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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 June, 2010, Thursday

How many multivitamins a day should one prescribe?

Dear Colleague

Compensating for dietary deficiencies by popping a multivitamin every day is no longer recommended. Many multivitamins contain some micronutrients in amounts greater than those recommended. One should take no more than one multivitamin tablet daily if one has to and no more. It’s not a good idea to take extra multivitamins in an effort to increase the intake of a single micronutrient. Doing so can be harmful reports Hravrad Medical Newsletter.

The benefits of multivitamins remain uncertain. The Women’s Health Initiative study concluded that postmenopausal women who took multivitamins did not have a lower death rate than others and were just as likely to develop cardiovascular disease or cancers of the lung, colon and rectum, breast, and endometrium.

There is little evidence of protection against cardiovascular disease or cancers from vitamin E, vitamin C, beta carotene, and the two of B vitamins – B6, B12 , and folic acid.

In 2008, a Cochrane Collaboration review found that low–risk people who were given vitamin A, vitamin E, and beta carotene had a slightly higher death rate. Excess folic acid has been shown to be contributing to rise in incidence of colon polyps.

The best way to get the nutrients we need is through food. However, adequate calcium and vitamin D are essential in preserving bone density. One may get the recommended 1,200–mg calcium requirement in the diet, but, it may be almost impossible to get the recommended 1,000 mg of vitamin D, which is essential for calcium absorption, through food intake and sun exposure.


Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature

World Environment Day 2010

Padma Shri & Dr BC Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Shri Sushil Kumar, Olympic Bronze Medal Winner wrestler at a Press Conference organized to earmark the ‘World Environment Day’ falling on June 6, 2010. The focus was ‘Biodiversity – Ecosystems Management and the Green Economy’.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update

A fully human monoclonal anti–CD20 monoclonal antibody, ofatumumab, was approved by US FDA for treatment of chronic lymphocytic leukemia (CLL) that is refractory to both fludarabine and alemtuzumab.


  1. Coiffier B, Lepretre S, Pedersen LM, et al. Safety and efficacy of ofatumumab, a fully human monoclonal anti–CD20 antibody, in patients with relapsed or refractory B–cell chronic lymphocytic leukemia: a phase 1–2 study. Blood 2008;111:1094.
  2. Kipps TJ, Osterborg A, Mayer J, et al. Clinical improvement with a novel CD20 mAb, ofatumumab, in fludarabine–refractory chronic lymphocytic leukemia also refractory to alemtuzumab or with bulky lymphadenopathy (abstract). J Clin Oncol 2009;27:7043.
  3. Wierda WG, Kipps T, Mayer J, et al. Activity of ofatumumab, a novel CD20 mAb, and prior rituximab exposure in patients with fludarabine– and alemtuzumab–refractory or bulky fludarabine–refractory chronic lymphocytic leukemia (abstract). J Clin Oncol 2009;27:7044.


emedinews regrets to informthe sudden and untimely death of Dr. R.R. Thukral, Vice-President, IMSA, WHQ on 2.6.2010. One can send condolances at imsawhq06@gmail.com

 MCI News

The bail plea of Dr Ketan Desai on health grounds, which came for hearing on Wednesday was deferred for 3rd June Thursday by the high court.  The court is due for vacation. If the high court denies the bail today the next hearing will be only after the vacation.

Readers Response: APPEAL


DR.V.K.MUTREJA, CONTACT NO. 9810786142, vkmutreja@rediffmail.com

Mnemonics of the Day (Dr Prachi)

Peripheral vascular insufficiency: Inspection criteria (SICVD)

Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair

News and Views

Switching glasses when outdoors may reduce falls (Dr N P Singh)

The results of a randomized trial say that a second pair of distance–only glasses for older bifocal or progressive lens wearers may help prevent falls in some high–risk populations. For older adults at an increased risk of falls, replacing multifocal glasses with single–vision ones for walking and outdoor activities resulted in 40% reduction in incidence rate compared with the control group (1.26 vs 16 falls per person over 13 months) among those with an above–average level of outdoor activity.

Role of endoscopy in the management of patients with diarrhea (Varesh Nagrath)


1. Stool and laboratory tests should be the initial step for the evaluation of clinical scenarios suggestive of infectious diarrhea.

2. In patients with chronic unexplained diarrhea, colonoscopy with random biopsies of the right and left side of the colon is suggested. Sigmoidoscopy is an alternative option, although this may miss right–sided organic disease.

3. For patients undergoing evaluation of chronic diarrhea, intubation of the terminal ileum during colonoscopy is recommended. There are insufficient data to determine whether biopsy of an endoscopically normal–appearing terminal ileum should be routinely performed, but the yield of this is likely low.

4. EGD (Esophagogastroduodenoscopy) with small–bowel biopsy is recommended in patients with chronic diarrhea or suspected malabsorption and inconclusive evaluation after colonoscopy with biopsy and in patients with positive celiac serology.

5. A minimum of 4 duodenal biopsy specimens for evaluation of suspected celiac disease should be obtained.

6. Enteroscopy is not recommended for the routine evaluation of chronic diarrhea but may be useful for evaluation of small–bowel disease when other investigations are nondiagnostic.

7. VCE (Video capsule endoscopy) is not recommended for the routine evaluation of chronic diarrhea.

8. In patients with HIV and diarrhea, either flexible sigmoidoscopy or colonoscopy should be done, if laboratory evaluation is nondiagnostic.

9. In the absence of a diagnosis on flexible sigmoidoscopy, a full colonoscopy with biopsy and/or EGD with biopsy for HIV patients with persistent diarrhea are recommended.

10. In patients with suspected GVHD (graft–versus–host disease) and diarrhea, flexible sigmoidoscopy with distal colon biopsies as the initial endoscopic evaluation is recommended. In the event of negative colonic histology findings or when upper GI symptoms predominate, an EGD with biopsies is recommended.

(Source: Gastrointestinal Endoscopy May 2010, Vol 71, Issue 6)

Physician suggests payment solution for medical complications (Dr Moinica & Brahm Vasudeva)

Medicare and Medicaid would no longer pay for the treatment costs of some conditions acquired during an inpatient stay that could reasonably have been prevented, in an effort to improve patient safety and rein in healthcare costs. Hospitals and physicians would have to take responsibility for these errors and cover their own costs.

Quote of the day (McMahon Pharmacy Practice News, November 2009)

Portfolio Life – Where can it take you?
David Corbett’s book, "Portfolio Life, The New Path to Work, Purpose and Passion after 50."

Corbett also identifies five helpful paths to a new mindset. They are:
1. Go with your strengths and leverage them
2. Create and develop new paths
3. Go with your gut
4. Don't fear failure
5. Connect with others

Question of the Day

Why does the prevalence of type 2 diabetes mellitus vary with age, sex and ethnicity? (Dr Uma Mahesh, Chennai)

The development of type 2 diabetes mellitus is profoundly influenced by attained age, or as age, advances the risk increases.
Other reasons for ethnic differences in the rise of type 2 diabetes are not entirely understood, for e.g. Asian–Indians have remarkably high prevalence of type 2 diabetes compared to Caucasians. However the incidence of obesity is an important risk factor in the development of type 2 diabetes and is significantly lower in Asian–Indians compared to Caucasians.
Though westernization of lifestyle modification with dietary changes and lack of exercise may play a role in increased prevalence of type 2 diabetes mellitus, one important factor contributing to increased type 2 diabetes is that Indians have excessive insulin resistance. This difference in the degree of insulin resistance may be explained by either due to environmental factor or genetic factor or by consummation of both. Asians–Indians have upper body adiposity and higher visceral fat for a given BMI when compared with western population. In Indian population, an interaction between upper body adiposity and general adiposity increased the risk of type 2 diabetes at lower tertiles of BMI for both men and women.

Liver Fact

SGOT rarely exceeds 300 U/L in alcoholic hepatitis.

Women Safety Tips

ALWAYS take the elevator instead of the stairs. Stairwells are horrible places to be alone and the perfect crime spot. This is especially true at NIGHT!

7 Myths About Bipolar Disorder (2)

Bipolar disorder is rare.

eMedinewS Try this it Works : Check the pulse in suspected paradoxus

A quick bedside test to check for presence of pulses paradoxus consists of feeling the pulse and noting whether or not it changes with respiration. The test is positive if you can feel the pulse diminish in amplitude and even disappear during inspiration. On the other hand, a normal–volume pulse during inspiration rules out significant pulsus paradoxus.

Dr Good Dr Bad

Situation: Embolization occurs in how many patient of DVT (JR to SR).
Dr Bad: Rare!
Dr Good: Common!
Lesson: Embolization occurs in about 50% of patients having proximal vein DVT.

Make Sure

Situation: A patient with pygenic meningitis developed complications.
Reaction: Oh my God! Why was an antibiotic not given when meningitis was suspected?
Lesson: Make sure that the first dose of antibiotic is given at the time when meningitis is suspected.

IMANDB Joke of the Day (Anuj Goyal)

Mental Asylum

During a visit to the mental asylum, a visitor asked the Director how do you determine whether or not a patient should be institutionalized.

"Well," said the Director, "we fill up a bathtub, then we offer a teaspoon, a teacup and a bucket to the patient and ask him or her to empty the bathtub."

"Oh, I understand," said the visitor. "A normal person would use the bucket because it's bigger than the spoon or the teacup."

"No." said the Director, "A normal person would pull the plug. Do you want a bed near the window?"

Formulae in Clinical Practice


The calculation of the annual cost of increased absenteeism per employee.
Formula: Cost Absent = (Days ever – Days never) × Daily wages (1 + Benefits)

Milestones in Cardiology

1912: James B. Herrick, an American physician, first described heart disease resulting from hardening of the arteries.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Routine Stool Examination

Detection and identification of parasites: included are Giardia, Entamoeba histolytica (amoeba), helminth eggs, protozoa, larval worms, and segments (proglottids) of tapeworms

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Naratriptan (as HCl) Tablets 1/ 2.5mg

For the acute treatment of migraine with or without aura in adults




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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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Public Forum (Press Release for use by the newspapers)

Over 50 years, focus only on upper blood pressure

New Delhi: 3 June 2010: For patients over 50, doctors only need to monitor the upper systolic blood pressure, and can ignore lower diastolic blood pressure reading said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Systolic blood pressure – the top number in a reading – is the pressure exerted at the beginning of the heart's pumping cycle, while diastolic pressure records the lowest pressure during the resting cycle of the heart. Both pressures are routinely measured when taking blood pressure.

As per a report published in the journal The Lancet, there is such an emphasis on diastolic pressure, that the patients are not getting their systolic blood pressures adequately controlled. The fact is that people over the age of 50 probably do not even need to measure diastolic – it's only the systolic blood pressure that should be the focus.

Generally, systolic blood pressure continues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time when cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent. Rising systolic pressure is the most significant factor in causing stroke and heart disease.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, a continued emphasis on both systolic and diastolic blood pressures is needed. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too.

For people 50 or older, systolic pressure is high if it is 140 mmHg or above.

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Forthcoming eMedinewS Events: Register at emedinews@gmail.com

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 day-long 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

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

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

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

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

eMedinews Revisiting 2010

The 2nd 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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If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.