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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

7th February 2010, Sunday

Practice Changing Updates: Oral bicarbonate for chronic kidney disease
One should use sodium bicarbonate (in a daily dose of 0.5 to 1 mEq/kg per day) to maintain the serum bicarbonate concentration above 23 mEq/L in patients with chronic kidney disease.

A randomized trial has shown that treatment with oral bicarbonate slowed progression of chronic kidney disease and improved nutritional status of patients with creatinine clearances between 15 and 30 mL/min per 1.73 m2.

Prior to this trial, the beneficial effect of alkali therapy were only shown to preserve renal functions in experimental models of chronic kidney disease.

Reference:de Brito-Ashurst I, Varagunam M, Raftery MJ, et al. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 2009;20:2075.

 Dr KK Aggarwal
Chief Editor


  1. According to a new study, levels of vitamin D correlated with poorer lung function, increased airway reactivity, and reduced response to steroid treatment in adult asthmatics. For every 1–ng/mL increase in serum levels of 25–hydroxyvitamin D (25–OH–D), forced one–second expiratory volume (FEV1) increased by 21 mL (P=0.03, r=0.8). The study findings are reported online in the American Journal of Respiratory and Critical Care Medicine.
  2. Nucleic acid amplification–The New York City Department of Health has demonstrated the utility of nucleic acid amplification (NAA) testing for diagnosis of tuberculosis (TB) in a large public health setting. This further supports recent recommendations from the CDC that NAA testing be performed on at least one respiratory specimen from patients with suspected pulmonary TB. The findings should encourage wider use of NAA testing for TB (Clin Infect Dis 2009;49:46.)
  3. Artesunate resistance: P. falciparum with reduced in vivo susceptibility to artesunate is emerging in western Cambodia. The most likely cause is widespread use of artemisinin monotherapy in the region. An intensive campaign has been launched by the World Health Organization (WHO) to contain artemisinin resistance, as there is no alternative class of malaria drugs to replace the artemisinin derivatives. (N Engl J Med 2009;361:455.)
  4. Mumps–The Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committees have recommended that the needed isolation time for patients with mumps infection be reduced from nine days to five days since the risk of transmission after this time appears to be low. (MMWR Morb Mortal Wkly Rep 2008;57:1103.)
  5. Moxifloxacin–In a trial of 328 patients with active pulmonary TB randomized to receive moxifloxacin or isoniazid (in addition to rifampin, ethambutol and pyrazinamide), comparable rates of sputum culture negativity after eight weeks were observed (55 and 60 percent). Based on these findings, moxifloxacin may be a suitable alternative for patients who are intolerant of INH or infected with INH–resistant Mycobacterium tuberculosis. Pending further data, however, fluoroquinolones should be used only in persons with intolerance of or resistance to first–line agents. (Am J Respir Crit Care Med 2009;180:273.)
  6. Chlorhexidine bathing–Daily chlorhexidine bathing for ICU patients may reduce the acquisition of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE). The approach may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare–associated bloodstream infection. (Crit Care Med 2009;37:1858.)

Obesity delays puberty in males and brings it on early in females
Unlike overweight girls, who tend to enter puberty early, overweight and obese boys begin puberty later than thin boys. At 11.5 years, boys with the highest body mass index were 165% more likely to be pre pubertal than the thinnest boys (P=0.04), as per a report in Feb. 1 issue of Archives of Pediatrics and Adolescent Medicine.

Metformin can help loose weight in teenagers
Metformin can help obese teenagers lose weight even if they don’t have the disease. In a randomized, placebo–controlled study that combined nearly two years of treatment and follow–up, the drug was associated with a statistically significant drop in BMI. (Dr Darrell Wilson, Stanford University, February 2010. Archives of Pediatrics & Adolescent Medicine.)

Herbal drugs not always cardiac safe
Many herbal drugs including Aloe Vera, ginkgo biloba, ginseng, and green tea, can interact with conventional cardiovascular drugs and lead to serious adverse reactions (Dr Arshad Jahangir, Mayo Clinic in Scottsdale, Ariz.)

Grapefruit juice occupies the CYP3A4 enzyme, leading to slower–than–expected metabolism and, therefore, higher blood levels of a host of pharmaceuticals. These include the statins, calcium channel antagonists, several common anti–arrhythmic drugs, and the angiotensin receptor blocker irbesartan. Garlic is one of several common herbal remedies with specific cardiovascular effects in its own right (others include ginkgo biloba, ginseng, and saw palmetto). Garlic inhibits platelet aggregation and thus can lead to increased bleeding risks when combined with aspirin, clopidogrel, or warfarin.

Conference Calendar
IHEC 2010
International Health Expo and Conference
February 5–8, 2010
Venue: Exhibition Grounds, Sec–34–A, Chandigarh.

Public Forum
Press Release

Examination Stress
Parents play a very important role in carving the future of their children, said Dr. KK Aggarwal President, Heart Care Foundation of India and Editor eMedinewS.

HCFI has laid down few tips, which parents should remember while dealing with their children during their academic career.

1. Kids should not compared: it can lead to anger or depression in the child.
2. One should unconditionally appreciate whatever the child has achieved.
3. One should avoid giving false promises, for example, "If you come first, you will get a bike". When that happens, "You are not yet 18–so you can’t get a license. This time, settle for a bicycle and later we’ll get that bike". Broken promises hurt the child.
4. Avoid anger chain, for example, the father unleashes his anger on the mother (because she does not answer back), and she takes it out on the child (because of the same reason). And the child takes it out on books or studies or younger sibling or hired help at home!
5. Do not force your expectations on the child, for example, you should only become a doctor.
6. Avoid giving the child two conflicting messages like mother asks child to study and father says– "do not force him".
7. Make your child exercise daily, learn pranayama and meditation.
8. Provide your child with balanced, nutritious diet. Avoid overeating or long hunger periods. Restrict caffeine, give more water.
9. Ensure adequate sleep with a consistent schedule to improve concentration, memory and mood. It also reduces irritability.

Punjab & Sind Bank
Central Bank of India

Question of the Day
Should phenobarbital be given to patients with convulsions in malaria?

  1. Cerebral malaria is a common complication of P. falciparum malaria.
  2. A Cochrane review evaluated the effect of routine anticonvulsant drugs in patients with cerebral malaria.
  3. Three RCTs with a total of 573 participants met the inclusion criteria. All three compared phenobarbital with placebo or no treatment. In the two trials with adequate allocation concealment, death was more common in the anticonvulsant group (RR: 2.0; 95% CI: 1.20–3.33, fixed–effect model). In all three trials, phenobarbital was associated with fewer convulsions than placebo or no treatment (RR: 0.30; 95% CI: 0.19–0.45, fixed effect model).

Suggested reading: Meremikwu M, Marson AG. Routine anticonvulsants for treating cerebral malaria. Cochrane Database Sys. Rev. 2002;2:CD002152.

eMedinewS Try this it Works
Outstretched arms equal height

In a patient who cannot stand by himself or herself because of orthopedic problems, measure the distance between the end of the third finger of one hand and the end of the third finger of the other hand. The spread is practically equal to the patient’s height.

Dr Good Dr Bad
Situation: A CAD diabetic needed Vitamin D supplement.
Dr Bad: it’s ok to have any amount.
Dr Good: You need them in limits.
Lesson: In CAD, it is necessary to limit dietary vitamin D and its derivatives during treatment.

Make Sure
Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my god! Why was the prophylaxis nit started?
Make sure that one administers secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.

Laughter the best medicine
Three nurses arrive at the pearly gates. St. Peter asks the first why he should admit her. She replies that she has been an emergency room nurse and has saved thousands and thousands of lives.
"OK", he says, "Come on in!"
The second reports that he has been an ICU nurse and he, too, has saved thousands and thousands of lives.
St. Peter lets him in, too. St. Peter asks the third nurse the same question.
She replies that she has been a TPA nurse and has saved thousands and thousands of dollars for the insurance company.
St. Peter replies, "OK. Come on in. But you can only stay three days."

Formulae in Imaging
Liver Cysts:
Ultrasound features that are specific for a cyst include a well–defined thin wall and increased through–transmission. Lesions which show these features need no further evaluation. Small (<1 cm) cysts may be difficult to characterize with confidence.

ENT Facts
Patients who do not respond symptomatically within 48 to 72 hours should be re–examined.

SMS Anemia
Hemolysis or blood loss can be associated with a low reticulocyte count if there is a concurrent disorder that impairs RBC production (e.g., infection, prior chemotherapy.

Milestones in Neurology
William Alexander Hammond, (August 28, 1828–January 5, 1900) was an American neurologist and the 11th Surgeon General of the U.S. Army (1862–1864). In addition to his pioneering work in neurology and his military service, especially during the Civil War, he founded the Army Medical Museum (now called the National Museum of Health and Medicine), co–founded the American Neurological Association, and gave his name to Hammond's disease, a type of athetosis which he was the first to describe in 1871.

Mistakes in Critical Care
The Institute for Safe Medication Practices has compiled a list of "high–alert" drugs. These medications require extra precaution because they can cause serious patient harm when used in error. These are amiodarone (IV); colchicine injection; heparin, low molecular weight, injection; heparin, unfractionated (IV); insulin (subcutaneous and IV); lidocaine, IV; magnesium sulfate injection; methotrexate (oral), non–oncologic use; nesiritide; nitropr usside sodium for injection; potassium chloride for injection concentrate; potassium phosphates injection; sodium chloride injection, hypertonic (more than 0.9% concentration) and warfarin.

Readers Responses

  1. Dear Dr. Aggarwal, KK: Heartiest congratulations on your getting one of the highest Awards (Padma Shri) of the Country. You have added more feathers to the Medical eternity. God may bless you with more such awards in your life. With affection, yours sincerely: Dr. S M Govil, 9810310546
  2. Dear Dr K.K.Aggarwal, Congratulations and keep the flag high. Regards and good wishes: Dr Nikhil Mital Dear Sir, Congratulations for bringing out National daily e–medical newspaper. I am feeling great on having something daily in my inbox related to ‘medicine around us’. I am sure many people share this feeling. I would like to contribute to the newspaper as an author in the form of weekly column/ Pediatric corner or something like that. Currently I am working as senior resident in Pediatric Intensive Care at PGIMER, Chandigarh. I feel this newspaper can work as a great platform in many fields of medicine in India. Kind regards: Lokesh. 9216117255. (Emedinews response: Dear Lokesh: Thanks. We would love to have your weekly columns. Please start sending them.)
  3. Hearty CONGRATULATION for Padma award. U deserves that: Farahim Chaudhary
  4. Hello Dr Aggarwal, congratulations for padmashree award. Your dedication to medical work and your consistent work has made you proud. I am forwarding a mail to you, pls. go through and confirm if you can make it.I shall wait to hear from you. thanks. Dr. Ashok Kakar contact no. 9811300388
  5. Dear Dr KK Aggarwal, congratulations from all of us CGHS Mayur Vihar. Dr. Sharda Varma.
  6. Respected sir!! Congratulations for the great honor and we are really very proud to be associated with you. Following people have sent you congratulations messages.
    Dr.V.Mohan, Dr.Vijay Viswanathan, Dr.V.Seshiah, Dr.Ramachandran, Dr.Anand Moses, Dr.Vijayakumar, Dr.Deepa, Dr.N.Dorairajan, Dr.Parthasarathy, Dr.Sidhartha Das; Dr.S.K.Rajan Dr.Mani, Dr.Chandrasekar, Dr.Gajanan Rao, Dr.Leena Dennis, Dr.Muruganathan, Dr.Premkumar Sathya, Dr.Rajamani, Dr.Ravishankar, Dr.Sandya; Dr.A.V.Srinivasan, Dr.Biswakumar, Dr.Nagarajan; Dr.Georgi Abraham; Dr.Jayanthi, Dr.Malathi Sathiyasekaran, Dr.Neha, Dr.J.S.Rajkumar, Dr.V.S.Sankaranarayanan, Dr.Shanthi, Dr.Thayumanavar; Dr.John, Dr.Kiran; Dr.Murali Poduval; Dr.Kamala Selvaraj, Dr.Thankam Varma, Dr. Satya; Dr.Pramod Jaiswal and Dr.Sengutavellu. Regards: Chitra

eMedinewS-PadmaCon 2010 
Will be organized at MAMC on 4th?July Sunday to commomorate Doctors' day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

eMedinewS–revisiting 2010
The second eMedinewS–revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on 2nd January 2011. The event will have a day–long CME, doctor of the year awards, cultural hangama and live webcast. Suggestions are invited.

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

(Advertorial section)

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LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009

Drug Name Indication Approval Date
Methylcobalamin 1500 mcg + Calcium 200mg + Calcitriol 0.25 mcg + Folic Acid 1.5mg + Pyridoxine 3mg Capsules
For the treatment of vitamin deficiency states in adults