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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

3rd May, 2010, Monday


Dear Colleague

Most think of osteoporosis (loss of bone mass and density) as a disease of older women. Its true that it is more common in women but men are not immune. Most men are living long enough to end up with age–related osteoporosis. Osteoporosis starts earlier and gets worse faster in women because of hormonal shifts, but at age 65, both sexes lose bone at the same rate. The main fear of osteoporosis is a broken bone. 25% men over 50 years will have an osteoporosis–related fracture some time in his life. A broken bone can end up with lingering pain, loss of mobility, long-term disability, and loss of independence.

Osteoporosis is associated with some male-only conditions. 1. Abnormally low testosterone levels. 2. Psoriasis effect both women and men but is linked to loss of bone density in men only. 3. Androgen deprivation therapy, used to treat advanced prostate cancer,involves drugs that interfere with testosterone. 

Some drugs affect bones in both sexes. Long–term cortisone therapy can diminish bone mass. The proton–pump inhibitors and the selective serotonin reuptake inhibitor antidepressants too, may contribute to bone loss.

Lifestyle and health habits are also a major factor in osteoporotic risk, for both men and women. Smoking and heavy alcoholic drinking weaken bones. Men are more likely than women to engage in those behaviors.

Keeping bones strong is yet another reason to exercise. Vitamin D is important for bone health. We should be getting at least 800 to 1,000 international units (IU) of vitamin D daily, especially during winter. The recommendations of calcium intake for men are unclear. There is an association between long–term daily calcium intake at levels of 1,500 mg and a greater risk of developing advanced prostate cancer. On the other hand, there’s a string of results that suggest the mineral may lower colon cancer risk.

Daily calcium recommendation is at 700 mg, which most men should be consuming. For men at risk of osteoporosis, the right balance may be about 700 mg - 1,000 mg, which can be achieved with a normal diet that includes one to two servings of dairy products, and plenty of vitamin D, which usually means taking the vitamin in pill form.

Most drugs have been tested only in women. Alendronate in the bisphosphonate class, has been shown to be effective in men. An alternative for men receiving androgen deprivation therapy is one of the selective estrogen receptor modulator drugs. The experimental drug, denosumab,may have promise for treating men with bone loss resulting from hormonal therapy.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature

Sh Lamba, Vice Principal DPS Mathura Road, Dr U Kakroo, Advisor Heart Care Foundation of India, Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal along with the winning team of Slogan Writing Competition organized on World Earth Day, April 22, 2010 at DPS Mathura Road. (For health awareness, organise school competitions).

Dr k k Aggarwal

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

New guidelines for treatment of HIV infection

The 2009 US HIV treatment guidelines recommend initiation of antiretroviral therapy in patients with a CD4 count of less than 500 cells/mL. Raltegravir, an integrase inhibitor, is a new option for therapy in treatment–naive patients. (DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV–1 infected adults and adolescents. www.AIDSinfo.nih.gov. (Accessed on December 1, 2009).)

News and Views (Dr Brahm and Monica Vasudeva)

Majority of newly emerging infectious diseases originated in animals

As many as 75 % of newly emerging infectious diseases in humans, including bird and swine flus, are ‘zoonoses,’ meaning they originate in animals. zoonotic killers include HIV/AIDS (transmitted to humans by wild African chimpanzees) and severe acute respiratory syndrome (bats)." In fact, "even malaria...now appears to be zoonotic."

Lucentis helps with diabetic macular edema vision loss

A study published in Ophthalmology found Lucentis (ranibizumab) can improve eyesight being lost to diabetic macular edema.

GlaxoSmithKline offering fast–dissolving, mini Nicorette lozenges

GlaxoSmithKline is selling a fast–dissolving lozenge version of its Nicorette anti–smoking lozenges. The mini lozenge is said to dissolve up to three times faster than similar products.

Avandia trial should be halted

A leading public health advocate, Dr. Sidney Wolfe, pressed his case Wednesday to halt a trial of GlaxoSmithKline’s diabetes drug Avandia (rosiglitazone), telling a House subcommittee that the pill needlessly increases patients’ heart attack risk.

Mnemonic of the Day (Dr Prachi Garg): Indications of Coronary artery bypass graft: DUST

Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

What’s New

In a study of 2–month–old infants with moderate unilateral hydronephrosis, 94 % of infants had resolution of their hydronephrosis (defined as two consecutive ultrasounds with a renal pelvic diameter ≤ 5 mm) by 12 to 14 months of age. (Mami C, Paolata A, Palmara A, et al. Outcome and management of isolated moderate renal pelvis dilatation detected at postnatal screening. Pediatr Nephrol 2009;24:2005)

Quote of the Day

"Nothing is as difficult as to achieve results in this world if one is filled full of great tolerances and the milk of human kindness. The person who achieves must generally be a one–idea individual, concentrated entirely on that one idea, and ruthless in his aspect toward other men and other ideas." Corinne Roosevelt Robinson

Do You Know?

We live in a nation where pizza can be guaranteed in 30 minutes but not an ambulance.

DMA Update: 9th May is Mother’s Day

In women of any age, 90% of incontinence is in the storage group.

Question of the Day: Dr GM Singh

If a single anti–emetic is not effective should we be substituting another agent or adding in another? How long do we need to continue the anti-emetic?

It is essential to review palliative care patients regularly as symptoms may change. If the first-line treatment is ineffective it is often better to change the route of administration rather than change the drug as patients who have been nauseated or vomiting for several days will have poor oral absorption. Switching from oral to subcutaneous administration for 48 hours is a good strategy. If symptoms persist the management will again depend on the cause of the vomiting. If there is a mixed gastric and chemical cause then add a low dose of the broad–spectrum anti–emetic levomepromazine (6.25–12.5mg SC/24hrs) to metoclopramide. For chemical causes substitute haloperidol with levomepromazine. Around a third of patients may require a combination of two or more.

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

The first World Asthma Day, in 1998, was observed in more than 35 countries in union with the first World Asthma Meeting held in Barcelona, Spain. The main purpose was to generate knowledge of the disease, its appropriate care, defensive methods amid the general public, health care providers, employees as well as government officials.

Stupid Questio: (drsooneita@gmail.com)

At a funeral: One of the teary–eyed people asked...
Stupid Question: Why, why him, of all people.
Answer: Why? Would it rather have been you?

SMS of the Day

1st Baby: Mere papa bahut darpok hain.
2nd Baby: Why?
1st Baby: Jab bhi road cross karte hai, meri ungli pakad lete hain aur kahte hai chodna mat.

eMedinewS Try this it Works

One should keep in mind that food items such as pickles, chutney, papad have a high salt content and should be consumed in moderation, if at all.

Dr Good Dr Bad

Situation: Following a clean operation a patient comes for wound dressing.

Dr Bad: Take Prophylactic antibiotics.

Dr Good: There is no need for antibiotics.You need sterile dressings only

Lesson: Prophylactic antibiotics are not needed following routine clean surgery and unnecessarily increase he costs.

Make Sure

Situation: In a STD clinic, a 23–year–old heterosexual male presenting with dysuria, and uretheral discharge was prescribed azithromycin to cover suspected Chlamydia trachomatis infection.

Reaction: Oh my God! Why didn’t you advise the same treatment for his partner also?

Lesson: Make sure to remember that in such cases, it is essential that both the partners are treated.

IMANDB Joke of the Day

A waiter suddenly became ill and was rushed to the hospital emergency room. He was lying on the operation table in great pain when he saw an intern walk by. "Doctor, you have to help me," the waiter pleaded. "Sorry," the intern said. "This isn't my table."

Formulae in Obesity

Measuring Waist Circumference: To determine the waist circumference, locate the upper hipbone and place a measuring tape around the abdomen (ensuring that the tape measure is horizontal). The tape measure should be snug but should not cause compressions on the skin.

Milestones in Orthopedics

1510-1590 A.D: Ambroise Pare is known as father of French Surgery. He described the use of ligature for large vessels in amputations. He used a tourniquet in his amputations, designed forceps, instruments and braces of all kinds. Made artificial limbs from iron.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Beta–2 Microglobulin

To help identify a mycobacterial infection; to diagnose tuberculosis (TB); to monitor the effectiveness of treatment.

Public Forum (Press Release for use by the newspapers)

Five a Day

As per the USDA Food Guide Pyramid, one should take 5–9 servings of fruits and vegetables every day. Fruits and vegetables may help lower the risk of some cancers. Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber–containing grain products, fruits and vegetables may help reduce the risk of some cancers, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

A serving size is:

One medium–size fruit
1/2 cup raw, cooked, frozen or canned fruits (in 100% juice) or vegetables
3/4 cup (6 oz.) 100% fruit or vegetable juice
1/2 cup cooked, canned or frozen legumes (beans and peas)
1 cup raw, leafy vegetables
1/4 cup dried fruit
5 servings mean 2 fruits and 3 vegetables; 7 servings mean 3 fruits;4 vegetables and 9 servings mean 4 fruits, 5 vegetables
Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs" which can be incorporated in the 'five-a-day' diet.


  • Snacking on raw vegetables instead of potato chips.
  • Adding fruit to your cereal at breakfast.
  • Using the salad bar when you go out for lunch or to the grocery store.
  • Loading up on juice instead of a usual coffee, tea or soda.
  • Wash fruits and vegetables with water and scrub with a dish brush when appropriate: for example, before eating apples, cucumbers, potatoes, or other produce in which the outer skin or peeling is consumed.
  • Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  • Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  • When buying from a salad bar, avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been held at an improper temperature.
  • Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
  • Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too. 


Formula 1: Have a mix of seven colours and six tastes

Formula 2: Try to eat fruits alone and not mix them with any thing.

Formula 3: Vegetables can be mixed with any other food.


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  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 Response

A Man and his Wife went on vacation to Jerusalem. While they were there, the Wife passed away. The Undertaker told the Husband, "You can have her shipped home for $5,000, or you can Bury her Here, in the Holy Land, for $150."  The Man thought about it and told him he would just have her shipped Home. The Undertaker asked, "Why would you    spend $5,000 to ship your Wife home, when it would be wonderful to be buried here and you would spend only $150?" The Man replied, "Long ago a man called Jesus Christ died here, was buried here, and three days later He rose from the dead. I just can’t take that Chance. (Dr. Mayur Jain)


IMA-MCI Update

IMA office has postponed its scheduled Working Committee meeting. The Working Committee should have met and a collective opinion taken against or in favour of MCI working. The stand of the IMA leadership weather in favour or against the functioning of MCI, should have been endorsed by the Working Committee. Postponing working committee only indicates a leadership crisis in the present functioning of IMA. Will the general elections of IMA also get postponed? 

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Lidocaine Patch 700mg in aqueous base (50 mg per gram adhesive)

For the relief of pain associated with post-herpetic neuralgia. It should be applied only to intact skin.