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eMedinewS is now available online on www.emedinews.in or www.emedinews.org
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; 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 ...

26th September, 2010, Sunday

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

If PSA has to be done, do it at 60

An analysis of six randomized, controlled trials involving 387,286 participants by researchers at the University of Florida, in BMJ, did not find support for routine population screening for prostate cancer, although a single prostate–specific antigen (PSA) test at age 60 could identify those most likely to develop and die from the disease. Screening helps diagnose prostate cancer at an earlier stage, but does not significantly reduce mortality while risking overtreatment.

Instead, clinicians should focus attention on screening men at age 60 and finding out who has PSA levels above 2 ng/mL. Researchers in Sweden and at Memorial Sloan Kettering Cancer Center in New York determined that a single PSA test at age 60 strongly predicts a man’s lifetime risk of diagnosis and mortality. About 90% of prostate cancer deaths occurred in men who’d had the highest PSA levels at age 60. Men with average or low PSA levels had negligible rates of prostate cancer or death by age 85. Results suggest that at least half of men aged 60 and older might not need prostate cancer screening, which could reduce overdiagnosis and overtreatment.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

11th MTNL Perfect Health Mela 2004

In the photo: Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, president, Heart Care Foundation of India along with Minister of Education, Govt. of Delhi, Arvinder Singh Lovely and R S P Sinha, CMD, MTNL, addressing a press conference on the 11th MTNL Perfect Health Mela in 2004. 

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Prostate cancer

A systematic review has shown no evidence supporting the use of PSA velocity for clinical decision making.

(Vickers AJ, et al. Systematic review of pretreatment prostate–specific antigen velocity and doubling time as predictors for prostate cancer. J Clin Oncol 2009;27:398).

  National News

2nd BSNL Dil Ka Darbar 2010

The 2nd BSNL Dil Ka Darbar 2010 is being organized by the Heart Care Foundation of India on 26th September, Sunday at Maulana Azad Medical College, New Delhi from 8 AM – 5 PM. The event celebrates the World Heart Day falling on the same day. Organized along the lines of the Mugal Darbar, this one-day non stop Public Forum is a unique opportunity for the public or Fariyadis to directly address their questions to top medical experts free of charge.
The Focus of the event is Preventing Sudden Cardiac Death.
The Event will be blessed by Sh K.C.G.K. Pillai Principal General Manager Finance BSNL

Mr Rakesh Mehta, IAS, Chief Secretary, Delhi Govt. will be the Chief Guest. Sh.Rajendra Kumar IAS Principal Secretary Health & F.W. Delhi Govt will preside over the event.
Mr SS Ghonkrokta, Drug Controller, Delhi State; Dr S Bhattacharjee, Director, Health Services, Delhi Govt.; Dr PK Sharma, MOH, NDMC; Dr N K Yadav, MHO, MCD; Dr A.K.Aggarwal Dean Maulana Azad Medical College; Sh. Mohan Lal Director ISM & H Delhi Govt.; Dr Praveen Chandra, Chairman Interventional Cardiology, Medanta – The Medicity; Ms. Sushma Bhattar President, Maheshwari Club; Sh. D D Agrawal, President Marwari Yuva Manch, New Delhi; Lion C.P. Aggarwal President Lions Club of Alaknanda; Sh K D Baheti President All India Vaishya Federation (Delhi Pradesh); Lion Sunita Bansal, Chief Patron, Lions Club of New Delhi Shakti,; Ms Nalini and Kamalini are the Guests of Honour.

2000 general public has already registered for participating in the public forum.

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association. Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

MCI says no to Sola, Gotri medical colleges again

The newly–constituted of Board of Governors (BoGs) of Medical Council of India (MCI) today denied permission to start two new medical colleges at Sola and Gotri from the current academic session. Permission was denied to the two colleges for the second time this year. A state health department official said, "A three–page letter was sent (by MCI) to the health department on Thursday morning (denying permission). There were several things pointed out by MCI, one of them was lack of infrastructure." (Source: Indian Express)

Now, chikungunya rears its head in Capital

Even as 86 new cases of dengue — the highest so far — were recorded in the Capital on Wednesday, taking the total number to 2,536, yet another disease is now giving Health Department officials a hard time. At least six people were diagnosed with the chikungunya virus, also spread by mosquitos, in Palam Village on Wednesday.
Prior to these, two more cases of the virus had been reported by the National Institute of Communicable Diseases in Delhi, taking the total number of cases to eight. “While chikungunya doesn’t cause death as in the case of dengue, it does cause a lot of bodyache and fever,” MCD health official Dr VK Monga said. (Source: Indian Express)

  International News

(Contributed by Dr. Monica and Dr. Brahm Vasudev)

Healthy diet may ward off kidney stones, study suggests

According to the results of a new study, certain key ingredients of a diet designed to prevent high blood pressure can protect against kidney stones. Low–fat dairy products and/or plants may have potent kidney stone–fighting properties. The Dietary Approaches to Stop Hypertension (DASH) diet, which is high in foods such as fruits and whole grains and low on sweetened beverages and processed meats, effectively lowers blood pressure. The study will be published in a forthcoming issue of the Clinical Journal of the American Society Nephrology.

Phosphorus additives in fast foods enriched may affect health disparities in kidney disease

Processed and fast foods enriched with phosphorus additives may play a role in health disparities in chronic kidney disease, according to a study appearing in a forthcoming issue of the Journal of the American Society of Nephrology.

Poor initial response to darbepoetin alfa associated with adverse cardiovascular outcomes in chronic kidney disease

A new research published in the New England Journal of Medicine found that among patients with nondialysis chronic kidney disease, type 2 diabetes, and anemia who were receiving darbepoetin alfa, those who had a poor initial response to the drug were more prone to adverse cardiovascular outcomes and death.

eMedinewS congratulates its Guest Editor, Dr Monica Vasudev

eMedinewS congratulates its Guest Editor, Dr Monica Vasudev who was invited to participate in writing a Board Review for the American College of Allergy, Asthma and Immunology (ACAAI) and contribute chapters on Basic Immunology and Primary immune deficiencies. She is one of the 25 authors. The 1st edition of the book ‘ACAAI Review for the Allergy and Immunology Boards’ was released this week. The book has been designed for quick reference and review for exams with updated information. With time, many improved editions of the book may be brought out.

  Pediatric Update

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

Smoking initiation

Nicotine dependence can develop within days to weeks of the onset of occasional cigarette use, and often before the onset of daily smoking.1 Adolescents with early emergence of symptoms of nicotine dependence are significantly more likely to be smokers two years later, as compared with those who do not report early symptoms.2
1. DiFranza JR, et al. Initial symptoms of nicotine dependence in adolescents.      Tob Control 2000;9(3):313-9.
2. Dierker L, et al. Early emerging nicotine-dependence symptoms: a signal of propensity for chronic smoking behavior in adolescents. J Pediatr 2010;156(5):818-22.

  Infertility Update

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

What are the precautions to be taken after the IVF procedure?

The procedure demands no special precautions, but strenuous activity should be avoided. We advise the patients to be mentally and physically relaxed as much as possible. You can return to work if you wish, but first choose to have a few days rest.

A couple has been married for past 7 months, but they are unable to perform intercourse. What should they be advised?

Inability to perform natural intercourse can be because of defects in either the man or the woman. In most situations, these are physiological issues and counseling the couple will resolve the issue. However, erectile dysfunction in the man and imperforate hymen in the woman should be ruled out. Psychotherapy for vaginismus should be initiated. Artificial insemination can help this couple to get pregnant. Once a woman is pregnant performance anxiety is lowered considerably.

  Eye Update: Question of the Day

What are intermittent squints? How are they managed? (Dr Quresh Maskati)

As the name suggests, these squints are not constant. They may be seen or manifest only when the child is daydreaming or unwell or exhausted or emotionally upset. These squints are usually kept under observation. They may either resolve spontaneously, thus requiring no treatment or become constant requiring treatment.

  Medicolegal Update

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

Family decisions in US court

Terminate medical care when the patients have not left explicit statements

Several state supreme courts have limited the rights of families to decide for incompetent patients when there is no advance care directive or formal appointment of the proxy. These courts have accepted that, when a patient who is mentally incapacitated is in a persistent vegetative state, comatose, or terminally ill, family members (even if not formally appointed as proxy decision makers) can withdraw life–sustaining treatments based on prior conversations with the patient or their understanding of the patient’s values. However, these courts have refused to permit families not formally appointed as proxies to terminate life–sustaining treatments from mentally incapacitated but conscious patients, patients who can interact minimally. Explicit statements by the patient that relate to not wanting to be on life support or in a vegetative state, courts have argued, do not meet the standard of "clear and convincing" evidence.

  Medi Finance Update

Equity Fund

Investing in stocks is also riskier than other investments as stock prices can fluctuate more than other types of investments. The market price of a stock will vary with the company’s financial performance, general economic conditions in the country in which it operates, as well as investor perceptions.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Phenobarbitone with any anti–asthmatic drugs.

Jan 1, 2002

GRS 170(E) dt.12.3.01

  Lab Update


  • To screen for, detect, and monitor treatment for congenital adrenal hyperplasia (CAHP)
  • Part of a routine newborn screen, when an infant has ambiguous genitalia, when a young female has hirsutism or other symptoms of virilization, when a male child has premature sexual development
  • Periodically to monitor CAH treatment.

    (Contributed by Dr Arpan Gandhi and Dr Navin Dang)
  IJCP Special

Dr Good Dr Bad

Situation: A lady on disulfiram became pregnant.
Dr Bad: Continue the drug.
Dr Good: Stop the drug.
Lesson: Disulfiram may harm the developing fetus by increasing levels of acetaldehyde. In addition, the physiologic reaction between disulfiram and ethanol in the mother presents a potential risk to the fetus. For these reasons, disulfiram is rarely used in pregnancy.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving antibiotics?
Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough signifies viral infection.

SMS of the Day

Life is best for those who are enjoying it, difficult for those who are analyzing it and worst for those who are criticizing it. Our attitude defines our lives!

(Contributed by Dr GM Singh)

  Mind Teaser

Read this…………………

mad U mad

Answer for yesterday’s Mind Teaser: "E"

• 50 year old male, non-smoker whose systolic is 140 mmHg and who is not on medication for hypertension. His total cholesterol is 300mg/dl and HDL cholesterol is 55mg/dl.
• 45 year old female with diabetes mellitus who is a non-smoker and her systolic pressure is 110 mmHg. Total cholesterol is 130 and HDL is 70mg/dl.
The National Heart, Lung and Blood Institute has provided an online 10–year cardiovascular risk (CVD) calculator to assist physicians in making the right treatment decisions for their patients. Please paste the following link in your web browser: http://hp2010.nhlbihin.net/atpiii/calculator to access the calculator in your office.
ATP III guidelines suggest that those with > 20% 10–year risk of CVD should be prescribed statins. Those with a risk below 10% are considered low risk and statin therapy is not indicated. When risk is between 10–20%, statin use is discretionary. Patients with diabetes mellitus, coronary artery disease, cerebrovascular disease and peripheral vascular disease are all considered at high–risk of CVD. The above risk calculator does NOT apply to these patients and they should all be on statins as long as they have no contraindications.

Correct answers received from: Dr Prachi, Dr GM Singh

Answer for 24th Sept Mind Teaser is: "Hitting below the belt".
Correct answers received from: Dr. Dinesh Kumar S, Dr Anurag Jain, Dr Farha Raza Khan, Dr. Satish Gunawant, Dr, Ajay Gandhi., Dr Vikas Kumar, Dr. Alok Deb, Dr. Anupam Sethi Malhotra, Dr(LtCol)Gopal Agarwal, DR. Puneet Kumar, Dr Vijau Gaur

Send your answer to ijcp12@gmail.com

  Humor Section

Hard Working? 
A business owner decides to take a tour around his business and see how things are going. He goes down to the shipping docks and sees a young man leaning against the wall doing nothing. The owner walks up to the young man and says, "Son, how much do you make a day?" The guy replies, "150 dollars."
The owner pulls out his wallet, gives him $150, and tells him to get out and never come back. A few minutes later the shipping clerk says to the boss, "Have you seen that UPS driver? I left him standing around here?"
(Contributed by Dr. GM Singh)

Important laws which the great Newton forgot to state
Law of the Result

When you try to prove to someone that a machine won’t work, it will!
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

Two Wolves
One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, "My son, the battle is between two wolves inside us all.
"One is Evil – It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self–pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.
The other is Good – It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith.–
The grandson thought about it for a minute and then asked his grandfather: "Which wolf wins?" The old Cherokee simply replied, "The one you feed."

  Readers Responses
  1. Respected and Dear Friends, following a public health research on the subject of Vaccine Preventable Diseases – Measles and Rubella in the states like Himachal Pradesh (which is one of the well–performing states in India) and subsequent recommendations to Govt of India through Govt. of Himachal Pradesh for MR vaccination with first booster of DPT at the age of 16–24 months, the vaccine in question has been proposed to be introduced in National Immunization Schedule in 2009–10 by the Ministry of Health and Family Welfare, Govt. of India. The scientific papers in this regard have gone to national and international conferences and journals. For the favour of your kind information, I am referring to the Immunization Handbook for Medical Officers (page 19, NIS) (www.mohfw.nic.in). Indeed a great achievement for the downtrodden and marginalized sections of the society of Himachal Pradesh by HIS GRACE and a visible step up progress of Health Department of Himachal Pradesh!! With warm personal regards: Dr. Surender N. Gupta, Faculty, Regional Health and Family Welfare Training Centre, Chheb, Kangra–Himachal Pradesh, India. E-mail IDs: drsurendernikhil@yahoo.com, drnikhilsurender@gmail.com
  Public Forum

(Press Release for use by the newspapers)

 2nd BSNL Dil Ka Darbar Held

The 2nd BSNL Dil Ka Darbar was held on Sunday 26th September 2010 at MAMC College Auditorium. It was organized to earmark World Heart Day. The Darbar solved and gave second opinions to the problems and queries of the common man and focused on sudden cardiac death.
Inaugurating the day long 2nd BSNL Dil Ka Darbar, Sh K.C.G.K. Pillai Principal General Manager Finance BSNL expressed concern about the rising lifestyle disorders in the city. He also said that communicating right preventive health message to the public at the right time can save a lot of lives. Chief Guest of the event Shri Rakesh Mehta, Chief Secretary, Delhi Government  and it was preside over by Sh. Rajendra Kumar IAS Principal Secretary Health & F.W. Delhi Govt., said that one should maintain a healthy weight to reduce the risk of heart disease. They requested the public to go back to earlier times where children used to play and skipped in the grounds everyday.
Conducting the public heart forum Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, said that one should not ignore early morning chest pain as most fatal heart attacks occur early in the morning, A heart attack can present with chest pain, discomfort, heaviness or burning in the center of the chest lasting for minutes, always more than 30 seconds, which is diffuse in nature and never localized.
Cardiologists and Doctors from other specialities present at the Darbar were Dr S K Parashar, Dr. Praveen Chandra, Dr Sanjay Sood, Dr Vinay Singhal, Dr Samir Srivastava, Dr Rakesh Verma, Dr. Saket Bhardwaj, Dr. S. Pandey, Dr. H. K. Chopra, Dr. G.K.Mani, Dr. Vijay Trehan, Dr N P Singh, Dr. Ajay Kriplani, Dr Kaberi Banerjee, Dr Sudesh Ratan, Dr. A.K. Bali, Dr Pawan Gupta, Dr R.K. Manchanda (Homeopath), Dr. B.T. Chidananda Murthy (Director Central Council for Naturopathy & Yoga), who answered questions raised by the people.

Some salient features of the discussions by these Panelists in response to queries of the public included:

  • A discomfort, which lasts less than 30 seconds and can be pinpointed with a finger, can be ignored as a non-cardiac chest pain.
  • A burning in the chest occurring at 2 O’clock in the night may be due to acidity but any acidity occurring for the first time in life after the age of 40 years, early in the morning should        be considered cardiac in origin unless proved otherwise. 
  • Similarly, any breathlessness appearing for the first time in life after the age of 40 years is cardiac in origin unless proved otherwise.
  • Chewing a tablet of aspirin at the onset of cardiac chest pain can reduce chances of cardiac death by 22%.
  • All chest pain patients should be moved to the nearest cardiac hospital as timely clot dissolving therapy or clot removing angioplasty can practically cure a patient. The life saving window is to reach hospital within 3 hours.
  • ECG can often detect abnormal sounds in first six hours of heart attack but with viscope it is always possible to detect abnormal sounds during chest pain. Angiography is the gold-standard investigation if a patient with chest pain comes within three hours as it can help removing the clot by primary angioplasty.
  • A heart attack is caused by stable blockages that create over years slowly occluding the arteries supplying blood to the heart. It is caused by a blockage that primarily ruptures causing sudden formation of blood clot in the artery which then suddenly occludes the artery.
  • Rupture and clotting is probably just as likely to happen in a blockage that is causing only a 10 % fix blockage as in one that is causing 80% blockage. Therefore, stenting a blockage that is causing greater degree of fix blockage may relieve only heart pain but may not reduce the risk of future acute heart attack. Answer, therefore, lies in stabilizing blockages and making them less likely to rupture with aggressive lifestyle management and optimal drug treatment. This involves weight reduction and control of cholesterol, blood pressure and sugar by regular exercise and other lifestyle measures.
  • Doing unnecessary angioplasty is not safe. Out of 1000 chronic patients undergoing angioplasty, two will die, two will have heart attack related to the procedure, 60 to 90 will have improved symptom relieve and 800 will have no extra benefit than that given by drug treatment.
  • The results of the COURAGE trial have shown that aggressive medical and lifestyle therapy should be considered for all patients with stable angina unless they are unstable when diagnosed.
    Ms Nalini and Kamalini, eminent Kathak exponents talked on the role of dance in health. They said that all women should maintain a healthy weight to reduce the risk of heart disease.
    Guests of Honour who also spoke on the occasion were Dr S Bhattacharjee (Director, Health Services, Delhi Govt.), Dr PK Sharma (MOH, NDMC), Dr NK Yadav, (MHO, MCD), Sh.Mohan Lal Director ISM & H Delhi Govt, Mr. S.S.Ghonkrokta, Drug Controller, Delhi State, Dr A.K.Aggarwal,  Dean Maulana Azad Medical College, Dr Praveen Chandra, Chairman, Interventional Cardiology, Medanta- The Medcity, Sh. DD Agrawal, President Marwari Yuva Manch, New Delhi, Lion C.P.Aggarwal President Lions Club of Alaknanda, Sh K D Baheti President All India Vaishya Federation, (Delhi Pradesh),  Lion Sunita Bansal, Chief Patron, Lions Club of New Delhi Shakti, Ms.Sushma Bhattar President, Maheshwari Club.             
  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Today BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi 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

Dr. Sood Nasal Research Foundation Announces

 Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr.   Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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