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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; Member 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

1st May, 2010, Saturday

People on restricted or special diets may have additional needs
for vitamin supplementation


Vitamin B12 levels are affected by dietary intake. In younger adults, low consumption of animal-source food is the main cause of low vitamin B12 levels. The lowest intakes of vitamin B12 are seen in those who eat no animal products, and intake increases with increasing intake of animal source foods.

Types of food habits

  • Semivegetarian: Meat occasionally is included in the diet. Some people who follow such a diet may not eat red meat but may eat fish and perhaps chicken.

  • Lactoovovegetarian: Eggs, milk, and milk products (lacto = dairy; ovo = eggs) are included, but no meat is consumed.

  • Lactovegetarian: Milk and milk products are included in the diet, but no eggs or meat are consumed.

  • Macrobiotic: Whole grains, especially brown rice, are emphasized and vegetables, fruits, legumes, and seaweeds are included in the diet. Locally-grown fruits are recommended. Animal foods limited to white meat or white-meat fish may be included in the diet once or twice a week.

  • Vegan: All animal products, including eggs, milk, and milk products, are excluded from the diet. Some vegans do not use honey and may refrain from using animal products such as leather or wool. They also may avoid foods that are processed or not organically grown. People who consume a vegan diet should be supplemented with vitamin B12 (at the RDA of 2.4 micrograms/day) if they do not consume other fortified food products (such as cereals). They are also at risk for inadequate vitamin D status and should consider a supplement, particularly during winter months. Lactoovovegetarians and lactovegetarians should also consider supplementation with vitamin B12. In contrast, people consuming a very low carbohydrate diet (e.g., "Atkins" style) may consume few fruits and vegetables, particularly during the initial phase.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature

Health awreness: Involve the people who counts.

Famous Kathak Dancers Nalini-Kamalini and 'Guruji Jitender Ji Maharaj'' being felicitated with a memento. Also in the picture (left to right):  MI Hussain, Principal DPS Mathura Road, R Mehta, Advisor Min. of Env. & Forests, GOI; Sh Pramod Grover, Vice Chairman DPS Society; Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal. 

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Treatment for primary sclerosing cholangitis

The 2010 guidelines issued by the American Association for the Study of Liver Diseases (AASLD) recommend against use of ursodeoxycholic acid in the treatment of primary sclerosing cholangitis.

The guidelines note the lack of proven efficacy on specified outcomes (death or liver transplantation) for low or intermediate dose UDCA (13 to 15 mg/kg per day) and findings from a randomized trial that high dose UDCA (20 to 30 mg/kg per day) resulted in worse outcomes. Although standard doses of UDCA have not been associated with adverse outcomes, UDCA cannot be recommended for routine use, pending further data. In patients who have already been treated with UDCA, reinstituting UDCA at doses of 13 to 15 mg/kg per day if significant symptoms (pruritus or jaundice) recur after medication withdrawal has been suggested. (Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010; 51:660.)

News and Views (Dr G M Singh)

Offer HIV testing routinely to:

  • All patients where HIV infection enters the differential diagnosis or primary HIV is suspected

  • All men who report sex with another man

  • All men and women from a country with high HIV prevalence

  • Anyone reporting sexual contact abroad or with people from countries with high HIV prevalence

  • Anyone diagnosed with an STI

  • All children of HIV-positive mothers

  • All sexual partners of HIV-positive individuals

  • Any injecting drug users

  • All female sexual partners of men who report sex with men

Glucocorticoids and atrial arrhythmia

A population-based study has found that glucocorticoid use is associated with a doubling of risk of atrial fibrillation and flutter, particularly in new users.The increased risk was unrelated to the presence of underlying pulmonary or cardiovascular disease.

Alzheimer's survival rates

Alzheimer's disease, which is classified into three stages -- early, middle and late -- takes no single pathway in all patients, but the average life span of a person after diagnosis is about seven years. (Murali Doraiswamy, MD, of Duke University Medical Center).

Sexual problems in cancer patients

According to research appearing in the journal Psycho-Oncology, sexual problems commonly do not resolve in the first two years of disease-free survival in cancer patients. The vast majority of patients said that sexual intimacy was less important than basic survival, but that it was still a critical component of quality of life.

Mnemonic of the Day (Dr Prachi Garg): ST elevation causes in ECG - ELEVATION

Early repolarization
Ventricular hypertrophy
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm

What’s New

The US Preventive Services Task Force (USPSTF) concluded that data were insufficient to recommend universal bilirubin newborn screening to prevent kernicterus. (Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. Pediatrics 2009;124:1172.)

Quote of the Day

"The greater the difficulty the more glory in surmounting it. Skillful pilots gain their reputation from storms and tempests." Epictetus

Diabetes Fact

Diabetes in malnourished children: high fasting sugar which responds to giving proteins and calories, (not enough proteins to make insulin)

DMA Update: 9th May is Mother’s Day

Workup for incontinence is a multistep process.

Question of the Day: What are the 10 most significant facts of development?

  1. Early foundation is critical.
  2. Role of maturation
  3. Role of learning
  4. Development follows a predictable pattern.
  5. All individuals are different.
  6. Each phase of development has a characteristic behavior.
  7. Each phase of development has its own hazards.
  8. Development is aided by stimulation.
  9. Development is affected by cultural changes.
  10. Social expectations for every stage of development.

World Asthma Day (May 4, 2010): (Dr. Sukanta Sen)

Asthma is a chronic Inflammatory disorder of bronchi characterized by Episodic, reversible bronchospasm resulting from an exaggerated bronchoconstrictor response (hyperreactivity) to various stimuli-allergy.

Stupid Question: (drsooneita@gmail.com)

At the movies: When you meet acquaintances/ friends.. .....
Stupid Question: Hey, what are you doing here?
Answer: Don't u know, I sell tickets in black over here..

SMS of the Day

No sound in the world can be louder than silence, if anyone can understand your silence then they can never misunderstand your words

eMedinewS Try this it Works: That aching knee

When you suspect osteoarthritis of the knee in a patient whose weight-bearing posteroanterior (PA) radiographs of the knee are essentially unremarkable, a 45° PA flexion weight-bearing radiograph can provide more answers. This view is more accurate, specific, and sensitive for joint-space narrowing than the conventional radiograph. It is also helpful to better define overall degenerative changes of the joint.

Dr Good Dr Bad

Situation: A patient being treated for Lung infection develops recurrent small grouped vesicles in the orolabial region, suggestive of herpes simplex.

Dr Bad: Start the patient on topical acyclovir therapy.

Dr Good: Start the patient on systemic Acyclovir therapy, As he has severe orolabial lesions.

Lesson: In patients with recurrent, severe orolabial herpes simplex, systemic acyclovir therapy should be started at a dose of 200 mg five times.

Make Sure

Situation: A patient undergoing surgery was given 4th generation cephalosporin

Reaction: Oh my God? Why was a fourth generation drug given?

Make sure that later generation cephalosporins are not used for infections due to gram-positive cocci (except penicillin-resistant pneumococci) or Acinetobacter. They are not currently recommended for prophylactic use in surgery.

IMANDB Joke of the Day

A man said to his doctor, ' I think there' s something wrong with me; I' ve got a pain here,one over there & he went on and on about his symptoms. Everytime he paused for breath the doctor said,  Fine! Fine! Go on, go on! When he' d finally finished the story, the doctor said, ' You know, you' ve got a disease that was supposed to have been extinct long ago.'

ECG Formulae: Duration of QRS complex in frontal plane

Normal: 0.06-0.10 second
Prolonged QRS duration (>0.10 second)

Milestones in Urology

1677- 1761: Stephen Hales studied stones taken from the bladder and kidneys and suggested solvents which might reduce them without surgery. He also invented the surgical forceps.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Beta-2 Microglobulin

To help evaluate the severity and prognosis of multiple myeloma, leukemia, or lymphoma; to distinguish between kidney disorders and to detect kidney damage.

Public Forum (Press Release for use by the newspapers)

Can we ward off diabetes?

Adhering to Mediterranean diet, rich in fruits and vegetables and low in animal products, may protect one against developing type 2 diabetes said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, quoting a Spanish study. The diet emphasizes olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and deemphasizes meat and dairy products. It is a healthy eating plan that seems to help in the prevention of heart disease.

In the study published in the British Medical Journal, researchers tracked the diets of 13,380 Spanish university graduates with no history of diabetes. Participants filled out a 136-item food questionnaire, which measured their entire Mediterranean diet (including their intake of fats), their cooking methods and their use of dietary supplements. During an average of 4.4 years of follow-up, the team found that people who adhered to a Mediterranean diet had a lower risk of developing type 2 diabetes. In fact, those who stuck very closely to the diet reduced their risk by 83 percent.

Moreover, the people who tended to stick closest to the diet were those with factors that put them at the highest risk for developing diabetes, such as being older, having a family history of diabetes and being an ex-smoker. These people were expected to have a higher rate of diabetes, but when they adhered to the Mediterranean diet this was not the case.

Type 2 diabetes is typically brought on by poor eating habits, too much weight and too little exercise.

One key factor that might be responsible for the protective effect of the Mediterranean diet is its emphasis on olive oil for cooking, frying, putting on bread and mixing in salad dressings.

Tips to prevent diabetes-

  1. Eat less
  2. Omit refined carbohydrates (white sugar, white rice and white maida)
  3. Use olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and reduce meat and dairy products. 

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Contact: drkk@ijcp.com emedinews@gmail.com


eMedinewS Padma Con 2010

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS revisiting 2010

The second 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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Readers Responses

  1. Dear Dr. K.K.Aggarwal, Sir i want to know that is there any kind of insulin patch available in the market which helped the patient not to take insulin inj for almost 6 months. please clarify and please tell is there any kind of insulin pump available in market. thanks: Dr Neeraj Gupta eMedinewS reply: insulin pumps are available in the market.
  2. DENTIGEROUS CYSTS: Dentigerous cysts are the second most common type of odontogenic cysts. A dentigerous cyst is always associated with the crown of an unerupted tooth. It is formed by accumulation of fluid between the remnants of the enamel organ and the tooth. The most common site is the third molar regions and the maxillary canine. A dentigerous cyst is asymptomatic, but it is capable of achieving a large size. Radiographically, it appears as a well-defined radiolucent unilocular area associated with a crown. The differential diagnosis includes odontogenic keratocyst, ameloblastoma, and several other odontogenic cysts and tumors. The treatment is enucleation. Histologic examination should be always done. The prognosis is excellent. (DR.G.M.SINGH)

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Fluvoxamine Maleate100/150mg ER Tablets

For the treatment of obsessive compulsive disorder (OCD)and depression