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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

30th June, 2010, Wednesday

Binge eating disorder

Binge eating disorder (BED) is binge eating i.e. eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, two days per week for duration of six months. The mean lifetime duration of BED is 14.4 years.

Binge eating is associated with a lack of control over eating, and with distress over the binge eating. The binges associated with BED must have at least three of the following five criteria

1. Eating much more rapidly than normal
2. Eating until uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of embarrassment
5. Feeling disgusted, depressed, or very guilty after overeating


Diagnostic and Statistical Manual of Mental Disorders, 4th ed, American Psychiatric Association, Washington, DC 1994.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)


World Environment Day

Heart Care Foundation of India conducted a press conference involving officials from Govt. Department and celebrities to discuss the issue "Melting Glaciers" on World Environment Day June 5, 2007


Dr k k Aggarwal
In the photo Ms. Komala Vardhan, bharatnatyam dancing ace, during a press conference to mark the World Environment Day. Also in the photo Padma Shri and  B C Roy Awardee Dr. K K Aggarwal


News and views

Late reperfusion therapy increases mortality (Dr Varesh Nagrath)

Reperfusion therapy delivered outside guideline–recommended times was associated with significantly increased 30–day mortality in ST–elevation myocardial infarction (STEMI) patients, according to a new Canadian study. Patients receiving late reperfusion also had a nonsignificant increase in one-year mortality and a significantly increased risk of the composite of mortality/recurrent MI/ heart failure at one year. The study, published in the June 2, 2010, issue of JAMA, was conducted by a team led by Dr Laurie Lambert (Quebec Healthcare Assessment Agency, Montreal).

One should give the reperfusion therapy that one can deliver on time. The guidelines recommend this to be within 90 minutes of presentation at the hospital for primary percutaneous coronary intervention and within 30 minutes for fibrinolysis. If it is going to take much longer than 90 minutes to get the patient to the PCI hospital, then fibrinolysis is an acceptable treatment with good outcomes when done within 30 minutes.

Cord blood storage (Dr G M Singh)

When you complete your preadmission paperwork, don’t be surprised if you’re asked what you want to do with the umbilical cord blood of your newborn. Cord blood is rich in stem cells that can be used in transplants for diseases like leukemia and that may one day play a role in "building" new tissue.

New limits on medical residents' work hours proposed (Dr Brahma and Monica Vasudeva)

The Accreditation Council for Graduate Medical Education has proposed new guidelines, published in the New England Journal of Medicine, to limit the number of work hours for medical residents and to increase supervision for those with less experience. Under the guidelines, new doctors in their first year of residency training programs would be more closely supervised by experienced doctors and the maximum length of their work shifts would be cut from 24 hours to 16 hours.

The procedures would trim the length of time interns can be on call to 16 hours from 30 previously. In 2003, intern working hours were restricted to no more than 80 a week, and 30 at one stretch after a 1999 Institute of Medicine report found medical errors claimed 44,000 to 98,000 lives annually. The guidelines would allow residents to work a maximum of 28 hours after their first year.

Role of statins in sinusitis

Release of inflammatory mediators is an active process that involves the release of polyunsaturated fatty acids from phospholipids for enzymatic conversions of biologically active mediators. Hence it has been hypothesized that counter-regulatory lipid synthesis inhibitors, such as statins can block the release of these mediators. An exvivo analysis of the inflammatory mediators in 20 patients with symptomatic sinusitis, who underwent sinus surgery, was performed. All patients on statin therapy showed statistically significant (p<0.005) decrease in the expression of cytokines and chemokines, vs patients not on any anti-inflammatory agents. This study concluded that statins may induce significant anti-inflammatory effects in sinusitis and suggests that statins may have a role in the treatment of chronic airway inflammation. (Am J Respir Crit Care Med 181;2010:A4219)

MCI News

Gujarat HC asks Ketan Desai's wife to file bail plea in lower court

Alka Desai had sought transit anticipatory bail as her name appears in the case filed by CBI against Desai, for having disproportionate assets. When the matter came up for hearing before justice Z K Saiyed, CBI laywer Y R Ravani submitted that Alka had not approached the lower court and had directly come with the anticipatory bail plea to the high court. Hence, she first needs to file bail plea in CBI sessions court, Ravani contended. The court agreed to this argument, following which Alka Desai's anticipatory bail application was withdrawn by her lawyer so that they could approach the lower court first. Alka, in her application has claimed that the CBI had arrested her husband in a second case as soon as he was granted bail by Delhi court. She has further claimed that her mother was not well and was admitted in intensive care unit of a private hospital. Also, her son is in class 12, and in case she is arrested, both her mother and son would be affected, Alka had said.Hence, she should be protected from arrest by CBI till she obtains regular anticipatory bail from Delhi court. [PTI]


Legal Column

When is a claim for medical negligence maintainable?

Every claim for medical negligence is not true and every claimant cannot stand before the court, asking to be heard fully on the merits of his case. First, the issue of maintainability has to be settled even before deciding whether the medical service rendered was deficient and/or negligent. The Supreme Court has observed that: Even if all the treating doctors are not impleaded as parties, the complaint is still maintainable. The court reasoned that since it is difficult to pinpoint exactly whose negligence led to the injuries, hence even if all the concerned parties are not in the complaint, the complaint would still be heard.

In fact in one of the cases of medical , the court was approached by way of a writ petition by a nurse who had suffered injuries from sexual abuse in the hospital and had also not been given treatment diligently because of which she lost an eye. An objection was raised about maintainability of the petition on the ground that petition raised disputed and complex questions of facts and circumstances which should not be decided in writ jurisdiction. For exercise of writ jurisdiction, a fundamental right of the citizen has to be violated by a public body.

The High Court of Delhi held that: Distinction between public law and private law remedy by judicial adjudication is gradually being judicially marginalised and getting obliterated. As a consequence, certain private institutions having an element of public duty can be corrected/directed by courts. The hospital was thus held responsible for the injuries caused to the petitioner nurse.

Forensic Column

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

What is Othello Syndrome?

Othello syndrome or morbid jealousy is a psychotic disorder where the affected person has delusions of infidelity of a spouse or partner. Recurrent accusations of infidelity are a characteristic feature of this disorder. The affected person starts seeking proof that such activity are occurring and searches for evidence, repeatedly interrogates the partner, tests his partner’s fidelity. Sometimes, stalking may also be a feature. The partner may succumb to pressure and falsely confess that she has indeed been unfaithful. This becomes a trigger point and the same confession result in violent murderous attack and jealous homicide. It may be associated with alcoholism, paranoid schizophrenia.


Experts’ Views

Question of the Day

Can testing of nonHDL cholesterol replace testing of triglycerides in our country?

Dr. Sanjay C. Shah Ahmedabad

Non–HDL–C enc includes all cholesterol present in potentially atherogenic lipoprotein particles (VLDL, intermediate–density lipoproptein (IDL), LDL and lipoprotein(a)).

At present, the concentration of LDL–C is estimated using the Friedewald equation: LDL–C=TC–HDL–C–TG/5 mg/dl.
This equation requires measurement of total cholesterol (TC), triglycerides (TGs) and high–density lipoprotein (HDL–C). Although the LDL–C concentration estimated by this method provides a reasonable estimate of the amount of LDL–C, it also includes LDL–C and lipoprotein (a). The Friedwald equation is generally considered to be less accurate with increasing TG levels and inapplicable at TG concentration 7>400 mg/dl.

The advantages of using non–HDL–C as a screening tool include the fact that only TC and HDL–C need to be measured, both of which can be measured reasonably accurately in a non-fasting sample, as opposed to LDL-C measurement, which requires a fasting sample.

Mental exercise to prevent dementia:  Dr Anupam Sethi Malhotra

Fourteen punctuation marks in English grammar: Period, comma, colon, semicolon, dash, hyphen, apostrophe, question mark, exclamation point, quotation mark, brackets, parenthesis, braces, and ellipses.


Public Forum (Press Release for use by the newspapers)

17th MTNL Perfect Health Mela Theme and Logo released

The country’s popular 17th MTNL Perfect Health Mela will be held from 23rd to 31st October, 2010 at NDMC Grounds, Laxmi Bai Nagar, New Delhi.

Prof. (Dr. ) Kiran Walia, Minister of Health, Government of Delhi, in her message to the press said that Delhi is prepared from health point of view for the forthcoming Commonwealth Games. She said that Delhi will not only be a hygienically clean place but will also provide all facilities to the Commonwealth Games visitors vis–à–vis health starting from preventive to the most advanced care.

Former international cricketer Sh. Chetan Chauhan released the theme and the Logo of the mela. The theme for this year's mela is Rising Problems of Lifestyle Disorders. On this occasion he said that sports should be the key to a healthy and a fit lifestyle.

The mela is being organised by Heart Care Foundation of India jointly with Health Department, Govt. of Delhi, MTNL, NDMC, MCD, LIC, Deptt. Of Science & Technology, Govt. of India, Coca Cola India Ltd. etc.

17th in a row, the brainchild of Heart Care Foundation of India, the mela attracts 3–5 lakh members of the public over 10 days duration.

The mela is organised every year between Dushehra and Diwali and creates health awareness about all aspects of health amongst people from all walks of life and all ages, incorporating all pathies under one roof through the medium of infotainment. The mela is right mix of health picnic, exhibition, competition and infotainment.

Addressing the press, Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy Awardee, President of the mela, said that for the first time a special day will be devoted for the care of women and a Sarvadharma Sammellan will be organised in collaboration with World Fellowship of Religions.

Acharya Dr. Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions, said that Sarvadharma Sammellan will focus on peace and safe environment.

Dr. P.K. Sharma, MHO, NDMC, Dr. Yadav, MHO, MCD and Dr K S Bhagotia CMO, DHS in a joint statement, said that the problems of dengue, malaria and chikungunya is well under control and we don't anticipate any problem vis–á–vis forthcoming Commonwealth Games.

Mr. Sunil Kumar PGM, MTNL said on behalf of CMD, MTNL that mela will be a right place to know everything that is happening in medicine.

Dr K K Dwivedi Head NCSTC, Deptt. Of Science & Technology said that Department of Science & Technology will focus on science behind health and miracles.

Addressing the gathering on the occasion, Mr Sinha from LIC and representatives from, Coca Cola India Ltd. said that the mela would be a perfect picnic spot and a shopping mall for the general public.


An Inspiring Story (Arun Rai)

Some anecdotes about Albert Einstein…… honored by Time magazine as the ‘Man of the Century’

One day during a speaking tour, Albert Einstein’s driver, who often sat at the back of the hall during his lectures, remarked that he could probably give the lecture himself, having heard it so many times. Sure enough, at the next stop on the tour, Einstein and the driver switched places, with Einstein sitting at the back in his driver’s uniform.

Having delivered a flawless lecture, the driver was asked a difficult question by a member of the audience. "Well, the answer to that question is quite simple," he casually replied.

"I bet my driver, sitting up at the back there, could answer it… "


IJCP Special

Dr Good Dr Bad

Situation: A patient of right ventricular (RV) pacing developed significant MR.
Dr Bad: Nothing can be done.
Dr Good: We should try biventricular pacing.
Lesson: RV pacing behaves like left bundle branch block (LBBB) and can cause functional mitral regurgitation (MR). This interventricular dyssynchrony can be improved with biventricular pacing.

Make Sure

Situation: A diabetic hypertensive was denied a betablocker because of traditional teaching.
Reaction: Oh my God! You should have used nebivolol.
Lesson: Make sure that diabetics are not denied betablockers when indicated. Nebivolol has no effect on glucose metabolism unlike atenolol. (Source: Am J Hypertens 2005;18 (12, pt. 2):169S176S)

Mistakes in Clinical practice

Do not write "CC" for Cubic Cm: it can be mistaken as "U" (units) when poorly written

Mnemonic of the Day (Dr Prachi)

Pancreatitis: Diagnostic criteria – PANCREAS

PaO2 below 8
Age >55
Neutrophils: WCC >15
Calcium below 2
Renal (Urea >16)
Enzymes: (LDH >600; AST >200)
Albumin below 32
Sugar: (Glucose >10, unless diabetic patient)


International Medical Science Academy Update (IMSA)

The Advisory Panel of the Department of Health and Human Services has made changes to the HIV treatment guidelines; the initiation of antiretroviral therapy is now recommended in patients with a CD4 count less than 500 cells/mL (DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV–1 infected adults and adolescents. www.AIDSinfo.nih.gov. (Accessed on December 1, 2009). In addition, raltegravir, an integrase inhibitor, along with two nucleoside analogs, is considered an option for firstline therapy in treatmentnaive patients.

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Everolimus 5/10mg Tablets (Addl. Indication)

Treatment of advanced renal cell carcinoma


Medi Finance

Personal Accident individual
Risk Group I: Accountants, doctors, lawyers, architects, consulting engineers, teachers, bankers, and persons engaged in administrative functions and people primarily engaged in occupation of similar hazard.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

D Testing (Du) in blood grouping.

Some red cells possess the D antigen but it is expressed so weakly that the cells are not agglutinated directly by antiD sera. An indirect antiglobulin test is necessary to identify patients with the Weak D (formerly known as Du) phenotype. Weak D testing is done on all prenatal patients and candidates for Rh immune globulin including Rh negative donors to ensure they are truly D negative.
It should be done routinely on Rh negative candidates for transfusion, depending on the policy of the transfusing institution.


Humor Section

Funny Definitions

Terminal Illness………… Getting sick at the airport

Medical bloopers on medical charts!

The patient is tearful and crying constantly. She also appears to be depressed.


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

The true spiritual warrior never fears feelings of helplessness, because she recognizes such states as the heralds of new powers to come, like storm clouds before spring flowers.

Redaers Response

Dear KK, With all the respect to the individuals and their views which I believe are independent and not motivated, probably many persons do not know inthings of MCI. Govt has taken the right step.I have my own views based on deep knowledge of MCI, and therefore can add further, that the govt should have not put a limit of one year for the Board, but continuity until reforms are accepted and implemented. Dr KK Arora


Forthcoming Events

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

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

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

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

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

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

eMedinews Revisiting 2010

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