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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 January, 2011, Friday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Facts about snoring

  • Habitual snoring is seen in 44% of males and 28% of females between 30–60 years of age in the general population. Occasional snoring is almost universal.
  • Snoring means there is high resistance in the upper air way canal. It can be a sign of obstructive sleep apnea, which occurs when the upper airway canal resistance is severe and the patient gets episodes of low breathing or absent breathing during sleep.
  • Snoring may be present with or without sleep disruption.
  • Sleep apnea is a disease and indicates interrupted sleep.
  • Uncontrolled snoring may lead to high blood pressure and can lead to heart diseases and paralysis.
  • Snoring is associated with carotid artery atherosclerosis.
  • Snoring can be a cause of sleeplessness.
  • Snoring can lead to marital dissatisfaction.
  • Snoring is more common in people who have truncal obesity with a BMI>30.
  • Snoring is common in people with large neck circumference.
  • Fifty percent of patients of sleep apnea have high blood pressure which is often most elevated in the morning.
  • Snoring is common in man with collar size > 43.18 cms (17") and in women with collar size > 40.64 cms (16").
  • Low thyroid state can precipitate OSA (obstructive sleep apnea) in the persons of snoring
  • Snoring is associated with increased traffic accidents.
  • Snoring is associated with sudden death.
  • Sleep studies are needed to evaluate snoring and sleep apnea.
  • Look for snoring and sleep apnea in patients who awaken with a chocking, gasping, smothering; who have restless sleep; have episodes of cessation of breathing; morning headache, reduced libido and impotence, pass urine in the morning more than 4 times, have history of high blood pressure, cardiovascular diseases, cerebrovascular diseases, renal diseases, type 2 diabetes.
Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  2nd eMedinewS Revisiting 2010

Revisiting the year 2010 with Dr KK Aggarwal
"New Test to Predict Cardiac Risk in Healthy Patients"

Audio PostCard
  SMS of the Day

(By Dr GM Singh)

"Man may dismiss compassion from his heart, but God never will."

William Cowper

    Photo Feature (from the HCFI Photo Gallery)

 2nd eMedinewS Revisiting 2010

Dr Kaberi Banerjee presenting a talk on 'What’s New in IVF’ in the 2nd eMedinewS revisiting 2011 held at Maulana Azad Medical College, New Delhi on 9th January 2011.

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

PM launched scheme to keep cell number but switch operator

Prime Minister Manmohan Singh unveiled a new scheme that will permit mobile phone users to change their service providers without having to forgo their numbers in what in industry jargon is called mobile number portability. India currently has over 700 million mobile phone users, making the network the largest in the world after China but ahead of the US. The country has been adding 15–18 million new mobile phone connections to the network every month. To avail the service, a customer will have to pay a maximum of Rs.19 to the new operator for "porting" the numbers. The customer then has to remain with the new operator for at least three months. The customer has to send an SMS from the existing phone to 1900. Based on this, a unique porting code will be sent by existing provider. The customer has to file an application then with the new service provider mentioning the code for transferring the connection. Officials said the maximum waiting period fixed for porting is seven working days. But the number will remain out of service for just two hours.

Apollo Hospitals first in Chennai to use bio–resorbable stents

The next generation in devices that relieve blood vessel blocks will dissolve within a couple of years. The Apollo Hospitals, one of the six centres in India to be part of a global trial on using drug–eluting bio–resorbable stents, are the first in Chennai to use the product. The device works like a regular stent by restoring blood flow to a clogged vessel. It also contains a drug that is slowly released to help the healing process. But what stands out is the fact that the stent dissolves harmlessly inside the blood vessel and restores flexibility of the affected vessel. Mathew Samuel Kalarickal, director, Interventional Cardiology, Apollo Hospitals, Chennai, during a media interaction on Tuesday said the bio–absorbable stent, which initially propped up the blood vessel, aided the healing process and, after a while, disappeared from the body. In this aspect, it scores tremendously over the previous generation of drug–eluting stents that leave the metal support inside the blood vessel, additionally requiring the patient to be on blood–thinner drugs for life. (Source: The Hindu, Jan 19, 2011)

    International News

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

Working out for as little as 15 minutes three days a week reduces the risk of dementia and Alzheimer’s by 40%

This long–term study (more than six years) determined that men and women aged 65 and older dramatically lessened their chances of developing the heart –breaking conditions of dementia and Alzheimer’s by regularly exercising.

(Dr GM Singh)

Is 10,000 steps a day a good target for an older person?

If you are reasonably healthy, 10,000 steps a day is a good goal for you. It is the equivalent of walking two to three miles per day. You can cover this distance with a walk of 45 minutes or so, and get in your 10,000 steps even if you do nothing else for the rest of the day. Ten thousand steps a day may not be feasible if you have arthritis, heart failure, or other health issues. No one is saying you must hit this target every single day. But if you have a day or two in a row with much lower numbers, consider pushing yourself harder during the next few days.

(Dr Monica and Brahm Vasudev)

Sorafenib active in resistant GIST

According to results of a study to be presented at the Gastrointestinal Cancers Symposium, two–thirds of patients with advanced gastrointestinal stromal tumors (GIST) achieved disease control after second– and third–line treatment with sorafenib (Nexavar). Sorafenib was found to demonstrate definite clinical activity in imatinib– and sunitinib–resistant GIST.

CVD risk linked with bone loss

Review of literature suggests that older patients who have subclinical cardiovascular disease are at risk for osteoporosis and fractures. In one study that included more than 30,000 twins and involved 20 years of followup, there was an increased risk for hip fracture after the diagnosis of any cardiovascular disease in men (HR 6.65, 95% CI 4.82 to 9.19) and women (HR 4.42, 95% CI 3.49 to 5.61). In the same study, fracture risk was increased in patients with both coronary heart disease (HR 2.32, 95% CI 1.91 to 2.84) and cerebral vascular disease (HR 5.09, 95% CI 4.18 to 6.20). The study findings are reported online in Arthritis Research & Therapy.

Influenza update: European study estimates H1N1 vaccine effectiveness at 72%

Results of a case–control study published Jan. 11 in PLoS Medicine show that the vaccine for pandemic 2009 H1N1 influenza was about 72% effective across seven European countries.

FDA rejects inhaled insulin

The FDA has not given its approval to Afrezza (MannKind), an inhaled insulin device pending further data. The FDA has asked for a new trial in type 1 diabetes patients and another in type 2 patients with the next–generation device

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How to retrieve sperms in patients with Klinefelter syndrome?

Sperm retrieval rates are higher in Klinefelter syndrome patients with serum testosterone near the reference range ( >250 ng/dL).

What is Artificial insemination with donor semen?

The alternative to ART for many couples, including those who fail ART, is artificial insemination with donor sperm. This time–tested method has a very high success rate in apparently normal female recipients: 50% pregnancy rate with six cycles of insemination. Children born from pregnancies resulting from donor insemination grow and develop normally, both physically and psychologically

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

After vaccination with Hepatitis B vaccine, which patients require followup testing to check for the response to vaccination?

Persons who remain at risk for HBV infection such as infants of HBsAg–positive mothers, health care workers, dialysis patients, and sexual partners of carriers should be tested for response to vaccination. Postvaccination testing should be performed at 9 to 15 months of age in infants of carrier mothers and 1–2 months after the last dose in other persons. Furthermore, annual testing of hemodialysis patients is recommended since immunity wanes rapidly in these individuals who are at a high risk of continued exposure to HBV.

    Medicolegal Update

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

Advertisement relating to pre–natal determination of sex is punishable

Prohibition of advertisement relating to pre–natal determination of sex and punishment for contravention

  • No person, organization, genetic counseling center or genetic laboratory or genetic clinic shall issue or cause to be issued any advertisement in any manner regarding facilities of the pre–natal determination of sex available at such center, laboratory, clinic or any other place.
  • No person or organization shall publish or caused to be published any advertisement in any manner regarding facilities of the pre–natal determination of sex available at such genetic counseling center, genetic laboratory, genetic clinic or any other place.
  • Any person who contravenes the provisions of sub–section (1) or sub–section (2) shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees.
  • For the purpose of this section, "advertisement" includes any notice, circular, label, wrapper or other document and also includes any visible representations made by means of light, sound, smoke or gas.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. A patient was operated in 2003. A claim against the doctor has been made in 2011. How long should medical records be preserved?


  • The consumer can file a complaint till 2 years after the service was provided. This is usually extended to mean—"Till 2 years after the defect in service comes to notice". Courts can condone delay.
  • Records should be kept as follows:

A. Under MCI Regulations, 2002, applicable to doctors (not to hospitals) – As per Regulation 1.3.1 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, "Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3".

B. Under the DGHS guidelines, applicable to central government hospitals –

The guidelines for the government hospitals have been published by the DGHS vide letter No. 10–3/68–MH dated 31–8–68 as follows:

For inpatient medical records (case sheets)………………………10 years

For medico–legal registers………………………………………10 years

For outpatient records……………………………………………5 years

The above requirement can be found in the "Hospital Manual" published in 2002 by the Directorate General of Health Services, MOHFW, GOI, in chapter 12 titled "Medical Record Services".

C. Under other Acts applicable in the state concerned (such as the respective Clinical Establishments Act, Nursing Home Act etc.) – As per the provisions of the Act concerned.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Total cholesterol

Total cholesterol has been found to correlate with total and cardiovascular mortality in the 30–50 year age group. Cardiovascular mortality increases 9% for each 10 mg/dL increase in total cholesterol over the baseline value of 180 mg/dL. Approximately 80% of the adult male population has values greater than this, so the use of the median 95% of the population to establish a normal range (as is traditional in lab medicine in general) has no utility for this test. Excess mortality has been shown not to correlate with cholesterol levels in the >50 years age group, probably because of the depressive effects on cholesterol levels expressed by various chronic diseases to which older individuals are prone.

    Medi Finance Update

Can losses from the business or profession be set off?

Yes, loss from one’s business can be set off against other income from business under the same head. Interhead loss adjustment can also be made subject to some restrictions i.e. speculation loss can be set off only from speculation income.

Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
DCI Approval Date
Propanol 1–ol 18gm + Ethanol 100% 45gm/100ml solution
For hygenic and surgical hand disinfection
    IMSA Update

International Medical Science Academy (IMSA) Update

The diagnosis of diabetes mellitus can be established by a hemoglobin A1C level ≥6.5% as recommended by an International Expert Committee consensus report and confirmed by the American Diabetes Association.

    IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have high triglycerides
Dr. Bad: Stop fat intake.
Dr. Good: Reduce refined carbohydrates.
Lesson: Triglyceride are refined carbohydrates dependent and not fat.

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prabha Sanghi)

Spilt milk

Have you heard of the story – Spilt Milk? Well, we all know there is no use crying over spilt milk. But this story is different. I would hope all parents would respond in this manner.

I recently heard a story about a famous research scientist who had made several very important medical breakthroughs. He was being interviewed by a newspaper reporter who asked him why he thought he was able to be so much more creative than the average person. What set him so far apart from others?

He responded that, in his opinion, it all came from an experience with his mother that occurred when he was about two years old. He had been trying to remove a bottle of milk from the refrigerator when he lost his grip on the slippery bottle and it fell, spilling its contents all over the kitchen floor—a veritable sea of milk!

When his mother came into the kitchen, instead of yelling at him, giving him a lecture, or punishing him, she said, "Robert, what a great and wonderful mess you have made! I have rarely seen such a huge puddle of milk. Well, the damage has already been done. Would you like to get down and play in the milk for a few minutes before we clean it up?"

Indeed, he did. After a few minutes, his mother said, "You know, Robert, whenever you make a mess like this, eventually you have to clean it up and restore everything to its proper order. So, how would you like to do that? We could use a sponge, a towel, or a mop. Which do you prefer?" He chose the sponge and together they cleaned up the spilled milk.

His mother then said, "You know, what we have here is a failed experiment in how to effectively carry a big milk bottle with two tiny hands. Let’s go out in the back yard and fill the bottle with water and see if you can discover a way to carry it without dropping it." The little boy learned that if he grasped the bottle at the top near the lip with both hands, he could carry it without dropping it. What a wonderful lesson!

This renowned scientist then remarked that it was at that moment that he knew he didn’t need to be afraid to make mistakes. Instead, he learned that mistakes were just opportunities for learning something new, which is, after all, what scientific experiments are all about. Even if the experiment "doesn’t work," we usually learn something valuable from it.

Wouldn’t it be great if all parents would respond the way Robert’s mother responded to him?

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: Weather feeling
Answer for yesterday’s Mind Teaser:
Feeling under the weather

Correct answers received from: Dr Anil Kumar, Dr Nagendra Gupta, Dr Satish Gunawant, Dr Neeraj Sharma, Dr Sudipto Samaddar, Dr Rakesh Bhasin, Dr K.Raju, Dr Suman Kumar Sinha, Dr T. Samraj, Dr Rajiv Dhir, Deepti Katyal Uppal

Answer for 19th January Mind Teaser: condescending
Correct answers received from: Dr R.K.Mehra

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr Chandresh Jardosh)

Different Phases of a man

After engagement: Superman
After Marriage: Gentleman
After 10 years: Watchman
After 20 years: Doberman

    Readers Responses

Dear Sir

Its good that Shri MC Gupta, legal expert has clarified in his column dated 19.1.2011 that a non medical person cannot practice pathology and run a diagnostic lab. These are some of the very confusing issues. Can you enlighten us who is entitled to use a prefix of ‘Dr.’ before their name in India alongwith the supporting references. Please especially focus on the following categories:

  1. Dentists with BDS and MDS qualification using a prefix of ‘Dr’ before their name. The degree they hold is a Bachelor or a Master.
  2. MBBS qualified persons using a prefix of ‘Dr’ before their name. Again here, the university degree is a Bachelor one.
  3. MD qualified persons seem most appropriate as their university degree is ‘Doctor of Medicine’
  4. MS (Master of surgery), whether they should prefix Master instead of ‘Dr’.
  5. BPT qualified and practising physiotherapy independently esp. since physiotherapy is a medical discipline.
  6. Holder of PhD (Doctor of Philosophy) qualification in medical subjects.
  7. People holding non–medical ‘PhD’ qualification in medical facilities especially as it is misleading to patients who take them to be a medical doctor.

I am sure this information will help clarify the issue for most of the readers. Regards: S.K.Sinha

    Public Forum

(Press Release for use by the newspapers)

Depression should be treated in patients with diabetes

Presence of depression in diabetic patients is the most important factor leading to erectile dysfunction in these patients.

Commenting on an Indian cum US study published in the Journal of Urology, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, said that depression and erectile dysfunction are related to each other in the form of a vicious cycle. Depression instigates erectile dysfunction and erectile dysfunction perpetuates the symptoms of depression.

Diabetic patients who complained of erectile dysfunction in the study also had higher prevalence of high blood pressure and cholesterol abnormalities. These patients were also of older age with uncontrolled diabetes, history of smoking and longer duration of diabetes.

It was also shown that patients who developed erectile dysfunction also had diabetes, eye disorders, neuropathy and peripheral vascular disease.

India is the diabetic capital of the world and both the incidence and prevalence of diabetes are increasing day by day. It is, therefore, important for the family physician to look for presence of depression in patients with diabetes.

Effective control of diabetes may reduce both depressive symptoms and erectile dysfunctions in such cases.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Conference Column

Workshop on Fetal and Paedatric Echocardiography Pre and perinatal management of heart disease
13th February 2011, Sunday, Moolchand Medcity

  1. Fetal Echocardiography- How to get it right: Dr Vandana Chaddha
  2. Fetal Cardiac Spectrum- abnormal cases with interactive session: Dr Vandana Chaddha
  3. Neonatal Cardiac Cases- Hits and misses inetractive session: Dr Savitri Srivastava
  4. Intima Media Thickness and Plaque Volume, New Marker for Atherosclerosis Regression: Dr KK Aggarwal

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