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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 ...

30th October 2010, Saturday

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

CDC study predicts increase in Diabetes Incidence in the U.S.

A study from the CDC has forecast a rise in incidence of diabetes in the US. It states that up to one-third of US. adults could have diabetes by 2050 assuming that current trends continue.
Theodore J. Thompson, of the agency's Division of Diabetes Translation, and colleagues report in the journal Population Health Metrics that if the recent increases in the incidence of diabetes persist and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by the year 2050. They also suggest that with low incidence and comparatively high mortality, total prevalence of diagnosed and undiagnosed diabetes could be no more than 21% by 2050, up from 14% in 2010. However, the incidence will go up sharply over the next 40 years due to an aging population more prone to develop type 2 diabetes, increases in minority groups that are at high risk for type 2 diabetes, and increase in life expectancy of people with diabetes.
According to the researchers, the previous lower estimates were outdated probably as they used 1990 census projections that did not account for the increasing size of the Hispanic and foreign-born U.S. populations at higher risk for developing diabetes. These data also did not take into consideration undiagnosed cases and assumed that there would be no increase in incidence of the disease. In the present study, the authors used data from the U.S. Census Bureau and the CDC. The census data were based on numbers from the 2000 census and include estimates of the 2007 population and estimates of mortality rates, net migration, and births from 2008 through 2050. The CDC data included estimates of diagnosed diabetes for the U.S. adult population (ages 18 to 79 years) from 1980 through 2007.

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

 17th Perfect Health Mela 2010
Divya Jyoti 

Nurses from Delhi and NCR participated in various competitions like Health Model display in Divya Jyoti.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Acute Otitis Media and Influenza

Children receiving live attenuated influenza vaccine (LAIV) had a high level of protection against influenza–associated AOM when compared with placebo or trivalent inactivated influenza vaccine (TIV). This was most evident in children older than 2 years, for whom LAIV is indicated. LAIV recipients who contracted breakthrough influenza illness despite vaccination developed AOM at a significantly lower rate than did unvaccinated children who developed influenza.

Ref: Block SL, et al. The Efficacy of Live Attenuated Influenza Vaccine Against Influenza-associated Acute Otitis Media in Children. Pediatr Infect Dis J 2010 Oct 7. (Epub ahead of print)

  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

MCD gets Rs. 35 crore to control dengue

The Delhi Government has sanctioned an additional Rs.35 crore to the Municipal Corporation of Delhi for intensifying anti–larval and anti–adult–vector measures to effectively control diseases like dengue, chikungunya and malaria in the city. This was decided at a high–level meeting attended by Health Minister Prof. Kiran Walia and Finance Minister Dr. A.K. Walia at Delhi Secretariat on Tuesday. The meeting was also attended by several senior officials. (Source: The Hindu)

3rd Great Himalayan bird count takes off

Uttarakhand Principal Chief Conservator of Forests Raghu Bir Singh Rawat on Wednesday flagged off from Dehradun volunteers participating in the Third Great Himalayan Bird Count. Organised by Action and Research for Conservation in Himalayas, the event is supported by the Uttarakhand Forest Department and Uttarakhand Space Application Centre. (Source: The Pioneer)

  International News

(Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Most medical errors do not lead to lawsuits

Just 22% of medical errors examined in a recent study led to malpractice claims or lawsuits, according to a study led by Philip Stahel, a surgeon at Denver Health Medical Center. That’s even though about one–third of the errors created long–term negative consequences for the patient.

(Dr Monica and Brahm Vasudev)

FDA warns consumers against Vita Breath

Vita Breath is marketed as an herbal supplement for people with asthma. FDA is now warning consumers not to buy or consume it after a sample of the product was shown to contain 10,000 times the recommended limit for lead in candy.

Certain GnRH agonists may increase risk of diabetes, heart attack, FDA warns

The US FDA is looking into data suggesting a group of prostate cancer drugs increase the risk of diabetes and heart disease.

Experts concerned about growing number of caesareans in the US

Caesareans are necessary in certain cases, such as in a breech presentation. But, medical experts are concerned that too many women are using the procedure, particularly since the number of caesareans in the US has increased from 21% in 1998, to about one-third of all births. Some women who have had caesareans refuse to deliver any additional children vaginally because they are worried about the uterus rupturing. But, according to experts, about 74% these women can in fact have a successful vaginal delivery.

FDA approves Pradaxa for prevention of stroke in atrial fibrillation patients

The Food and Drug Administration approved the direct thrombin inhibitor dabigatran (Pradaxa) on Oct. 19 to prevent stroke and blood clots in people with atrial fibrillation. It is the first approval of an oral anticoagulant in more than 50 years. Dabigatran, manufactured by Boehringer Ingelheim Pharmaceuticals Inc., will be distributed in 75–mg and 150–mg capsules. Dosage recommendations are based on the patient’s creatinine clearance: For patients with a creatinine clearance greater than 30 mL/min, the recommended dosage is 150 mg twice daily; for those with a level of 15–30 mL/min, the recommended dosage is 75 mg twice daily. There is no dosage recommendation for those with a creatinine clearance below 15 mL/min.

  Gastro Update

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

What are the various extraintestinal manifestations of IBD?

About a third of the pediatric and adolescent patients with IBD may have at least one extraintestinal manifestation as a presentation sign.

  • In children and adolescents, arthritis and arthralgia are the most commonly reported extraintestinal manifestations, with an incidence ranging from 7% – 25% in different series. Arthritis in adults occurs when the disease is active, but in children the arthritis may occur years before any gastrointestinal symptom develop.
  • Other extraintestinal manifestations include erythema nodosum, pyoderma gangrenosum, perianal disease, primary sclerosing cholangitis, nephrolithiasis, UTI, uveitis, vasculitis, anemia, thrombocytosis, osteoporosis, etc.
  Infertility Update

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

How many people are affected by infertility?

Estimates are that one in six couples is affected by some measure of infertility. However, that number may be very deceptive. Many couples choose to lead child–free lives rather than look for treatment for their infertility, and we believe they are rarely included in infertility estimates. Others suffer frequent pregnancy losses which are, in a way, a form of infertility and are not technically considered "infertile" because they are able to conceive. INCIID is in the process of creating a survey designed to provide new insights about who is infertile, what kinds of infertility they are experiencing, what kinds of treatments have been successful for specific diagnoses, and much more. This survey will be conducted online, and is expected to be a source of important clinical information for practitioners as well as consumers.

  ENT Update: Question of the Day

When should antibiotics be given in community-acquired acute bacterial rhinosinusitis? (Dr Bina Jain)

For patients who present with 10 or more days of symptoms of purulent rhinorrhea, nasal congestion and facial pressure, the likelihood of a diagnosis of ABRS increases. Observation is considered a viable option due to a high rate of spontaneous resolution in community–acquired, uncomplicated rhinosinusitis.  

  • Mild symptoms: Watchful waiting, with assurance of follow–up, has been recommended in 2007 guidelines from a multidisciplinary expert panel for selected patients with symptoms suggestive of mild ABRS: Mild pain and temperature <38.3°C or 101°F. Supportive treatment for symptomatic relief is indicated for patients under observation for seven days after the time of diagnosis. If there is no improvement, or if symptoms worsen, then antibiotics are then initiated. Factors such as age, general state of health, and comorbidities should be considered when choosing this option.
  • Patients with moderately severe symptoms who meet clinical criteria for ABRS, and patients with severe symptoms regardless of duration of illness, should be treated with an antibiotic.

(Ref: Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007;137:S1).  

  Medicolegal Update

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

The Death of John F. Kennedy

Was the killer Oswald just a "crazed lone gunman"? Still a forensic mystery

On November 22, 1963, President John F. Kennedy, who was riding in an open car during an official visit to Dallas, Texas was shot dead. Three shots were heard and the President fell forward bleeding from the head. The President was pronounced dead approximately thirty to forty minutes after receiving his wounds. The body was transported via the Presidential plane to Washington, D.C. and subsequently to the Naval Medical School, National Naval Medical Center, and Bethesda, Maryland for postmortem examination. The fatal missile had entered the skull above and to the right of the external occipital protuberance. The other missile entered the right superior posterior thorax above the scapula and traversed the right side of the neck. Autopsy surgeon opined that the wound of the skull produced such extensive damage to the brain as to preclude the possibility of the deceased surviving this injury. In the Warren Report Appendix IX – Autopsy surgeon say that based on the above observations it is our opinion that the deceased died as a result of two perforating gunshot wounds inflicted by high velocity projectiles fired by a person or persons unknown. The projectiles were fired from a point behind and somewhat above the level of the deceased. The observations and available information do not permit a satisfactory estimate as to the sequence of the two wounds.

There have been two official investigations of America in which one concluded Oswald acted alone, the other that there was a conspiracy. After forty four years, many of the key documents which could tell the whole story remain classified. John F. Kennedy’s brain is still missing from the National Archives. Why, if it is an open and shut case? Why the secrecy, if Oswald was just a "crazed lone gunman"?

The House Select Committee on Assassinations concluded that John F. Kennedy was the victim of a conspiracy based on the recording of the gunshots fired in Dealey Plaza, captured over a police radio. A total of 7 impulses were caught on the tape, but citing budgetary constraints, the HSCA only had 4 of them analyzed. The analysis concluded that all 4 were gunshots, two of them occurring within 1/2 a second of each other, too close to be fired by one man. Comparisons of the echoes with test shots fired in Deakel Plaza confirmed that at least one of the recorded shots had indeed been fired from the Grassy Knoll. Needless to say, the existence of 5, rather than just 3, gunshots destroyed the Oswald as lone gunman cover–up. Warren supporters quickly tried to dismiss the audio record of the gunshots by claiming that the recording was actually of gunshots in another part of the city, and confused for Dealey Plaza shots because of a timing error. Without explaining just where the other shots had occurred, or why the echo patterns matched the test shots fired in Dealey Plaza, the Warren supporters declared victory.

New research has shown that the report that dismissed the audio recording of the gunshots was itself deeply flawed and ignored evidence that confirmed both the location and time of the recording as being in Dealey Plaza at the time of the JFK assassination. This means that the original House Select Committee on Assassinations conclusion is the correct one. There were at least four gunshots in Dealey Plaza, two of them within 1/2 second of each other, and at least one of the shots came from the Grassy Knoll. The two Secret Service men walking on either side of the car would have been in an ideal position to protect Kennedy when the shooting started, but as this video shows, were ordered back into the Secret Service car following JFK's car. One agent clearly expresses confusion at this order. New study confirms HSCA conclusion of more than three gunshots and shot from Grassy Knoll.

(Reference: The Assassination of John F. Kennedy Warren ReportAppendix IX – Autopsy Report and Supplemental Report Clinical Record – Autopsy Protocol Date1/22/63 1300 (CST) Prosecter: CDR J.J. Humes, MC, USA (497831)

  Medi Finance Update

Individual Mediclaim policies

  • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X–ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of organs and similar expenses.
  • Pre and post hospitalization expenses.
  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

Drugs prohibited from the date of notification

All Pharmaceutical preparations containing Chloroform exceeding 0.5% w/w or v/v, whichever is appropriate

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Antinuclear Antibody test (ANA test)

To screen for certain autoimmune disorders, such as systemic lupus erythematosus (SLE), polymyosistis etc. The pattern could be:

  • Homogenous (diffuse): Associated with SLE and mixed connective tissue disease,
  • Speckled: Associated with SLE, Sjogren’s syndrome, scleroderma, polymyositis, rheumatoid arthritis, and mixed connective tissue disease
  • Nucleolar: Associated with scleroderma and polymyositis
emedinews 3D echocardography
  IJCP Special

Dr Good Dr Bad

Situation: A 70–year–old elderly diabetic patient had HbA1c of 7%.
Dr. Bad: This is poor control of diabetes.
Dr. Good: This value is ok.
Lesson: European Diabetes Working Party guidelines for elderly type 2 DM patients consider frailty, recommending a conservative target (HbA1c <8%). Tight glycemic control for such patients increases the risk of hypoglycemia and significant functional decline.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh My God! His HBAIC is very high?
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Quote of the Day (Dr GM Singh)
"We must be the change we wish to see." Mahatma Gandhi

Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "The whole nine yards "

Correct answers received from: Dr Deepti Katyal Uppal, Dr Rashmi Chhibber,  Dr.K.P.Rajalakshmi, Dr Vishanji Karani, Dr Geeta Yadav, Dr. K.V.Sarma,

Answer for 28th October Mind Teaser: "dinner’s on the table "
Correct answers received from: Dr Deepti Katyal Uppal, Dr Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

Dispatcher: Sir, an ambulance is on the way. Are you an asthmatic?
Caller: No
Dispatcher: What where you doing before you started having trouble breathing?
Running from the police

An Inspirational Story

(Contributed by Dolly Aggarwal)
10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren’t caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free

Don’t take things so personally

Most people, even your friends and colleagues, aren’t talking about you, thinking about you, or concerned with you at all for 99% of the time. The ups and downs of life, the warmth and coldness of others, aren’t personal at all. Pretending that they are will only make you more miserable than is needed.

Don’t assume your emotions are trustworthy

How you feel isn’t always a good indicator of how things are. Just because you feel it, that doesn’t make it true. Sometimes that emotion comes from nothing more profound than being tired, hungry, annoyed, or about to get a head–cold. The future won’t change because you feel bad—nor because you feel great. Feelings may be true, but they aren’t the truth.

  Readers Responses
  1. Dear Sir, it was interesting to read the story on the new mutant form of the H1N1 virus. The spotlight once again shifts to preventive medicine. Antiviral drugs should only be given to confirmed cases. Regards Dr Anupam.
  Public Forum

(Press Release for use by the newspapers)

Over 3000 nurses participate at MTNL Perfect Health Mela

The main attraction of the MTNL Perfect Health Mela on Thursday was Divya Jyoti, a Festival of Nurses. More than 3000 form various hospitals, across Delhi and the NCR participated in the festival. Various Competitions were held which included Health Model Display, Poster cum Slogan making, Skit, Debate and Collage making on various Health Topics.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India, Dr. KK Aggarwal, said that sensitization of nurses and medical students is necessary for upliftment of the healthcare state of the country.

A Seminar on Infertility was also organized. The participants included Dr. KK Aggarwal, Dr. Kaberi Banerjee, Dr. V.K. Khanna, Dr. Rakhi Mehra, Dr. Suman, Dr. Yadav, Dr. Anupama Sethi Malhotra and Mr. Praveen Aggarwal.

The take home message was that proper management can reduce problem of infertility to a large extent.

Russian Ballet at MTNL Perfect Health Mela

Russian Cultural Centre performed a Russian Ballet at the Mela venue which was followed by cultural evening by Dr. Arthi Pathak, a medical doctor.

Over 5000 examined at the health mela

A large number of school children and general public got their health checkups done. Majority of the patients examined were with joint pains.

Khoya adulteration awareness at the Mela.

  1. About seven per cent of milk produced in India is used for making khoya.
  2. It constitutes one of the two basic ingredients (other being ‘Chhena’) for the preparation of indigenous sweets.
  3. Khoya is loosely wrapped in paper, muslin cloth, jute bags, bamboo baskets or any other less expensive and unhygienic packaging material for transportation. Such packed khoya is often  susceptible to deterioration through microbial contamination.
  4. Khoya is highly prone to adulteration during handling and transportation.
  5. Khoya is adulterated with ‘maida’, blotting/filter paper, mashed potatoes and sweet potatoes.
  6. Halwaiis also use different colouring agents to improve the appearance of sweets.
  7. In India addition of only eight food colouring agents viz Erythrosine, Carmoisine, Ponceau 4R, Tartrazine, Sunset –yellow FCF, Indigo carmine, Brilliant blue FCF and Fast green FCF are permitted in quantities specified depending upon the food item.
  8. Non-permitted colours/dyes including Metanil yellow, Malachite green, Rhodamine, Auramine etc., are used in the preparation of sweets, confectionery, bakery, ice-creams and other food items.
  9. Non-permitted colours and excess of permitted colours can have adverse effects on human health.
  10. Some of the common after-effects of prolonged use of synthetic colours were allergy, hyper-acidity, asthma, kidney and liver damage, development of tumor and cancer.
  11. One should prefer sweets prepared with pure khoya and edible colours.
  12. Generally, consumption of coloured sweets should be discouraged.
  13. Khoya (Mava) is milk in which the water content is reduced to between 20% and 25%. It is prepared by vigorously boiling milk and stirring it continuously to avoid burning at the bottom or overflowing at the top. When cooled, khoya forms a uniform mass, containing fats, heat-coagulated proteins and lactose. Khoya supplies 82 kcal (344 KJ) per tablespoon.
Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
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
17th MTNL Perfect Health Mela 2010 day programme
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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