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  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com 

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)


3rd November Tuesday

Dear Colleague,

DMC update

 Doctors coming with Commonwealth Games 2010 team can practice: In a meeting held at Delhi Medical Council on 3/7/2009, it was decided that registration to such team doctors who have been authorized by their own country and are certified licensee to practice in their own country shall be given on temporary basis for practices on their own team in the games village/games venue. The same was approved in the council meeting held on 29/7/2009.

Can a person practice in a State without registering in that State: Under Indian Medical Council Act 1956, section 15(2)(b) states that no person other than medical practitioners registered with State Medical Registrar shall practice medicine in any State.


 Senior Citizen Medical Practitioners may get a wave off on reregistration fee: Many senior medical doctors have shown their anguish on DMC charging reregistration fee from them. Most overseas councils do not charge fee after a particular age. This issue was raised by me in the council on 28th October in writing. The same was discussed in council meeting also. Hopefully, soon in coming DMC council meetings, the fee for senior citizen medical doctors may find a wave off. The council under the act has powers to revise the fee. 


Doctor Protection Cell at DMC: As per Delhi Medical Council Act 2/10 under powers, duties and functioning of the Council, one of the clauses is to provide protection to its members in discharging professional duties. Unfortunately, DMC so far has never created a Doctors Protection Cell. I, myself, on 28th October, 09 raised this issue in writing with DMC,which was later also discussed in the Council meting. Hopefully, in near future we will see a Doctors Protection Cell in the council.


Can Delhi Medical Council at all charge reregistration fee: One needs to read clause 2.22.2 under Renewal of Registration which states as under: The Registrar shall, after the publication of the first notice under sub section 1, send a notice by registered post enclosing therewith the prescribed format of application to the registered practitioners at their addresses as entered in the register calling upon them to return the application to the Registrar for continuance of their names on the register within 45 days of the date of notice. If any of the registered practitioners fails to return such applications within the time specified, the registrar issues a further notice to such registered practitioners by registered post after the publication of the second notice under subsection (1) enclosing therewith the prescribed format of application to the registrar for the continuation of his name on the register within 30 days of the date of further notice together with a fee as may prescribed from time to time.


In the above, it is very clear that in the first notice issued by the council, no mention is made about the fee. Fee is only mentioned at the time of second notice. Renewal fee is mentioned in rules as Rs. 1000/- which is probably meant for the second notice and not the first notice. Even if it is mentioned in the rules, the rules have to be read as per the act. If there is no provision of fee in the act, then rules have to be interpreted accordingly or changed accordingly. (This is in response to a query from Dr Kamlesh Kanodia, this matter has been raised by me in the council meeting in writing. Hopefully a legal opinion will be taken by the council).

 World Pneumonia Day: 2 November 2009
he first ever World Pneumonia day was observed on 2nd November 2009. This served as a call to focus attention and take action to help prevent millions of avoidable deaths in children due to pneumonia.
Of the 9 million children aged under 5 who die each year, at least 1.2 million die from pneumonia. That is a terrible statistic.
The offending infectious organism is Streptococcus pneumoniae (or pneumococcus). The yearly death toll attributable to pneumococci in patients with AIDS and other immunocompromised states, elderly people, and those with comorbid illnesses is difficult to quantify, but probably exceeds the infant mortality rate. This bacterium  continues to kill millions of people every year.
On World Pneumonia Day  a 6-year plan from WHO and UNICEF  the Global Action Plan for Prevention and Control of Pneumonia (GAPP) was  announced. The plan aims to place children in an environment where they are at low risk of pneumonia, prevent them developing it, and treating those who contract it. Key interventions include exclusive breastfeeding in the first six months of life, use of vaccines, and management of the condition in clinics and, importantly, at the community level. Successful implementation of GAPP could substantially reduce child pneumonia mortality.

Time to get a flu and pneumonia shot

Flu vaccine should be prescribed to all heart patients as death from flu is more common among people with cardiovascular disease than any other chronic condition.

The American Heart Association and American College of Cardiology also recommend that all heart disease patients get flu shots.

Influenza, also known as the flu, is a highly contagious viral infection of the respiratory tract. Extremes of ages tend to get it more often. The illness occurs from November to April, with most cases occurring between late December and early March.

Annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions.

November is the best time to get a flu shot, but getting a shot in January or even later can still be beneficial. It takes one to two weeks for the flu shot to take effect. Each September, a new flu vaccine is introduced. The vaccine is approximately 70 to 90 percent effective for healthy adults.

FDA warning for body builds supplements
The FDA is notifying the public about new safety information concerning products marketed for body building and increasing muscle mass.  The FDA has sent a Warning Letter to a manufacturer of body building supplements that claim to contain steroid-like ingredients, but in fact contain synthetic steroids.  The products named in the Warning Letter are marketed by American Cellular Laboratories, Inc., and include TREN Xtreme, MASS Xtreme, ESTRO Xtreme, AH 89 Xtreme, HMG Xtreme, MMA 3 Xtreme, VNS 9 Xtreme, and TT 40 Xtreme.

The FDA has received reports of serious adverse events associated with the use of these products and other similar products.  Products like these are frequently marketed as alternatives to anabolic steroids for increasing muscle mass and strength and are sold both online and in retail stores.  They are often promoted to athletes to improve sports performance and to aid in recovery from training and sporting events.  Although products containing synthetic steroids are frequently marketed as dietary supplements, they are NOT dietary supplements, but instead are unapproved new drugs that have not been reviewed by the FDA for safety and effectiveness.  Adverse event reports received by the FDA for body building products that are labeled to contain steroids or steroid alternatives involve men (ages 22-55) and include cases of serious liver injury, stroke, kidney failure and pulmonary embolism (blockage of an artery in the lung).  

New Viagra guidelines
Doctors should prescribe oral phosphodiesterase type 5 (PDE-5) inhibitor drugs for men with erectile dysfunction, unless the patient is on nitrate therapy, according to a clinical practice guideline issued by the American College of Physicians. Qaseem and colleagues analyzed the findings of 130 studies that evaluated PDE-5 inhibitors alone or combined. They found that treatment with the drugs led to statistically significant and clinically relevant improvements in sexual intercourse and erectile function in men with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or ED severity at the start of the study. Overall, PDE-5 inhibitors were relatively well-tolerated and associated with only mild or moderate side effects, such as headaches, flushing, upset stomach and runny nose, the authors found. The guideline is published in the Oct. 20 issue of the journal Annals of Internal Medicine.

No H1N1 parties please
Some people in the US are advocating arranging swine flu parties similar to chicken pox or measles parties, so the healthy children can be exposed to the virus through kids who are already sick with the H1N1 flu. The rationale may be to give a child the swine flu while it is still relatively mild, before it mutates into something more virulent. But, so far, all indications point to the H1N1 virus staying as mild to moderate as when it first appeared in the spring.
Parents also think that the disease is somehow better than unknown side effects associated with the H1N1 vaccine. But, there appear to be no untoward side effects associated with the shot other than redness, tenderness and swelling at the injection site, according to the U.S. Centers for Disease Control and Prevention. But doctors are universal in their condemnation of the practice of swine flu parties as any time you willingly subject your children to an infectious disease, you run the risk of all sorts of complications.
Pandemic (H1N1) 2009 influenza: experience from the critical care unit
From an intensive care unit in the West Midlands: data is for four critically ill patients admitted with severe hypoxia. Two of the patients failed a trial of continuous positive airway pressure and all underwent controlled ventilation within 24 h of admission. Bilevel and high frequency oscillatory ventilation were the most useful modes. Our patients generally had one organ failure and were ventilator dependent for relatively short periods of time. Three of the patients made a full recovery and one required ongoing dialysis. Anaesthesia 64 (11), 1241-5 (Nov 2009)

All pregnant women should be screened for gestational diabetes
The same should be done with one-step oral glucose tolerance testing, according to new international guidelines. The International Diabetes Federation said its recommendations should supercede those of the American Diabetes Association, which suggest a risk-based screening strategy and, typically, two-step diagnosis.
The organization also released two other controversial guidelines at the conference:
1. A recommendation for self-monitoring of blood glucose in type 2 diabetes not treated with insulin, to be used for education and feedback purposes to monitor and adjust treatment and lifestyle
2. A recommendation that diabetes patients follow oral health guidelines for the general population given the lack of evidence on periodontitis risk in diabetes
The guidelines recommend an immediate 75-g oral glucose tolerance test at the first prenatal visit for women at high risk because of prior gestational diabetes, but universal testing at 26 to 28 weeks' gestation for those who have a normal initial result and all other women.

Hypoglycemia Linked to Mortality in Hospitalized Pneumonia Patients

Patients with hypoglycemia at the time of hospitalization for community-acquired pneumonia have an increased risk of death compared with patients with normoglycemia. The in hospital and 30-day mortality rates were both 20% for those with admission hypoglycemia, compared with 9% and 10%, respectively, in those with normoglycemia (P<0.05), according to John-Michael Gamble, MSc, of the University of Alberta School of Public Health in Edmonton, Canada. Hypoglycemia is an easy-to-measure variable on admission, and should be a red flag to alert physicians to possible high-risk pneumonia patients.

Smog Tougher on the Obese

Air pollution appears to hit the obese hardest, causing significant increases in blood pressure. Air pollution has been linked to a variety of health problems including asthma, heart disease and diabetes, but this is the first time obesity has been taken into account. For those who are obese, exposure to air pollution further exacerbated systolic blood pressure and pulse pressure, said lead researcher Srimathi Kannan, an assistant professor at the School of Public Health and Health Sciences of the University of Massachusetts at Amherst. The report is published in the Oct. 16 online edition of the Journal of Epidemiology and Community Health.

Green tea may curb risk of some cancers
Drinking green tea may lower your risk of developing certain blood cancers, but it will take about 5 cups a day, according to a study from Japan. Drinking green tea has been associated with lower risk of dying and heart disease deaths as per  Dr. Toru Naganuma, at Tohoku University School of Medicine in Sendai, Japan. The current study suggests drinking green tea may have a favorable effect for particular cancers. Overall risk for blood cancers was 42 percent lower among study participants who drank 5 or more, versus 1 or fewer, cups of green tea daily. Drinking 5 or more cups of green tea daily was also associated with 48 percent lower risk for lymph system cancers. [American Journal of Epidemiology, September 15, 2009]

Tips to Prevent Vericosity:
1. Apply sunscreen to help protect your skin.
2. Get regular exercise that focuses on strengthening the legs and improving circulation. Walking or running are good choices.
3. If you're overweight, lose weight to reduce pressure on the legs.
4. Sit with your feet on the floor, rather than crossing your legs. And when you can, prop up your feet.
5. Avoid sitting or standing for too long.
6. Support the legs with elastic support stockings, but avoid tight-fitting clothing.
7. Stick to a diet that's low in salt and high in fiber. 
Blood Glucose Levels Edge Up in Latest Teen Data
Although most U.S. teens have normal blood glucose levels, more than 30% are above normal weight, which has public health officials worried about the future burden of hyperglycemic illness. Among non diabetic teens who underwent fasting glucose testing in a national sample, 17% were overweight and 16% were considered at risk, with body mass indices hovering closer to overweight than normal, Deborah B. Rolka, MS, of CDC's diabetes unit, said at the International Diabetes Federation World Congress of Diabetes. Impaired fasting glucose (IFG), defined as a fasting glucose level of between 100 and 125 mg/dL, was present in 11% of the teens who had fasting blood glucose testing, and it was this group of 415 teens that had the highest mean HbA1c levels (5.27%).

Hopelessness and apathy have a direct effect on health
A depressed emotional state, feelings of hopelessness and apathy, could have a direct effect on physical health. A study of stroke survivors found a slower rate of recovery among those experiencing apathy, caring little about themselves and the world around them. And a study of healthy middle-aged women found an association between hopelessness and unexpected thickening of the carotid artery, the main blood vessel to the brain. Both findings are reported in the Aug. 27 issue of Stroke.

Over 65: Take lots of vitamin D to prevent a fall
Important news for seniors: A daily dose of vitamin D cuts your risk of falling substantially. But not just any dose will do. Drug dose should be 700 to 1000 international units (IU) of vitamin D per day and it will work.

Valuable Tips to Avoid Back Pain
1. Avoid tossing and turning at night and getting rid of sagging mattress if you have one.
2. Reading or watching television while lying down is best avoided as when you lift your head to view the screen your muscles may contract causing pain in the neck.
3. Apparently, staying in a particular position for too long stresses the postural muscles in your body. Hence, one should frequently change positions.
4. Crossing a leg if you are sitting for long hours in a particular place, like while in a theatre, as it helps move back and hip muscles.
5. Regularly used household items should be preferably kept on easily accessible shelves, as it can help avoid bending and stretching movements.

Thought of the Day

You are waht your deep rooted desires are.

Conference Calendar

Revisiting 2009, 10th January, MAMC Delhi, emedinews@gmail.com

Funny one liners

 Silence of 2 minutes in a women conference.

Advertising in emedinews

emedinews is a new venture of IJCP Group and is the first daily emedical newspaper of the country. One can advertise with a singe insertion or with 30 insertions in a month. For details contact drkk@ijcp.com.

emedinews: revisiting 2009
IJCP Group is organizing emedinews: Revisiting 2009, a day-long medical conference on 10th January, 2010 at Maulana Azad Auditorium. It will be attended by over 1000 doctors. Topics will be top happenings in the year 2009. There will be no registration fee. Advanced registration required.  Top experts will deliver lectures. It will be followed with lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com

Letters to the editor

1. Aapki tareef karna Suraj ko deeya dikhane jaisa lagta hai.Meera Rekhari. meerarekhari@yahoo.com
God Bless You.
2. The amazing work you are doing dear is DIVINE WORK. Keep it up. I am very sure there are THOUSANDS who appreciate everything you do. I am one of those.God bless you. Dr N K Bhatia drnkbhatia@yahoo.com

3. E-medinews Daily has become a daily addiction to me. Dr. Vinod K. Gupta, Janakpuri, New Delhi


A young woman went to her doctor complaining of pain.
Where are you hurting? asked the doctor.
You have to help me, I hurt all over, said the woman.
What do you mean, all over.  Asked the doctor, be a little more specific.
The woman touched her right knee with her index finger and yelled, Ow, that hurts.
Then she touched her right cheek and again yelled, Ouch! That hurts, too.
Then she touched her left earlobe, Ow, even THAT hurts, she cried.
The doctor checked her thoughtfully for a moment and told her his diagnosis, 
You have a broken finger.

Bedside Formula to know

In a peripheral smear, count the nomer of white cells in one high power field. Multiply it by 2500 it will give rough TLC count. 



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