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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

28th August, 2010, Saturday

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

New Guidelines against Surgical Errors: No mobiles please in the OT

Preventing surgical errors is the responsibility of the entire healthcare provider team and should involve educating the patient who has the greatest stake in avoiding problems according to new recommendations from the American College of Obstetricians and Gynecologists.

  1. A preoperative briefing should assign essential roles to all members of the team and should include an introduction of each person by name and role to improve communication.
  2. The patient should be involved in the prevention of surgical errors, which requires personal effort by the surgeon to educate the patient during the preoperative evaluation process. This should include involving the patient (or their designee) in identifying the correct surgical site during both informed consent and actually marking the site in the preoperative area.
  3. Members of the surgical team should be alert and well rested because stress and fatigue are well–known causes of human error. Adequate backup personnel should be available in case a member of the team detects diminished performance in themselves or others.
  4. All distractions, including beepers, phones, and nonessential conversations, should be kept to a minimum. The presence of nonparticipating observers should be carefully assessed and must not compromise patient safety.
  5. Surgeons incorporating new surgical techniques should be supervised by a more experienced colleague until competency is demonstrated, whenever possible.
  6. When new equipment is introduced into the operating room, all members of the surgical team should be trained to use it and should have practiced with it.
  7. For obstetric surgery, checklists and protocols for massive transfusion in the event of a large obstetric hemorrhage are recommended for labor and delivery units.

As per the Joint Commission, there were 116 wrong–site surgical errors in the US in 2008. Although relatively rare, such errors are more likely when many surgeons are involved in an operation; multiple procedures are being performed at the same time, or the patient has unusual physical characteristics, like morbid obesity or a deformity.

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

In the photo: Late Shri Krishna Kant, Former Vice president of India, Smt Suman Krishna Kant, and Padma Shri and Dr B C Roy Awardee Dr K K Aggarwal, President HCFI.

Visiting people who count and getting a health message released by them has been a regular and effective module used by Heart Care Foundation of India. During the visits Dr K K Aggarwal took the opportunity to discuss the health concern of the country and the related measures that can be taken up by people at large.


K K Aggarwal


International Medical Science Academy (IMSA) Update

Pallidal versus subthalamic deep–brain stimulation for Parkinson’s disease

Deep brain stimulation of the subthalamic nucleus and globus pallidus pars interna have similar effectiveness and safety in improving motor function in patients with Parkinson’s disease.


1. Follett KA, Weaver FM, Stern M, et al. N Engl J Med 2010;362:2077–91.


News and Views

National News

Cancer review (Dr. G.M. Singh)

Male breast cancer is a rare cancer and accounts for around 1% of all breast cancer cases; but the incidence has increased over the past 25 years. The rarity of this disease prevents prospective randomized clinical trials. Notable differences have been observed between breast carcinoma in both genders, even though they share some characteristics. Familial cases usually have BRCA2 rather than BRCA1 mutations. Klinefelter syndrome is the strongest risk factor for male breast carcinoma. Men are usually diagnosed at an older age vs women. The clinical presentation is usually a painless lump, but is often late, with more than 40% of individuals having stage III or IV disease. Outcomes for male and female patients with breast cancer are similar, when survival is adjusted for age at diagnosis and stage of disease. Surgery involves usually mastectomy with axillary clearance or sentinel node biopsy. Because 90% of tumors are hormonal receptor positive, tamoxifen is standard adjuvant therapy. The indications for chemotherapy and radiotherapy are similar to female breast cancer. For metastatic disease, hormonal therapy is the main treatment, but chemotherapy can also provide palliation.

Addition to the Formula of Eighty

The formula for what men favored in women is a waist-to- hip ratio of 0.8. This means, a waist measurement exactly 80% of the hip circumference is the perfect number.

International News (Dr Brahm and Dr Monica Vasudev)

NIH Director's Response to Stem Cell Injunction

"Human embryonic stem cell research holds great promise for the development of treatments for people threatened by potentially curable diseases. The recent court ruling that halted the federal funding of human embryonic stem cell research could cause irreparable damage and delay potential breakthroughs to improve care for people living with serious diseases and conditions such as spinal cord injury, diabetes, or Parkinson’s disease. The injunction threatens to stop progress in one of the most encouraging areas of biomedical research, just as scientists are gaining momentum—and squander the investment we have already made. The possibility of using these cells to replace those that have been damaged by disease or injury is one of the most breathtaking advances we can envision. Human embryonic stem cells also represent a powerful new approach to the early stages of screening for new drugs, and may hold the secrets to creating entirely new, targeted clinical therapies. We must move forward—without delay—to sustain this field of research that provides so much hope for thousands of patients and their families." [Francis S. Collins, M.D., Ph.D., Director, National Institutes of Health]

Migraine with aura linked to small increase in heart, stroke risks

Two new studies published in the Aug. 25 online edition of the BMJ show that migraine patients with aura are at increased risk of mortality due to heart disease and stroke. According to the U.S. National Women’s Health Information Center, about one in five migraine sufferers have auras, temporary visual or sensory disturbances that occur before or during a migraine headache.

Two diabetes drugs pose similar cardiac risk

Pioglitazone causes as many heart problems as rosiglitazone; a study published online Aug. 24 in the journal Circulation: Cardiovascular Quality and Outcomes has reported. Both drugs belong to the thizolidinediones, which decrease the insulin resistance of body tissues and modify cholesterol production. They are regarded as among the most effective drugs for treating type 2 diabetes, but have been beleaguered by reports of side effects.

Insulin users may face increased cancer risk

A Danish study reports that diabetics who take insulin have a higher risk of developing cancer. Data on about 30,000 cancer cases among diabetics, including tumors of the digestive tract, liver, and pancreas were reviewed. Compared with the general population, patients on insulin were 50 % more likely to get cancer.


Hepatology Update: Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

How to soothe a baby crying during vaccination?

A meta–analysis of randomized controlled trials that studied the use of sucrose or glucose for control of pain before immunization in infants (1 to 12 months) found significant reductions in the incidence and duration of crying when compared with water or no treatment.


1. Harrison D, Stevens B, Bueno M, et al. Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child 2010;95:406.

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

Q. Is IVF very expensive?

A. IVF is not as expensive as perceived in general. Generally, the cost of IVF cycle depends upon the dose of drugs that would be needed for ovarian stimulation. It is only as expensive as perhaps gall stone removal or removal of uterus surgery.

Nutrition: Question of the day

Q. Is it possible to take too much vitamin C?

Vitamin C (ascorbic acid) is an essential nutrient. Yet, it’s possible to have too much of it.

Vitamin C is a water–soluble vitamin that supports normal growth and development. It also helps the body absorb iron. Because the body does not produce or store vitamin C, it’s important to include vitamin C in the diet. For most people, a small glass of orange juice plus a serving of strawberries, chopped red pepper or broccoli provides enough vitamin C for the day. Any extra vitamin C will simply be flushed out of the body in urine.

For adults, the recommended upper limit for vitamin C is 2,000 mg per day. Although too much dietary vitamin C is unlikely to be harmful, megadoses of vitamin C supplements can cause:
• Diarrhea
• Nausea
• Vomiting
• Heartburn
• Abdominal cramps
• Headache
• Insomnia
• Kidney stones

Remember, for most people, a healthy diet provides an adequate amount of vitamin C.

ENT Update (Dr Abha Bhatnagar)

Remember, for most people, a healthy diet provides an adequate amount of vitamin C.

Monsoon brings lots of ear problem due to increased humidity.

Otomycosis: It is a fungal infection of outer ear canal caused by fungi Aspergillous niger and Candida albicans. The opportunist spores of these fungi present in the air and cotton buds etc get favourable condition to grow in the ear canal such as humidity, sweating, darkness in a cosy place. A fungal infection cause itching to begin with the starting followed by pain due to extensive ulcerations.
Wax: Due to humidity, the hygroscopic nature of cerumin blocks the ear canal and cause mild to moderate conductive deafness.
Acute external otitis: This is quite commonly associated with fungal infection and cerumin accumulation. precisely swimmer's ear does not belong exclusively to swimmers, thanks to the monsoons which are responsible for this malady in non swimmers too.

Evidence-based Medicine: Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital 

Ethnic differences in blood pressure response to first and second–line antihypertensive therapies in patients randomized in the ASCOT Trial

Background: Some studies suggest that blood pressure (BP)–lowering effects of commonly used antihypertensive drugs differ among ethnic groups. However, differences in the response to second–line therapy have not been studied extensively. Methods: In the BP–lowering arm of the Anglo–Scandinavian Cardiac Outcomes Trial (ASCOT–BPLA), BP levels of European (n = 4,368), African (203), and South–Asian– (132) origin patients on unchanged monotherapy (atenolol or amlodipine) and/or on second-line therapy (added thiazide or perindopril) were compared. Interaction between ethnicity and BP responses (defined as end BP minus start of therapy BP) to both first– and second–line therapies were assessed in regression models after accounting for age, sex, and several other potential confounders.
Results: BP response to atenolol and amlodipine monotherapy differed among the three ethnic groups (interaction test P = 0.05). Among those allocated atenolol monotherapy, black patients were significantly less responsive (mean systolic BP (SBP) difference +1.7 (95% confidence interval: –1.1 to 4.6) mm Hg) compared to white patients (referent). In contrast, BP response to amlodipine monotherapy did not differ significantly by ethnic group. BP responses to the addition of second–line therapy also differed significantly by ethnic group (interaction test P = 0.004). On adding a diuretic to atenolol, BP lowering was similar among blacks and South–Asians as compared to whites (referent). However, on addition of perindopril to amlodipine, BP responses differed significantly: compared to whites (SBP difference –1.7 (–2.8 to –0.7) mm Hg), black patients had a lesser response (SBP difference 0.8 (-2.5 to 4.2) mm Hg) and South-Asians had a greater response (SBP difference –6.2 (–10.2 to –2.2) mm Hg).
Conclusions: Authors found important differences in BP responses among ethnic groups to both first– and second–line antihypertensive therapies.

Reference: Gupta AK, Poulter NR, Joanna Dobson J, et al. Am J Hypertens 2010;23(9):1023–30. Epub 2010 Aug 19


Legal Update: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is the right to refuse medical interventions?

Right of religious freedom

Before 1976, legal cases in the US involving refusal of life–sustaining medical care usually involved Jehovah’s Witnesses. These decisions were justified based upon the First Amendment’s right of religious freedom. In 1975, this changed with the Quinlan case. In that case, 21–year–old Karen Ann Quinlan suffered two 15–minute long apneic periods probably related to intoxication with alcohol and drugs. While her friends had attempted resuscitation, she was comatose when she arrived at the hospital and, one year later, was in a persistent vegetative state requiring respiratory support and artificial feedings. After consulting with his priest, Quinlan’s father wanted her to be taken off the ventilator. Initially, his request was denied. The New Jersey Supreme Court ruled that the right to privacy includes a right to refuse medical care; this right extends to incompetent patients, and the right can be exercised on their behalf by their legal guardian.

Importantly, the Court argued that decisions to withdraw medical treatments did not require going to court but could be handled by hospital ethics committees, clinicians, and families.


Medi Finance Update

Q. Why is tax deducted at source from salaries and can it be claimed back, if extra tax is deducted by the employer?

Ans. Every employer is required to deduct income tax at source in case of employees whose income from salary is liable for income tax. In case extra tax is deducted from the salary income, it can be claimed as refund from the Income Tax Department by making a claim in the income tax return for that year.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Amlodipine 5mg + Ramipril 10mg/5mg Tablets (additional strength)

For the treatment of hypertension only



Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

Fine Needle Aspirate Cytology

Reactive lymphadenopathy is a non–neoplastic enlargement in response to antigenic stimuli. It can be caused by proliferation of normal lymph node follicles (lymphoid hyperplasia), or distortion of lymph node architecture by inflammatory response (lymphadenitis). Reactive lymph nodes are tender and mobile.


IJCP Special

Dr Good Dr Bad

Situation: A patient with fever without chills was diagnosed with gram negative bacteria.
Dr.Bad: Diagnosis is wrong.
Dr.Good: You need intensive treatment.
Lesson: Patient with gram negative bacteria may have fever with or without chills.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

Quote of the Day

Mother Teresa…"Be faithful in small things because it is in them that your strength lies."

Asthma Alert

Near Fatal Asthma

Minor risk factors

  1. Respiratory viruses
  2. Current smoke exposure is predictive of acute care need for asthma and both in–hospital and post–hospital mortality are increased in smokers who require mechanical ventilation for asthma.
  3. Long duration of asthma
  4. Systemic steroid dependence
  5. Non-adherence to therapy
  6. Poor asthma control

Mind Teaser (Vivek Kumar)

Read this………………


The answer for yesterday’s Mind Teasure: "Growing Economy"

Correct answers received from: Dr.P.K.Sablok, Dr.Rohini Vaswani, Dr. Nagendra Gupta, Dr Jayashree B Keshav, In Charge - Scientific Publications, The Himalaya Drug Company, Dr. Anjani., Dr Kala Sarma, Dr Chandresh Jardosh, Dr  Saurabh yadav, Dr ASHOK WASAN, Dr Simran Singh, Dr Gagan Shrivastava

Correct answers received for 26th August Puzzle from: Dr. ASHOK WASAN, Dr Yogesh Saxena

Send your answer to ijcp12@gmail.com


Humor Section


When your LIFE is in DARKNESS, PRAY to GOD and ask him to free you from Darkness. If even after you pray, U R still in Darkness – Please PAY the ELECTRICITY BILL.

(Contributed by Dr Chandresh Jardosh)

Funny One Liner

Philosopher: A fool who torments himself during life, to be wise after death


An Inspirational Story

The Chinese farmer

There is a Chinese story of an old farmer who had an old horse for tilling his fields. One day the horse escaped into the hills and, when all the farmer’s neighbours sympathised with the old man over his bad luck, the farmer replied, ‘Bad luck? Good luck? Who knows?’

A week later the horse returned with a herd of wild horses from the hills and this time the neighbours congratulated the farmer on his good luck. His reply was, ‘Good luck? Bad luck? Who knows?’

Then, when the farmer’s son was attempted to tame one of the wild horses, he fell off its back and broke his leg. Everyone thought this very bad luck. Not the farmer, whose only reaction was, ‘Bad luck? Good luck? Who knows?’

Some weeks later the army marched into the village and conscripted every able–bodied youth they found there. When they saw the farmer’s son with his broken leg they let him off.

Now was that good luck? Bad luck? Who knows?


Readers Responses

  1. Dr. R. S. Bajaj, Consultant Paediatrician, Sector 13 , DDA Market, Rohini,DelhiDear Dr Aggarwal, I listened to the Rajya Sabha debate on “Amendment to Indian medical council act” yesterday at the fag end of day. There were two important speakers who spoke   in favour of doctors and deserve gratitude of doctors. One was Mrs Kashyap- She highlighted the point faced by doctors who are being asked to rural areas – The excerpts are Why we malign the doctors and ask them to go to rural areas. Are they being provide the basic infrastructure – like a suitable accommodation ? The society has changed and why we ( members of parliament) expect doctors to show the holy attitude like service to humanity ? What about the members and bureaucrats are not supposed to have the same attitude? She advocated extra incentives to be provided to doctors who serve in rural areas” Another person “ Mrs.  Brinda Karat the veteran l leader of CPM spoke in favour of autonomy for INDIAN MEDICAL COUNCIL. She was of the opinion that action of one individual does not mean that we should take away the autonomy of council which has stood the test of time. She asked the Health Minister that when he brings the final bill later he should ensure that this body continues to remain autonomous and should have representation from the states as well . She emphasized that this body should not become another dept under union govt. of health and family welfare.


Public Forum (Press Release for use by the newspapers)

Diabetics considered coronary artery disease equivalent patient

It has been estimated that by the end of 2010 there will be more than 22 crore people in the world with diabetes. Of these 97% will have type 2 diabetes, which is strongly associated with abdominal obesity. This was stated by Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

The incidence of diabetes increases with age. Elderly diabetes is now becoming increasingly common. If untreated, diabetes can cause permanent damage to kidneys, eyes, and heart and peripheral nerves.

A diabetic patient is considered a coronary artery disease equivalent as a diabetic patient has similar rate of complications as that of a person who has suffered from a heart attack.

All diabetic patients should be considered for ACE inhibitor group of drugs which are otherwise given for lowering the blood pressure, especially if their urine shows presence of albumin in micro amounts, irrespective of whether they do or do not have high blood pressure.

Most diabetics require multiple drugs to control BP and keep it lower than 120/80 mmHg and to keep bad LDL cholesterol lower than 70 mg%.

Most diabetic patients should ask their doctor for a cocktail of polypill therapy to prevent themselves from getting a future heart attack or paralysis.

Till today we have no answer to diabetic complications. Lifestyle management alone or along with any other ‘pathy’ has not shown any significant advancement in preventing diabetic complications.


Conference Calendar

IOSS 2010

16th Workshop – International Otology & Skull Base Surgery 2010
Date: August 28–29, 2010
Venue: Govt., E.N.T.Hospital, Visakhapatnam, Andhra Pradesh.


Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi Gate.

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

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
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

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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