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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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


26th June, 2010, Saturday

The Need Is To Unite And Not To Divide The Profession
High Court Appoints Justice S K Aggarwal as the IMA Elections Observer

Dear colleague,

You are all aware that I have devoted over 2 ½ decades of life for the profession. I at different points of time have also served the profession in responsible positions to the best of my ability. I have over the last many years actively contributed to the Indian Medical Association for the larger interest of the medical profession and the citizens of India. When I was awarded the Padmashri this year, I took it as recognition not for myself individually but for the entire medical profession. Over the past few years, I have held responsible positions at the national headquarters of India Medical Association including serving as the Chairman of IMA Academy, National Finance Secretary and the Director, IMA AKN Sinha Institute. At the state level, I had served as the President of Delhi Medical Association and tat of New Delhi Branch. My contributions to the profession in all these assignments is well known and something that I am proud of.


Few weeks back, I went to the Central Working Committee meeting of IMA organised in Gujarat. As an immediate Past Director of IMA AKM Sinha Institute and a recent recipient of Padmashri, I thought that I could contribute positively to chalk out proactive actions in the medical profession at an hour when the medical profession is passing through very troubled waters. This is a time when the entire profession should stand united to carve out a path of honesty, transparency and bold positive working. The image of the profession is at its lowest ebb. All of us owe it to our dear profession that we should take bold and honest stand so that the long tarnished image of medical profession could be improved. Also, our voice on pertinent and important issues should be heard with due respect.

However, I was surprised, stunned and demoralized to see that some WC members ensured a non-welcome approach towards my presence. Leave aside recognizing the fact that I was the only doctor present who was recently conferred the Padmashri, some vested interests were trying to give an impression that my presence at Central Working Committee was unwanted. It is clear and apparent that some individuals from Delhi who have been holding the office at IMA headquarters have always tried to ignore and shun other colleagues and the majority opinion of Delhi doctors. Probably, they felt that my presence could be a threat to their manipulative working. It is pertinent here to mention that while the majority leadership of Delhi Medical Association supported by few friends from Kerala and other States had openly opposed the BRMS (BRHC) issue, these very friends from Delhi had gone ahead to openly support it. What made them backtrack on their earlier stand of supporting it is well known to all. It is also well known that the clinical establishment bill about which some of these friends are now making noise was actually put forth with their approval. Today, they have decided to wake up from their slumber when major damage has already been done. Friends, it is issues like this clubbed with their manipulative actions to dissuade positive thinking, which made me return back to Delhi a saddened man.


As if that was not enough, I was aimed with another rude shock. In the list of Central Council of Members of this year was released (incidentally, they are the electoral college/ people who can contest the elections for this year IMA elections), I was shocked to see that my name was removed from the list. I am an elected Central Council representative from New Delhi branch and the results of the elections have been duly communicated to IMA headquarters and acknowledged by them. When I wrote to the Honorary Secretary General of IMA, for almost a week there was no response. When they responded (though late, by the time the case had gone to the court) they forwarded my csae to the election commision which is suppose to take over on 1st July after the elections are announced. The preperation of the list is the job of the office and not the election commission. I was convinced that the medical profession in general and that of Delhi in particular is again going to be subjected to manipulations in the coming elections. Emotionally, here again I had no option but to approach the Hon’ble High Court of Delhi seeking the relief.

I have pleasure in informing you that the Hon’ble High Court of Delhi, even during its vacation session, took up my application as an urgent application and granted hearing yesterday. The Hon’ble High Court has ensured that my name is included in the Central Council and voters cum contestants’ list. Also, to ensure that any manipulations are not carried out in the elections, as apprehended by most doctors in Delhi and across the country, the Hon’ble High Court has appointed Justice S.K. Aggarwal as the Court Observer to supervise and oversee the entire election process of IMA headquarters this year.


Friends, this is only the beginning of important my and your crusade for transparency, honesty and relentless fighting for the cause of the medical profession. I assure you of my total positive and proactive working and seem your active indulgence to see that the medical profession of the country this year election a team of dedicated office bearers to the IMA national headquarters who would be able to fearlessly, honestly and aggressively take up burning issues facing the profession and seek remedial measures. The profession needs today is that we shun divisive forces who work only for personal grandiose and with vested interests hidden agenda.

Let all of us honestly march forward to give the profession the dignity, the respect and the place in society we genuinely deserve.

With warm regards,

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

 

20 minutes of daily entertainment in any form is good for health

is one of many one–liner health tips that Heart Care Foundation of India (HCFI) has been propagating amongst the common masses. HCFI has involved celebrities to release these messages, as they have a direct impact on the masses.

Dr k k Aggarwal

In the photo: Bali Brahmbhatt, famous singer, releasing a health message along with Padma Shri & Dr BC Roy Awardee Dr K K Aggarwal, President HCFI.


 

News and views

Emotions should be taken seriously (Dr G M Singh)

For most women, having a baby is a joyful experience. But it is not unusual for new mothers to be hit by grief, anxiety and depression. Global figures suggest that 13-16 % of women giving birth for the first time suffer from depression. This figure rises to a worrying 30–40 % for the second birth.

FDA approves prostate cancer drug Jevtana (Dr Monica and Brahma Vasudeva)

FDA has approved SanofiAventis SA’s chemotherapy drug Jevtana (cabazitaxel) for the treatment of prostate cancer that does not respond to hormonedeprivation treatments or to docetaxel, the cancer drug most commonly used to fight prostate tumors.

Aspirin for primary prevention of cardiovascular events in people with diabetes: ADA /AHA/ACCF Position Statement (Dr Varesh Nagrath)

Aspirin should not be recommended for CVD prevention for adults with diabetes at low CVD risk (men under age 50 years and women under 60 years with no major additional CVD risk factors; 10–year CVD risk under 5%) as the potential adverse effects from bleeding offset the potential benefits.

COPD care fails to match guidelines

Most patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) are initially treated with high–dose IV corticosteroids, clinical guidelines to the contrary. In a cohort study of nearly 80,000 patients, 92% were given IV steroids and only 8% were initially treated with low-dose oral medications as guidelines urge, according to Peter Lindenauer, MD, of Baystate Medical Center in Springfield, Mass., and coauthors.

 

Legal Column

DMC Decision

Can a person file a complaint after nine years?

No. As per order numberDMC/DC/F.14/Comp.562 dated 2nd September, 2009, The Delhi Medical Council examined a complaint of Shri J.S. R, President All India ITDC Workers Federation, alleging professional misconduct on the part of Dr A K K of J G Hospital. On perusal of the complaint, the Council noted that allegation of impropriety has been raised against Dr A K K regarding bills / certificates in respect of treatment of one Shri P.P.S in the year 2000. The Delhi Medical Council observed that since the cause of action, in this matter, arose in the year 2000 and the complaint has been made after a period of almost nine years, the same does not merit consideration and stands rejected.

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medicine and law have been related from the earliest time as per Gradwohl's legal medicine. The function of the doctor and the police is nothing but like hermit, sage, kaji and priest. They are intermediary between God and man.The purpose of medicine is to maintain the patient in the best health, to overcome his diseases, injury and to lengthen his healthy life. The purpose of law is to maintain peace and order in the society, respect of humans through human rights and to provide equality of opportunity. To achieve these purposes medicine emerges from the laboratory by the scientific process and law emerges from the society by the process of experience. "People follow medicine and Law follows people".

 

Experts’ Views

Interesting tips in Hepatology & Gastroenterology

(Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi)

Recurrent  Abdominal Pain in Children

Definition:

Recurrent Abdominal Pain (RAP) was defined by Apley and Naish as 3 or more bouts of pain, that persists for more than 3 months and is severe enough to affect normal  activities.  The pain could occur daily or it could be episodic.

Incidence

Recurrent abdominal pain had been reported to occur in 10-15 % of children between the ages of  4 and 16 yrs.   In its first peak between 5 -7 years, both sexes are equally affected, while in the 2nd peak between 8-12 years, females are more affected.

Clinical Profile & Etiology :

Recurrent Abdominal Pain is organic in  10% -30%of the cases in different series while in the rest of the children it is functional abdominal pain. The term functional is used in gastroenterology when no definite structural, infective, inflammatory or biochemical cause is identified.

'Red Flags' that could reflect an organic form of isolated    paroxysmal abdominal pain.

History

  • Pain awakening the child at  night
  • Pain further away from the umbilicus
  • Fever
  • Loss of appetite or energy
  • Weight loss
  • Change in bowel habits, particularly diarrhoea, constipation, or nocturnal bowel movements. 
  • Blood in stools
  • Repititive emesis, esp. if bilious
  • Rap occuring in a child younger then 4 yrs of age
  • Positive family H/o of peptic ulcer
  • IBD

Examination

  • Anaemia
  • Loss of wt, or decline in ht velocity
  • Organomegaly
  • Localized abdominal tenderness
  • Perirectal abnormalities(eg, Fissures, Ulceration, or skin tags
  • Joints swelling, redness, or heat, rash
  • Ventral hernias of the abdominal wall

Investigation

  • Anaemia
  • Raised ESR
  • Urinary abnormalities
  • Stool occult blood positiveAnaemia

Patient with the above reflux signs need to be investigated to rule out an organic pathology

Question of the Day

Are there any pathological differences in arterial disease seen in diabetic visavis nondiabetic patient

Dr AK Jhingan, New Delhi

Yes. Multiple metabolic, vascular and coagulation abnormalities among the patients with diabetes interact and contribute to the high rates of artherosclerosis. Important abnormalities of endothelial function, plaque stability and platelet function underlie the higher frequency of acute coronary syndrome in diabetics compared to nondiabetics.

Endothelial cells release cytokines which decrease the synthesis of collagen by vascular smooth muscle cells and increase the production of matrix. Metalloproteinase, which promote collagen breakdown lead to propensity for plaque rupture.

In diabetic patients, it involves all the three vessels. It is long segment involvement and there are high chances of plaque rupture (plaque instability).

In comparison to diabetics a nondiabetic patient usually has a single vessel disease and there is often plaque stability.

Mental exercise to prevent dementia:  Dr Anupam Sethi Malhotra

The only two vegetables that can live to produce on their own for several growing seasons: Asparagus and Rhubarb.

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Public Forum (Press Release for use by the newspapers)

Pay attention to prehypertension in young people

We should pay attention to prehypertension in young people. Young adults with borderline high blood pressure called prehypertension are more likely to have calcium deposits in their coronary arteries and heart blockages later in life said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Quoting a study published in Annals of Internal Medicine. Dr Aggarwal said that of the 3,560 participants whose ages were 18 to 30 when the study started, almost 20 percent developed prehypertension –– which is blood pressure higher than the recommended 120 over 80 but below the 140 over 80 reading of treatable high blood pressure –– before the age of 35. Coronary scans showed accumulation of calcium deposits in their heart arteries during the 20–year study. These low–level elevations, above 120 over 80, are associated with atherosclerosis later in life and probably with heart attacks and stroke.

Earlier reports have shown an association between prehypertension in early adulthood and abnormalities of the heart muscles.

Prehypertension early in life is associated not only with development of atherosclerosis (formation of plaques that can eventually block arteries), but also with arteriosclerosis (stiffening of the arteries).

Drug treatment is not a real option for prehypertension in young people. Hence, it is important to pay attention to borderline high blood pressure in young people; if found, preventive measures should be recommended.

The recommendation is for lifestyle modifications, more exercise, better diet, quitting smoking and so on, to improve cardiovascular health.

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with laryngopharyngeal reflux was not responding.
Dr. Bad: Increase the drugs.
Dr. Good: What diet do you take?
Lesson: Foods and beverages containing caffeine (coffee, tea, sodas, etc), alcohol, chocolate, and peppermints weaken the protective esophageal sphincters that normally hold stomach contents in the stomach and esophagus.

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.
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Mistakes in Clinical practice

Do not write ‘SC’: it can be mistaken as "SL" (sublingual ) when poorly written.

Milestones in Neurology

Sir Alan Lloyd Hodgkin was a British physiologist and biophysicist, who with Andrew Fielding Huxley, won the Nobel Prize in Physiology or Medicine in 1963 for his work on the basis of nerve ‘action potentials,’ the electrical impulses that enable the activity of an organism to be coordinated by a central nervous system.

Mnemonic of the Day (Dr Prachi)

Indications of Dialysis HAVE PEE

Hyperkalemia (refractory)
Acidosis (refractory)
Volume overload
Elevated BUN (> 36 mM)
Pericarditis
Encephalopathy
Edema (pulmonary

 

Drug Update

International Medical Science Academy Update (IMSA)

Updated guidelines suggest pentoxifylline as an alternative to glucocorticoids in selected patients with severe alcoholic hepatitis.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Artesunate (25/50/100mg) + Amodiaquine (67.5 mg/135/270mg) bilayerd Tablets

For the treatment of uncomplicated malaria due to plasmodium falciparum strain in various age groups

01.09.2009

Medifinance

Family Package Cover

  • Self covered for 100% indemnity.
  • Spouse covered for 50% of indemnity.
  • Dependent child for 25% of indemnity.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Laboratory Tests for superficial Fungal Infections
Tests for superficial infections
Many fungal skin infections are diagnosed by the doctor based on a clinical evaluation and his experience. A clinical evaluation cannot, however, definitively tell the doctor which microorganism is causing a fungal infection. A few laboratory tests may be useful in detecting and confirming a fungal infection and may help guide treatment. They may include: Microscopic examinations, such as potassium hydroxide (KOH) preparation and calcofluor white stain; Fungal culture and susceptibility testing

 

Humor Section

IMANDB Joke of the Day

The patient went to his doctor for a checkup, and the doctor wrote out a prescription for him in his usual illegible writing. The patient put it in his pocket, but he forgot to have it filled. Every morning for two years, he showed it to the conductor as a railroad pass. Twice, it got him into the movies, once into the baseball park, and once into the symphony. He got a raise at work by showing it as a note from the boss. One day, he mislaid it. His daughter picked it up, played it on the piano, and won a scholarship to a conservatory of music.

Funny Definitions

Cauterize……………………Made eye contact with her

Medical bloopers on medical charts!

The patient was in his usual state of good health until his airplane ran out of gas and crashed.

 

SMS of the Day (Vivek Kumar)

You get rich as you grow old: silver in your hair, gold in your teeth, sugar in your blood, precious stones in your kidney and a never ending supply of gas.

The Ten Traits of the True Spiritual Warrior (Guy Finley) 4/10

The true spiritual warrior leads by example, never fearing to make an example of himself –– no matter what the cost.

 

Readers Responses

1. It is quite natural for doctors to be stressed which becomes often visible in their rude behavior many a time, especially in government hospitals, when the actual demand of patients might be explanation of cause of disease and other related issues. The conditions leading to stress needs to be changed, and a lot has to be done at the doctors' end itself as the general environment would take longer time owing to culturalbehavioral issues of the general public and financial issues. By the way Dr KKA, I failed to understand your phrase" The ego strength of an average Indian is pretty fragile". What does it mean by ego strength?

Well I liked the great knowledge to common public that "a single additional serving of leafy green vegetables cut the risk of diabetes typeII by 9 percent and Juice is a big sugar load and it comes in a liquid form which is absorbed rapidly." I find packaged juices are fast getting into a daily habit in so many families.

But "SMS of the Day" is not like whole fruit, it is rather like packaged juice. It said: "Always ask God to give what you deserve and not what you desire because your desires may be few but you deserve a lot." This is artificial outcome of positive thinking. The truth is people ask God for what they do not deserve like make me first rankholder in examination though the person might deserve only 1, 00, 000th rank. (Vinod Varshney)

 

Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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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