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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 ...

21st November 2010, Sunday

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

Women with demanding jobs are 40% more at risk of heart attack, stroke

Results of the longest, 10–year, major study on stress in women, presented at the American Heart Association conference on Nov. 14 has shown that women with demanding jobs are 40% more likely to have a heart attack or stroke than women with less stressful jobs. There were 17,415 participants in the Women’s Health Study.

Stressful positions were defined as those with demanding tasks and little authority or creativity. Women with demanding jobs and little control over how to do them were nearly twice as likely to have suffered a heart attack as women with less demanding jobs and more control. Also women with high–stress jobs face about 88 percent more risk of a heart attack than if they had low workplace strain.

Worrying about losing one’s job also raised the odds of having cardiovascular disease risk factors, such as high blood pressure and higher cholesterol levels –– but not actual heart attacks, stroke or death.  

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
  Quote of the Day

(By Dr. GM Singh)

"Truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self–evident."

    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela - Heritage 2010

Heritage – An Inter School Festival of Classical Dances is a well-known and appreciated competition in the Perfect Health Mela. Students from various schools of Delhi and NCR perform different traditional dances in the competition in different categories.

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

Blood sugar testing strip to cost as less as Rs 5

Blood sugar testing strips could soon cost as little as Rs 5 each. Each strip now costs around Rs 35, which makes it quite expensive for dibetics who need to test their blood sugar levels at regular intervals. Indian Council of Medical Research (ICMR) is working on developing the country’s cheapest strips at the behest of Union health minister Ghulam Nabi Azad. ICMR has backed three projects, which will be financially supported by the Union health ministry. ICMR director general Dr V M Katoch told ToI that one of these tests include checking blood sugar levels with a saliva swab. (Source: The Times of India)

    International News

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

Lack of exercise, rather than poor diet, may be to blame for obesity in some children

A study by Telemark Univeristy College and the Norwegian Institute of Public Health of 900 elementary school students found that overweight children ate healthy foods more frequently than their normal weight peers. The research suggests that exercise along with good diet is a key component to combat childhood obesity. Professor Anne Lise Brants'ter, the lead researcher for the study said, "It is positive that parents and children emphasize healthy food choices. However, it is important to note that the amount of healthy foods must be adapted to a child’s activity level to limit further weight gain."

(Dr Monica and Brahm Vasudev)

Mouse study shows effect of blood pressure drug on Alzheimer’s disease

Diazoxide, used decades ago to treat high blood pressure has been shown to improve learning and memory in mouse models of Alzheimer’s disease, according to a new study by researchers at the National Institute on Aging (NIA), part of the National Institutes of Health. Diazoxide, acted on nerve cells in the mouse brain in ways that slowed the development of the neurodegenerative disorder. The findings appear in the Nov. 15, 2010, print edition of the Journal of Alzheimer’s Disease. Diazoxide stabilized nerve cells in the brain and prevented a biological cascade in the mice that can result in the destruction of these cells. The drug also improved blood flow in the brain and prevented the harmful accumulation of two proteins, beta–amyloid and tau, which are hallmarks of Alzheimer’s. Widely used in the 1970s and ‘80s to treat patients with severe hypertension, diazoxide is currently used to treat hypoglycemia, or low blood sugar.

Understanding risk factors for gangrene

According to the U.S. National Library of Medicine, the following factors increase a person’s risk of developing gangrene:

  • Suffering a serious injury.
  • Having a disease of the blood vessels, such as hardening of the arteries.
  • Being diabetic.
  • Having a compromised immune system (i.e., from HIV or chemotherapy).
  • Having surgery

New protocol reduces children’s radiation exposure during cardiac procedures

A protocol that uses continuous real–time radiation monitoring, low–dose imaging programs and requires physician awareness of radiation dose, significantly reduced radiation exposure during electrophysiology procedures and catheter ablations to diagnose and treat heart arrhythmias in children.

Death of spouse, child may cause higher heart rate, other dangers

The death of a spouse or child can cause elevated heart rate and other potentially harmful heart rhythm changes among the recently bereaved.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

Does one need to get admitted in the IVF process?

A patient undergoing IVF does not require admission. However, one should visit the center 3–5 times during monitoring cycle. On the day of egg collection, the patient would need to fast for 6 hours and come to the clinic (the procedure takes about 30 min). Patients can go home after the effect of anesthesia wears off which takes about 2–3 hours. The next scheduled visit is after 2–3 days for the embryo transfer, which again takes about half an hour and patients are free to go home after resting for one hour.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

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

What causes Alagille's?

  • In some families this condition is passed on through the parents i.e. genetically. The inheritance is not straightforward as in some diseases, and the condition may have presented differently in other family members. On questioning there may be some family history of liver and heart disease.
  • It is also possible that some viruses such as Rubella (German measles) contracted by the mother during pregnancy, may make Alagille’s syndrome more likely to occur.
  • Often there is no explanation for this disorder which was only recognized in 1975.
    Medicolegal Update

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

WMA non–therapeutic biomedical research guidelines involving human subjects

The WMA standards as drafted are only a guide to Doctors/physicians all over the world. Doctors are not relieved from criminal, civil and ethical responsibilities applicable to them under the laws of land.  All precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subject’s physical and mental integrity/health. In the purely scientific application of medical research carried out on a human being, it is the duty of the doctor to remain the protector of the life and health of that person on whom biomedical research is being carried out.

  • The subjects should be volunteers–either healthy persons or patients for whom the experimental design is not related to the patient’s illness.
  • The investigator or the investigating team should discontinue the research if in his/her or their judgment it may, if continued, be harmful to the individual.
  • In research on man, the interest of science and society should never take precedence over considerations related to the wellbeing of the subject. Reference 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975.
    Clinical Tips

5 steps to a pain–free back (Harvard News Letter)

Step 4. Lighten your load

Backpacks increase the risk of certain types of back pain, especially in students. A survey by the American Academy of Orthopedic Surgeons found that nearly 60% of the doctors responding had treated school–age patients complaining of back and shoulder pain caused by heavy backpacks. Hauling an overloaded backpack can also cause muscle fatigue and strain and encourage the wearer to bend forward unnaturally. If you use a backpack, you can take steps to protect yourself.

  • For starters, use both of the pack’s straps instead of slinging one strap over a shoulder.
  • Try to carry only the essentials, and lighten your load whenever possible.
  • Opt for backpacks that have different–sized compartments to help distribute weight evenly. And look for wide, padded straps and a padded back.
  • When carrying a heavy load, put the heaviest items as close as possible to the center of the back, and use the hip strap for support. For very heavy loads, use a backpack with wheels.
  • Above all, remember to bend from your knees when picking up your pack
    Lab Update

Dr Arpan Gandhi and Dr Navin Dang

To help monitor your over time, especially if it is not possible to monitor using the A1C test; to help determine the effectiveness of changes to your diabetic treatment plan.

    Medi Finance Update

Index funds

The risks associated with index fund investing are similar to those of bond and equity funds; however, index funds can have significant exposure to individual stocks when the weighting in the index is in excess of that allowed for actively managed funds. This can reduce the diversification in the fund.

    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

Fenfluramine and Dexfenfluramine

    IMSA Update

International Medical Science Academy (IMSA) Update


In a randomized trial of women with stress urinary incontinence comparing a continence pessary with pelvic floor muscle training found an initial lower rate of symptom resolution with the pessary but outcomes were similar with long–term use of either strategy.

(Ref: Richter HE, et al. Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 2010;115:609).

    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure wanted to know whether he needed a flu vaccination.
Dr. Bad: There is no need.
Dr. Good: You need to take the flu vaccine.
Lesson: Pneumonia and flu vaccination should be considered in a patient with heart failure.

Make Sure

Situation: A patient with hyperthermia with absent shivering died.
Reaction: Oh my God! Why was intensive management not given?
Lesson: Make sure that all patients of hyperthermia with no shivering are treated aggressively. Absence of shivering is bad prognostic sign.

    Lighter Side of Reading

An Inspirational Story

The King and the Sage

Once there was a king who was always fighting. One day he was badly wounded in a battle. A sage passed by and touched him, and the king was cured. He wanted to give the sage a reward for saving him, but the sage didn't want anything. The king said, "I don’t want to be indebted to you." The sage said, "In the future I’ll ask for something. I don’t need anything now, but one day I’ll come."

Months passed and the sage was praying to God one day for peace, light and bliss, when a desire entered his mind. For the past few months his cow had not been producing milk. "She’s old," he said. "I’ll ask the king for a new cow." He went to see the king and found him in a temple. He was praying for more wealth and more fame. The sage said to himself, "I won’t ask him for a cow. He’s a beggar like me." And he turned to leave. The king stopped him and said, "Sage, you saved my life. Please tell me what you want. I’ll give you anything."

The sage said, "I pray to God and meditate. He is all I need. I don’t want to take anything from anyone in need. You told me you took an oath that you would not be indebted to anyone. I, too, have taken an oath. My oath is that if anyone is in need, then I won't take anything from that person. That’s why I won’t take anything from you. You’re praying to God for material things. You're begging for God to give you wealth and fame. So how can I ask anything of you? God has shown me that everyone is a beggar. So if I need something, I’ll get it from Him."


Mind Teaser

Read this…………………

basket weaving  

Yesterday’s eQuiz: A 71–old-woman presents with a couple of weeks of generalized headaches with achiness of her shoulders and lower back. Her physical examination is completely normal apart from a limited motor exam due to muscle pain. Lab data shows mild normocytic anemia, normal creatinine kinase and ESR was 20. Which is the next best test to perform?

A. Temporal artery biopsy
B. MRI of the brain
C. Electromyogram
D. Carotid artery Doppler

Answer for yesterday’s eQuiz: "A".
This patient has giant cell arteritis with polymyalgia rheumatica. Other symptoms that patients with this condition may have are scalp tenderness, jaw claudication and carotidynia. ESR is elevated in majority of the patients but 10–20% may have a normal sedimentation rate. Temporal artery biopsy is the gold standard of diagnosis. There is recent literature to show that a temporal artery biopsy done up to two weeks after starting steroids may not alter biopsy results.

Correct answers received from: Dr S. Upadhyaya, Dr Rozario Meneze

Answer for 19th November Mind Teaser: "Order in the court"
Correct answers received from:  Dr Rashmi Chhibber, Dr.K.Raju, Sudipto Samaddar, Dr Rajiv Kohli, Dr. Anjani

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Doctor, Doctor I keep thinking I'm invisible.
Who said that?

    Readers Responses
  1. Dear Sir/Madam: This is to represent my personal view on the issue of "Effects of recent amendments by BOG/MCI in regard to minimum requirement of faculty". It is the constitutional duty of the central government to uphold the standards of medical education in India. It is the legal duty of the MCI to act as the watchdog for such standards. Now consider one situation in a college which admits 100 students annually. As per recent amendments, only a Professor and one Assistant Professor/ Associate Professor are required (In Forensic Medicine).
    The job profile requires the faculty to look after autopsies, Expert opinion, Court duties, other medicolegal work  (like exhumation, scene of incident visit, age estimation, examination of sexual assault victim/ accused, injury  certification, disability certificate issuance and much more....), theory & practical classes (on an average 2-3 batches) which are daily affairs. In addition, there will be meetings, examinations and leaves availed by the faculty. Some medico legal cases require a panel of 2 to 3 doctors. Sir, humanly it does not appear feasible to cope with. Moreover, our country needs more and more medico legal experts to cope with the ever increasing medicolegal work. There will be very less time available for teaching to Undergraduates and hence the standard will fall drastically. Moreover, the present amendment will discourage the budding doctor to opt for this subject that will further worsen the problem. 
    I hope that I have been able to convey the possible difficulties and repercussions that will arise out of the current amendment and thus will force the BOG to rethink and status quo will be maintained. Looking forward to a proper and timely response. With warm regards: Dr. Lavlesh Kumar M.D., Associate Professor Forensic Medicine & Toxicology, S B K S Medical Institute & R C, Piparia, Waghodia, Vadodara, Gujarat,  India
    Public Forum

(Press Release for use by the newspapers)

Eggs bad for Diabetics

Dietary cholesterol raises total serum cholesterol said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The relative risk of coronary heart disease is 1.30 for each 200 mg increment of dietary cholesterol per 1000 kcal of energy intake.

Consumption of up to one egg per day (containing about 213 mg of cholesterol per egg) does not appear to substantially influence the risk of coronary heart disease or stroke among men and women without pre-existing diabetes mellitus or hypercholesterolemia.

People with diabetes and/or high cholesterol levels should restrict their intake of eggs. The white of an egg, on the other hand, is a pure protein and safe for consumption. Two whites of an egg can be substituted for every egg yolk for food preparations.

Games like ‘ludo’ and ‘worms & ladders’ are on display and children apart from enjoying are going home with simple health messages from the stall put up by Heart Care Foundation of India which has set up live health games at the Ministry of Health and Family Welfare Pavilion, India International Trade Fair at Pragati Maidan.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant

Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 – 9.30 AM:
Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 – 10.00 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion
12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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