Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
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


Dear Colleague

3rd April, 2010 Saturday

Omalizumab: a new (but costly) introdcution to asthma treatment

Excerpts from a seminar organsied by International Medical Sciences Academy, at Lady Harding Medical College, New Delhi

Most asthmatics are atopic and have raised circulating IgE concentrations, which plays a central role in the mechanism of immediate bronchoconstriction in allergic asthmatics after inhalation of allergen.

Omalizumab is a recombinant humanized IgG1 monoclonal antibody that binds circulating IgE, forming immune complexes that are subsequently cleared by the hepatic reticuloendothelial system. This binding inhibits interaction of IgE with IgE receptors on mast cells, basophils, and other cell types.

Randomized trials with moderate and severe persistent asthma have shown that anti–IgE therapy significantly reduces severe exacerbations and the need for inhaled glucocorticoids.

Omalizumab is approved as an add-on therapy in inadequately controlled moderate–to––severe asthmatics. The 2007 NAEPP asthma guidelines recommended that omalizumab should be considered as adjunctive therapy in step 5 or 6 care for patients with allergies and severe persistent asthma.

The drug is to be given by subcutaneous injection undersupervision. No specific lab tests are required. Total serum IgE levels are not helpful as these do not distinguish free IgE from IgE complexed to the drug, and total IgE levels typically increase three to six–fold on therapy. The drug is well tolerated. Anaphylaxis occurs in approximately 2 in 1000 patients, and can develop after any dose, including the first one, or have delayed onset or protracted course. Patients should be observed for two hours after each of the first three injections, and for 30 minutes after each subsequent injection, in addition to other precautions. Urticarial skin rash is seen in approximately one percent of patients, and mild injection site reactions occur in 44 percent.

Dr KK Aggarwal
Chief Editor

News and views

More hospitals offering therapeutic hypothermia for comatose survivors of cardiac arrest

Since the American Heart Association issued recommendations and guidelines for inducing mild hypothermia in comatose survivors of cardiac arrest in 2005, the number of hospitals offering the treatment has climbed. Therapeutic hypothermia is one of the most exciting and promising interventions for the treatment of cardiac arrest. Cancer patients with diabetes may have higher postoperative mortality risk People with diabetes are at substantially greater risk (over 50%) of dying after undergoing cancer surgery, according to research published in the journal Diabetes Care.

Meeting Notes
American College of Cardiology
Atlanta, GA ? March 14 – 16, 2010

1. Radial artery matches saphenous vein for CABG

Coronary artery bypass grafts taken from the radial artery provide short–term patency that is just as good as standard saphenous vein grafts. Radial artery grafts remained open at one week in 99% of patients, compared with 97% for saphenous vein grafts. The rates were identical at 89% after one year. (Dr Steven Goldman, Tucson VA Hospital, Arizona)

2. New anticoagulants signal start of post–warfarin era

Atrial fibrillation is both a major stroke risk and a looming public health problem since the risk of afib increases with age, and the standard treatment, warfarin, is often a clinical management challenge. But a number of investigational therapies suggest that a post–warfarin era is beginning. American College of Cardiology president Ralph Brindis, MD, of the University of California San Francisco, says two new compounds, betrixaban and dabigatran, have raised the threshold for anticoagulation therapy. But neither compound has been approved for clinical use.

3. Genotyping improves warfarin outcomes

Genetic testing to guide early warfarin dosing appears to hospitalizations. Patients genotyped for the warfarin metabolism gene CYP2C9 and the vitamin K blood clotting activator gene VKORC1 had a relative 28% fewer hospitalizations for bleeding and thromboembolism than historical controls. Giving physicians the genotype results with interpretation for dosing also appeared to reduce total hospitalization risk by an adjusted 31% compared with the historical controls. (Dr Robert S. Epstein, Medco Health Solutions, Franklin Lakes, N.J)

What’s New: H. pylori eradication reduces chances of gastric ulcer

A meta–analysis of seven controlled trials in populations at high risk for gastric cancer found a significantly lower rate of gastric cancer following H. pylori eradication (1.1 versus 1.7 percent).

Diabetes Fact

Somogyi effect: If at 3am sugar low, also at 8am sugar is low. Solution: Reduce night dose


Public Forum (Press Release)

S. Moorei responsible for bad breath

Solobacterium moorei, a gram–positive anaerobic bacillus originally isolated from human feces has been shown to be responsible for chronic bad breath, or halitosis. Persistent bad breath, is often caused by the breakdown of bacteria in the mouth, producing foul–smelling sulfur compounds that reside on the surface of the tongue.

As per Betsy Clark, at the State University of New York at Buffalo School of Dental Medicine, in a study of 21 people with chronic bad breath and 36 subjects without this problem, S. moorei was found in every patient who had halitosis compared with only four control subjects.

Brushing twice a day with antibacterial toothpaste and using a toothbrush with a built–in tongue scraper can eliminate chronic bad breath.

Bad oral hygiene is also associated with increased risk of heart disease said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Identifiable cause of bad breath are periodontal disease, gingivitis, postnasal drip, systemic illness.

Oral source of bad breath may be alleviated by:

  1. Proper dental care and oral hygiene.

  2. Gentle cleaning of the posterior portion of the tongue dorsum with a plastic tongue cleaner.

  3. Rinsing and deep gargling with an effective mouthwash. One should extend the tongue while gargling.

  4. Eating fibrous foods especially at the breakfast.

  5. Brief gum chewing for five minutes if the mouth is dry, or after meals, especially with high protein intake.

  6. Sufficient water intake.

  7. Antibiotics, if bacteria are present, for temporary relief. One should floss their teeth properly, smell the floss between each passage, and clean the malodorous sites carefully. Flossing should include cleaning the posterior surface of the back teeth as well.

 Effective tongue brushing requires access to the deep posterior part of the dorsal tongue; odors often lurk 10 cm or more back from the tongue tip. The basic idea is to sweep away the mucus, desquamated cells, and other debris.

Some mouthwashes contain components that may harm soft oral tissues (eg, alcohol, sodium codicil sulfate, strong oxidizing agents). The most efficacious mouthrinses for short–term use are probably those containing 0.2 percent chlorhexidine gluconate.

The best time to use a mouthwash is before bedtime since the residue of the mouthrinse may remain in the mouth for a longer period of time and have a greater effect. Also bacterial activity leading to bad breath is greatest during the nighttime, when saliva flow is practically zero and microbial activity is highest.

Question of the day

How do you prepare your patient for laser hair removal?

Patient is counseled about multiple sittings and told to have realistic expectations. Information is given about results to be expected (permanent hair reduction and not permanent hair removal).

Female patients are investigated for causes of hyperandrogenism.

Patients are evaluated for type of hair and skin type and contrast between skin color and hair color. The best results are to be expected in fair patients with thick dark hair.

A bleaching cream with hydroquinone and a sunscreen is prescribed for a few days before the procedure – to reduce effect of tanning. In patients with a history of recurrent herpes simplex on face, a prophylactic course of acyclovir is started a day before the procedure and continued for five days.

Written informed consent is taken.

Whenever feasible, a ‘test patch’ is done (a pilot study on a small covered area to know the most appropriate laser parameters for that patient) Hair to be treated is removed from surface either with a razor or a depilatory cream to avoid thermal damage to surface epidermis due to heated hair. Patient is told to avoid exposure to sunlight for about 5 to 7 days after the procedure.

eMedinewS Try this it Works

Keep the healthy lung down

In patients with unilateral lung disease, positioning the healthy lung down––in the most dependent position possible––may improve the ventilation–perfusion "mismatch" and raise oxygen saturation levels. This can buy valuable time and turn an emergent situation into an urgent one that allows proper preparation.

Dr Good Dr Bad

Situation: A diabetic patient presented with first onset CAD to a GP.

Dr Bad: You need a cardiac consult.

Dr Good: You need a cardiac and a dental consult.

Lesson: Diabetic persons with severe periodontal disease may be particularly susceptible to microvascular and macrovascular complications, which are primarily responsible for the increased morbidity and mortality associated with diabetes. Several epidemiological studies suggest that periodontal infection may be a risk factor for heart disease. Periodontal disease is a strong predictor of death from cardiorenal disease in those with type 2 diabetes. (Diabetes Care 2005;28(1):27–32)

Make Sure

Situation: A foreigner presents with travelers diarrhea

Reaction: Put him on ciprofloxacin

Make sure that foreigner patients with travelers diarrhea are put on a course of ciprofloxacin and tinidazole


Laughter the best medicine

Patient: Doctor, what does the X–ray of my head show?

Date: Absolutely nothing!

Formulae in Critical Care

Volume loss

Formula: Actual bp (previous) – present bp

Comment: A fall of more than 30 mmHg systolic suggests
10% volume loss. Systolic BP of <90 mmHg suggests>20% blood volume loss.

Milestones in Medicine

900 A.D. Avicenna, renowned Arab physician, compiled a vast medical encyclopedia that influenced medical education in Europe for centuries to come.

Lab Test (Dr Naveen Dang)

Typhidot has no FDA approval and has got minimal supportive literature to prove its accuracy.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Ambroxol 30mg + Levo salbutamol 1mg+ Guiphenesin 50mg /5ml syrup

For the symptomatic relief of bronchospasm in bronchial asthma & chronic bronchitis


(Advertorial section)


Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

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

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17 – 18 April). Over 400 Registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards


Delhi Medical Council Presents

An interaction with

Dr. Ketan Desai, President, Medical Council of India  
Mr. Mukul Rohtagi, Senior Advocate, Supreme Court of India
Dr A K Aggarwal, President, Delhi Medical Council

Topic: Medical Ethics & Doctor–Pharma Relationship – New MCI Amendments

Date: April 10, 2010, Saturday

Time: 6 pm – 9 pm

Venue: Maulana Azad Medical College Auditorium, Dilli Gate, New Delhi

Dr KK Aggarwal: Moderator and Member Delhi Medical Council

Dr Girish Tyagi: Registrar, Delhi Medical Council

For Registration SMS to Dr KK Aggarwal: 9811090206 or email to emedinews@gmail.com

No fee

Readers Responses

  1. Respected Dr Aggarwal sir, CONGRATULATIONS for receiving the PADMASHRI! Dr Vijayshri M. Parkale

  2. Dear KK, We are proud to see you receiving the Padma award from the President Smt. Pratibha Patil. Congratulations: Vikas and Meena Jain

  3. Mr K K Aggarwal, Pl accept my heartiest congratulations for being awarded the 4th highest civilian award which you deserve beyond doubt: R C Grover

  4. Heartiest congratulations to Dr KK Aggarwal for the Padma Awards. I watched the programme live on TV just for you. May God give you many more success in life: Farhat Manzoor