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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

5th July, 2010, Monday

FDA warns about the aphrodisiac coffee

The FDA has cautioned about a potential serious side effect associated with an instant coffee marketed as a dietary supplement that enhances sexual experiences. Magic Power Coffee, which is sold online, contains the undeclared active drug hydroxythiohomosildenafil, a compound similar to sildenafil, the active ingredient of Viagra. Like sildenafil, the drug can interact with nitrates, causing dangerous decrease in blood pressure. Deborah M. Autor, director, Center for Drug Evaluation and Research’s Office of Compliance, FDA, said that since this product is an instant coffee labeled as an all naturaldietary supplement, consumers may assume it is harmless and poses no health risk.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Follow: Twitter: drkkagarwal  Facebook: krishan kumar aggarwal


Photo Feature (From HCFI file)

17th MTNL Perfect Health Mela

The Logo and Theme of 17th MTNL Perfect Health Mela were released by Former international cricketer Sh Chetan Chauhan during a press conference on 30.6.2010. The theme for this year is "Rising Problems of Lifestyle Disorders."

Neck circumference measurement is a simple way to identify overweight and obese patients prone to sleep apnea.

Dr k k Aggarwal
Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal, President HCFI demonstrating the importance of measurement of neck circumference


News and views

Dr Monica and Brahma Vasudeva

Celebrex may cause less GI bleeding, fewer ulcers

Celecoxib causes less bleeding and fewer ulcers in the gastrointestinal tract than a combination of generic painkiller drugs and heartburn drugs. A study published online June 17 in The Lancet reports that arthritis patients on Celebrex were four times less likely to start bleeding anywhere from the stomach to the colon vs those given the generic drugs diclofenac and omeprazole.

If gastric band fails, drug therapy may help

In a retrospective study, weight loss increased by 50% in obese patients treated with medical therapy after failure of laparoscopic adjustable gastric banding. Total weight loss before medical augmentation averaged 30% of excess body weight, increasing to 45% after augmentation. All of the commonly used drugs helped jump start weight loss from plateaus, but combination therapy was most effective, more than doubling weight loss from plateau levels, Michael Rothkopf, MD, of Morristown (NJ) Memorial Hospital. The study findings were presented at the American Society of Metabolic and Bariatric Surgery meeting.

Dr G M Singh

Dark chocolate lowers blood pressure

Eating dark chocolate can significantly reduce blood pressure in people with hypertension. The results of 15 studies on the effects of flavanols, the compounds in chocolate which cause dilation of blood vessels, on blood pressure were combined and reviewed.

Breast milk transmits drugs and medicines to the baby

Give up smoking, do not drink more than three cups of coffee per day, do not take any kind of drug, or if you do, take it as long as possible before feeding your baby. These are some of the recommendations contained in a study produced by Spanish researchers on methods for detecting medicines and drugs in breast milk. The study shows that the risk from substances such as alcohol is still not well understood.

MCI News

The bail application of Dr DEsai will come on 6th in the lower court on DA case. Also the anticipatory bail applicatrion willmcpm on 8th July.

Common entrance test in medical education soon

Dr Shiv Sarin, Chairman Medical Council of India’s board of governors said that the MCI plans to introduce common entrance tests for admission in under-graduation and post-graduation courses in medical colleges across the country. The Central Board of Secondary Education (CBSE) is being consulted for the same.  MCI has in principle agreed for a common entrance test for post-graduation and under-graduation in the coming years. This test will oversee undergraduate admissions to all government and private colleges.


Legal Column

Forensic Column

Dr Sudhir Gupta, MBBS (Gold Medal), MD (BHU), DNB, MNAMS, Associate Professor, Forensic Medicine & Toxicology, AIIMS

If a doctor examines any patient aged 15 years or above due to a motor vehicle accident, the patient must allow the doctor to take a blood sample for testing for alcohol and drug content in a way that preserves the chain of evidence. If this process is skipped the doctor may not be able to discover the alcohol blood level. The results can be used as evidence in subsequent court proceedings.

In Delhi, as per Section 185 of the Motor Vehicles Act 1988, the punishment is imprisonment of 6 months and/or fine of 2000 Indian Rupees (INR) for a first offence. If a second offense is committed within three years, the punishment is an imprisonment of 2 years and/or fine of 3000 Indian Rupees (INR). The clause of 30 mg/dL was added by an amendment in 1994. It came into effect beginning 14 November 1994.


Experts’ Views

Interesting tips in Hepatology & Gastroenterology

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

Complications of Celiac Disease

Damage to the small intestine and the resulting problems with nutrient absorption put a person with celiac disease at risk for several diseases and health problems.

  • Lymphoma and adenocarcinomia: types of cancer that can develop in the intestine.

  • Osteoporosis: condition in which the bones become weak, brittle, and prone to breaking. Poor calcium absorption is a contributing factor to osteoporosis.

  • Miscarriage and congenital malformations of the baby, such as neural tube defects, are risks for untreated pregnant women with celiac disease because of malabsorption of nutrients.

  • Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child's normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.

  • Seizures, or convulsions, result from inadequate absorption of folic acid. Lack of folic acid causes calcium deposits, called calcifications, to form in the brain, which in turn cause seizures.

If the diet compliance of the patient is not good then, he / she is predisposed to the above complications.


Public Forum (Press Release for use by the newspapers)

Heart disease survivors can resume marital activity

Heart patients and paralysis survivors can resume usual marital activity as soon as they feel ready to do it, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

After recovery heart patients and stroke survivors may feel depressed, which is normal, and in 85% of cases it goes away within three months. If a person can walk one kilometre or climb two flights of stairs without any discomfort in the chest or breathlessness, he or she can indulge in normal marital activity without any cardiac risk.

It is very rare for patients with heart disease to die while having marital activity.

However, Dr. Aggarwal cautioned that extramarital affairs are dangerous to heart patients as they are done in unfamiliar situations, time and places & with younger partners.

Dr. Aggarwal further said that first-onset erectile dysfunction after the age of 40 may also be an indication of underlying coronary blockages as blockages in the male organ goes hand in hand with blockages in the channels supplying blood to the heart.

Viagra-like drugs are a boon for heart patients as they can improve blood circulation to the male organ and make them perform better. However, these patients should not be on nitrates as combination of nitrate and Viagra can cause deadly lowering of blood pressure.

Also people with heart blockages who are unstable, who have not had a relationship with their partner for years should not indulge into a marital activity using Viagra-like drugs without a medical supervision. Any unaccustomed exercise, in patients with underlying coronary blockages, which may be silent, can precipitate heart attack and sudden cardiac death.


An Inspirational Story (Anuj Goyal)

Einstein was once traveling from Princeton on a train when the conductor
came down the aisle, punching the tickets of every passenger. When he came to Einstein, Einstein reached in his vest pocket. He couldn’t find his
ticket, so he reached in his trouser pockets. It wasn’t there, so he looked
in his briefcase but couldn’t find it. Then he looked in the seat beside
him. He still couldn’t find it.

The conductor said, ‘Dr. Einstein, I know who you are. We all know who you
are. I’m sure you bought a ticket. Don’t worry about it.’ Einstein nodded appreciatively.

The conductor continued down the aisle punching tickets. As he was ready to move to the next car, he turned around and saw the great physicist down on his hands and knees looking under his seat for his ticket.

The conductor rushed back and said, ‘Dr. Einstein, Dr. Einstein, don’t
worry, I know who you are. No problem. You don't need a ticket. I'm sure
you bought one.’

Einstein looked at him and said, ‘Young man, I too know who I am. What I don’t know is where I’m going."


IJCP Special

Question of the Day

What is treatment failure in otitis media? (Dr VP Sood, New Delhi)

With appropriate antimicrobial therapy, the signs of systemic and local illness in otitis media usually resolve within 2472 hours. Lack of improvement after 4872 hours in a patient treated with antimicrobial therapy suggests either presence of another disease or inadequate initial therapy.1–3

Inadequate therapy is usually related to infection with an organism resistant to βlactam antibiotics (nontypeable H. influenzae and drugresistant S. pneumoniae are becoming increasingly important). But, infection with less common organisms, such as S. aureus, also must be considered, particularly in children with tympanostomy tubes. Fluid may persist in the middle ear for prolonged periods even though the antimicrobial agents have sterilized the effusion and the acute signs and symptoms are no longer present; persistent middle ear effusion after the resolution of acute symptoms is not an indication of treatment failure.


  1. AlShawwa BA, Wegner D. Trimethoprimsulfamethoxazole plus topical antibiotics as therapy for acute otitis media with otorrhea caused by communityacquired methicillinresistant Staphylococcus aureus in children. Arch Otolaryngol Head Neck Surg 2005;131:782.

  2. Santos F, Mankarious LA, Eavey RD. Methicillinresistant Staphylococcus aureus: pediatric otitis. Arch Otolaryngol Head Neck Surg 2000;126:1383.

  3. Pichichero, ME, Casey, JR. Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7valent conjugate vaccine as an otopathogen in children. JAMA 2007;298:1772.

Dr Good Dr Bad

Situation: A patient with laryngopharyngeal reflux wanted to know whether he could take Seltzer water.
Dr Bad: Yes, you can take.
Dr Good: No, you must avoid it.
Lesson: Even noncaffeinated carbonated beverages such as seltzer water will cause belching and can result in stomach acid and enzymes coming up into the laryngopharynx with each burp.

Make Sure

Situation: A 50yearold patient, highly stressed at work and a hypertensive as well, complained of acid eructations and indigestion
Reaction: Oh my God! He has hyperacidity. Put him on magaldrate.
Lesson: Make sure that patients who are suffering from stress, diabetes and/or hypertension and who have hyperacidity/GERD/peptic ulcers, are put on magaldrate which is safe and effective as an antacid.

Mistakes in Clinical practice

AZT Zidovudine (Retrovir) can be mistaken as Azathioprine or Aztreonam

Mnemonic of the Day (Dr. Varesh Nagrath)

Warning signs for delayed wound healing


Opening (of the edges)

Cellulitis (what these signs would indicate)

Temperature change (local warmth or systemic fever)



Quote of the Day (Dr. Santosh Sahi)

"It is not where you start it is where you finish that counts." Zig Ziglar

Milestones in Diabetology

In 1987, Gerald Nepom, MD, PhD, Director of Benaroya Research Center, discovered the genetic marker for Type 1 diabetes.


Site to know

Checkout the following website (Dr Reshma Aggarwal)


Just write down any address and the map will pop up!


International Medical Science Academy Update (IMSA)

While sexually active adolescents are more likely than adult women to become infected with HPV and to have abnormal cervical cytology, these abnormalities are mostly transient. Cervical cancer is exceedingly rare in young women, and treatment for abnormal cytology has longterm effects. The benefits of screening in this population may be offset by potential harms, weighing against aggressive screening in this age group.1 The American College of Obstetrics and Gynecology (ACOG) released new guidelines in 2009, recommending initiating Pap smear screening at age 21.2


  1. Sawaya GF. Cervicalcancer screening –– New Guidelines and the Balance between Benefits and Harms. N Engl J Med 2009; 361:2503.

  2. ACOG Practice Bulletin No. 109: Cervical Cytology Screening. Obstet Gynecol 2009;114:1409.

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Retapamulin Ointment 1%

For the topical treatment of bacterial skin and skin structure infections: Primary impetigo, secondarily infected traumatic lesions, secondarily infected dermatoses.


Medi Finance

Individual-mediclaim Policy
Age Limit : This insurance is available to persons between the age of five and 80 years. Children between the age of three month and five years of age can be covered provided one or both parents are covered simultaneously.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Cardiolipin Antibodies

Tests for IgG and IgM cardiolipin antibodies are frequently ordered to help determine the cause of an unexplained thrombotic episode, recurrent miscarriage, or thrombocytopenia. They may be ordered along with lupus anticoagulant testing to help investigate the cause of a prolonged PTT (activated partial thromboplastin time), especially if clinical findings suggest that the patient may have SLE or another autoimmune disorder


Humor Section

Joke : How painful?

A woman goes to her doctor who verifies that she is pregnant. This is her first pregnancy. The doctor asks her if she has any questions. She replies, "Well, I'm a little worried about the pain. How much will childbirth hurt?" The doctor answered, "Well, that varies from woman to woman and pregnancy to pregnancy and besides, it's difficult to describe pain." "I know, but can't you give me some idea?," she asks. "Grab your upper lip and pull it out a little..." "Like this?" "A little more..." "Like this?" "No. A little more..." "Like this?" "Yes. Does that hurt?" "A little bit." "Now stretch it over your head!"

Funny Definitions

Duct Tape………………………Suture on a roll

Medical bloopers on medical charts!

The patient expired on the floor uneventfully.


 Readers Responses

  1. This is indeed amazing Doctor Aggarwal. Happy Doctor’s Day & wish you success in your efforts to bring life into our Fraternity: Raghuveer Rao
  2. Dear Sir, IMA Calcutta branch is going to organise day long Dharna and Public Convention at Kolkata at a very prominent place at Esplanade opposite Metro Cinema on 15th July to oppose : Arbitrary Dissolution  of MCI; BRHC and Clinical Establishment Act. As per the decision taken at the Dharna organised by IMA H.Q. at New. Delhi on 20th June to organise similar types of Dharnas all over the country. We shall be highly obliged if you kindly lend your valuable support and inspire us by joining us in Dharna on 15th July. Dr. R.D. Dubey, President, IMA Calcutta Branch
  3. The column by Dr Neelam  Mohan is very inspiring and informative. Dr Anupama Malhotra

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