Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
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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

2nd July, 2010, Friday

Clinical alert to guide clopidogrel prescribers

Two cardiology groups released a clinical alert to guide doctors prescribing clopidogrel after the FDA added a boxed warning to the label about genetic variations that affect the drug’s efficacy. The FDA estimates that 2% to 14% of patients poorly metabolize clopidogrel.

The American College of Cardiology (ACC) Foundation and the American Heart Association (AHA) issued recommendations:

  1. Evidencebased guidelines for using antiplatelet therapies should remain the foundation of care. If clopidogrel is prescribed, doctors should ensure that patients take it as prescribed.

  2. Doctors must be aware that in certain patients with either acute or chronic coronary artery disease, genetic variability in response to clopidogrel can affect its inhibition of platelet function.

  3. Careful clinical judgment, including weighing the risks and benefits, is needed in considering all therapies.

  4. The new boxed warning points out that for clopidogrel, if there is a lack of efficacy, the outcome could be fatal.

  5. Genetic testing to check if a patient is a poor metabolizer may be considered before starting clopidogrel therapy in patients believed to be at moderate or high risk for poor outcomes, such as patients undergoing elective highrisk percutaneous coronary intervention procedures.

  6. Using alternative antiplatelet therapies or altering the dosing of clopidogrel may be reasonable options in patients who experience an adverse event while taking clopidogrel and have been taking the drug as prescribed.

  7. Patients currently taking clopidogrel should not stop the drug unless advised by their clinician.

  8. The American Academy of Family Physicians, the Society for Cardiovascular Angiography and Interventions and the Society for Thoracic Surgeons have also endorsed the recommendations, which be published July 20 in the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Motivational Workshop at ITL Public School

Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal being felicitated by the ITL Public School, Dwarka, New Delhi in the workshop.


Dr k k Aggarwal


News and views

1. Less weight gain with biking, fast walking

Overtime, brisk walking and bicycling appear to reduce weight gain. Among premenopausal female nurses, those who reported walking briskly or bicycling gained less weight over a 16year period than those who didn’t participate in those activities. The findings were magnified in overweight and obese women These findings are reported in the June 28 issue of Archives of Internal Medicine.

2 Pfizer withdraws Mylotarg from US market

FDA has announced that Pfizer Inc. has withdrawn Mylotarg (gemtuzumab ozogamicin) for patients with acute myeloid leukemia. from the US market following research indicating that the medication was not effective and was linked to safety issues.

3. Blood and urinary concentrations of salbutamol in asthmatic subjects
(Dr GM Singh)

A study which assessed the pharmacokinetics of salbutamol (inhaled and oral) in patients with asthma concluded that median urinary concentrations after oral administration of 8 mg of salbutamol were significantly higher than those after inhalation of 0.8 mg of salbutamol.

4. GI index of food



Roasted and salted peanuts




Whole milk


Skimmed milk






Apple juice, unsweetened




All Bran  




Orange juice 


Brown Rice




Basmati Rice 




Ice cream


Coca cola


White bread






To read more on the subject: click on http:// www.lifemojo.com /lifestyle / lowglycemicindexdietgidiet5503110#ixzz0s4SIiCCO

5. Starting dialysis earlier in chronic kidney disease may not improve survival (Dr Monica and Brahma Vasudeva)

A study published June 27 in the New England Journal of Medicine reports that, planned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes.


6. MCI News

The bail plea of Dr Ketan Desai will be heard today at 12 noon in the high court. As per sources ten more cases are likely to be filed under the POCA act. CBI is unlikely to file the charge sheet in the first case tomorrow. In the DA case the bail is likely soon.


7. Air India flight

On thursday i was travleleing air india 5.50 flight from Delhi and Mumbai and saw only 33 passengers in the flight. I was worried why was the flight boarded with only a few passengers. When we got the lemon water bottle it was having an expiry of 1st July 2010 and many passengers noticed the same. The creq answer ws thatr July 1st is not yet over. If this is the servive no wonder why many of us would not like to travel air india.

Legal Column

Forensic Column

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

Human error plays a key role in blood transfusion mishaps

Tthe ancient Indian system of Medicine mentions the importance of blood various aspect of hematology including blood letting. The earliest record of transfusion of blood into a human being was made by a French physician in 1704. The blood was that of sheep and the transfusion was a fatal failure. The discovery of blood groups by Steiner in 1901 paved the way of successful blood transfusions. Before the second world war, most blood transfusions were performed directly from the donor to the recipient.

Advances in techniques to preserve/store blood and blood products and cross check incompatibility reaction have made blood transfusion a routine/common medical procedure.

Blood transfusion is a surgical process and except in case of emergency (when done in good faith), the doctor/hospital should perform transfusion only with the written informed consent of recipient. If the recipient is below 18 years of age, the consent of guardian must be taken. The Blood Bank should record the details of grouping/cross matching and screening procedure conducted in each unit of blood.

Human error plays a key role in transfusion mishaps. Hence, there is a need to develop a foolproof system in a hospital for transfusion under the supervision of doctor. In cases of civil litigation, vicarious liability is considered, which makes the doctor as well as hospital liable for the error of technician/paramedics in blood/blood products transfusion reaction/mishap resulting in damage.

Incompatible transfusions may result in severe disseminated intravascular coagulation, prolonged hypotension, acute uremia, which may be life-threatening. The standard imminent medical care should be given to the patient and each clinical finding and the medical response to it alongwith date and time must be clearly documented by the medical professionals/hospital for any reference required in legal issues in case of inevitable medical accident.

As Susuratham said, "Rudhiranyavadharyathe rakta jeeva ithi sthiti" i.e. Rakta or rudhiram is the basis of life.


Experts’ Views

Interesting tips in Hepatology & Gastroenterology

Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi

Celiac Disease (Contd.)

Q: Is Celiac disease life long ?

A:Yes, celiac disease is lifelong. If someone feels that he/she was diagnosed initially and later became normal, then the fact is that the diagnosis of 'celiac disease' at the initial stage was not true.

Q: Can celiac disease present as just iron deficiency / anemia?

A: Yes, it is possible. Parents and adults find it difficult to believe that when there are no other problems besides anemia, then how can celiac disease be diagnosed. Well, even anemia may be the sole manifestation of celiac disease, just as only rickets or short stature may the sole manifestations.


Mental exercise to prevent dementia:  Dr Anupam Sethi Malhotra

Six (or more) things you can wear on your feet beginning with ‘S’: Shoes, socks, sandals, sneakers, slippers, skis, kates, snowshoes, stockings, stilts


Public Forum (Press Release for use by the newspapers)

Women with kidney patients can have pregnancy

Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease) said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Maternal and peribirth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to nondiabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction, and preterm birth.

Preconceptional treatment with drugs like angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.


An Inspirational Story (Anuj Goyal)

A popular motivational speaker was entertaining his Audience. He said: The best years of my life were spent in the arms of a woman who wasn’t my wife!

The audience was silent and in shock. The speaker added: And that woman was my mother!

Laughter and applause...

A week later, a top manager trained by a Motivational speaker tried to crack this very effective joke at home. He was a bit foggy after a drink. He said loudly to his wife who was preparing dinner, "The greatest years of my life were spent in the arms of a woman who was not my Wife!"

The wife went, Ahhhh! with shock and rage.

Standing there for 20 seconds trying to recall the second Half of the joke, the manager finally blurted out and said I can’t remember who she was!

By the time the manager regained his consciousness, he was on a hospital bed.

Moral of the story: Don’t Copy if you can’t PASTE.


IJCP Special

Dr Good Dr Bad

Situation: A CAD patient on lowdose aspirin was to be prescribed a NSAID.
Dr Bad: You can take it anytime.
Dr Good: Take aspirin 2 hours before
Lesson: In patients using NSAIDs on an occasional shortterm basis, aspirin should be taken at least two hours before the NSAID.

Make Sure

Situation: A terminally ill patient, who develops bed sores, is given systemic antibiotics only.
Reaction: Oh My God! Also change the position of the patient frequently and keep the skin clean and dry.
Lesson: Make sure that good nursing care and maintenance of skin hygiene should be advised first to patients with bed sores, along with topical antibiotics.

Mistakes in Clinical practice

Do not write "IJ" for injection: it can be mistaken as ‘N’ or Intrajugular

Milestones in Neurology

Sir Andrew Fielding Huxley is an English physiologist and biophysicist, who won the 1963 Nobel Prize in Physiology or Medicine with Alan Lloyd Hodgkin for his work on the basis of nerve action potentials, the electrical impulses that enable the activity of an organism to be coordinated by a central nervous system.

Mnemonic of the Day: Dr Maj Prachi Garg

Rashes: time of appearance after fever onset i.e. Number of days after onset of fever when a rash will appear.

"Really Sick Children Must Take No Exercise"

1 Day: Rubella
2 Days: Scarlet fever/ Smallpox
3 Days: Chickenpox
4 Days: Measles (see the Koplik spots one day prior to rash)
5 Days: Typhus & rickettsia (this is variable)
6 Days: Nothing
7 Days: Enteric fever (salmonella)


International Medical Science Academy Update (IMSA)

The 13valent pneumococcal conjugate vaccine (PCV13) was licensed by the US FDA in February 2010 for use in children 6 weeks through 71 months of age. PCV13 replaces PCV7 (the 7valent pneumococcal conjugate vaccine) in the routine childhood immunization schedule and catchup schedule.

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Mometasone 0.1 % + Fusidic acid 2% cream/ointment

For the treatment of dermatoses where secondary bacterial and/or candidial infection is present


Medi Finance

Personal Accident individual
Risk Group III
Persons working in underground mines, explosive magazines, workers involved in electrical installation with high tension supply, jockeys, circus personnel, persons engaged in activities like racing on wheels or horse back, big game, hunting, mountaineering, winter sports, skiing, ice hockey, ballooning, polo and persons engaged in occupations/activities of similar hazard.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Activated Partial Thromboplastin Time;

Also known as aPTT; APTT; done as part of an investigation of a bleeding or thrombotic episode; to monitor unfractionated (standard) heparin anticoagulant therapy


Humor Section

A Marvelous Answer

A mechanic was removing the cylinder heads from the engine of a car when a famous heart surgeon entered his workshop.

The mechanic straightened up, wiped his hands on a rag and asked argumentatively, "So doctor, look at this. I also open hearts, take valves out, grind ’em, put in new parts, and when I finish, this will work as a new one… So how come you get the big money, when you and me are doing basically the same work? "

The doctor leaned over and whispered to the mechanic. The Doctor said: "Try to do it when the Engine is RUNNING"


Forthcoming Events

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5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

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29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

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31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

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