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Dr K K Aggarwal

Dear Colleagues,

As you are aware, Delhi Medical Council elections are scheduled on October 4. It is unfortunate that these elections are becoming more like a national political elections with mudslinging on each other.

To inform our colleagues, 21 members are to be elected for Delhi Medical Council and only 8 are contesting from open house on the 4th. Rest 13 which form the majority are either nominated by Government (4 nominees, 1 DHS, 1 Dean of Faculty) or sent by various medical colleges (one each from one medical college). One person is elected by the DMA from amongst its members.

Four of us in the current FAITH team, of which I am a part of, are re-contesting the elections and the remaining four are contesting for the first time. Obviously, the propaganda that 'you need a change in DMC' does not apply as four could not have constituted a majority in the last DMC.

One of the basic objectives for which we are fighting is activation of the Doctors' Protection Cell of Delhi Medical Council where any doctor should be able to approach against any grievance. The aim of the cell should be to protect its member. Unfortunately, the perception of our fellow colleagues is that the function of the DMC is only to punish doctor through Disciplinary Committee. For the last five years, we have been successfully fighting against compulsory CME Credit Hours which otherwise have been made mandatory by Medical Council of India. As of today, there is no requirement of Delhi Medical Council to have compulsory CME Credit Hours for its registration. 

We agree with most of our members that there should be a one-time registration and not re-registration every five years. If we succeed in these elections, we will fight for this issue. Under the Doctors? Protection Cell, we are also thinking about activating a team whose purpose should be to liaison between the patient and doctors and help in out-of-court settlements in case there are legal disputes.

We sincerely request all our colleagues to elect me and also the FAITH group in the forthcoming DMC elections.

Kindly note the date and venue for the election: October 4, 2009, Sunday at Pusa Institute, Pusa Road, New Delhi.


Dr K K Aggarwal

For the Clinician
New Research
News you can use
Pharma Update
TB Update
Electrocardiography Formulae
Indian Penal Codes to know
Funny One liners!!!
The Simple Facts


For the Clinician

Implantable Cardioverter-defibrillators

Implantable cardioverter-defibrillators (ICDs) did not reduce all-cause mortality in women with advanced heart failure, according to a meta-analysis that raises questions about the value of using data from male-dominated trials to treat females. Pooled data from 934 women enrolled in five primary prevention trials (MUSTT, MADIT II, DINAMIT, DEFINITE, and SCD-HeFT) revealed a hazard ratio of 1.01 for death, according to Hamid Ghanbari, MD, of Providence Hospital Heart Institute and Medical Center in Southfield, Mich., and colleagues. The findings were published in the September 14 Archives of Internal Medicine. Reducing that finding to simple numbers, it means that one would need to treat 40 women with ICDs to save a single life, versus implanting ICDs in a dozen men to save a life.

Prevention Strategy Relies on Lifestyle

Stenting may not always be the answer to treating heart disease as per German researchers. A Germans study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event-free survival than those who had percutaneous coronary intervention (PCI). Dr Rainer Hambrecht, MD, of Klinikum Links der Weser in Bremen, Germany, has shown that after four years, 70% of patients in the exercise program had event-free survival -- no stroke, heart attack, or death -- compared with 50% of stented patients. Exercise is ostensibly an important part of any type of prevention, and that it should be instituted for "anyone with coronary heart disease." Hambrecht's data on stenting versus exercise come from a continuation of a pilot study first reported in 2004 in Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients. The updated data presented here reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home. Patients with angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased. The clear message for patients is to get 30 to 60 minutes of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

New monkey malaria 'poses human threat'

A new form of malaria by parasite Plasmodium knowlesi, known only to infect monkeys poses a deadly threat to humans. It has recently been found to be widespread in humans in Malaysia, and the latest study confirms that it can kill if not treated quickly. Unlike its cousin, P. knowlesi has the ability to reproduce every 24 hours in the blood - meaning infection is potentially deadly. Early diagnosis and treatment are crucial. All the P. knowlesi patients had a low blood platelet count, significantly lower than that usually found for other types of malaria.



New Research

How salmonella can be used to kill tumors

German researchers show how a blood messenger streams into cancerous tissues from the vessels, causing tumors to die by developing a so called 'necrosis'. It is named after its role in the immune system: tumor necrosis factor or TNF-alpha for short. They say immune cells produce TNF-alpha when they recognize salmonella. According to them, a small amount of TNF-alpha is enough to dissolve the walls of blood vessels in the tumor. Since salmonella can live even in tissues that are badly supplied with blood, the researchers believe they can be used in tumor therapy.



Antibiotic resistance clue found

US scientists have uncovered a defense mechanism in bacteria that allows them to fend off the threat of antibiotics. Nitric oxide produced by the bacteria eliminates some key effects of a wide range of antibiotics. One UK expert said inhibiting nitric oxide synthesis could be an important advance for tackling tricky infections. Antibiotic resistance, for example with MRSA, is a growing problem and experts have long warned of the need to develop new treatments. They said if the enzyme which creates nitric oxide could be inhibited; it could suppress the ability of the bacteria to counteract antibiotics.


Forgotten memories still exist in brain

A research team put some students inside an fMRI (functional magnetic resonance imaging) scanner. The students were shown words and asked to perform various tasks and their brain activity was recorded. The scientists then associated the different tasks with distinct patterns of brain activity. When a student had a strong recollection of a word from a particular task, the pattern was very similar to the one generated during the task. When recollection was weak or nonexistent, the pattern was not as prominent but still recognizable as belonging to that particular task. ?This tells us the brain knew something about what had occurred, even though the subject was not aware of the information?, the expert added.


Vitamin C can help protect DNA damage of skin cells

Researchers from Portugal have found that vitamin C can help protect DNA damage of skin cells and lead to better skin regeneration. Their study analyzed the effect of sustained exposure to a vitamin C derivative, ascorbic acid 2-phosphate (AA2P), in human dermal fibroblasts. They investigated what genes were activated by vitamin C in these cells, which are responsible for skin regeneration. It demonstrated that vitamin C might improve wound healing by stimulating quiescent fibroblasts to divide and by promoting their migration into the wounded area.



News you can use

Ascorbic acid and sugar in green tea absorb antioxidants better

A digestion model with human intestinal cells was adapted by Mario Ferruzzi, associate professor of food science, Purdue University. The study showed the amount of catechins that can be absorbed into the bloodstream increases by as much as three times when ascorbic acid, sucrose or both was added in green tea. Catechins, a class of polyphenols common in tea, cocoa and grape are antioxidants thought to fight heart disease, stroke, cancer, diabetes and other diseases.



Nostalgia Eases Effects of Dementia 

A research team led by Professor Catherine Haslam, at the University of Exeter, showed that 'reminiscence therapy' can significantly increase cognitive recall and agility of the mind by up to 12% within six weeks. The researchers recruited 73 people - aged between 70 and 90 and some with dementia - and split them into three groups. They were made to sit around once a week in sets of five and reminisce about the old days such as childhood, weddings and family holidays, as well objects that could spark memories such as old-fashioned ink pots and hats. After six weeks, the standard cognitive tests showed that the memory had improved by 12%.

Taking showers 'can make you ill'

Tests revealed nearly a third of shower devices harbor significant levels of a bug that causes lung disease, Mycobacterium avium. Since people tend to take more showers and fewer baths, their findings might explain why there have been more cases of these lung infections in recent years. These bacteria-filled droplets that suspend themselves in air can easily be inhaled into the deepest parts of lungs. It?s particularly dangerous when the shower is first turned on. Risk group includes those with weakened immune systems, like the elderly, pregnant women or those fighting off other diseases.


Pharma Update

Extended-release Hydromorphone Meets Primary Efficacy End-point in Phase III Trial

Results of a new pivotal Phase III clinical trial show that an investigational extended-release version of the pain drug hydromorphone HCl (Exalgo, Neuromed Pharmaceuticals) statistically significantly reduces pain intensity. Hydromorphone is a Schedule II opioid that is currently available in immediate-release forms from other manufacturers. Exalgo was previously known as NMED-1077 and OROS Hydromorphone - the latter named after the osmotic delivery system used to release the drug at a continuous, controlled rate. If approved by the FDA, Exalgo would be indicated for the management of moderate-to-severe chronic pain in opioid-tolerant patients. The Exalgo clinical trial program included more than 2,000 subjects. The FDA?s approvable letter to Neuromed stressed the need for one positive trial for Exalgo?s approval. To that end, investigators designed a randomized, double-blind, placebo-controlled trial with a primary efficacy end-point of mean change in patient-reported weekly pain intensity scores (on an 11-point Likert numerical rating scale) from baseline to study end (week 12) or last visit, compared with placebo. The 65-center trial included 268 opioid-tolerant (previous tolerance of opioid therapy equivalent to ?60 mg/day of oral morphine) patients with chronic moderate-to-severe low back pain. Exalgo was statistically significant in reaching the primary efficacy end-point. The most commonly reported adverse events in the trial (nausea, constipation, vomiting, arthralgia, insomnia and headache) were consistent with those of previous Exalgo trials and those seen with the use of other strong opioids, according to the investigators. Neuromed hopes to submit an application to the FDA for Exalgo by June 2009.

Source: Pain Medicine News 2009;7(6):5.


Dysport Approved for Cervical Dystonia Pain

The FDA has approved the Biologics License Application for Dysport (abobotulinumtoxin A; Ipsen) for the treatment of cervical dystonia. Dysport, an acetylcholine release inhibitor and a neuromuscular blocking agent, reduces the severity of abnormal head positions and neck pain in adults. Ipsen expects to launch Dysport for cervical dystonia in the second half of 2009. For more information, go to

Source: Pain Medicine News 2009;7(6):5 


TB Update
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".


World's oldest surviving medicine system gets government recognition

The world's oldest surviving system of medicine called 'Sowa-Rigpa', practiced in India in Sikkim, Arunachal Pradesh, Darjeeling in West Bengal, Lahaul and Spiti in Himachal Pradesh and Ladakh region of Jammu and Kashmir, got official approval from the Indian government. The theory and practices are similar to Ayurveda, it also includes few principles of traditional Chinese medicine. Legal recognition of Sowa-Rigpa will lead to the protection and preservation of this ancient system of medicine. ?Sowa Rigpa? is one of the five major traditional Tibetan sciences. Commonly known as 'Amchi?, this system of medicine is believed to have been taught by Buddha himself and is closely linked with Buddhist philosophy.




Indian Penal Codes to Know

IPC 320

Grievous hurt

The following kinds of hurt only are designated as "grievous":

  • Emasculation 
  • Permanent privation of the sight of either eye
  • Permanent privation of the hearing of either ear
  • Privation of any member or joint
  • Destruction or permanent impairing of the powers of any member or joint
  • Permanent disfiguration of the head or face
  • Fracture or dislocation of a bone or tooth
  • Any hurt which endangers life or which causes the sufferer to be during the space of 20 days in severe bodily pain, or unable to follow his ordinary pursuits.

Defines hurt and grievous hurt. This is one section where every emergency care physician is required to distinguish a hurt as a grievous or a non-grievous one


Funny One liners!!!

  • I am not a vegetarian because I love animals.
  • I am a vegetarian because I hate plants.
  • I couldn't repair your brakes, so I made your horn louder.
  • I didn't say it was your fault. I said I was going to blame you.
  • I don't suffer from insanity. I enjoy every minute of it.
  • I feel like I?m diagonally parked in a parallel universe.
  • I get enough exercise just pushing my luck.
  • I just got lost in thought. It was unfamiliar territory.



The doctor was off teaching a class, so one of his new students answered the phone in his office. The call was from the school's football coach.
"Doc, it's Sonu, he is in extreme pain" said the coach, "He broke his arm in the fourth quarter." "I see,? said the aspiring doctor. "Exactly what part of the arm is that?

As the doctor approached the school boy to give him an injection, the boy yelled out loud with pain.
"What's the matter?" said the doctor crossly. "I haven't touched you yet." "You're standing on my foot!? answered the boy.


The Simple Facts

  • Did you know you share your birthday with at least nine other million people in the world?
  • The human heart creates enough pressure when it pumps out to the body to squirt blood 30 feet.
  • Banging your head against a wall uses an average of 900 calories an hour.
  • On average, people fear spiders more than they do death.
  • The strongest muscle in the body is the TONGUE.
  • "I am." is the shortest complete sentence in the English language.
  • Our eyes are always the same size from birth, but our nose and ears never stop growing.

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