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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

  Editorial ...

27th September, 2010, Monday

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

Seven steps to shape your personal plan (Harvard Health Beat)

  • Select a goal. Choose a goal that is the best fit for you. It may not be the first goal you feel you should choose. But you’re much more likely to succeed if you set priorities that are compelling to you and feel attainable at present.
  • Ask a big question. Do I have a big dream that pairs with my goal?
  • Pick your choice for change. Select a choice that feels like a sure bet. Do you want to eat healthier, stick to exercise, diet more effectively, ease stress? It’s best to concentrate on just one choice at a time. When a certain change fits into your life comfortably, you can then focus on the next change.
  • Commit yourself. Make a written or verbal promise to yourself and one or two supporters you don’t want to let down: your partner or child, a teacher, doctor, boss, or friends. That will encourage you to slog through tough spots.
  • Scout out easy obstacles.
  • Brainstorm ways to leap over obstacles. Now think about ways to overcome those roadblocks.
  • Plan a simple reward. Is there a reward you might enjoy for a job well done?
Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  Photo Feature (from the HCFI Photo Gallery)

2nd BSNL Dil Ka Darbar 2010

Eminent doctors of the city interacted with public in an open forum at 2nd BSNL Dil Ka Darbar on Sunday, 26th September 2010, Maulana Azad Medical College, New Delhi. In the photo: Dr Sudesh Ratan, Dr Uday Kakroo, Dr H K Chopra, Padma Shri and Dr B C Roy National Awardee Dr K K  Aggarwal, Mr K C G K Pillai, Mr Sanjay Sinha, Dr Sanjay Sood, Dr S N Yadav, Ms Kamalini and Ms Nalini.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

A systematic review of ten randomized trials showed no difference in abstinence rates between those who reduced smoking before the quit date and those who quit abruptly, regardless of using pharmacologic and/or behavioral treatments.

(Reference: Lindson N, et al. Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database Syst Rev 2010;3:CD008033).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association. Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Mumbai’s heart stronger than Delhi’s

On the eve of World Heart Day, here’s a chilling reminder of how prone Indians are to deadly heart diseases. A survey of 60,000 Indians shows that one in four has higher than usual levels of low–density lipoproteins (LDL), better known as the bad cholesterol that leads to development of plaque on the arterial walls. "Urban India has high levels of LDL (24.3% of those surveyed), triglycerides or TGL at 28.7% and low levels of good cholesterol or HDL at 17.7%," said the survey. Mumbai and Hyderabad are fence–sitters, but residents of Bangalore are among the unhealthiest as far as lipids are concerned along with Chandigarh and Delhi. Kolkata has emerged as the city for people with the healthiest hearts. (Source: The Times of India)

  International News

(Contributed by Dr Monica and Brahm Vasudev)

Children who swallow disc–shaped batteries should be treated as quickly as possible

Children who are suspected of swallowing Disc-shaped batteries require treatment at the earliest, reports a new study in the Archives of Otolaryngology –– Head & Neck Surgery. The window for safely removing batteries in the throat is only two hours. Disc–shaped batteries are increasingly becoming an issue in our high–tech environment. In addition to the choking hazard, the alkali in the power cells can destroy tissue, and small–voltage electrical shocks can cause internal burns.

Emergency appendectomy not a must for all with acute appendicitis

Appendectomy is the most common emergency surgery worldwide. However, a study from the Oregon Health & Science University says that it doesn’t have to be the most common surgery. The patients were grouped into three depending on how soon they underwent the surgery after being hospitalized. There was no significant difference among the groups in the patients’ condition 30 days after surgery or in the length of their operation or hospital stay. Data from more than 30,000 patients were assessed in the study published in the Archives of Surgery.

Less invasive surgery to remove selected lymph nodes may be suitable for some breast cancer patients

Researchers from USA and Canada report that some breast cancer patients may do just as well with a less invasive surgery to remove selected lymph nodes rather than the aggressive operation.

Cocaine use linked with readmission following heart failure treatment

A retrospective chart review reports that almost one–fourth of patients hospitalized for heart failure had a history of cocaine use as a potential contributing factor. The findings were presented at the meeting of the Heart Failure Society of America.

  Pediatric Update

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

Atypical antipsychotics

A clinical trial of 272 children ages 5 to 19 years found that children receiving the atypical antipsychotic medications olanzapine, quetiapine, or risperidone had average weight gains of 18.7, 13.4, and 11.7 pounds, respectively, after 12 weeks of treatment. Participants in an untreated comparison group gained an average of 0.4 pounds.

(Reference: Correll CU, et al. Cardiometabolic risk of second–generation antipsychotic medications during first–time use in children and adolescents. JAMA 2009;302:1765)

  Infertility Update

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

How does a woman know that there is a problem in her tubes?

Tubal problem in the form of blockage is usually due to infection. Infection may be symptomatic or silent. The symptoms can be in the form of fever, lower abdominal pain, irregular bleeding, and watery discharge per vagina. Tubal problem can then be confirmed by hysterosalpingography or laparoscopy. However, at times tubal problems may be completely silent because it can damage the inner lining of the tube which has fine hair called cilia.

  Obstetrics Update: Question of the Day

How to choose an anticoagulant for the pregnant patient? (Dr. Suresh C. Vijan, Mumbai)

Warfarin is the anticoagulant of choice for patients who require anticoagulation. Commonest reason for anticoagulation in a young female is rheumatic mitral stenosis with atrial fibrillation, prosthetic valve surgery, DVT and recurrent pulmonary embolism with IVC filter implantation. Warfarin is associated with facial defects in the baby (warfarin embryopathy). The risk is highest for warfarin exposure during the first trimester of pregnancy. The only way to prevent this is to avoid pregnancy or stop warfarin before conception. The second issue is bleeding during delivery in the third trimester. The date of delivery or onsets of labor pains are unpredictable. Hence, warfarin will have to be discontinued in the third trimester and heparin will be restarted. This will provide better control on anticoagulation during delivery. To minimize risk of severe bleeding, it is preferable to induce delivery or plan elective caesarian section with appropriate antibiotic cover.

The following steps should be adopted in patients who need anticoagulants and have conceived:

  • Stop warfarin and start unfractionated heparin (uFH) or low molecular weight heparin (LMWH) as soon as conception is confirmed. Continue this for the 1st trimester after which warfarin can be restarted and heparin discontinued.
  • Warfarin will have to be stopped at the start of the third trimester and heparin restarted and continued till delivery.
  • In patients who do not want any risk of warfarin embryopathy, stop warfarin before attempted conception. Patient will need to be on heparin or LMWH till end of first trimester. Subsequent protocol is as above.
  Medicolegal Update

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

Communication by doctor must be documented

Doctor–patient/doctor–family communication is essential for patient/family satisfaction/approval with the provided medical care. An open exchange of information must be encouraged. This is very important to reduce litigation. Details of interactions should be included in the medical record as they both relate to decisions about current care and can potentially help in future care decisions. Key components of this documentation include who participated in the meeting, how they are related to the patient, and the patient’s competency if he/she participates in the discussion along with decisions that were made. Documentation of physician–patient discussions about patient wishes while the patient is still able to express them can help once the patient is no longer mentally competent. Along with medical facts such as physical exam and laboratory values, clinician decision–making and the reasons behind the decisions should be incorporated into the medical record.

  Medi Finance Update

Net Worth
Assess the net worth of the company by adopting the following formula: Net worth = Shareholders, funds less goodwill and intangible assets.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Pancreatin or Pancrelipase containing amylase, protease and lipase with any other enzyme.

Sept. 1, 2000

GSR 814(E) dt.16.12.99

  Lab Update

Rheumatoid Factor

To help diagnose rheumatoid arthritis (RA) and Sjögren’s syndrome, when a patient presents with fatigue, joint pain, weakness, or dry eyes or dry mouth

(Contributed by Dr Arpan Gandhi and Dr Navin Dang)

  IJCP Special

Dr Good Dr Bad

Situation: A patient came with malena.
Dr Bad: Get colonoscopy done.
Dr Good: Get colonoscopy and lower GI studies done.
Lesson: Malena is a small intestinal disorder.

Make Sure

Situation: An asthmatic with respiratory rate of 37! developed respiratory arrest.
Reaction: Oh my God: Why was the patient not put on the ventilator in time?
Lesson: Make sure to remember that a respiratory rate of > 35 is a warning signal to start ventilation therapy.

Quote of the Day

"Everyone who got where he is has had to begin where he was." Robert Louis Stevenson
(Contributed by Dr.G.M.Singh)

  Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "Mad about you".

Correct answers received from: Dr.G. Padmanabhan, Dr. Satish Gunawant, Dr Kalpana Mohan, Dr Nagendra Gupta, Dr Devi Prasad Mohapatra, Dr Meera Rekhari, Dr Chandresh Jardosh

Answer for 24th Sept Mind Teaser is: "E:"

  • 50 year old male, non–smoker whose systolic is 140 mmHg and who is not on medication for hypertension. His total cholesterol is 300mg/dl and HDL cholesterol is 55mg/dl.
  • 45 year old female with diabetes mellitus who is a non–smoker and her systolic pressure is 110 mmHg. Total cholesterol is 130 and HDL is 70mg/dl..

Correct answers received from: Dr Anupam

Send your answer to ijcp12@gmail.com

  Humor Section

The son of a general practitioner had recently qualified in medicine, and his father took him into partnership. A few months later, the old doctor went away on holiday, leaving the youngster to look after the practice. On his return his son informed him smugly that during his absence he had affected a complete cure of the back pains which has troubled an elderly private patient for years. "You did a grand job there, son," smiled his father. "Especially as it was those back pains which put you through medical school."
(Contributed by Dr. GM Singh)

Important laws which the great Newton forgot to state
Law of Biomechanics
The severity of the itch is inversely proportional to the reach.
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

The secret of happiness
A certain shopkeeper sent his son to learn about the secret of happiness from the wisest man in the world. The lad wandered through the desert for 40 days, and finally came upon a beautiful castle, high atop a mountain. It was there that the wise man lived.
Rather than finding a saintly man, though, our hero, on entering the main room of the castle, saw a hive of activity: tradesmen came and went, people were conversing in the corners, a small orchestra was playing soft music, and there was a table covered with platters of the most delicious food in that part of the world. The wise man conversed with everyone, and the boy had to wait for two hours before it was his turn to be given the man’s attention.
The wise man listened attentively to the boy’s explanation of why he had come, but told him that he didn’t have time just then to explain the secret of happiness. He suggested that the boy look around the palace and return in two hours. "Meanwhile, I want to ask you to do something", said the wise man, handing the boy a teaspoon that held two drops of oil. "As you wander around, carry this spoon with you without allowing the oil to spill".
The boy began climbing and descending the many stairways of the palace, keeping his eyes fixed on the spoon. After two hours, he returned to the room where the wise man was. "Well", asked the wise man, "Did you see the Persian tapestries that are hanging in my dining hall? Did you see the garden that it took the master gardener ten years to create? Did you notice the beautiful parchments in my library?" The boy was embarrassed, and confessed that he had observed nothing. His only concern had been not to spill the oil that the wise man had entrusted to him. "Then go back and observe the marvels of my world", said the wise man. "You cannot trust a man if you don't know his house". Relieved, the boy picked up the spoon and returned to his exploration of the palace, this time observing all of the works of art on the ceilings and the walls. He saw the gardens, the mountains all around him, the beauty of the flowers, and the taste with which everything had been selected. Upon returning to the wise man, he related in detail everything he had seen. "But where are the drops of oil I entrusted to you?" asked the wise man. Looking down at the spoon he held, the boy saw that the oil was gone.
"Well, there is only one piece of advice I can give you", said the wisest of wise men. "The secret of happiness is to see all the marvels of the world and never to forget the drops of oil on the spoon".

  Readers Responses
  1. Dear Dr Aggarwal, You are a genius and great academician. We have supported you personally in IMA election and urge others to do outside existing lobbies, IMA will improve academically once teacher like you get elected. Dr. DR Nakipuria, Siliguri
  2. Dear Dr Aggarwal, Why is there no representative of IMA in the newly formed board of MCI, who can put forward positive feedback of the IMA members who are mainly practitioners and who are looking after the health of the country’s major population. Vivek Kumar, Varanasi
  Public Forum

(Press Release for use by the newspapers)

World Heart Day observed

Concluding the World Heart Day celebrated in the form of BSNL Dil Ka Darbar with a view to create awareness about sudden cardiac death which is known to occur in over 40 lakh people in the country every year, Padma Shri and Dr. B. C. Roy National Awardee Dr K.K. Aggarwal said that all patients of heart diseases, obesity, hypertension or with family history of sudden death, should get themselves evaluated for the following symptoms.

  • Presence of snoring with interrupting breaths increases chances of sudden death.
  • Heavy smokers have more chances of sudden death.
  • Drinking more than 5 pegs of alcohol in less than one hour increases chances of sudden death
  • People who get chest discomfort, pain or burning or breathlessness after walking less than 2 kms distances or climbing 2 flights of stairs, need investigations.
  • People whose ECG QRS duration is more than 120 ms and heart patients with pumping action of the heart less than 30% are at increased risk of sudden death.
  • Patients with uncontrolled Blood Pressure, Cholesterol and Diabetes are at higher risk of sudden death.
  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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