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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 …

10th February, 2011, Thursday                                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

Enteroviruses strongly associated with type 1 diabetes in children

Youngsters with type 1 diabetes are almost 10 times more likely to be infected by an enterovirus, compared to their counterparts without the disease, according to a meta–analysis published online Feb. 3 in the British Medical Journal.

For the study, investigators carried out a trawl of 26 published studies that tested the blood or stools of patients for telltale genetic material and protein from enteroviruses.

However, researchers are not sure whether enterovirus may cause diabetes or if diabetes may increase susceptibility to enterovirus.

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 vitamin D guidelines


Audio PostCard
  Quote of the Day

(By Dr GM Singh)

The only limit to our realization of tomorrow will be our doubts of today. Franklin Delano Roosevelt

    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

Live Cultural Evening in the 2nd eMedinewS Revisiting 2010 held at Maulana Azad Medical College 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

Medicos up in arms against syllabus tweak

MUMBAI: Medical teachers and postgraduate students of public hospitals in the city joined hands on Saturday to protest against the changes proposed by the Medical Council of India (MCI) in the MBBS curriculum. Their main contention is that many important subjects, which were earlier mandatory, have now been either made optional or included on the elective list. The proposed document Vision 2015 for under–graduate medical education states that 78 subjects, including forensic medicine and toxicology, ENT, ophthalmology, dermatology, orthopaedics, radiology and psychiatry, will be optional for students or can be treated as electives to be taught in the second or third year of the graduation course. While, teachers of other streams from most of these streams are still discussing the repercussions of the change, those from the forensic medicine department have come out in strong protest. They are particularly angry with the MCI’s plan to teach the subject in bits and pieces along with other streams such gynaecology and obstetrics, surgery or pharmacology rather than a complete subject. They feel that this change will make the already poor state of medico–legal cases in India worse. According to Dr S D Nanandkar, head of the forensic medicine department of J J Hospital, India needs at least 6,000 experts and so far, only 20% of the demand has been fulfilled. (Source: The Times of India, Feb 6, 2011)

    International News

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

February is Heart Health Month. Today’s tip

Chronic stress can raise blood pressure, adding to your risk of atherosclerosis, (build–up of plaque from cholesterol in arteries). In some people, stress might directly increase cholesterol levels. Reduce your stress levels with relaxation exercises, meditation, or biofeedback. Focus on taking deep, refreshing breaths. It’s a simple stress–buster you can do anywhere.

(Dr Monica and Brahm Vasudev)

New mosquito type seen making malaria fight harder

French scientists who collected mosquitoes from ponds near villages in Burkina Faso say they identified a subtype of the Anopheles gambiae mosquito that is highly susceptible to infection with the malaria parasite, likes to rest outside, not indoors, and can therefore evade most current control measures. (Ken Vernick, at the Unit of Hosts, Vectors and Pathogens at the French National Center for Scientific Research in Paris)

Study supports recommendation to begin annual mammograms at age 40

A study published in the American Journal of Radiology, which analyzed the same data as the USPSTF concurs with earlier guidelines, women who receive annual mammograms starting at age 40 can significantly reduce the risk of dying from breast cancer by 71 percent. This is in contrast to women who follow the USPSTF recommendations, who had a 23.2 percent reduction in mortality.

Skip OTC remedies to treat colds in young children

The Food and Drug Administration does not recommend giving children under age four any sort of over–the–counter cold remedy because of the possibility of potentially life–threatening side effects.

Right internal thoracic artery comparable to left for CABG

Coronary artery bypass graft (CABG) conduit, the ‘forgotten’ right internal thoracic artery provides outcomes just as good as the more popular one on the left, according to research presented at the Society of Thoracic Surgeons meeting.

    IMT Update

IMT/CCA plaques are surrogate markers for coronary atherosclerosis.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What advice do you have for young women to prevent possible future fertility problems?

Sexually transmitted diseases (STDs) can be a major cause of future infertility, so young women should ALWAYS have protected sex. Also, women should consult with their Ob/Gyn if they have irregular menstrual cycles or have painful periods or ovulation. If your doctor is dismissive and does not offer to find a cause and solution to your problems, find a physician who will. Unfortunately, many couples’ biggest barrier to conception is an Ob/Gyn who is unfamiliar with the latest technology to treat the causes’ of infertility even though the woman may not presently be trying to conceive.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

What are the precautions to prevent an asthmatic attack?

An essential component in asthma treatment is the control of factors contributing to asthma severity. Clinicians should evaluate patients with persistent asthma for allergen exposures and sensitivity to seasonal allergens. Some common precautions especially in children are:

  • Keep the house clean.
  • The child should avoid places where there is a lot of smoke and pollution.
  • Compliance of asthmatic drugs must be monitored and children must carry an inhaler on them.
  • Make sure that the school of child is asthma–friendly. Parent’s must discuss the child’s condition with their teacher and explain to them the action plan to be followed if the child has an attack.
  • Avoid active and passive cigarette smoking. Passive smoke can be one of the triggers of asthma, which is usually ignored as an advice to parents.
  • Make sure that child’s toys and other playthings are hypoallergenic.
  • Even the clothes that parents buy for the child should be hypoallergenic so that child does not get allergic to their stuffed animals or clothes.

For queries contact: drneelam@yahoo.com

    Medicolegal Update

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

How is a sample for Touch DNA collected?

Touch DNA is usually not visible and since it is often deposited in smaller amounts than the DNA found in bloodstains or other body fluids, it is more difficult to obtain DNA profiles from these samples. The key to obtaining successful Touch DNA results depends on recognizing items which may be suitable for Touch DNA analysis and using the sampling technique or collection method that will recover the highest number of skin cells.

  • Swabbing: Surface of the item is rubbed with a cotton swab to collect possible cells. This method is preferred for hard items such as glass or plastic.
  • Cutting: May be used for soft items, such as clothing, in which fabric from areas of interest is cut to collect possible cells.
  • In addition to the commonly used swabbing and cutting methods, latest technologies have recently started using the "Scraping" and "Tape Lift" methods, in which the surface of soft items such as clothing are either scraped with a blade, or sampled with a small piece of tape, to collect possible cells.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. How are paternity tests conducted? What are their legal aspects?


  • When an unmarried woman needs to know the biological father for claiming child support
  • When a married woman is suspected of adulterous relationship
  • When there are accusations of rape
  • When child support is claimed and denied on grounds of paternity
  • Paternity tests are basically DNA tests where the DNA of the couple and the child are tested. Samples tested may be those of: Blood; cord blood; buccal swab; semen; hair; other tissue. Paternity tests are conducted to confirm the biological father. The test may be done for reasons of curiosity or legal need. Curiosity need may arise when a woman has had several sex partners.
  • Postnatal tests are risk free. Prenatal tests need a special procedure to collect the child’s tissue by one of the following means:
    • Amniocentesis: This test is performed in the second trimester, anywhere from the 14th–20th weeks of pregnancy. A small amount of amniotic fluid is collected from the uterus through a needle passed trans–abdominally under ultrasound guidance. There is a slight chance of miscarriage. Other side effects may include cramping, leaking of amniotic fluid and vaginal bleeding.
    • Chorionic Villus Sampling (CVS): The chorionic villus tissue, attached to the walls of the uterus, is obtained through a needle passed through the cervix under ultrasound guidance. This testing can be done earlier in pregnancy from the 10th–13th weeks. The chorionic villi and the fetus come from the same fertilized egg, and have the same genetic makeup.
  • Examples of legal need for paternity testing are as follows:
  • When paternity testing is done for legal need, it must be legally admissible. It may be legally admissible if done in a government laboratory or a recognised laboratory. The cost in USA can vary from $ 400 to 2000 depending upon the status/accreditation of the laboratory. The results are available within a week.
  • The American Pregnancy Association advises as follows:


    "If there is a question on who the father is, paternity testing should be done as soon as possible. Most states have laws that require an unmarried couple to fill out an Acknowledgment of Paternity (AOP) form at the hospital to legally establish who the father. If the couple is unmarried and the mother has not been married in the last 300 days, then no father will be listed on the birth certificate until this legally binding form is filled out. The AOP is sent to the states Bureau of Vital statistics, is recorded, and the father listed becomes the legal father.

    After the AOP is signed, couples have a limited amount of time, depending on the state, to request a DNA paternity test to be done and amend the AOP; if this is not done, the father previously listed on the AOP could be held legally responsible for the child even if he is not the biological father.

    If the mother is married to someone other than the father of the baby or has not been divorced for over 300 days, her husband is presumed to be the father of the baby. The biological father can only be named the legal father if he fills out an AOP and the husband also signs a denial of paternity. If the husband does not sign the denial of paternity, then either biological parent would need to take action in court to establish true paternity.

    During the time that no father is listed as legal father, the baby’s rights are not fully protected. Naming a legal father is vital in ensuring that the baby is eligible for child support, and benefits such as social security, veterans benefits, and health care."
  • In India, the following may be contacted for paternity testing:

    Center for cellular and molecular biology, Uppal Road, Hyderabad 500007 Tel: 040 - 27192653, 040 - 27192748, nidan@ccmb.res.in, Nidan@gmail.com.
  • The following news item appeared in Express India on 8 December 2008


    “New Delhi–– A city court has held in a recent order that in case a man disputes the fatherhood of his child, he cannot ask his wife to share the cost of a paternity test. Deciding a revision petition on the issue of cost–sharing, Additional Sessions Judge Deepak Garg held that if a man questions his fatherhood, he has to pay for the DNA tests and other such medical provisions himself. There will be no liability on his wife, the court ruled.

    The case involved a couple who had filed for separation. When the wife sought maintenance for herself and her three daughters in a petition filed before a magistrate, the husband challenged the fatherhood of the youngest daughter and said he could not be held liable for paying alimony towards her maintenance. Allowing his application, the magistrate, in July, had asked the woman to share the cost of DNA test. The couple was asked to appear before the Medical Superintendent of the AIIMS to get paternity test done on the child. Aggrieved, the woman then moved the Sessions court to seek quashing of the order.

    Differing from the magistrate’s order, Additional Sessions Judge Deepak Garg took into account relevant provisions of the Hindu Marriage Act and observed that any child born to a married couple is presumed to be legitimate and any party questioning the same has to bear the sole onus of rebutting the presumption. "Admittedly, the child was born after the marriage of the parties and hence there is presumption in favour of the legitimacy of the child," the judge ruled. "If the respondent is disputing the legitimacy of the child in question, the entire cost of DNA test should be borne by the party challenging the same." The court also pulled up the magistrate for not passing appropriate directions to AIIMS, where doctors were to conduct the paternity test, and sent back the court records with a directive to issue correct instructions.
Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
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  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

"e–patient" … The Impatient Patient

Dr. Parveen Bhatia: MS, FRCS (Eng.), FICS, FIAGES (Hon.), FMAS, FIMSA, Chairman, Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, Consultant Laparoscopic & Bariatric Surgeon & Medical Director, Global Hospital & Endosurgery Institute, New Delhi

Dr. Pulkit Nandwani: MD, DMAS (WALS), DMAS (CICE, France), Associate Consultant Gynaecologist and Laparoscopic surgeon, Bhatia Global Hospital & Endosurgery Institute, New Delhi

How should doctors deal with the empowered "e–patient"?

Doctors should positively encourage people to search for information about their medical problems and potential treatment options. The Internet provides easy access to medical information outside of the consultation. Patient’s search of disease on internet is not indicative of a lack of faith in, or attempt to undermine, the doctor, but rather a desire to have an informed discussion with the doctor. Doctors must realize that there are scattered nuggets of excellent medical information hidden among the mountains of health.coms. These gems can truly enhance the quality of care; smarter patients are better patients. They can remind patients that the severely limited time allocated for the doctor–patient visit compels both parties to use it wisely. Therefore, patients should carefully plan, in advance, questions raised by surfing the Net.

Doctors should become "URL–proactive". Handouts in their offices are one means, but the best approach is via their own professional websites displaying correct information. Also, greater physician interest in building practice–related websites and stronger belief in website potential to educate patients indicate physicians may be warming up to the Internet’s strength. Use clinic website for patient’s registration, appointment, prescription and also for issuing patient education material.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum Sodium

This test is done

  • To check whether sodium concentration is within normal range
  • To evaluate electrolyte balance and kidney function

Hypernatremia (high sodium levels in blood): Commonly this is due to loss of Sodium that can be related with excessive sweating, diarrhea, diuretics intake, kidney disease, or Addison’s disease.

Hyponatremia (low sodium levels in blood): This can be due to excessive water intake or fluid retention and typically due to edema.

    Medi Finance Update

Investing a significant portion of your portfolio in one industry can be risky, especially if that industry falls on hard times. However, the upside can be equally as good if the industry performs well. (We have seen this in the technology sector.) However, if you have a diversified portfolio you may be able to reap some incremental returns by investing in an industry–specific fund.

    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
DCI Approval Date
Calcium acetate 435mg + Magnesium carbonate 235mg tablets
For the management of hyperphosphatemia in adults patients with renal failure being treated with dialysis (hemodialysis or peritoneal dialysis
    IMSA Update

International Medical Science Academy (IMSA) Update

Treatment of co–occurring depression and alcohol dependence

A randomized trial of outpatients with alcohol dependence and major depression found that combined treatment with naltrexone and sertraline reduced relapse and increased time to heavy drinking compared to either drug individually and to placebo.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with hypertension had non–responding cough.
Dr. Bad: Take an X–ray.
Dr. Good: Stop ACE inhibitors.
Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Chandresh Jardosh)

I wanted to change the world

When I was a young man, I wanted to change the world.
I found it was difficult to change the world, so I tried to change my nation.
When I found I couldn’t change the nation, I began to focus on my town.
I couldn’t change the town and as an older man, I tried to change my family.

Now, as an old man, I realize the only thing I can change is myself, and suddenly I realize that if long ago I had changed myself, I could have made an impact on my family. My family and I could have made an impact on our town. Their impact could have changed the nation and I could indeed have changed the world.


Mind Teaser

Read this…………………

a chance n

Yesterday’s Mind Teaser: Pot O O O O O O O O

Answer for Yesterday’s Mind Teaser: Potatoes

Correct answers received from: Dr Manjesha. Dr K.V.Sarma, Dr Y. J. Vasavada, Dr S. Upadhyaya, Dr S. Upadhyaya, Dr Jainendra Upadhyay, Dr Satyoban Ghosh, Dr Bina Sawhney, Dr Rawat Purushottam Singh

Answer for 8th February Mind Teaser: Take "FE" out of "FIVE" and you get "IV", four in roman numerals!

Correct answers received from: Dr Jainendra Upadhyay, Dr K.Raju

Send your answer to ijcp12@gmail.com


Laugh a While
(Dr. Narendra Kumar)

A patient on her second visit to the optometrist’s clinic: "I see specs before my eyes". The optometrist asks, "Didn’t the new spectacles help?" The patient replies, "Sure, the specs now appear clearer."

Knowledge is amusing

JEEP is a vehicle with unique Gear system. It was invented during World War II (1939–1945). It was named ‘General Purpose Vehicle (GP)’.GP was changed into JEEP later.

    Readers Responses
  1. Dear sir, it was a pleasant surprise to me when a friend of mine forwarded to me your emedinews. It is very informative, useful, thought provoking, educational and entertaining as well. Thank you for publishing such a wonderful journal. It would be so kind of you if you could enroll me as a regular subscriber of your newsletter. Thank you so much. Dr Manjunath KC.
    Public Forum

(Press Release for use by the newspapers)

Erectile Dysfunction Campaign at Moolchand Medcity

Presence of Erectile Dysfunction in young males may be a marker of future heart attack as erectile dysfunction is associated with blockages in the male organ arteries and simultaneous blockages in the heart arteries.

In a press statement, Senior Consultant Moolchand Medcity and President, Heart Care Foundation of India Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee said that Valentine’s Day is a good opportunity for those with erectile dysfunction to get heart check–up done.

The check–up must include measurement of wall thickness of neck artery and also a stress treadmill test. If heart blockages are detected in time in patients with erectile dysfunction, one can predict future heart attack, paralysis and sudden death.

Special provisions are being made at Moolchand Medcity in the month of February for people with erectile dysfunction to have heart checkups done.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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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