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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

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  Editorial …

25th May 2013, Saturday

Govt reconstitutes MCI, ex-DGHS to head Board of Governors

The government today approved the reconstitution of Medical Council of India (MCI) with former Director General Health Services R K Srivastava replacing K K Talwar as Chairman of the Council’s Board of Governors.

“The formal notification in respect of the MCI reconstitution would be issued tomorrow by the Health Ministry,” a top Ministry official told PTI.

The new seven-member board to run the apex medical regulator, approved by Health Minister Ghulam Nabi Azad, will have a term of six months within which MCI elections is to be held and the original democratic structure of the Council restored.

The government has already moved a new bill in this regard which is yet to be passed in Parliament. An ordinance was today issued by the government for putting in place the new MCI Board of Governors (BoG) to run the medical regulator. The Union Cabinet had approved the issuance of such an ordinance.

The term of the last BoG expired on May 13, necessitating issuance of an ordinance to form a new board until Parliament passes the new Indian Medical Council Amendment Act, which provides for the restoration of elected MCI and fixes the tenure of its President to root out corruption.

The new Board of Governors approved today by the Health Ministry comprises only two members of the former BoG. BoG members who have been retained are Kailash Sharma of Tata Memorial Centre, Mumbai and K Mohan Das, Vice-Chancellor, Kerala University.

The other new members of the Board of Governors are Raja Babu Panwar, Vice-Chancellor, Rajasthan Health University; B K Rao, former chairman of Sir Ganga Ram Hospital, New Delhi and current chairman at Gangaram’s Critical Care Unit; A K Bardan, a West Bengal-based cardiologist and Manoj Singh, Professor of Pathology at AIIMS, New Delhi.

Top Health Ministry sources said the gazette notification on the MCI reconstitution would be formally issued tomorrow, allowing the new BoG to assume charge and start working. (PTI)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2013

Heart Care Foundation of India and World Fellowship of Religions in association with Ministry of Earth Sciences Govt. of India and Delhi Public School Mathura Road observed World Earth Day 2013.

Dr K K Aggarwal
    National News

World Bank funds for National AIDS Control Support Project approved

New Delhi: The Cabinet Committee on Economic Affairs has approved a proposal by the Department of AIDS Control for the implementation of the National AIDS Control Support Project (NACSP) at a cost of Rs. 2,550 crore, as reported in The Hindu.

The NACP is financed by the government and the World Bank in equal proportion. This project will contribute towards intensifying and consolidating prevention services with a focus on highly vulnerable populations, high risk groups and bridge population, strengthening Behaviour Change Communication (BCC) and demand generation, and institutional strengthening and financial management. This project would help in providing the desired impetus required for further consolidation of gains made in containing the spread of HIV infection in the country, an official release said here.

The primary objective is to increase safe behaviour among high risk groups in pursuance of the national goal of accelerated reversal of the HIV epidemic by 2017. The focus of the project activities would be strengthening and scaling up of prevention interventions and related BCC strategies for sub-groups of population identified to be most-at-risk by the NACP. These include Female Sex Workers (FSW), Men who have sex with Men (MSM), Transgender (TG) populations and Injecting Drug Users (IDU).
The project would also support the planned expansion and consolidation of tailored interventions for other at-risk populations, including migrant workers and truckers which play a critical role in the transmission dynamics of HIV in the country. The BCC strategies developed under the project would provide emphasis on demand generation for prevention services among high risk groups and vulnerable populations, including a specific focus on youth. This component would also address the need for reduction of stigma associated with HIV by focused IEC (information, education and communication) to change the prevailing attitudes and perceptions.

The NACP of India has been a success in its third phase (2007-2012) and the country is on track to meet the Millennium Development Goal (MDG) for HIV prevention and control. Over the last decade, there has been a reduction of 57 per cent in the new HIV infections and 29 per cent reduction in AIDS-related deaths. This has led to the recognition of India`s HIV programme as a global best practice, and has been an important factor behind the decision of the World Bank to support the prevention component of the HIV programme, the official release said. (Source: The Hindu, May 24, 2013)

For comments and archives

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand

Childhood sexual abuse (CSA) is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30. After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen’s d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

(Source: Fergusson DM, McLeod GF, Horwood LJ. Child Abuse Negl. 2013 Apr 24)

For comments and archives

    Valvular Heart Disease Update

The incidence and pattern of mitral valve pathology in RHD varies according to age and geography. Younger patients under the age of 30 years present predominantly with isolated mitral regurgitation, whereas middle-aged adult patients develop mitral stenosis from the third decade, with mixed mitral valve disease becoming more dominant in older patients.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Yellow fever vaccination: No booster needed for immunity

A report by the World Health Organization's (WHO's) Strategic Advisory Group of Experts (SAGE) on immunization reveals that a single yellow fever vaccination is sufficient for immunity against the disease. A summary of the report was published online May 17 in the WHO's Weekly Epidemiological Record. (Source: Medscape)

ICD may be no barrier to active sports

Many people with implantable cardioverter-defibrillators (ICDs) can safely take part in sports, including some that are highly vigorous and competitive, researchers reported. (Source: Medpage Today)

Cardiac arrest survival highest at hospitals with fewest

Hospitals with the highest survival rates for in-hospital cardiac arrest also appear to be better at preventing cardiac arrests in the first place, according to a study published online May 20 in JAMA Internal Medicine. (Source: Medscape)

OK to discharge ICD patients on same day

Same-day discharge for patients receiving an implantable cardioverter defibrillator (ICD) is safe, feasible, and cost-effective, a retrospective study found. (Source: Medpage Today)

FDA approves AIC test to diagnose diabetes

It is official: Health professionals can use the Cobas Integra 800 Tina-quant HbA1cDx assay (Roche) to diagnose diabetes, the US Food and Drug Administration announced. It is the first HbA1c test that the agency has allowed to be marketed for diabetes diagnosis. The HbA1c tests currently on the market are FDA-cleared for monitoring blood glucose control but not for diagnosing diabetes. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Preventing heat disorders http://blog.kkaggarwal.com/2013/05/preventing-heat-disorders/ …

@DeepakChopra: What evidence is there to support that most of our body's molecules get replaced every year? http://tinyurl.com/meuxb5e #askdeepak

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

2% versus 10% sugar

White sugar is a slow poison. In ancient India, people used to consume either sugarcane juice, jaggery or brown sugar (khand). The use of refined white sugar is not mentioned. White sugar has high glucose index and acts as a slow poison as over a period of time, it is responsible for high levels of insulin in the blood and subsequently, insulin resistance.

Traditional soft drinks today have over 10% sugar and sweets contain 30-50% sugar. Sweets have minimum of 30% sugar but if made of chashni (concentrated sugar), the amount of sugar may even be up to 50%.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is ovarian tissue cryopreservation?

Doctors are experimenting with a procedure to freeze the tissues from a woman’s ovary. The ovaries produce eggs. In this procedure, doctors cut the tissue from one of your ovaries into thin slices. These slices are then frozen. After your cancer treatment, the doctors can place a slice of thawed ovarian tissue back into your body. The tissue does not need to go back where it came from in order to start producing eggs. You may need to be treated with fertility hormones in order for this tissue to produce an egg. Once the tissue produces an egg, your doctor will retrieve it and fertilize it in the laboratory. After your doctor places the subsequent embryo into your uterus, you may be able to get pregnant. There are some disadvantages to this procedure. You will need to have surgery several times. It also is dangerous if you have cancer of the ovary. If the tissue has cancer and is placed back in your body, the cancer could spread.

    An Inspirational Story

Anger, Envy & Insults

Near Tokyo lived a great Samurai, now old, who decided to teach Zen Buddhism to young people.

One afternoon, a warrior – known for his complete lack of scruples – arrived there. The young and impatient warrior had never lost a fight. Hearing of the Samurai’s reputation, he had come to defeat him, and increase his fame. All the students were against the idea, but the old man accepted the challenge.

All gathered on the town square, and the young man started insulting the old master. He threw a few rocks in his direction, spat in his face, shouted every insult under the sun – he even insulted his ancestors. For hours, he did everything to provoke him, but the old man remained impassive. At the end of the afternoon, by now feeling exhausted and humiliated, the impetuous warrior left.

Disappointed by the fact that the master had received so many insults and provocations, the students asked: “How could you bear such indignity? Why didn’t you use your sword, even knowing you might lose the fight, instead of displaying your cowardice in front of us all?”

“If someone comes to you with a gift, and you do not accept it, who does the gift belong to?” asked the old Samurai. “He who tried to deliver it.” replied one of his disciples.

“The same goes for envy, anger and insults.” said the master. “When they are not accepted, they continue to belong to the one who carried them.”

For comments and archives

  Cardiology eMedinewS

Physician inertia to blame for small BP changes in BARBER-1 Read More

  Pediatric eMedinewS

Childhood ADHD linked to obesity in adults for first time Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What should be done if the ID injection fails, that is, spills out or goes subcutaneous?

The WHO recommends that in cases where the wheal over the skin is not formed then the patient should receive another dose of vaccine at a site nearby. If the IDRV fails in any one of the sites after two attempts, then the vaccine must be given by IM route and the remaining doses of the schedule given by IM route only.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with insulin resistance developed MCA infarction.
Dr. Bad: The two are unrelated.
Dr. Good: They are related in terms of persistent arterial occlusions.
Lesson: A prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis concluded that high insulin resistance may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis (Diabetes Care 2011 Nov;34(11):2413-7).

Make Sure

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

  Quote of the Day (Dr GM Singh)

A great man shows his greatness by the way he treats little men. Thomas Carlyle

    Mind Teaser

Read this…………………

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
b. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.

Yesterday’s Mind Teaser: A 2-month-old baby hasn’t received any immunizations. Which immunizations should nurse Jess prepare to administer?

a. Measles, mumps, rubella (MMR); diphtheria, tetanus, pertussis (DTP); and Hepatitis B (HepB)
b. Polio (IPV), DTP, MMR
c. Varicella, Haemophilus influenzae type b (HIB), IPV, and DTP
d. HIB, DTP, HepB; and IPV

Answer for Yesterday’s Mind Teaser: d. HIB, DTP, HepB; and IPV

Correct answers received from: DR ARPAN GANDHI, Dr. P. C. Das & Dr. Mrs. S. Das, Dr.(Maj. Gen.) Anil Bairaria,, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, daivadheenam, DR JAYANT SHAH, Muthumperumal Thirumalpillai, Dr.mahendra p shah, DR.NAGESWARA RAO PATNALA, Dr Avtat Krishan, Dr. Thakor Hitendrsinh G, Dr. Pawan Mehta, Dr.Chandresh Jardosh, DR K P CHANDRA, Dr Avtar Krishan, Tukaram Pagad.

Answer for 22nd May Mind Teaser: a. Hepatomegaly

Correct answers received from: Dr. Pawan Mehta, Dr.Chandresh Jardosh, DR K P CHANDRA, Dr Avtar Krishan, Tukaram Pagad.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A little girl was talking to her teacher about whales.

The teacher said it was physically impossible for a whale to swallow a human because even though it was a very large mammal its throat was very small.

The little girl stated that Jonah was swallowed by a whale.

Irritated, the teacher reiterated that a whale could not swallow a human; it was physically impossible.

The little girl said, "When I get to heaven I will ask Jonah".

The teacher asked, "What if Jonah went to hell?"

The little girl replied, "Then you ask him ".

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Exhumation of corpse – America

In America corpses are exhumed when there is a need to identify a body or to establish cause of death like in the case of suspected homicide.

  • The remains of President Zachary Taylor were exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
  • Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
  • In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
  • Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
  • California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Tobacco Products in Urine - A Marker of Passive Smoking

In homes where at least one parent smokes, the infants have 5.5 times higher levels of a nicotine product, called cotinine, in the urine than infants of non-smokers, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA. Cotinine is created as the body tries to get rid of the nicotine in inhaled smoke.

According to study published in the Archives of Diseases in Childhood, sleeping with smoker parents is a known risk factor for sudden infant death syndrome. One of the reasons for the same could be proximity of the infant to parent’s clothing or other objects contaminated with smoke particles.

The study consisted of 104 twelve-week old infants. Of these, 71 of them had one parent who smoked; there were 33 infants whose parents did not smoke.

If the mother smoked the chances of the infant’s urine containing nicotine products was four times higher than in non smoking parents. With the father smoking, the chances of having nicotine products in the urine of the infant was two times than of a non smoking parent.

The study also showed that sleeping with smoker parents or sleeping in lower temperature rooms was associated with increased nicotine products in the urine of the infants.

Higher nicotine products in the urine were also observed in colder times of the year indicating more closed door smoking during this period of the year.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 50457 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Dear Sir, you are providing useful information. Regards: Dr Shreya

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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