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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; 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 ...

28th September, 2010, Tuesday

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

Blood test may predict those at risk of getting
type 2 diabetes 10 years earlier

Researchers have developed a blood test that could predict those at risk of getting type 2 diabetes 10 years earlier than current diagnosis, according to research presented at the British Science Festival. The test, which can identify around half of people who will develop type 2 diabetes, detects blood levels of a microRNA molecule. The test can also distinguish between those who will and will not go on to develop some of the complications of diabetes caused by damage to blood vessels, such as heart attack, stroke, and poor circulation.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  Photo Feature (from the HCFI Photo Gallery)

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, explaining the concept of the Health Mela to Ms Smriti Irani, TV Actor.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Prevention of cancer

EPIC study, a cohort study of nearly 500,000 European men and women followed for nine years, found only a weak association between increased intake of fruits and vegetables with overall risk of cancer.

(Boffetta P, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010;102:529)

  National News

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.

JIPMER project approved

The phase III of the ongoing infrastructure expansion at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) has been approved "in principle" by the Planning Commission recently and funds to the tune of Rs 120 crore have been allocated. According to officials of JIPMER, the third phase would involve the building of a geriatric hospital, a screening OPD block and expansion of existing super–specialty blocks. A state–of–the–art multi–disciplinary advanced research centre will also be built in the complex apart from the modernisation of the existing JIPMER hospital. (Source: The Hindu)

New milestone for our Guest Editor

Dr. Neelam Mohan Chief Liver Transplant Physician and Director – Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta Medicity hospital has another new achievement of a successful liver transplant in a 6-month-old baby with severe factor VII deficiency  - first in Asia and youngest such case in the world.
His parents Sanketh and Bijal had been living under constant fear of their little son having sudden life-threatening bleeding ever since he was born. He suffered many episodes of bleeding under his skin, and in his brain and kidneys before specialists could diagnose his rare condition - Factor VII deficiency. This factor, normally produced in the liver, is essential for normal clotting of blood. To prevent fatal bleeding, Tavish needed frequent hospital admissions for bleeding and administration of Factor VII injections costing around Rs 1 lac per month. After being told by several doctors that Tavish’s condition was incurable and eventually fatal, his parents contacted Medanta where doctors immediately advised a liver transplant – something that had never been attempted previously in India for such a case.
Factor VII deficiency, which occurs 1 in 500,000 births has almost always been fatal in the past due to difficulties in diagnosing and treating it. Patients would die either from sudden rapid bleeding of undiagnosed cause or be faced with the impossible commitment of taking Factor VII injections for life. Since dose and duration of effect of these injections is unpredictable, patients may bleed before the next injection can be given. Tavish faced similar problems since birth. He was suffering from severe factor VII deficiency where his levels were less than 1 % and he had not only bruises on skin and gum bleeds, but also renal, gastrointestinal bleeds and bleed in brain. Preparations for the transplant were very challenging. His mother, who was the liver donor, had a fatty liver which was treated with a strict exercise routine for 1 month before it was safe to go ahead.  
Despite having managed India's largest series of pediatric liver transplants (nearly 60), this case was unique, explained Dr Mohan. He has now factor VII levels of 38% 3 weeks post transplant. He has been discharged and is doing well.

Vaccination camp on Rabies Day

To curb this fatal disease, September 28 is marked for World Rabies Day. In this connection Veterinary Hospital, GADVASU, is holding a free anti-rabies vaccination camp at its small animal clinic on Monday from 9.30 am to 12.30 pm. All the pet owners have been invited to avail of the vaccination facility and protect their pets against this deadly disease. Rabies is endemic in India, and is primarily a disease of terrestrial and airborne mammals, including dogs, wolves, foxes, coyotes, jackals, cats, bobcats, lions, mongooses, skunks, badgers, bats, monkeys and humans. The dog has been, and still is, the main reservoir of rabies in India. (Source: The Times of India)

  International News

(Contributed by Dr Monica and Brahm Vasudev)

Many Americans may be unaware of their hepatitis C status

Individuals who used drugs, opted for tattoos or underwent procedures before the blood supply was screened for certain viruses, or simply shared a toothbrush may be carrying hepatitis C without even being aware of it.

Adults vaccinated for seasonal influenza may be less prone to suffer heart attacks

Adults who had received vaccine for seasonal influenza were at less risk of suffering a heart attack says a study published online Sept. 20 in the Canadian Medical Association Journal.

FDA panel recommends blood–thinning drug for approval

FDA’s cardiovascular and renal drugs advisory committee on Monday unanimously recommended approval for the blood–thinning drug Pradaxa (dabigatran) to reduce the risk of stroke and blood clots in patients with atrial fibrillation.

Breakthrough in drug trial spells optimism for heart attack patients

The ONSET/OFFSET study has found that platelet function in patients on ticagrelor recovered much faster after discontinuing the drug vs clopidogrel, the current gold standard drug. The trial also confirmed that breathlessness occurs as a side effect of ticagrelor but this is not associated with any harmful effects on lung or heart function.

  Hepatology Update

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

When should chronic liver disease be suspected in children ?

• Chronic liver disease includes a wide spectrum of diseases characterized by ongoing inflammation of liver tissue which can progress to cirrhosis or end stage liver disease.

• It refers to long standing disease usually >3-6 months leading to various manifestations and complications of CLD.

  Infertility Update

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

What are the pros & cons of single vs multiple embryo transfer in IVF? What is the usual practice in Delhi fertility centers regarding the same?

The initial practice of IVF and Embryo Transfer involved the transfer of multiple embryos, usually 3-5. It was soon realized that the number of multiple pregnancies especially higher order, that is more than three, was increasing. This was associated with pre-term delivery which led to premature babies and developmental delays with occasional mental handicap in the long run. This leads to enormous psychological and financial burden to the person and society in general. A drive was therefore started in the west in those countries where the government is responsible for healthcare, especially the Nordic countries and UK to limit the number of embryos to be transferred. They have in fact suggested transferring a single embryo to further reduce the chance of twin pregnancy.
The following steps should be adopted in patients who need anticoagulants and have conceived:This would hold good for a system where

  • The cryopreservation systems are excellent.
  • The government is funding atleast partially for the IVF treatment, as the patient's would need multiple attempts at transfer to get a viable pregnancy. In India, where the patient has to pay for each cycle, it becomes difficult to justify single embryo transfer. I usually practice transferring between 2-3 embryos. This gives me a good pregnancy rate of 40% vs 25% of single embryo transfer. If the lady has triplets we then offer fetal reduction.
  ENT Update: Question of the Day

How is acute rhinosinusitis treated? (Dr PP Singh, New Delhi)

Acute rhinosinusitis (ARS) can be either viral or bacterial. Acute viral rhinosinusitis usually resolves within 10 days. Acute bacterial rhinosinusitis (ABRS) may also resolve spontaneously within the first 10 days.

  • Symptoms <10 days, in the absence of high fever or symptoms suggesting complicated illness: Such patients should be managed with supportive care. One can give mild analgesics, systemic or limited–duration topical decongestants, and fluids. One can also give intranasal steroids. Antihistamines or zinc offer no added advantages.
  • Mild symptoms lasting >10 days: Observe and supportive therapy for an additional 7 days.
  • Moderate–to–severe symptoms of ABRS (T > 101°F, severe pain), or for patients whose symptoms worsen during observation: Antibiotics. Give topical glucocorticoids as adjunctive therapy.

Complications of ABRS occur rarely, and include orbital cellulitis, osteitis and meningitis.
Nosocomial ABRS is relatively common in patients with prolonged. nasotracheal intubation, and often involves Gram–negative organisms. Nasal foreign bodies should be removed and patients treated with culture–directed antibiotic therapy. Immunosuppressed patients are at risk for acute fulminant invasive fungal rhinosinusitis; treatment involves endoscopic biopsy, emergency surgical debridement, and systemic antifungal therapy.

(Hickner JM, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med 2001;134:498).

  Medicolegal Update

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

Exposure to a poison leads to illness

The very old, very young or those in poor health suffer greater damage

When people are in contact with a poison they are said to be exposed to it. The effect of exposure depends partly on how long the contact lasts and how much poison gets into the body, and partly on how much poison the body can get rid of during this time. Exposure may happen only once or many times.
  • Acute exposure is a single contact that lasts for seconds, minutes or hours, or several exposures over about a day or less.
  • Chronic exposure is contact that lasts for many days, months or years. It may be continuous or broken by periods when there is no contact. Exposure that happens only at work, for example, is not continuous. Chronic exposure to small amounts of poison may not cause any signs or symptoms of poisoning at first. It may be many days or months before there is enough chemical inside the body to cause poisoning. For example, a person may use pesticide every day. Each day the person is exposed to only a small amount of pesticide, but the amount of pesticide in the body gradually builds up, until eventually, after many days, it adds up to a poisonous dose. Only then does the person begin to feel unwell.
  Medi Finance Update

Q. Is it required to file the return of loss?

Yes, it is required to file the return of loss within the prescribed time, if it is desired to carry forward and set off such losses.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Vitamin B1, Vitamin B6 and Vitamin B12 for human use

Jan 1, 2001

GSR 702(E) dt.14.10.99

  Lab Update

Lab tests for Inflammatory Bowel Disease

To rule out other causes of diarrhea and inflammation

  • Stool culture to look for bacterial infection
  • O&P (Ova and parasites) to detect parasites
  • Clostridium difficile to detect toxin created by bacterial infection; may be seen following antibiotic therapy
  • Fecal occult blood to look for blood in the stool
  • Celiac Disease tests

(Contributed by Dr Arpan Gandhi and Dr Navin Dang)

  IJCP Special

Dr Good Dr Bad

Situation: A patient developed tetany after he was given metoclopramide.
Dr Good: Stop metoclopramide. Give inj promethazine.
Dr Bad: Give calcium.
Lesson: Metoclopramide can cause extra pyramidal symptoms

Make Sure

Situation: A patient with angina and abnormal endothelial functions was put on atenolol.
Reaction: Oh my God! Why you did not consider nebivolol?
Lesson: Make sure that nebivolol is used as the beta blocker of choice in patients with proven endothelial dysfunction. (Kardiologiia 2004;44(2):15–18)

Quote of the Day

"Continuous effort, not strength or intelligence is the key to unlocking our potential." Winston Churchill.
(Contributed by Dr.G.M.Singh)

  Mind Teaser

Read this…………………

bad bad

Answer for yesterday’s Mind Teaser: "Platinum".

Correct answers received from: Dr. Rohini. Vaswani, Dr Devi Prasad Mohapatra, Dr Meera Rekhari, Dr.Anita Rajorhia, Dr.A.K.Saxena, Ms. Deepti Katyal Uppal, Dr. Dinesh Kumar S, Dr Virender Prakash Gautam, Dr Aruna Tyagi,Dr.K.P.Rajalakshmi, Dr Mukesh Bhandari, Dr.K.Raju

Answer for 26th Sept Mind Teaser is: "Mad about you".
Correct answers received from:Dr Chandresh Jardosh, Dr. Rajiv Dhir, Dr Virender Prakash Gautam, Dr.K.V.Sarma, Dr Vikas, Dr Anurag Jain, Dr Muthumperumal Thirumalpillai, Dr. Dinesh Kumar S, Dr S.Upadhyaya, Dr Ajmer Singh

Send your answer to ijcp12@gmail.com

  Humor Section

The LAPD, The FBI, and the CIA are all trying to prove that they are the best at apprehending criminals. The President decides to give them a test. He releases a rabbit into a forest and each of them has to catch it. The CIA goes in. They place animal informants throughout the forest. They question all plant and mineral witnesses. After three months of extensive investigations they conclude that rabbits do not exist. The FBI goes in. After two weeks with no leads they burn the forest, killing everything in it, including the rabbit, and they make no apologies. The rabbit had it coming. The LAPD goes in. They come out two hours later with a badly beaten bear. The bear is yelling: "Okay! Okay! I’m a rabbit! I’m a rabbit!"
(Contributed by Dr. GM Singh)

Important laws which the great Newton forgot to state
Theatre Rule

People with the seats at the furthest from the aisle arrive last.
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

Parable of the Pencil

The Pencil Maker took the pencil aside, just before putting him into the box. "There are 5 things you need to know," he told the pencil, "Before I send you out into the world. Always remember them and never forget, and you will become the best pencil you can be."

  1. "You will be able to do many great things, but only if you allow yourself to be held in someone’s hand."
  2. "You will experience a painful sharpening from time to time, but you’ll need it to become a better pencil."
  3. "You will be able to correct any mistakes you might make."
  4. "The most important part of you will always be what’s inside."
  5. "On every surface you are used on, you must leave your mark. No matter what the condition, you must continue to write."

The pencil understood and promised to remember, and went into the box with purpose in its heart.
Now put yourself in the pencil’s place. Always remember them and never forget, and you will become the best person you can be.

  1. You will be able to do many great things, but only if you allow yourself to be held in God’s hand. And allow other human beings to access you for the many gifts you possess.
  2. You will experience a painful sharpening from time to time, by going through various problems in life, but you’ll need it to become a stronger person.
  3. You will be able to correct any mistakes you might make.
  4. The most important part of you will always be what’s on the inside.
  5. On every surface you walk through, you must leave your mark. No matter what the situation, you must continue to do your duties.

Allow this parable on the pencil to encourage you to know that you are a special person and only you can fulfill the purpose to which you were born to accomplish.
Never allow yourself to get discouraged and think that your life is insignificant and cannot make a change.

  Readers Responses
  1. Dear Dr Agarwal, I admire you for the vast knowledge. This emedinews is the best and first in the medical world. This gives updates in all aspects of medical practice. All the doctors are grateful for your service. Dr Valluri Ramarao, Chennai.
  2.  Dear Dr.K.K.Aggarwal, Being a central committee member of the IMA, I along with my Team at North Bengal,I wrote an appeal to all central committee members to caste vote in your favor. Dr. D.R. Nakipuria Siliguri.
  3. Greetings. We have to discuss and decide very soon how to counter tirades by media, lay public and the inane politicians who have skyhigh impractical expectations and drills only from doctors and laying down populist policymaking to score in the eyes of a lay public. Courtesy media and due to other reasons we are surrounded by a hostile mob which harms at the very first hint. The baseless accusations need to be tackled by IMA on behalf of each doc- Govt or Pvt. Recently Zee TV vitrioled govt docs accusing on "commission” or "careless treatment". We have to safeguard against these academic entrapments. Then we have to take step now that govt is trying to cover its incompetencies in not giving basic amenities to the doctors in rural areas by raising havoc. In raising half doctors how they would be good, can they be asked? And how about such a half baked coming to practice in cities, how it’s going to be stopped? Isn’t the govt now legalizing mediocracy and resorting to unconstitutional crookery? Already 'munnabhais', 'russia returns' and millions of quacks have done or doing big time damage to the prestige. Who will ensure this? Why can’t doctors ask this? And why can’t all of them go to strike at one go and demand an explanation, assurance and apology from the govt? Docs are corned by the politicians. How long we are going to wait? As representing docs, IMA must respond and so must the MCI. Dr Shailesh Gupta, Asst Prof, IMS, BHU
  Public Forum

(Press Release for use by the newspapers)

Health Tip: Debunking Diabetes Myths

If you’ve just been diagnosed with diabetes, it may be difficult to separate fact from fiction, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Heart Care Foundation of India debunks some popular myths about diabetes.

  1. Diabetes is not contagious and one cannot get diabetes from some one else.
  2. Diabetes does not mean that one cannot have desserts for ever. While eating too many sugary foods is a bad idea, one can have an occasional dessert, especially if one exercises and otherwise eats healthy.
  3. Eating too much sugar can’t "cause" diabetes. The disease stems from genetic and lifestyle factors. But consuming too much white sugar can cause insulin resistance.
  4. Carbohydrates and starches (bread, potatoes, pasta) aren’t off–limits, but healthy portion sizes are important.
  5. Diabetics aren’t more susceptible to colds and other illnesses but may have more complications of flu.
  6. Taking insulin doesn’t cause hardening of the arteries or high blood pressure.
  7. Fruit, while healthy, can’t be consumed in huge amounts, since it contains carbohydrates.
  Conference Calendar

International Nephrology & Nephropathology Update

Kasturba Medical College & Melaka Manipal Medical College under the aegis of Manipal University are conducting a 2-day International Nephrology & Nephropathology Update at Manipal. Distinguished Faculty from Mayo Clinic & Harvard Medical School are delivering Lectures & conducting Case Discussions with plenty of Clinico- Pathologic Correlates.
Date: October 30-31, 2010
Venue: Chaitya Hall, Fortune Inn Valley, Udupi
Contact: Prof Lakshmi Rao, Professor and Head, Dept of Pathology, KMC Manipal. Ph: 0820 2571201 Ext.22396 or 0820 2922396. E-mail: pathology.kmc@manipal.edu

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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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