. (Chest 2008;133:299S. )

Make Sure

Situation: A patient was denied rheumatic prophylaxis as IM penicillin was under short supply.
Reaction: Oh my god! Why was he not given oral penicillin.
Lasson: Make sure that all such cases are not denied oral penicillin V.

IMANDB Joke of the Day (Dr Santosh Sahi)

A cute joke to share with readers

A little boy was waiting for his mother to come out of the grocery store. As he waited, he was approached by a man who asked 'Son can you tell me where the Post Office is?'
The little boy replied 'Sure just go straight down the street a couple blocks and turn your right'
The man thanked the boy kindly and said 'I am the new Pastor in town. I do like you to come to the church on Sunday and I'll show you how to get to Heaven.'
The little boy replied with a chuckle 'Awww, come on you don't even know the way to the Post Office?'

Formulae in clinical practice

Oxygen Uptake Index (Vo2I)

Formula: Vo2I = Vo2
BSA (BSA - body surface area)
Normal value = 115-165 (ml/min)/m2

Milestones in Diabetology

1849-1936: I.V. Pavlov, Czech researcher, discovered the links between the nervous system and gastric secretion, making an important contribution to science's knowledge of the physiology of the digestive system.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

H. pylori antibody test

Also referred to as H. pylori antigen test; H. pylori breath test; CLO test; Rapid urease test (RUT) for H. pylori is used to diagnose an infection with Helicobacter pylori that causes peptic ulcers.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Desvenlafaxine (as Succinate) ER Tablets 50mg/100mg

For the treatment of major depressive disorder (MDD)



Public Forum (Press Release for use by the newspapers)

Attack Heart Attack

Heart Attack can be attacked in the first six hours. Heart attack is reversible provided the clot in the heart artery is either dissolved with drugs or removed with angioplasty within 90 minutes of the onset of the heart attack chest pain. Time is, therefore, muscle and efforts should be made that patients with chest pain reach hospitals with facilities for clot managing therapies as soon as the heart attack is suspected.

This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.
Heart Care Foundation of India released the following guidelines for the public:

  1. Any chest pain which can be pinpointed by a finger is not a cardiac pain. Any chest pain which lasts less than 30 seconds is not a cardiac pain.

  2. 3D Echocardiography at the onset of chest pain can help early detection of heart attack.

  3. ECG can be normal in the first 6 hours of acute heart attack.

  4. Chewing water-soluble aspirin 300 mg at the onset of chest pain can reduce chances of death by 20%.

  5. Heart attacks normally occur during early hours of the day.

  6. Sudden death due to heart attack occurs maximally in the first hour of the onset of chest pain.

  7. Primary angioplasty can dissolve clot of the heart attack causing artery and prevent any damage by heart attack.

  8. Primary angioplasty can also be done if the clot-dissolving therapy has not worked.

  9. Sudden death after heart attack is reversible provided it is tackled within 5 minutes. It, therefore, becomes important not to leave the heart attack patients in the first hour and also not to transfer them to another hospital without a medical attendant.

  10. Twenty-five lakh people die in India every year because of heart attack and 18 lakh die before reaching the hospital.

  11. For every 10 cases of heart attacks, four occur in women.

  12. Heart attack in women is more lethal than in men.

  13. Heart attack amongst smokers is more complicated than in non-smokers.

  14. Heart attack in patients with diabetes may come without chest pain.

  15. It is possible to live a normal life after heart attack.

  16. People can enjoy normal sex life after recovering from heart attack or angioplasty.

  17. If a person can climb two flights of stairs or walk 1 km without discomfort, he or she is fit to have normal sexual activity with the partner.

  18. Extramarital sex is more dangerous to the heart as it is in unfamiliar circumstances, places, situations, time and with much younger partner and associated with performance anxiety.

  19. Viagra like drugs should not be taken without cardiologist clearance and also should never be taken with drugs called nitrates.



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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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Readers Responses

  1. Dear Dr. Aggarwal: As I have always commented that you are doing a commendable job with E medinews. It was nice that in your latest edition you have tried to highlight the point about Doctor- Pharma Relationship. You are the right person with the right platform to raise this issue with the six eminent new members of MCI. With this ruling it is the medical education rendered by medical conferences will suffer. The main sufferers will be young doctors, PG's, DM students whose finances do not allow for traveling, registration etc, though they are the persons involved in research and paper presentations thereby improving their CV & future career. Influential doctors will still manage their sponsorship through various means. Whether there is sponsorship or not, every doctor has some soft corner for certain pharma companies. As you know various companies spend millions of rupees for lunches and dinners on their favored products. I feel that families should not be sponsored and a doctor can choose about 2 conferences a year in India for which educational sponsorship can be given by companies. In any case sponsorships will still continue by various means whether it is legal or illegal. In any case your mind is almost 10 times more fertile and imaginative than many of us, so you can be the force behind it with your innovative ideas. Dr. S K Parashar

  2. Dear Editor, Everyone knows that spectacles, contact lenses and refractive surgery are the means to effectively manage errors of refraction like myopia, hypermetroia and astigmatism. But not many of us know that specialised products like Ptosis Spectacles left the drooping upper lid, and Recumbent Prismatic Spectacles allow bed-ridden patients to watch TV and read books more comfortably. Dr. Narendra Kumar

  3. Respected Dr KK, This is the time for introspection for the whole medical community. The times are past when doc was near god. We have to cleanse our own systems, medical institutions, bodies ourselves. OR ELSE we will be GULAMS of the govt, rich, famous people who will come and rule us from the top!!! Lets act now. Manisha Kukreja Bhatla
  4. Dear Dr Aggarwal: I think this is the first ever transparent account on MCI published by emedinews. IMA has till date remained silent as if in grief. Sanjay Dewal

  5. Dear Dr. Aggarwal: I wish to congratulate you for your untiring efforts for updating your readers about latest scientific information. more over you have given information regarding the MCI issue in a impartial way. there are many issues regarding the medical colleges.one important issue is the shortage of teaching faculty.few years ago a GO was issued by the HRD raising the age of retirement to 65 and age for reemployment to 70 yrs.It has been followed by central universities and dental council.However the MCI is keeping it pending for years for the reasons best known to its president.Once MCI follows this, it will take care of crisis of staff shortage at least up to some extent. Prof MAM CHANDRA, Retd Prof.& HOD Medicine CSMMU, Lucknow, (King Georges Medical University Lucknow)

  6. Respected Dr.Aggarwal, I agree with your opinion about need of more medical colleges in India, and BRMS is not going to be a solution.I think everythings boils down to money spent in the right way.It's sad to know that our Govt is ready to invest a huge sum of money on BRMS, and hardly cares for investing money in upgrading/upskilling available manpower. Dr Neeraj Gupta