Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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


Dear Colleague

7th March 2010, Sunday

Guidelines on Male Sexual Dysfunction: Erectile Dysfunction

  1. Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions.

  2. ED is highly prevalent, and 5–20% of men have moderate to severe ED.

  3. ED shares common risk factors with cardiovascular disease.

  4. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the complaints of the patient and risk factors.

  5. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5–Is), including sildenafil, tadalafil, and vardenafil. PDE5 inhibitors have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus.

  6. Treatment options for patients who do not respond to PDE5 inhibitors or for whom PDE5 inhibitors are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis.

Guidelines on Male Sexual Dysfunction: Premature Ejaculation

  1. Premature ejaculation (PE) has prevalence rates of 20–30%.

  2. PE may be classified as lifelong (primary) or acquired (secondary).

  3. Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction.

  4. Physical examination and laboratory testing may be needed in selected patients only.

  5. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anesthetics.

  6. Dapoxetine is the only drug approved for the on–demand treatment of PE in Europe.

  7. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy.
  8. Recurrence is likely to occur after treatment withdrawal.

    (Source: http://www.uroweb.org/nc/professional–resources/guidelines/online)
Dr KK Aggarwal
Chief Editor

News and Views

Diabetes: Shoes and socks (Dr G M Singh)

  1. Don’t wear shoes without socks.

  2. Don’t wear sandals or other open–toed shoes.
  3. Avoid high–heeled shoes and shoes with pointed toes.

  4. Wear well–padded socks or stockings that are 1/2 inch longer than your longest toe. Don’t wear stretch socks, nylon socks, socks with an elastic band or garter at the top, or socks with inside seams.

  5. Don’t wear uncomfortable or tight shoes that rub or cut into your feet. If you’ve had problems before because of shoes that didn’t fit, you may want to be fitted for a custom–molded shoe.

  6. Talk to your doctor before you buy special shoes or inserts.

  7. Shop for new shoes at the end of the day when your feet are a little swollen. If shoes are comfortable when your feet are swollen, they’ll probably be comfortable all day.

  8. Break in new shoes slowly by wearing them for no more than an hour a day for several days.

  9. Change socks and shoes every day. Have at least 2 pairs of shoes so you can switch pairs every other day.

  10. Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores.

Glaucoma drugs lowers mortality

Among glaucoma patients, the use of any class of glaucoma drug was associated with a significantly lower likelihood of dying, according to a study published in the February issue of the Archives of Ophthalmology.

Presswatch (Dr Vivek Chhabra, Sr Consultant, Max Healthcare, New Delhi)

ReNeuron approved for world first stem cell trial

ReNeuron has overcome the final regulatory barrier to treating stroke patients with stem cells. The UK Gene Therapy Advisory Committee granted its approval for the Guildford–based company to begin a clinical trial with a dozen stroke patients in Scotland. It will be the world’s first human test of stem cell therapy for strokes. Extensive animal tests have shown neural stem cells – derived from cells that originated several years ago in an aborted human fetus – could help a damaged brain to regenerate, potentially relieving some symptoms of strokes

Sepsis and pneumonia caused by hospital-acquired infections kill 48,000 patients Two common conditions caused by hospital–acquired infections (HAIs) killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone, according to a study released in the Archives of Internal Medicine.

ECG testing of young athletes cost–effective in preventing deaths. Routine testing of the hearts of young American athletes using ECGs to screen for sudden death is reasonable in cost and effective at saving lives, according to a new study by cardiologists at the Stanford University School of Medicine.

MRI for Diagnosing Testicular Cancer

Researchers have found that non–invasive magnetic resonance imaging (MRI) is a good diagnostic tool for the evaluation and staging of testicular cancer and may improve patient care by sparing some men unnecessary surgery, according to a study in the March issue of the American Journal of Roentgenology.

Weight–loss diets may reverse atherosclerosis in obese and overweight

A low–carbohydrate diet, a low–fat diet and the Mediterranean diet were equally effective in helping obese people to reverse carotid atherosclerosis after losing moderate amounts of weight and improving their blood pressure, in a study reported in Circulation, Journal of the American Heart Association.

Women need clot–busting therapy after stroke

New research shows women who do not receive a clot–busting drug after a stroke fare worse than men who are not treated. The study is published in the March 2, 2010, issue of Neurology, the medical journal of the American Academy of Neurology.

Long–time cannabis use associated with psychosis

Young adults who have used cannabis or marijuana for a longer period of time appear more likely to have hallucinations or delusions or to meet criteria for psychosis, according to a report posted online that will appear in the May issue of Archives of General Psychiatry.

Conference Calendar

Transforming Healthcare with IT 2010 (The 1st International Conference on Transforming Heathcare with Information Technology) Date: March 8–10, 2010
Venue: Intercontinental Eros, New Delhi.

Quote of the Day

Health is inner peace. Therefore, healing is letting go of fear. To make changing the body our goal is to fail to recognize that our single goal is peace of mind. (G G Jampolsky)

Diabetes Fact

More insulin is produced with oral drugs. With oral glucose, intestinal cells produces GIP and GLP–1 polypeptides which increases insulin secretion. These two are degraded by DPP

Public Forum (Press Release)

International Women Day: Focus on the heart of your beloved

All women are at risk of heart disease. Take all women older than 65 to a family doctor and ask for a prescription of 325 mg aspirin if not contraindicated.

To reduce their risk, advise Younger Women to indulge in minimum of 60––90 minutes of moderate–intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.

These are a few of the updated guidelines of prevention of heart disease in the women released by Heart Care Foundation of Indian on the occasion of International Women’s day.

Dr K K Aggarwal, President of the Foundation and Editor, eMedinewS said that a woman’s heart is different. They get less attention when there is a heart attack and when they do suffer one, the attack is more serious.

He said that women are at risk for heart disease and heart attacks, just like men. Heart disease is the leading cause of death among women over 65. Urban women are 4 to 6 times more likely to die of heart disease than of breast cancer.

Heart disease kills more women over 65 than all cancers combined.

Facts and guidelines

  1. Women develop heart problems later in life than men –– typically 7 or 8 years later. However, by about age 65, a woman’s risk is almost the same as a man’s.

  2. Women are less likely to survive heart attacks than men.

  3. Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low–fat dairy products.

  4. Advice women to quit smoking by counseling, nicotine replacement or other forms of smoking cessation therapy.

  5. Physical activity recommendations for women who need to lose weight or sustain weight loss includes minimum of 60––90 minutes of moderate–intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.

  6. All women should reduce their saturated fats intake to less than 7 percent of calories.

  7. Healthy women should eat oily fish at least twice a week for omega 3 fatty acids. Women with heart disease should take a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which is to be increased to 2–4 grams if associated high triglycerides.

  8. Hormone replacement therapy and selective estrogen receptor modulators are not recommended to prevent heart disease in women.

  9. Antioxidant supplements (such as vitamin E, C and beta–carotene) should not be used for primary or secondary prevention of heart disease.

  10. Folic acid should not be used to prevent heart disease.

  11. Routine low–dose aspirin therapy may be considered in women aged 65 or older regardless of heart disease risk status, if benefits are likely to outweigh other risks in other means if not contraindicated.

  12. The upper dosage of aspirin for high–risk women is 325 mg per day rather than 162 mg.

  13. Reduce bad LDL cholesterol to less than 70 mg/dL in very high–risk women with heart disease.

Top 10 points: Preventing heart diseases in the women

  1. Increased emphasis on lifestyle changes

  2. Hormone replacement therapy does not help heart disease

  3. All women need adequate intake of omega–3 fatty acids

  4. All women should decrease intake of saturated fats

  5. All women need frequent exercise

  6. Nicotine replacement therapy may be used

  7. Antioxidants don’t prevent heart disease

  8. Folic acid doesn’t prevent heart disease

  9. All women older than 65 should consider daily aspirin

  10. High risk women need more aggressive cholesterol treatment

Question of the day

Is there any role of Trichuris suis in IBD?

Inflammatory bowel disease or IBD, is a disease of industrialized countries and rare in the developing world. One reason is the relatively high rate of helminth colonization in less developed countries. Infection with helminths may reduce the risk of inflammatory bowel disease by decreasing the immune response.1,2 A potential therapeutic aspect to this association was evaluated in a study involving 54 patients with active ulcerative colitis who were randomly assigned to ingestion of Trichuris suis ova or placebo for 12 weeks.3 Improvement in disease activity was observed significantly more often in patients receiving active treatment (43 vs 17%). There were no side effects. Additional studies are needed before this approach can be recommended.


  1. Sabin EA, Araujo MI, Carvalho EM, et al. Impairment of tetanus toxoid–specific Th1–like immune responses in humans infected with Schistosoma mansoni. J Infect Dis 1996;173:269.
  2. Borkow G, Leng Q, Weisman Z, et al. Chronic immune activation associated with intestinal helminth infections results in impaired signal transduction and anergy. J Clin Invest 2000;106:1053.
  3. Summers RW, Elliott DE, Urban JF Jr, et al. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Gastroenterology 2005;128:825.

eMedinewS Try this it Works

Evaluating lipid panel results

Total cholesterol and high–density lipoprotein (HDL) levels are more accurate when samples are from non fasting patients.

Triglyceride levels should be measured only in samples from fasting patients, because triglycerides increase after a fatty meal.

Dr Good Dr Bad
Situation: A diabetic patient with uncontrolled diabetes came with cognitive impairment.
Dr Bad: Its dementia and nothing can be done.
Dr Good: Get your blood sugar controlled.
Lesson: An analysis of ~3,000 individuals with established type 2 diabetes demonstrates a clear age–adjusted inverse relationship between cognitive function and the degree of chronic hyperglycemia as measured by A1C level.
(Source: Diabetes Care 2009; 32:221–226.)

Make Sure
Situation: A patient developed dangerous arrthymias immediate post-CABG.
Reaction: Oh my God! Why did you not correct his K+ value of 2.5 pre–operatively?
Make Sure that a pre–operative K+ value of <3.5 is corrected. Cardiac surgery patients who have serum potassium levels below 3.5 mmol.L are at high risk for peri–operative arrhythmia.

Medi Finance
(BUDGET 2010–2011)


Contributions to the Central Government Health Scheme also allowed as a deduction under Section 80D.

Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Actual medical record:

Patient gets chest pain if she lies on her left side for over a year.

Formulae in Critical Care

Clearance of a drug from body
Clearance of a drug from body
Formula: CL = CL renal + CL hepatic

Milestones in Neurology

Robert Wartenberg (1886 – 1956) was an American neurologist native of Germany.Dr. Robert Wartenberg graduated from the University of Rostock, Germany in 1919. He worked with Max Nonne in Hamburg and Otfrid Foerster in Breslau. In 1933 he became head of the neurological clinic at Freiburg and Privatdozent in neurology. However, he was persecuted by the Nazis, and in 1935 he left Germany and settled in San Francisco. In 1952 he was appointed clinical professor of neurology at the University of California.

Mistakes in Clinical Practice

Write out ‘Units’ not U; U often is misinterpreted and read as the number 0, leading to massive overdoses.

11th March World Kidney Day (Dr N P Singh)

Importance of Early Detection: Did you know that the majority of individuals with early stages of CKD go undiagnosed. To mark the World Kidney Day, we are calling on everyone to check if they are at risk for kidney disease and to encourage more people to take simple kidney tests. Screening must be a high priority for people considered to be at risk of kidney disease. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or deterioration manifests itself through other complications.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

Any case of hematuria in old age should be investigated thoroughly to rule out cancer of bladder / prostate / upper urinary tract.

Lab test (Dr Navin Dang)

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Glatiramer Acetate Injection (20mg/ ml) & Pre–filled syringe (20mg/ml)

For the reduction of the frequency of relapses in patients with Relapsing–Remitting Multiple Sclerosis.


(Advertorial section)



Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com

eMedinewS–PadmaCon 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.


A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2pm onwards) and Sunday 18th April (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. Voluntary contributions welcome.

For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

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

Readers Responses

  1. Dear Editor, This is regarding the management of craniosynostosis in children. The Paediatric surgeons are the leading physicians in the management of this disorder. A great deal of work is being in this regard by Dept of Paediatric Surgery at AIIMS,New Delhi. Prof M Bajpai is a leading exponent in this regard. We at Dept of paediatric Surgery Army Hospital (R & R), New Delhi,manage about four to five such cases every year: M Arora

  2. Dear Dr. K.K. Agarwal, Please continue sending me ur esteemed emedinews. Thank U. Urs sincerley: Dr. H.K. Jagtiani.

  3. I strongly support Dr Pradeep Sharma who is consistent with my earlier observations and comments: Dr K K Arora

  4. CME ON SLEEP DISORDERS––as part of World Sleep Day celebrations–– " Obstuctive Sleep Apnoea– beyond snoring" in the DMA HALL, Daryaganj, Delhi, 10th March, 9 pm onwards, this will be followed by dinner. Organised by Dr.Manvir Bhatia, Chairperson, Dept of Sleep Medicine, Sir Ganga Ram Hospital, New Delhi. Also a free camp– consultation for Sleep Disorders––13th March–– 8 am –12 pm– Sir Ganga Ram Hospital, and 14th March, 9 am –1 pm, L–23, Hauz Khas Enclave, New delhi–16. email: neurologysleepcentre@gmail.com