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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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; Chairman Ethical Committee 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


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  Editorial …

eMedinewS and IJCP teams extend their best wishes to Dr K K Aggarwal, Group Editor–in–Chief on his birthday

5th September 2011, Monday

FDA Warning: Test kidney function before prescribing Zoledronic acid

FDA has updated a warning regarding kidney failure and use of zoledronic acid. Kidney failure is a rare but serious condition associated with its use in patients with a history of or risk factors for kidney impairment.

Doctors are being warned to check patient kidney function before prescribing zoledronic acid and to check those who are already taking the drug.

The new warning indicates that patients with creatinine clearance of less than 35 mL/min or evidence of acute renal impairment should not be given zoledronic acid for osteoporosis.

The warning also lists risk factors including advanced age, concurrent treatment with other nephrotoxic drugs, and dehydration secondary to fever, sepsis, gastrointestinal losses, or diuretic therapy.

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

FDA Warning: Test kidney function before prescribing Zoledronic acid

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Student participating in the Heritage – An Inter Dancing School Health Festival at Perfect Health Mela

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Water to get treated after immersion

BANGALORE: This year, there’s protocol to be followed before immersing idols of Lord Ganesha in Bangalore’s lakes. Also, the water will be treated before being let into the lakes. "From this year onwards, we will not let idol–immersed water flow directly into the lakes. Instead it will be first treated at BWSSB’s sewage treatments plants and the pollutants filtered from the water," deputy mayor S Harish told TOI. BBMP has come up with 89 tankers that will be stationed in different areas across the city apart from mobile immersion tankers. These can also be called to one's neighbourhood by ringing up BBMP’s nearest control room number. (Source: TOI, Sep 1, 2011)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

SATURN Statin Trial

Rosuvastatin failed to beat atorvastatin for improving atheroma volume in a large head–to–head trial.

For comments and archives

Atypical antipsychotic linked to life–threatening reactions

The US Food and Drug Administration (FDA) has issued a warning about possible severe allergic reactions, including anaphylaxis and angioedema, to the atypical antipsychotic asenapine maleate (Saphris, Merck). (Source: Medscape Medical News)

For comments and archives

EHR use linked to better diabetes care

Use of electronic health records (EHRs) for patients with diabetes improves achievement of care and outcomes targets, researchers found. Significantly more centers in the greater Cleveland area met standards for diabetes care and outcomes when they used EHRs compared with paper–based systems (P<0.001 and P=0.005, respectively), Randall Cebul, MD, of Case Western Reserve University, and colleagues reported in the Sept. 1 issue of the New England Journal of Medicine. (Source: Medpage Today)

For comments and archives

Antibiotic Rx for kids down, but not far enough

Gains are being made in the struggle to curb the overuse of antibiotics in children, but with resistance continuing to rise and antimicrobial choices dwindling, efforts must continue, according to the CDC. Between 1993 and 2008, the rate of antibiotic prescriptions for children with acute respiratory tract infections fell from 448 (95% CI 387 to 510) per 1,000 persons to 342 (95% CI 277 to 406) per 1,000 persons, a decrease of 24%, the agency reported in the Sept. 2 Morbidity and Mortality Weekly Report. (Source: Medpage Today)

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

High level of physical activity leads to less middle–age weight gain

Our body’s metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. According to a study published December 14 in JAMA, people who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. Women particularly benefited from 20 years of high activity, gaining on average 13 pounds less than those with low activity, says the study. Men who engaged in comparable exercise over the same time period gained about 6 pounds less than those with low activity.

The study of 1,800 women and nearly 1,700 men is a part of The Coronary Artery Risk Development in Young Adults, a prospective longitudinal study done over 20 years. The active group in the study comprised 12 percent of the participants. Lower levels of activity had a negligible effect on weight gain.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Life does not obey our expectations. Life obeys our intentions, in ways we may not expect. Lloyd Strom

@DeepakChopra: #CosmicConsciousness In my stillness I am the eternal possibility. In my movement I am the cosmos.

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

How should patients be counseled about diagnostic radiations?

All patients should be given a general idea about the magnitude of the proposed radiation dose. The exposure should be compared with an estimated effective dose to a single chest x–ray (0.02 mSv), a transcontinental airplane flight (0.02 mSv), or annual individual radiation dose from the natural background (3.0 mSv).

For comments and archives

    Spiritual Update

To err is human

When I missed the diagnosis?

We can also make mistakes but each such instance should be an opportunity to admit so that others do not make the same mistakes.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be…grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene. So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, "If I wasn’t so nice, I would blacken his eye." With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate. She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes. If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

For comments and archives

    Gastro Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

What are the features of physical examination of chronic liver disease in children?

Yes, celiac disease can present with abnormal liver enzymes; therefore, screening of celiac disease in patients with raised liver enzymes, especially if there is associated anemia, is a must.

  • Firm to hard hepatomegaly
  • Moderate to massive splenomegaly
  • Growth failure
  • Significant ascites, pedal edema, prominent abdominal veins, clubbing, muscles wasting, CLD signs

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

ENA Profile

The ENA panel is usually ordered following a positive ANA test in people who have clinical signs of an autoimmune disorder.

  • The 4–test ENA panel is used to help diagnose mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), and Sjögren syndrome.
  • The 6–test ENA can also help identify scleroderma and polymyositis.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic HIV patient came with A1c of 6.5.
Dr Bad: It’s perfect.
Dr Good: It is not 100% reliable for your situation.
Lesson: A1c may not be accurate for assessing glycemia among HIV–infected patients on NRTI–based therapy, especially those with macrocytosis or those on abacavir. In a prospective study evaluating the accuracy of A1c in HIV–infected patients with diabetes, glucose levels were significantly higher than anticipated by A1c levels when compared with HIV–uninfected control subjects and established reference values. Relative to the control subjects, A1C underestimated glucose by 29 ± 4 in the HIV–infected subjects (Diabetes Care 2009;32(9):1591–3).

For comments and archives

Make Sure

Situation: A 28–year–old male presents with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. A sterile pyuria is the first clue to diagnosis.

For comments and archives

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    Quote of the Day

(Dr.Chandresh Jardosh)

Never leave a true RELATION for few FAULTS. Think just once nobody is PERFECT. Nobody is always CORRECT. At the end AFFECTION is always greater than PERFECTION.


(Ms Ritu Sinha)

Bite off more than you can chew: To take on a task that is way too big.

    G P Pearls

(Dr Pawan Gupta)

For diagnosing latent TB, A positive quantiferron TB Gold test followed by a CXR in suseptible population is a good measure.– Thorax 2010(65) 178–180

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

In MLC cases, the direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.

  • Lacerations are tears or splits of skin, mucous membranes, muscle or internal organs produced by application of blunt force to a broad area of the body that has crushed or stretched tissues beyond the limits of their elasticity.
  • Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination.
  • Do not close a laceration if there is visible contamination, debris, non–viable tissue or signs of infection. Wounds may involve vascular areas of the face and scalp where the risk of infection is low or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage. The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.
  • When produced by a blunt weapon, such as club, crowbar, stone, brick etc., a lacerated wound is usually accompanied by a considerable amount of bruising of the surrounding and underlying tissues, and has inverted and irregular edges. The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.
  • When a heavy weight like a wheel of a heavy cart or a truck passes over an extremity, by its shearing and grinding force, it tears the skin from the underlying tissue and crushes the muscles and soft part lying beneath it realizing considerable blood and fat in them.
  • Crush injury syndrome or fat emboli may follow a lacerated wound. The tear, avulsion, split are types of laceration.

For comments and archives

    Mind Teaser

Read this…………………

Which one of the following is true of adrenal suppression due to steroid therapy?

1. It is not associated with atrophy of the adrenal glands.
2. It does not occur in patients receiving inhaled steroids.
3. It should be expected in anyone receiving > 5 mg prednisolone daily.
4. Following cessation, the stress response normalizes after 8 weeks.

Yesterday’s Mind Teaser: Which one of the following anesthetic agents causes a rise in the intracranial pressure?

1. Sevoflurane
2. Thiopentone sodium
3. Lignocaine
4. Propofol

Answer for Yesterday’s Mind Teaser: 1. Sevoflurane

Correct answers received from: Dr.Sukanta Sen, DR Valluri Ramarao, Dr. B. B. Aggarwal, Dr Anil Kumar Jain, Dr.K.Raju, Dr Manoj Sharma, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Neelam Nath, Dr Anil Bairaria,

Answer for 3rd September Mind Teaser: 2. Gram negative organisms
Correct answers received from: Dr Madhulika Sharma, Dr.Anurag julka, Dr Anil Kela, Dr. Anil Kumar Jain, Dr Ragavan Moudgalya, Dr.Sukanta Sen

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr. GM Singh)

Visiting kindergarten

Little Tommy’s kindergarten class was on a field trip to their local police station. There they saw pictures tacked to a big bulletin board. The label clearly read, "The 10 Most Wanted."
One of the youngsters pointed to a picture and asked if it really was the photo of a wanted person. "Yes" said the policeman, "the detectives want him very badly."

So Little Tommy asked, while tugging on the man’s belt, "Um, mister, why didn’t you keep them when you took their pictures?"

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Iloperidone Tablets 1mg/2mg/4mg/6mg/8mg /10mg/12mg
For the acute treatment of adults with schizophrenia.
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Replace beans for rice for preventing metabolic syndrome

Increasing consumption of beans while simultaneously decreasing consumption of white rice can lower the chances of developing the metabolic syndrome said Padmashri and Dr B C Roy National awardee
Dr K K Aggarwal
President Heart Care Foundation of India and MTNL Perfect Health Mela.

Quoting a study of 1,900 people in Costa Rica published in the September issue of the American Journal of Clinical Nutrition, Dr Aggarwal said that those who favored bean consumption over rice had a 35% decreased probability of displaying symptoms indicative of metabolic syndrome.

White rice has high glycemic index and can cause insulin resistance. Roasted rice and brown rice are better than white rice. Beans on the other hand are low in carbs and heart friendly.

For comments and archives

    Readers Responses
  1. Dear Sir, thanks a lot for providing so useful information “Purusharthas: Dharma, Artha, Karma and Moksha” Regards: Dr Anupama
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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