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    In This Issue ...
Dr K K Aggarwal

Dear Colleagues,

The Institute of Medicine (IOM) has revised their 1990 recommendations for weight gain in pregnancy. The changes apply to obese women: their lower limit of weight gain is reduced from 15 lbs (6.8 kg) to 11 lbs (5 kg) and an upper limit of weight gain (20 lbs [9 kg]) was added.

As per The United States Preventive Services Task Force (USPSTF), all women planning or capable of pregnancy should take a multivitamin containing 400 to 800 mcg of folic acid for prevention of neural tube defects (NTDs).

A systematic review of studies of proteinuria as a predictor of pregnancy outcome has shown that even high levels of proteinuria (>5 grams) is not predictive of major maternal, fetal, and neonatal complications. Determining the level of proteinuria is not a clinically useful test for management of pre-eclamptic pregnancies, but remains important in diagnosis of pre-eclampsia.

Increased rates of spontaneous abortion and preterm birth have been reported among pregnant women with H1N1 influenza A, especially those with pneumonia.

A prospective study of over one million women (average age 56 years) found that one alcoholic drink (10 g) per day increased the overall risk for cancer by 6 percent, including cancers of the oropharynx, esophagus, larynx, rectum, liver, and breast.

A randomized trial found that proton pump inhibitor therapy does not improve asthma-specific outcomes in patients who do not have symptoms suggestive of GERD.

Screening for prostate cancer has undergone changes. These include a lower PSA cutoff (3 ng/mL) for referral for biopsy, less frequent screening intervals (every 2 to 4 years), and a suggestion not to perform digital rectal examination as part of screening.

An international committee of experts, including scientists from the American Diabetes Association, the International Diabetes Federation, and the European Association for the Study of Diabetes, has released a consensus statement recommending the use of hemoglobin A1C (A1C) to diagnose diabetes mellitus. The report in June 2009, recommended that an A1C level >= 6.5 % be used to diagnose diabetes. The diagnosis should be confirmed with a repeat A1C. In making the recommendation, the report noted several technical advantages of the A1C assay over glucose testing, increased patient convenience (since there is no special preparation or timing required for the A1C test), and the correlation of A1C levels with retinopathy. The report also noted that if an A1C test is either unavailable or uninterpretable, for e.g. owing to rapid red cell turnover with anemia, the previous diagnostic methods and criteria, using glucose testing, should be used.

Escitalopram is now approved by the US FDA for the treatment of depression in adolescents aged 12 to 17 years.

The American Heart Association has published nutritional implementation strategies in 2009 for the prevention and treatment of dyslipidemia in children above 2 years of age. The guidelines include recommendations for daily moderate activity of 60 minutes, encouraging eating at home, and a diet high in vegetables, whole grains and low-fat dairy with reduction in salt and high glycemic intake.

Anti thyroid drugs, methimazole and propylthiouracil, are commonly used for treatment of Graves' disease in children and adolescents. Side effects are more frequent and more severe with propylthiouracil, and include a small risk of severe hepatotoxicity. Because of these safety concerns, the Endocrine Society now recommends AGAINST the use of propylthiouracil as first-line treatment for Graves' disease in children.

Fatal reactions related to calcium-ceftriaxone precipitates in the lungs and kidneys of neonates prompted a 2007 warning from the US FDA that concomitant use of ceftriaxone and calcium-containing products should be avoided in all patients. The FDA has updated those recommendations as follows: ceftriaxone and IV calcium products may be administered sequentially in patients >28 days of age, provided that the infusion lines are thoroughly flushed between infusions. Ceftriaxone should not be reconstituted or mixed with a calcium-containing product (e.g., Ringer or Hartmann solution or parenteral nutrition) and should not be administered simultaneously via a Y-site. Concomitant use of ceftriaxone and IV calcium-containing products remains contraindicated in infants <= 28 days of age.

And much more in this issue......

Dr K K Aggarwal

Pharma Update
In the News
News you can use
New Research
For the Clinician
Indian Penal Codes to Know
Formulae in Diabetology
Patient Information
Nice to Know This
Letter to Editor


Pharma Update

Two new antibodies may aid AIDS vaccine

The International AIDS Vaccine Initiative (IAVI) says two antibodies to HIV have been found that could help develop a vaccine. The discovery reveals a potential new Achilles? heel in the virus's defenses. The new antibodies - broadly neutralizing antibodies - are produced by a minority of people with HIV. It is widely believed that to prevent HIV infection a vaccine would be need to teach the body to produce these powerful antibodies before exposure to the virus. Only four antibodies to HIV had been discovered earlier. But they worked by binding to a place on the virus that is difficult for vaccine-makers to exploit. The latest duo is potentially much more useful as they bind to the virus at sites which scientists believe are more accessible.


Scientists closer to improved anthrax vaccine

Scientists from Albert Einstein College of Medicine of Yeshiva University have discovered two small protein fragments that could improve anthrax vaccine with fewer side effects. Anthrax partly results from toxic proteins that the multiplying bacteria produce. The current anthrax vaccine employs one of these proteins, which elicits protective antibodies when injected into people. But the 40-year-old vaccine has significant drawbacks. Immunity is temporary, and five injections over the course of 18 months are needed to sustain it. During the study, scientists focused on the protein toxin used in the current vaccine, looking for the smallest protein sections (known as peptides) that could trigger the production of protective antibodies when injected into animals. The current anthrax vaccine is intended mainly for members of the armed forces serving in areas considered high risk and for individuals involved in homeland biosecurity.

Source :


In the News

Infant with protruding heart stable after operation: doctors

Doctors at AIIMS operated upon an infant (barely ten days) born with a protruding heart and pushed the organ within the body after creating space for it. Operation lasted four hours; Dr. Bisoi led the team of five. The baby was suffering from thoracic ectopia cordis, a 'rarest of the rare heart defect' in which the heart is abnormally located. Mortality rate of this type is very high. The family is very poor. The institute bears every cost. "Children like these are either born dead or die within 36 hours. He has already created a record by surviving for so many days. It is a lifetime opportunity for professionals to learn how to deal with such kind of situation?, Bisoi said.



Stroke cures man's failing sight

Seventy-year-old Malcolm Darby after waking from surgery to remove a blood clot following a stroke said he had near-perfect vision. But this did not come free, it cost him his ability to speak French. He had been wearing glasses since two years of age after measles had damaged his sight. Experts say the side-effects of the stroke are "unusual". Initially it left him paralyzed and dumb. He said, "Before the stroke I could speak French and now I just can't get a word of it out". He also authenticated his miracle by relating that when a nurse walked past he realized he could read the words on a newspaper under her arm, which he would have been unable to do without one of six pairs of glasses beforehand. He is now able to talk again and walks four miles a day.


News you can use

Over-the-counter painkillers can become addictive within three days

It is warned that popular painkillers; routinely used to ease headaches, back problems and period pain, can cause addiction in just three days. Women are more at risk of developing the addiction. Due to its addictive nature, a series of measures to counter the problem has been drafted. Packets size will be limited to just 32 tablets. Clear warnings will be put on the front of packs, accompanying patient information leaflets, stating: 'Can cause addiction. For three days use only'. Advertising will no longer state that the drugs are remedies for things like coughs and colds and only that they are for acute and moderate pain.


Eat more greens to shield your heart

Most of heart disease is due to atherosclerosis i.e. fatty plaques in the arteries. It is the bends and branches of blood vessels that are more prone to the plaque accumulation. Now, a study published in the journal Arteriosclerosis Thrombosis and Vascular Biology has suggested a role for green vegetables such as broccoli, cabbage and cauliflower in protecting arteries from disease. A chemical found in the vegetables has been discovered that can boost a natural defense mechanism. According to Dr Paul Evans, the vulnerable areas of the arteries lack the active form of Nrf2, a protein that usually protects against plaque build-up. "Treatment with the natural compound sulforaphane activates Nrf2 which prevents the cells from becoming inflamed?, he added. This compound is found naturally in the green "brassica" vegetables such as broccoli. "Besides supporting the importance of eating 'five-a-day', the biochemistry discovered could lead to more targeted dietary or medical approaches to prevent or reduce disease that leads to heart attacks and strokes", said Professor Peter Weissberg, medical director of the British Heart Foundation.



New Research

How greens may protect the heart

Researchers from The Imperial College London claim that sulforapane can boost a natural defense mechanism to protect arteries from disease. Sulforapane can be found in vegetables such as broccoli, cabbage, sprouts and cauliflower. The latest study shows that a protein that usually protects against plaque build up called Nrf2 is inactive in areas of arteries that are prone to disease. But treatment with a chemical found in green 'brassica' vegetables such as broccoli can activate Nrf2 in these disease-prone regions. Using normal mice, and mice engineered to lack the Nrf2 protein, the research found that in straight sections of arteries, Nrf2 was present in the endothelial lining cells. Through its action on other proteins, it prevented the cells from becoming inflamed, an early stage in the development of atherosclerosis. They believe this will enable artery regions to remain healthy, even reduce the progression of existing disease. - 20 hours ago


Make Sure

New gene linked to progressive hearing loss identified

Scientists have team found a gene called Loxhd1, necessary for maintaining proper functioning of hair cells in the inner ear. But mutations in this gene can lead to their degradation and a disruption of the process that enables hearing. They used a technique called forward genetics in their quest to better understand the genetic basis of hearing and hearing loss. In forward genetics, scientists make mutations at random in germ cells, screen the resulting models for physical characteristics of interest (in this case hearing impairment), then amplify these traits through the breeding of several generations.


For the Clinician
Mela 2009

HPV vaccine could save women from breast cancer

Human papillomavirus (HPV) vaccine can prevent some forms of breast cancer in women and save thousands of lives each year, suggested an Australian study. HPV is present in a significant number of breast cancers and it has a 90-95% causal role in the cervical cancer development. "Confirming a cancer-causing role for HPV in some breast cancers establishes the possibility of preventing some breast cancers by vaccination against HPV", said Dr Noel Whitaker, a co-author of the new report. They validated their findings by looking for "telltale" changes linked to HPV such as enlarged nucleus surrounded by a characteristic "halo".

Moms with postpartum depression 'likely to contemplate suicide'

Mothers who contemplate suicide suffered greater mood disturbances, low maternal self-esteem, negative perceptions of their effectiveness as a new parent and noticeably less responsiveness to their infants' cues. Clinicians at the Jewish Family and Children's Service Early Connections program carried out the investigation to increase the mother's ability to be affectively present in her interaction with the child and to address issues that arise as result of becoming a mother. The participating women are in their 30s most of them first-time mothers. Fifty three percent of them comprised the high suicidality group. Treatment should include the mother with the infant -- not the mother alone -- to best remediate the relationship where depressed mothers are often less able to be sensitive and responsive to their babies.


'Thunder thighs' may help beat heart disease

A new study found that heart disease risk was more than doubled for both men and women who had a thigh circumference of less than 55 centimeters. Those volunteers with thighs between 55 and 60 centimeters received a protective effect against heart disease. However, that protective effect reduced for people with thighs above 60 centimeters in circumference. Thigh circumference is a broad indicator of physical activity and muscle mass is related to how much exercise people do. Muscle mass and strength are important determinants of longevity and health. Even moving from no activity to some activity has a dramatic effect.



  • In the Women's Health Initiative, among women who developed non-small-cell lung cancer, those who had been receiving combined estrogen-progestin therapy had a significantly shorter survival compared with those receiving placebo[,  accessed June 5, 2009]
  • The Endocrine Society has published evidence-based clinical guidelines on the evaluation and management of adult hypoglycemic disorders [J Clin Endocrinol Metab 2009; 94:70].
  • An international committee of experts, including scientists from the American Diabetes Association, the International Diabetes Federation, and the European Association for the Study of Diabetes, released a consensus statement recommending the use of hemoglobin A1C (A1C) to diagnose diabetes mellitus [Diabetes Care 2009]
  • The American Diabetes Association and the American Association of Clinical Endocrinologists published a consensus statement on inpatient glycemic control. They recommend fasting glucose goals of <140 mg/dL for general hospitalized patients, with random glucoses <180 mg/dL (10.0 mmol/L). For the majority of critically ill patients, they recommend a blood glucose target of 140 to 180 mg/dL. [Diabetes Care 2009; 32:1119]
  • In a two-year trial of 811 overweight and obese adults, who were randomly assigned to one of four diets based upon macronutrient content, weight loss (3 to 4 kg) was similar in all groups [N Engl J Med 2009; 360:859]
  • In the Prospective Studies Collaboration analysis of 57 prospective studies (894,000 subjects followed for a mean of eight years), mortality was lowest among men and women with a BMI between 22.5 to 25 kg/m2, and there was a 30 percent increase in overall mortality for each 5 kg/m2 increase in BMI [Lancet 2009; 373:1083]
  • Observational studies using PET-CT scanning have demonstrated the presence of metabolically active brown adipose tissue in adults. Brown adipose tissue is predominantly located in the supraclavicular and neck areas, and its activity is inversely related to BMI and percent body fat. [N Engl J Med 2009; 360:1518]
  • In a one-year trial of intravenous zoledronic acid (5 mg once) versus daily oral risedronate (5 mg) in 288 subjects who recently started glucocorticoids (prevention group) and 545 patients who had been taking them for more than three months (treatment group), zoledronic acid was at least as effective as risedronate [Lancet 2009; 373:1253].
  • In a two-year trial of risedronate (35 mg weekly, which is the current preferred regimen) versus placebo in 284 men with osteoporosis, treatment with risedronate significantly increased lumbar spine BMD (6.0 versus 1.4 percent with placebo) [J Bone Miner Res 2009; 24:719].


Indian Penal Codes to Know
Pratham Medicine

IPC 304-A

Causing Death by Negligence
Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

This is the most important section and applicable to medical profession as it defines death by medical negligence and also talks about the punishment


Formulae in Diabetology

Insulin therapy

1500 Rule = 1500/TD

Developed by Dr. Paul C. Davidson, Medical Director of the Diabetes Treatment Center in Atlanta, the 1500 Rule is also known as the Correction Factor or Insulin Sensitivity Factor (Regular insulin)

The 1500 Rule is defined as the number of mg/dL the blood glucose level will drop after the administration of one unit of regular insulin. In other words: when 1500 is divided by your total daily dose of insulin, the resulting number tells you approximately how far a blood glucose reading will be lowered by 1 unit of regular insulin.

If you use regular insulin (which is termed a short-acting insulin): If your total daily dose of insulin were 30, then 1500 divided by 30 = 50, meaning that 1 unit of regular insulin would drop your blood glucose by approximately 50 mg/dL.



Patient Information

Trans Fats

What are trans fats?
Trans fats are a type of fatty acid. Fatty acids are a source of energy for your body. Fatty acids come from fruit and vegetable oils, seeds, nuts, animal fats, and fish oils. Not all fatty acids are unhealthy, but some, such as trans fats, can be bad for you. Trans fats are often used in processed foods and baked goods because they are cheaper than animal fats, have a wide range of textures, and have a longer shelf life.

What types of foods contain trans fats?
Margarines, shortening, crackers, cookies, chips, salad dressings, and fried foods may be made with trans fats. Many foods from fast food restaurants also have high levels of trans fats.


Why are they unhealthy?
Trans fats may increase the levels of bad cholesterol in your body and decrease the levels of good cholesterol. Studies have found that eating more trans fats is linked to a higher risk of heart disease.

How do I avoid them?

You should add more fruits and vegetables to your diet in place of some packaged foods. Fruits and vegetables are naturally free of trans fats. You should also read food labels carefully. Many foods now say "trans fat free" on the package. Food labels must list trans fats, total fat, saturated fat, and cholesterol. Trans fats may also be listed on food labels as hydrogenated or partially hydrogenated vegetable oils. Some fast food restaurants do not use trans fats anymore, but it is important to ask before you order. The American Heart Association recommends that no more than 1 percent of your total calories per day come from trans fats. This equals about 2 to 2.5 grams per day.


Nice to Know This

Dr. Good Dr. Bad
  • Chewing on gum while cutting onions can help a Person from stop producing tears. Try it next time you chop onions!!!!!! !!!!
  • Until babies are 6-month-old, they can breathe and swallow at the same time. Indeed convenient!
  • Offered a new pen to write with, 97% of all people will write their own name.
  • Male mosquitoes are vegetarians. Only females bite.
  • The average person?s field of vision encompasses a 200-degree wide angle.
  • The names of the continents all end with the same letter with which they start.
  • Electricity doesn?t move through a wire but through a field around the wire.

Letter to Editor

 Dear Sir

Thanks for the journal and the agenda. Sir, I would like to draw your attention about what the DMC has done and doing about the medical fraternity. I?m talking about junior doctors and residents who are being thoroughly exploited by the private hospitals. We all are aware of the work of the residents; it is the residents who run the hospitals right from casualty admissions to the final discharge of the patients. What norms regarding working hours, salary structure, overtime, and timely salaries/payments are set by the DMC? I think none. Why? The reason is no one cares for the residents, though they pay the same amount for registration with DMC as other senior/consultant. So why is there a difference? No grievance cell has been formed by the DMC where residents can put in a complaint which can be looked upon by chair of doctors for a solution. It has also been very frequently seen that when the residents leave the hospitals they are not even paid their salaries; they run around for few days and then finally have to leave their salaries Why? Why are these hospitals not penalized for such inhuman harassment? Also there was a recent law that every hospital and nursing home should have a medical superintendent but do these medical superintendents have a degree or a diploma in hospital administration? No, they are just picked up at low salaries with just a MBBS degree and no knowledge of administration. I feel it is the duty of DMC to look. So kindly look into these matters and make it more doctor-friendly.

Dr. Vivek Sharma

Delhi Medical Council Needs A Visionary Leadership  

Dear Colleagues,

                   The  medical profession in the country is passing through trying times. We are faced with the challenge  of positioning our country and capital city as the global capital of health. We are also faced with the reality of a society  more hostile, litigious and suspicious of the medical  profession. Every day one hears of assaults on the profession. Every hour we face the  increasing menace of quackery breathing down our necks. AND every minute we are facing the wrath of innumerable authorities unaware of the realities of the profession.

The Delhi Medical Council (DMC) as the statutory body is responsible to provide protection to its members in discharging duties; ensure that no unqualified person practises modern scientific medicine in addition to receiving complaints form public against misconduct or negligence by doctors and take disciplinary action as deemed fit.

After the recent judgment by Hon'ble Supreme Court of India, it has become mandatory for Consumer Fora, Criminal Court and the police to first refer the matter to a compeptent doctor or committee of doctors, and only after that doctor or committee report that there is  a prima facie case of medical negligence can  notice be then issued to the concerned  doctor/hospital. Most of such cases are referred to DMC for opinion.

The  role of the DMC has thus become paramount.


With the elections for DMC already scheduled, we are now going to elect our next council for a five-year-term. It is in the interest of the medical profession and the society  at large to elect a dedicated team of professionals with  proven track record; vision and a pro-active and forward looking approach. It is these elected 8 representatives (plus 1 elected from amongst DMA members) who would represent you all and take care of the interests of the profession. 

Friends, we have been approached by innumerable colleagues in Delhi to field a team which fulfills the above. In all humility we offer ourselves to represent you in the DMC for the ensuing half a  decade. It is the under mentioned group of your representatives in DMA who have been responsible for the recent enactment of 'Delhi Medicare Service Personnel & Medical Service institution  (Prevention of Violence ) Act' by Delhi Assembly as well as the recent Supreme Court judgment protecting interests of Nursing Homes &  Medical Establishment in Delhi.



We Commit, that if elected we shall take care of the interests of the medical profession in Delhi to the best of our abilities.


Foremost amongst our AGENDA would be:


  1. To ensure that the DMC functions in a manner most transparent, positive and profession friendly.

  2. To Provide unstinted protection to medical professionals in  Delhi in discharging their professional duties.

  3. To root out the menace of quackery from Delhi by ensuring that no unqualified person  practies modern scientific system of  medicine.To adopt practical strategies for the above rather than keep making hue and cry on paper.

  4. To adopt  profession friendly strategies and prescribe a code of ethics for regulating the professional conduct of practitioners. To constantly update the profession  on issues: Legal, statutory, ethics-related which they must know.

  5. To fight for abolition of fees for Renewal of Registration in DMC.

The date of elections would be announced shortly. We shall also communicate the same to you. We look forward to your suggestions, and indulgence in this process. It's only our active indulgence today which would carve out a better future for all of us tomorrow.

Kind Regards 

Dr. Sanjiv Malik (mob. 9810026796)


Dr. Naresh Chawla (mob. 9811035060) 


Dr. Ashwini Dalmiya (mob. 9811542055)


Dr. K. K. Aggarwal (mob. 9811090206)


Dr. Chander Prakash (mob. 9810029000)


Dr. H. S. Kukreja (mob. 9810064847)


Dr. Vinod Khetarpal (mob. 9811054945)


Dr. Ramesh Dutta (mob. 9811086688)



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Delhi Medical Council




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