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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 ...

29th November 2010, Monday

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

For type 2 diabetes, prescribe both aerobics and resistance training

People with type 2 diabetes who did aerobic exercise some days and resistance training on others had lower blood sugar levels after nine months than people who did either type of exercise alone. The combination exercise program really works better said Dr. Timothy Church, director of preventive medicine research at the Pennington Biomedical Research Center at Louisiana State University System in Baton Rouge. The combination group was the only group that had significant improvement. They reduced their HbA1c levels, while also reducing the amount of diabetes medications.

‘The findings from the NIH funded study are published in the Nov. 24 issue of the Journal of the American Medical Association. The people in the resistance–training group exercised three days per week. Each session consisted of two sets of four upper–body exercises, three sets of three leg exercises, and two sets of abdominal crunches and back extensions. Most of these exercises were done with weight machines. The aerobic group did about 150 minutes a week of moderately paced walking on a treadmill. The combination group had two resistance–training sessions a week that consisted of one set each of the exercises listed above. They also walked slightly less than the aerobic–only group. The time each participant exercised each week was roughly the same, no matter which group they were in. The researcher supervised all of the exercise sessions.  

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr GM Singh)

"The best assets you can have during inflation are your abilities."

Warren Buffet

    Photo Feature (from the HCFI Photo Gallery)

Harmony School festival

‘Eat healthy Stay healthy’

Students enacting a health message in a skit in Harmony School festival in the 17th MTNL Perfect Health Mela 2010

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

Don’t screen children, schools told

Guidelines for admission in schools, issued under the Right of Children to Free and Compulsory Education (RTE) Act, 2009, prohibit screening of children and interviewing their parents. The guidelines issued by the Union Human Resource Development (HRD) Ministry have also asked the schools to adopt a random selection process. "The schools have to adopt an admission procedure which is non–discriminatory, rational and transparent and that schools do not subject children and their parents to admission tests and interviews in order to decide whether they will admit a child or not." (Source: The Hindu, Nov 27, 2010)

    International News

(Dr Monica and Brahm Vasudev)

Heart risk increased with weekend benders

Men in Belfast, Northern Ireland, a city where heavy drinking on weekends is common, were far more likely to suffer cardiovascular events than Frenchmen –– whose overall alcohol intake may be higher but is spread evenly throughout the week (Medpage today). Leaving the work force may improve one’s health A large, French cohort study has shown that among workers at a French national gas and electricity company, retirement was associated with sharp reductions in mental and physical fatigue, as well as more modest reductions in depression.

Most RA patients still not treated early enough

Majority of patients with rheumatoid arthritis are still not beginning treatment at a time when they are most likely to achieve remission and avoid joint destruction, a study conducted in the Netherlands found. (Dr Michael P.M. van der Linden, MD, of Leiden University, and colleagues)

Reflux drugs safe in early pregnancy

Proton pump inhibitors are not a major cause of birth defects when used early in pregnancy, results of a population-based study from Denmark showed. (BjÖrn Pasternak, MD, PhD, and Anders Hviid, DrMedSci, both of the Statens Serum Institut in Copenhagen).

Atrasentan reduce albuminuria in diabetic nephropathy

Patients with diabetic nephropathy had significant reductions in residual albuminuria when the endothelin antagonist atrasentan was added to ACE inhibitor or ARB therapy according to a study presented at the annual meeting of American Society of Nephrology.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How do I know if I am a candidate for IVF or ICSI?

IVF is indicated for blocked tubes and failure of conventional infertility treatment. ICSI is indicated for poor sperm count or function or failure of fertilization in previous IVF.

What is a typical IVF calendar?

The sequence of events depends on the treatment protocol that has been planned for you. Usually OPD–based injections are started on Day 20 of previous menses, further gonadotrophins with follicular monitoring and blood tests start from 2nd day of menses for about 10 days. You may need daycare admission for oocyte retrieval as you will be administered anesthesia. Two days later you will come back for Embryo transfer which is an OPD USG–guided procedure. In a different protocol, stimulation starts from Day 2/3 of period and collection is done around day 15 after 10–12 days of stimulation.

For queries contact: banerjee.kaberi@gmail.com

    Medicine Update

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

What is the treatment of febrile seizures?

A spinal tap may be done to be sure your child does not have a serious infection like meningitis, especially if your child is younger than 1 year of age.

In general, physicians do not recommend treatment of a simple febrile seizure with preventive medications. Diazepam and Clobazam for intermittent prophylaxis. Anti-fever drugs like acetaminophen and ibuprofen can help lower a fever, as can hydrotherapy but they do not prevent febrile seizures.

If your child has had a febrile seizure, do not fear the worst. These types of seizures are not dangerous to the child and do not cause long-term health problems. If you have concerns about this issue or anything related to the child's health.

Remember: While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, mental retardation, or death.

    Medicolegal Update

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

What is WMA Statement on In–Vitro Fertilization & Donation?

The technique of in–vitro fertilization (IVF) and embryo transplantation creates the possibility of donation of ova, sperm, and embryo, so that the biological donors may not be the parents of the child produced by this procedure. Such use of donated gametes or embryo may present serious legal, moral, and ethical issues for both patients and physicians involved in such IVF and embryo transplantation procedures.

  • The physicians must observe all applicable laws and ethical restrictions imposed by the National Medical Association or other appropriate medical organizations.
  • The physician must also be sensitive to, and respect, the moral and ethical principles of patients, and refrain from the use of donated gametes or embryos when it would conflict with legal or ethical restrictions or the moral principles of the patients.
  • The physician has the right to refuse any intervention he or she deems unacceptable.
  • The technique of cryopreservation increases the availability of gametes and embryos for donation. Where permitted, if one or more donors of gametes, or the donors of an embryo, will not be the functional parent (s) of the prospective child, the physician must obtain assurance that the recipients will accept full responsibility for the unborn child and that the donors will renounce all rights or claims to the unborn child without prejudice to the rights of the child when born.

In the case of an adult woman who is without a uterus, the use of the so–called method of substitute or surrogate motherhood may be used unless prohibited by applicable laws or the ethical rules of the National Medical Association or other appropriate medical organizations. Free and informed consent must be obtained from the parties who are participating in any way in such substitute or surrogate method.

Any commercialization by which ova, sperm, or embryo is offered for purchase or sale is expressly condemned by the World Medical Association. (Adopted by the 39th World Medical Assembly Madrid, Spain, October 1987)

   Legal Question

(Dr M C Gupta, Practicing advocate)

What are the legal implications of a false negative HIV test report?

HIV testing is a highly sensitive and critical matter. A false negative report, though well known in medical literature, constitutes a wrong report from the patient’s and the court’s perspective. If a particular test was advised by the hospital/doctors of the hospital and it was got done by the patient and the report was presented to and acted upon by the hospital, the hospital cannot evade responsibility for the false negative test. However, if the patient had gone to the laboratory on his own and got the blood tested and presented the report to a doctor/hospital unconnected with the laboratory, in that case the hospital and the doctor may plead innocence. The compensation claim could run into lakhs of rupees. The following measures may be adopted to avoid/minimize false negative HIV reports and their legal consequences:

  • The laboratory should include along with the report the note indicated above; It is essential that the laboratory should always add a foot note to the test report on the following lines: "The test was done by ……method and that as per scientific literature, the test may give a false positive report in … % cases and a false negative report in……% cases and that the test may not be reliable in infection less than ……weeks old."
  • The counselling/consent preceding HIV testing should include explaining to the patient the implications of false results/imperfectness of tests;
  • More than one test should be done, if possible, even in HIV–negative cases and not only for confirmation in positive cases;
  • Strict quality control should be observed while performing the test;
  • It should be ensured that the person performing the test/signing the test report is competent. As per High Court judgments and MCI pronouncements, the laboratory tests are pathological tests and amount to practice of the specialty of pathology and can, therefore, be performed only under the supervision of a pathologist and the report should be signed by a pathologist.
  • The best quality test should be used with minimum possibility of false negatives.
  • The pathologist and the laboratory and the treating doctors and the hospital should be covered by a professional indemnity policy.
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • To determine if an overdose has occurred
  • To determine risk of liver damage
  • To help determine if treatment with an antidote is required
    Medi Finance Update

Personal Accident Individual

Changes incurred at hospital or nursing home primarily for diagnostic, X–ray or laboratory examination not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury for which confinement is required at a hospital/nursing home.

    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

List of drugs prohibited for import


    IMSA Update

International Medical Science Academy (IMSA) Update

Fasting blood sugar in children

Even mild increases in fasting blood sugar levels during childhood predict risk for developing type 2 diabetes mellitus. In the Bogalusa heart study, children with fasting blood sugar values in the upper half of the normal range (between 86 and 99 mg/dL) had 2.1 times the risk for developing diabetes during adulthood, and 3.4 times the risk for developing pre–diabetes, independent of the child’s weight status.

(Ref: Nguyen QM, et al. Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med 2010;164:124).

    IJCP Special

Dr Good Dr Bad

Situation: A patient was put on six per week dialysis program.
Dr Bad: It is unethical.
Dr Good: Go ahead with it.
Lesson: Increasing hemodialysis frequency from three to six sessions a week significantly reduced the risk of mortality and adverse cardiovascular outcomes but increased vascular access problems, according to results of a multicenter clinical trial. More frequent hemodialysis was associated with a 40% reduction in the risk of death or increased left ventricular mass and a 30% decrease in the risk of death or a decrease in physical–health score. Moreover, six weekly sessions resulted in significantly greater urea clearance (Kt/Vurea). However, more frequent hemodialysis was associated with a 71% increase in interventions related to vascular access (The FHN Trial Group. In–center hemodialysis six times per week versus three times per week. N Engl J Med 2010 Nov 20. (Epub ahead of print)

Make Sure

Situation: A patient with LBBB in ECG developed acute pulmonary edema.
Reaction: Oh my God! Why was underlying low cardiac functions not suspected?
Lesson: Make sure all patients with LBB undergo echo to rule out ejection fraction. This may not be true for RBBB.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Jitendra Ingole, MD Internal Medicine)

From "Gift from an Angel" by Eileen Goble

"Always see the good in all things, even if the darkest side is what is shown to you. There remains the good to be recognized. Look with unconditional love, and you cannot fail"
"Fear not and be thankful, know your every need is being taken care of. If you are thankful, then you drive out fear. Do not worry about what is ahead, the journey ahead is assured. Have you not been brought forth so far in spite of all fears. Have you not traveled safely through all the trials, sorrows and tribulations of life. You never walk alone. Look back only to recognize the beauty you left behind, do not regret the past, bless it for had you not traveled by that path you would not be here."
"So your karma brings sorrows and anxieties. Fear not, have faith and courage for others look to you to see the light shining forth, maybe unconsciously, they still do, for they know you have something special which is helpful and good."
"Let go, surrender – lay down your problems, do not try to unravel the knots, it only gets tighter as you pull it. Let it go, concentrate with all your heart on love, knowing the knot will be unravelled if you stand back. Fill yourself with love and ask truly for guidance, your problems will be solved."



Read this…………………

A 75–year–old male is diagnosed with pulmonary embolism. His past medical history is significant for diabetes mellitus with retinopathy, hypertension and coronary artery disease. His admission labs show normal CBC, Sodium: 136, Potassium: 4.6, Glucose 200mg%, normal liver panel and Creatinine of 300 micromoles/liter.

Which of the following drugs would require monitoring during therapy?

A. Unfractionated heparin
B. Enoxaparin
C. Coumadin (Warfarin)
D. Argatroban

Contributed by Ashish Verma MD

Yesterday’s Mind Teaser: "long do"
Answer for yesterday’s Mind Teaser: "long overdue"

Correct answers received from: Dr U.C.Vasavada,   Dr.K.P.Rajalakshmi, Dr.K.Raju, Dr Sudipto Samaddar

Answer for 27th November Mind Teaser: "Wise guys"
Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr.K.P.Rajalakshmi,

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

A fellow finds himself in front of the Pearly Gates. St. Peter explains that it's not so easy to get in heaven. There are some criteria before entry is allowed. St. Peter asked the man, "Were you religious in life? Did you attend church services?" "No."
St. Peter told him, "That’s bad. Were you generous? Did you give money to the poor? To charities?" "No."
"That too is bad. Did you do any good deeds? Helped your neighbor? Anything?" "No."
St. Peter was becoming concerned. Exasperated, St. Peter said, "Look, everybody does something nice sometimes. Work with me, I’m trying to help. Now think!"
The man said, "There was this old lady. I came out of a store and found her surrounded by a dozen Hell’s Angels. They had taken her purse and were shoving her around, taunting and abusing her. I got so mad I threw my bags down, fought through the crowd, and got her purse back. I then helped her to her feet. I then went up to the biggest, baddest biker and told him how despicable, cowardly and mean he was and then spat in his face".

"Wow," said Peter. "That’s impressive. When did this happen?"
"Oh, about 10 minutes ago," replied the man.

    Readers Responses
  1. Dear KK, your news bulletin is very informative & up dates all medicos on various topics; my suggestion to add another medico legal column giving summery of judgments of various cases against doctors/hospitals in various courts including DMC without giving the name of the institution; this will make all of us more wiser in day at day practice (although the name is always published in all printed judgments). Dr V K Goyal
    Public Forum

(Press Release for use by the newspapers)

Heart failure patients beware of the winter

Several studies have shown a seasonal pattern of deaths from heart attack and sudden death, with more fatal events occurring in the winter than the summer said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

He was speaking to the public about the winter related problems in heart patients at the Heart Care Foundation of India stall being put up at the ongoing India International Trade Fair, Pragati Maidan in the Ministry of Health & Family Welfare pavilion.

A similar seasonal variation has been seen in men and women with chronic heart failure.

In a large study from France, deaths from heart failure peaked during the winter months of December and January. The distribution of monthly deaths differed by up to 35 percent when January was compared to August, which is when deaths were the lowest.

Hospitalizations for Heart failure followed the same seasonal pattern, with a winter–spring predominance.

However, sudden death in patients with heart failure does not follow a circadian rhythm, in contrast to the circadian variation (most deaths between 6 AM and 12 PM) that occurs in out–of–hospital sudden death or acute heart attack in the general population.

    Forthcoming Events

Hospital Infrastructure 2010

Date: December 7–9, 2010, Venue: Bombay Exhibition Center, Mumbai
Website: www.hospitalinfra–india.com

eMedinewS Events: Register at 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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