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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 January, 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Managing diabetes

  • If no contraindications are present always start with metformin as initial therapy in most patients with type 2 diabetes. However, consider insulin as first–line drug in patients presenting with A1C >10%, fasting sugar >250 mg/dL, random sugar consistently >300 mg/dL, or ketonuria.
  • Start with metformin at the time of diabetes diagnosis, along with lifestyle interventions. Titrate its dose to its maximally effective dose (2000–2500 mg/day) over 1 to 2 months.
  • If situations predisposing to lactic acidosis are present, avoid metformin and consider a shorter–duration sulfonylurea.
  • Star with lifestyle intervention first, at the time of diagnosis. If lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in sugar values after 1 or 2 weeks, add the first drug.
  • Those who cannot be given metformin or sulfonylureas, repaglinide is a alternative, particularly in a patient with chronic kidney disease at risk for hypoglycemia.
  • Other alternative is a pioglitazone, which may be considered in patients with lower initial A1C values or if there are specific contraindications to sulfonylureas. There is a concern about atherogenic lipid profiles and a potential increased risk for cardiovascular events with rosiglitazone.
  • One can consider sitagliptin as monotherapy for those intolerant of or have contraindications to metformin, sulfonylureas, or thiazolidinediones. It is a drug of choice as initial therapy in a patient with chronic kidney disease at risk for hypoglycemia. It is however, less potent than repaglinide, which can also be used safely in patients with chronic kidney disease.
  • In patients in whom it is difficult to distinguish type 1 from type 2 diabetes, start with insulin.
  • Further adjustments of therapy should be made every three months based on the A1C result aiming it close to the non diabetic range. If A1C values >7%, one need to further adjust the diabetic regimen.
  • If A1C remains >7% another drug should be added within 2 to 3 months of initiation of the lifestyle intervention and metformin.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

 2nd eMedinewS revisiting 2010

Revisiting the Year 2010 with Dr KK Aggarwal
New epidemics


Audio PostCard
  Quote of the Day

(By Dr GM Singh)

"Boredom is the deadliest poison."

William F. Buckley, Jr.

    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

Dr Ambrish Mithal recieving eMedinewS Medical Statesman of the year 2010 Award in the 2nd eMedinewS revisiting 2010 on 9th January 2011 at Maulana Azad Medical College.

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

A rare bird sighted in Okhla sanctuary

In a rare sighting, a leucistic Coot was spotted – probably for the first time in India – during the ongoing Asian Waterbird Census 2011 being carried out at the Okhla bird sanctuary here on the banks of the Yamuna. The AWC State Coordinator (Delhi) for Wetlands International–South Asia which is conducting the census, Tarun K. Roy said it was during a visit to the Okhla bird sanctuary on January 20 that he first spotted a leucistic Coot (Fulica atra) with a bright white plumage instead of the normal black plumage. "This is the first time in India that such a leucistic Coot has been spotted with the flock of common Coots," said Mr. Roy, who was accompanied by Ananada Mukharjee during the census at the time of the sighting. (Source: The Hindu, Jan 27, 2011)

    International News

(Contributed by Nilesh Aggarwal)

HRH Princess Haya urges development of an effective health strategy that serves all

Her Royal Highness Princess Haya Bint Al Hussein, wife of HH Sheikh Mohammed Bin Rashid Al Maktoum, Vice-President and Prime Minister of the United Arab Emirates and Ruler of Dubai, today, in Her keynote speech at Leaders in Healthcare, the flagship gathering at the 2011 Arab Health Exhibition and Congress, urged the development of an effective health strategy that serves all. The focus of this year’s Leaders in Healthcare was ‘specific drivers’ for leaders spearheading the partnership in healthcare - government, patient and physician - to improve the bottom line yet contribute to the overall quality of patient care and a higher quality of life for all people.

“It is clear that an effective health strategy that serves all must be far broader than medical interventions,” said HRH Princess Haya. HRH Princess Haya highlighted that the most destructive maladies worldwide and in the Gulf Region are not infectious diseases -- they are diseases we create with our own behavior – non-communicable diseases such as -- cardiovascular diseases, cancer, diabetes and some respiratory afflictions. She emphasized the importance of adopting practices to improve health, including regular physical checkups and dietary changes, both of which go a long way towards reducing the burden that such diseases take on the people of the Gulf Region. “The largest single killer here today is type 2 diabetes and the UAE ranks second in the prevalence globally. In the next 15 years, the cancer incidence in the Middle East will surpass that in any other region, increasing between 100 and 180 percent,” stated HRH Princess Haya. Such developments, as HRH Princess Haya underlined, are global challenges that lie in lack of research, patient-centric care, smart technology and treatment. Furthermore, the costs of medical interventions and drug development, home or institutional supervision and care for the uninsured, continue to skyrocket. “Whatever practical steps we take on these issues, we cannot avoid the simple fact that each of us has a role to play in public health – in our own personal health, our family’s and our community’s,” She concluded.

Topics of discussion throughout the day revolved around creating a ‘no wait’ culture for elective care in healthcare, developing an approach that is more accessible and cost-effective, integrating delivery and financing of healthcare as well as the role of primary healthcare in Singapore. The speaker faculty included some of the industry’s foremost thinkers, pioneers and business leaders, such as Raj Raja Rayan OBE - former adviser to UK Secretary of Health, Dr. Nipit Piravej, MD - CEO of the World Medical Center Group in Bangkok, and other specialist speakers.

The Arab Health Exhibition and Congress closed today (27TH January) at the Dubai World Trade Centre, featured more than 2800 exhibiting companies from 60 countries. Attended by in excess of 70,000 visitors it was the largest gathering ever of healthcare professionals in the Middle East.

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com)

Body fat may predict early obesity

Research appearing in the American Journal of Health Promotion found that despite the common view that heavy babies are healthy babies, babies who are overweight at nine months are more likely to be overweight at 2 years of age. Using data from the Early Childhood Longitudinal Study–Birth Cohort, researchers tracked 7,500 children at age 9 months and 2 years. The study found that 32% of babies were obese or at risk at 9 months and 34% were at risk by age 2. Researchers made sure to note that they are not saying that overweight babies are doomed to be overweight adults, but that being overweight at the age of 9 months can be an indicator of obesity later in childhood, as told to WebMD.

(Dr Monica and Brahm Vasudev)

Stress–reduction therapy may help heart disease patients

Reducing anxiety decreases heart attacks, deaths and other cardiovascular events, research suggests. A stress management program based on cognitive behavioral therapy may reduce the risk of heart attack, stroke and death in patients with heart disease, Swedish researchers report. About 30% of heart attacks may be linked to "psychosocial factors," including chronic stressors such as poverty or emotional problems, such as depression and hostility, the authors note in the Jan. 24 issue of the Archives of Internal Medicine.

Pen mightier than keyboard for making imprint on brain

As keyboards increasingly replace pens, new research cautions that the switch may come with an unforeseen price: the loss of critical brain activity central to learning that is uniquely tied to the old–fashioned act of handwriting.The concern stems from the results of a number of experiments recently reviewed by a pair of researchers in France and Norway, who concluded that writing by hand is actually a very different sensory experience than typing on a keyboard, with each activating distinctly different parts of the brain. Mangen and colleague Jean–Luc Velay of the University of Marseille together reported their observations in the journal Advances in Haptics.

Lowering BP can help reduce women's heart disease risk

A 15–point reduction in systolic blood pressure may aid disease prevention in middle age, study finds. Many middle–aged women could significantly reduce their risk of heart disease by lowering their blood pressure, researchers say. High systolic blood pressure (the pressure when the heart contracts) is a significant risk factor for cardiovascular disease and its common outcomes –– heart attack, heart failure and stroke –– in middle-aged and older women around the world, according to the report released Jan. 24 in the journal Hypertension.

    Infertility Update

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

What is Endometriosis?

In endometriosis, the endometrium (tissue from the lining of the uterus) forms and grows in places outside the uterus. These growths may cause pain and infertility. Up to 50% of women who have endometriosis may experience infertility. These lost endometrial cells respond to the body’s hormones in a similar manner as they would inside the uterus. Normally, the endometrium within the uterus thickens to prepare for an embryo. When pregnancy does not occur, the extra lining breaks down and is shed during menstruation.

For queries contact: banerjee.kaberi@gmail.com

    Pediatrics Update

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

What are the symptoms of hepatitis C?

The symptoms of hepatitis C infection include fever, nausea and vomiting, loss of appetite, stomach pain, extreme fatigue, and yellowing of the skin and eyes (jaundice).

Some people who are infected with hepatitis C virus have no symptoms and can infect others without knowing it. These persons are at risk of becoming ill at some time in the future. It has been estimated that it may take 10 years to develop symptoms.

    Medicolegal Update

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

What is The Medical Termination of Pregnancy Act, 1971?

  • It is an act to provide for the termination of certain pregnancies by registered medical practitioners.
  • Abortion or miscarriage is the premature expulsion of the fetus from the mother’s uterus at any time of the pregnancy before the full term pregnancy is complete.
  • Abortion may be i) Natural, i.e. spontaneous or accidental or ii.) Artificial, i.e., therapeutic justifiable, eugenic, humanitarian or social grounds. The Statement of Objects and reasons for introducing the Medical Termination of Pregnancy Bill, 2002 is as under:
  • The provisions regarding the termination of pregnancy in the Indian Penal Code which was enacted a century ago were drawn up in keeping with the then British Law on the subject. Abortion was made a crime for which the mother as well as the abortionist could be punished except where it had to be induced in order to save the life of the mother.
  • It had been stated that this very strict law has been observed in the breach in very large number of cases all over the country. Furthermore, most of these mothers are married women, and are under no particular necessity to conceal their pregnancy.
  • In recent years, when health services are expanded and hospitals availed to the fullest extent by all classes of the society doctors have often been confronted with gravely ill or dying pregnant women whose pregnant uterus have been tampered with a view to causing an abortion and consequently suffered very severely.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. Sometimes the relatives of an unconscious patient in a hospital request the doctor to attest the left thumb impression of the patient. Should the doctor agree to such request?

Ans. Legally speaking, attestation of signature or thumb impression means testifying that the signature/thumb impression has been made by the person concerned knowingly and voluntarily. This cannot be done by an unconscious person. Hence, the doctor should not agree.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Alternative name: Bone g1a protein measurement

Osteocalcin is a major protein found in bone. Small amounts of this protein are found in the bloodstream.This analysis is normally used:

  • To help evaluate bone formation disorders.
  • When a secondary malignant neoplasm of the bone is suspected.
  • To monitor postmenopausal women who are at risk for osteoporosis.

Causes of high osteocalcin levels in blood

  • Adolescent growth spurts (40–80 mcg/L in boys)
  • Chronic renal failure.
  • Hyperthyroidism.

Causes of low osteocalcin levels in blood

  • Pregnancy
  • Cirrhosis
    Medi Finance Update

Stock Market

  • Law of Economics, when the bank interest rate reduces, then stock market has to rise and vice versa. When the interest rate reduces, the profit increases.
  • Even a genius in stock market will be wrong in 3 out of 10 innings.
  • Do not invest in stock market directly, take the mutual funds route.
Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name


DCI Approval Date

Pregabalin SR 75/150/300mg + Methylcobalamin 1500mcg tablets

For the treatment of adult patients with peripheral neuropathy


    IMSA Update

International Medical Science Academy (IMSA) Update

Immunization Practices: ACIP recommendations

In 2010, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices expanded the recommendation for influenza vaccination to include all individuals 6 months of age and older.

(Ref: CDC’s Advisory Committee on Immunization Practices (ACIP) recommends universal annual influenza vaccination. www.cdc.gov/media/ pressrel/2010/r100224.htm.)

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with pinpointed chest pain.
Dr. Bad: It is a classical heart attack.
Dr. Good: It is non–cardiac chest pain.
Lesson: A cardiac chest pain can never be pinpointed by a finger.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction: Oh my God! You should have put him on magaldrate preparations?
Lesson: Make sure to remember that Magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The famous author of ‘The Power of Positive Thinking’ once told this story.

A man once telephoned Norman Vincent Peale. He was despondent and told the reverend that he had nothing left to live for. Peale invited the man over to his office. "Everything is gone, hopeless," the man told him. "I’m living in deepest darkness. In fact, I’ve lost heart for living altogether."

Norman Vincent Peale smiled sympathetically. "Let’s take a look at your situation," he said calmly. On a sheet of paper he drew a vertical line down the middle. He suggested that they list on the left side the things the man had lost, and on the right, the things he had left. "You won’t need that column on the right side," said the man sadly. "I have nothing left, period." Peale asked, "When did your wife leave you?" "What do you mean? She hasn’t left me. My wife loves me!" "That’s great!" said Peale enthusiastically. "Then that will be number one in the right–hand column—Wife hasn’t left. Now, when were your children jailed?" "That’s silly. My children aren’t in jail!" "Good! That’s number two in the right–hand column – Children not in jail," said Peale, jotting it down.

After a few more questions in the same vein, the man finally got the point and smiled in spite of himself. "Funny, how things change when you think of them that way," he said.

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s eQuiz: A 25–year–old homeless male is brought to the emergency room by the police who found him unresponsive on the pavement. Patient is intubated for airway protection. He is afebrile and blood pressure is normal. Remainder of the physical examination is unremarkable too. Laboratory data is consistent with a severe anion gap metabolic acidosis with a pH of 7.0 and an acute kidney injury. Ethanol was undetectable in his blood. Serum betahydroxybutyrate and lactate were undetectable. Which of the following is the next best step in the management of this patient.

A. A sepsis workup including chest xray and culture of blood, sputum and urine.
B. A lumbar puncture to rule out meningo–encephalitis.
C. Urine sediment exam for oxalate crystals and serum methanol and ethylene glycol assay.
D. A stat head CT to rule out catastrophic intracranial bleeding.
Answer for Yesterday’s eQuiz: The correct answer is C. While all the options are reasonable possibilities in a comatose patient with no history and it is likely that in the real world, we may do all those tests anyway. But a closer look at the limited clinical data presented to us shows that apart from being ‘unresponsive’, this patient is hemodynamically stable and has no tell tale signs of sepsis or neurological catastrophe. The presence of a severe anion gap metabolic acidosis and acute kidney injury is pointing to the consumption of either methanol (wood spirit) or ethylene glycol (anti–freeze). Other causes of anion gap acidosis are less likely given that diabetic ketoacidosis is ruled out by absence of ketosis or lactic acidosis. This patient had consumed ethylene glycol and responded to fomepizole (specific antidote for antifreeze toxicity) and hemodialysis.

Correct answers received from: Dr K.Raju, Dr Anil Bairaria

Answer for 27th January Mind Teaser: That is besides the point
Correct answers received from: Dr C.Vaishnavi. Dr Anil Sharma, Dr K.Raju

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

Anniversary Gift

After she woke up, a woman told her husband, "I just dreamed that you gave me a pearl necklace for our anniversary. What do you think it means?" "You’ll know tonight," he said. That evening, the man came home with a small package and gave it to his wife. Delighted, she opened it – to find a book entitled "The Meaning of Dreams."

    Readers Responses
  1. Sir, I would like to highlight a wrong policy of MCI which is wrongfully hurting a lot of young teachers like me all over the country. According to MCI, the requirement for becoming an Assistant Professor or a Senior Resident in a Medical College is same i.e. a postgraduate degree in the concerned subject. For becoming an Assistant Professor, one requires a 3–year teaching experience, which according to MCI is earned during post graduation, therefore practically there is no differentiation between qualification requirement for Assistant Professor and Senior Resident. This has resulted in gross disadvantage for doctors who after completing their 3 years of Senior Residency join as Assistant Professor (1st Group) vis a vis those who join as Assistant Professor soon after completing their postgraduation (2nd Group). The first group of doctors now becomes 3 years junior to the 2nd group in spite of having more experience. This also results in 2nd group becoming Associate Professor earlier even when their overall teaching experience is less than the 1st group.

    MCI should remove this anomaly by including the teaching experience gained during senior residency from a teaching institute equivalent to that of Assistant Professor for promotion from Assistant to Associate Professor. This would remove this anomaly and also wouldn’t discourage people from doing senior residency, which I believe is an essential part of training as of now. At a time when MCI is advocating an increase in medical professionals and in increasing retirement age of Professors to overcome shortage of teachers, it should consider removing this anomaly to remove the bottleneck of shortage of teachers at rank of Associate Professor, which again promotes dishonesty among Private colleges by keeping part time Associate Professors. I hope that this will initiate discussion among BOGs and encourage other similarly aggrieved doctors to take up this cause. Regards, Dr. Vineet Jain, Assistant Professor Orthopaedics, Sharda University, Gr. Noida.
    Public Forum

(Press Release for use by the newspapers)

Act fast: you can reduce the Damage and Death from Heart Attack if……?

As per Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, water soluble aspirin and clot–dissolving drugs can stop most heart attacks in progress, reducing disability and saving lives. They work best if given within 1 hour of when signs of heart attack appear. It is therefore important to recognize the warning signs of a heart attack and act right away.

Every year, over 24 lakh people die of heart attacks in India. About half of those deaths take place within one hour of the onset of warning signs and before the patient even reaches a hospital.

5 Warning Signs of a Heart Attack that everybody must know

  • Pain or discomfort in the jaw, neck or back
  • Feeling weak, lightheaded or faint
  • Chest pain or discomfort
  • Pain or discomfort in the arms or shoulder
  • Shortness of breath

Act fast

  1. Take 300 mg water–soluble aspirin and chew it if a heart attack is suspected.
  2. Get yourself rushed to a nearest heart centre for clot–dissolving treatment.
  3. You may require an emergency angiography to get the clot removed manually.
  4. If there is a cardiac arrest, the bystander should give chest compression, 100 per minute, over the centre of the chest for the next 10 minutes.
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Conference Column

Workshop on Fetal and Paedatric Echocardiography Pre and perinatal management of heart disease

13th February 2011, Sunday, Moolchand Medcity

  1. Fetal Echocardiography–How to get it right: Dr Vandana Chaddha
  2. Fetal Cardiac Spectrum– abnormal cases with interactive session: Dr Vandana Chaddha
  3. Neonatal Cardiac Cases– Hits and misses inetractive session: Dr Savitri Srivastava
  4. Intima Media Thickness and Plaque Volume, New Marker for Atherosclerosis Regression: : Dr KK Aggarwal

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