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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

7th May, 2010, Friday

Long–term use of anabolic steroids weaken heart

Dear Colleague

Long–term use of anabolic steroids damages the heart more than researchers previously believed. As per a new study in Circulation the previously known side effects of these drugs include liver tumors, jaundice, high blood pressure, shrinkage of the testicles, reduced sperm count, development of breasts, paranoid jealousy, extreme irritability and impaired judgment.


A Harvard–led team of investigators enlisted 19 male weightlifters, including 12 who reported taking, on average, about 675 mgs of steroids a week for nine years and nine who said they never used steroids.


In the study 10 of the 12 steroid users had ejection fractions of left ventricle less than 55%, which has been linked to an increased risk for heart failure and sudden cardiac arrest. Only one of the seven weightlifters with no history of steroid use had a low ejection fraction.


Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature(From file)

Pioneers in Indian Classical Dance forms together as photo-feature

According to Heart care foundation of India Indian dance forms as being practiced since ages in the country are a perfect combination of yogic exercises which are so arranged that it stretches all the plexuses present in Human body, medically talking it is an ideal art form which helps rejuvenation of the body and soul. It is thus an important module for health advocacy. (In the picture Pt Birju Maharaj; Shashwati Sen, Raja Reddy, Geeta Chandran and Dr KK Aggarwal) [Photo from File]

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Changes in UpToDate recommendations for cervical cancer screening

Screening for cervical cancer should be initiated no earlier than age 21, regardless of the age of initiation of sexual activity. It is also now being suggested that Pap smear screening in average risk women less than 30 years old be initiated at intervals of one to two years, lengthening the screening interval to two to three years after three consecutive negative smears or at age 30, whichever comes first.

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 long–term 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

While high quality evidence is not available to define the appropriate age to initiate testing, UpToDate has revised a previous recommendation and now suggests that testing be initiated no earlier than age 21, regardless of the age of initiation of sexual activity. We also no longer suggest annual screening at initiation, but rather screening every one to two years until three consecutive negative smears or age 30, and every two to three years thereafter.

1. Sawaya GF. Cervical–Cancer 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.

DMC Update

Can a patient complain to DMC on e mail?

No. As per DMC/DC/F.14/Comp.664/2010 ordr dated 20th April, 2010, The Delhi Medical Council examined a representation (through email) of Shri Sunil Prakash, President, Consumers’ Forum, 68, Sidhartha Enclave, New Delhi, forwarding a complaint of Ms. Vibha r/o. D–39, Hauz Khas, New Delhi against Max Hospital, referred by Medical Council of India. "On perusal of the email of Shri Sunil Prakash, the Delhi Medical Council observed that in terms of Rule 32 of Delhi Medical Council Rules, 2003, no complaint shall be entertained unless it is in writing and signed by the person making it, hence, the present email of Shri Sunil Prakash cannot be entertained and stands rejected."

News and views ( Dr Brahm and Monica Vasudeva)

Cancer risk after kidney transplant similar from all antirejection drugs

Drugs taken by kidney transplant recipients to prevent organ rejection carry similar risks of cancer, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology. No one drug can be singled out as the culprit.

Healthy hypertensive patients with microalbuminuria have increased risk of developing kidney and heart complications

Healthy people with high blood pressure who excrete a slight excess of protein in the urine raise their risk of (2.1 times) developing kidney and heart complications, according to a study to appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology.

Taking PPIs plus phosphate binders improve phosphorus control in hemodialysis patients

According to research presented at the National Kidney Foundation 2010 Spring Clinical Meetings, taking a proton pump inhibitor with a phosphate binder might improve phosphorus control in patients on hemodialysis.

Enzyme may play as much a role in heart disease risk as hypertension, bad cholesterol

Lipoprotein-associated phospholipase A2, an enzyme linked to inflammation, boosts the risk of heart disease as much as high blood pressure and high cholesterol, according to a paper in The Lancet.  

Overweight pts with type 2 diabetes may have low plasma H2S levels

According to a study published online April 23 in the journal Diabetologia, individuals with type 2 diabetes and who are overweight have low plasma levels of hydrogen sulfide (H2S). Hydrogen sulfide acts as a vasodilator. It reduces BP and also controls insulin synthesis.  

Mnemonic of the Day : Treatment of Myocardial infarction–INFARCTIONS

IV access
Narcotic analgesics (e.g. morphine, pethidine)
Facilities for defibrillation
Aspirin/ Anticoagulant (heparin)
Converting enzyme inhibitor
IV beta-blocker
Oxygen (60%)
Stool Softeners

Quote of the Day: Prakash Rajpal

To be an average performer you need good network and friends but to be a successful performer, you need competition and enemies.

DMA Update: 9th May is Mother’s Day

If the transient causes have been addressed but the urinary incontinence persists, internists should treat appropriately according to type. For urge incontinence caused by detrusor overactivity, the cornerstone of treatment is behavioral. Physicians should consult the voiding diary and start with bladder retraining, prompted voiding regimens, and urgency suppression methods. Anticholinergic bladder relaxants should be used only as a last resort. The only place for drugs is at the very, very, very end, after you’ve done the rest. Desamino d–arginine vasopressin (DDAVP), has no role in treating urinary incontinence.

Question of the Day (Dr G M Singh)

It is sometimes difficult to distinguish clinically between claudication and leg pain caused by spinal stenosis. How can we differentiate between them in a primary care setting?

Typically, vascular claudication is associated with cramping calf pain, which comes on after walking and is relieved by rest. Patients with spinal stenosis pain usually complain of weakness, heaviness or sensory symptoms rather than pain and often have bilateral symptoms and back pain. Examination of the lower limb often reveals vascular abnormalities, such as diminished pulses, in patients with peripheral arterial disease (PAD).

But for this differential to be clarified, the ankle–brachial pressure index (ABPI) in both legs should be measured. This simple, non–invasive test is done by measuring blood pressure at the ankle and in the arm using a sphygmomanometer and handheld Doppler device while a patient is at rest. A normal resting ABPI (lower than 1.0) tends to rule out PAD as a cause of the pain.

Occasionally, measurement of ABPI after exercise can pick up occult cases of PAD. A decrease in the ABPI result with exercise sufficient to produce the pain is a sensitive indicator of PAD. If there is no drop in the ABPI, then the pain is more likely be due to spinal claudication.
To date, the ABPI is the most effective, accurate and practical method of PAD detection. If there is continuing doubt, then referral for a vascular opinion and Duplex scanning or angiography may occasionally be required.

 Stupid Question: (drsooneita@gmail.com)

When you get woken up at midnight by a phone call...
Stupid Question Sorry. Were you sleeping?
Answer: No. I was doing research on whether the Zulu tribes in Africa marry or Not. You thought I was sleeping.... You dumb-witted moron.

eMedinewS Try this it Works: Have a second look at the eyes

After staining an eye with fluorescein, check it with UV light as usual, then irrigate the eye to remove the stain. Check it again with the UV light. Many times an abrasion or defect that did not show up originally can be seen with the second look. This also helps demarcate the abrasion.

SMS of the Day (Shantanu Sharma–MAMC)

Nanhi Jaan, Nanhi muskaan , kyun cheene usse janam ka adhikar, Nanhi Kali par badi pehchan, beti ke janam ka bhi ho abhiman

Dr Good Dr Bad

Situation: One whole family came for typhoid vaccination.
Dr Bad: Bring your family tomorrow for vaccination.
Dr Good: Also bring your servants and food handlers at home for vaccination
Lesson: It is not only important to vaccinate your family members but equally important to simultaneously vaccinate the workers at your home, especially food handlers, to break the cycle.

Make Sure

Situation: A patient with serum creatinine of 1.2 developed renal failure after he was given a painkiller.
Reaction: Oh my God! Why was painkiller not avoided?
Lesson: Make sure to remember that in patients with borderline renal function even a single tablet of painkiller can precipitate renal failure.

IMADNB Joke of the Day (Dr Tarun Gupta)

The philosopher, on being interrupted in his thoughts by the violent cackling of a hen that had just laid an egg, was led to express his appreciation of a kind Providence by which a fish while laying a million eggs to a hen's one, does so in a perfectly quiet and ladylike manner.

Formulae in Clinical Practice

Non HDL Cholesterol = Total Cholesterol – HDL Cholesterol

Normal Goals: 30 more than LDL cholsterol goals.

Milestones in cardiology

1628: William Harvey, an English Physician, first described blood circulation. “Movement of the blood is constant in the circle and is brought about by the beat of the heart.”

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

ADH:Also known as Antidiuretic Hormone; To help detect, diagnose, and determine the cause of antidiuretic hormone (ADH) deficiency or excess; to investigate low blood sodium levels (hyponatremia); to distinguish between the two types of diabetes insipidus.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Lornoxicam SR 16mg Tabs

For the symptomatic treatment of pain and inflammation in patients of osteoarthritis & rheumatoid arthritis




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eMedinewS?Padma Con 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 .


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Public Forum (Press Release for use by the newspapers)

Women should quit smoking to lower their risk of heart disease
9th May is Mother’s Day

New Delhi, Friday, May 7, 2010: Smoking is still the leading preventable cause of death. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases. As per WHO, an estimated 3 million people in industrialized countries will have died as a result of tobacco use by 2030, and an additional 7 million people in developing countries face the same fate.

The harms of smoking are reversible and can decline to the level of nonsmokers, as per a report in Journal of the American Medical Association, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Women who quit smoking have a 21 percent lower risk of dying from coronary heart disease within five years of quitting their last cigarette. The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease. For chronic obstructive pulmonary disease, it may take up to 20 years. It's never too early to stop, and it's never too late to stop.

Women who are current smokers have almost triple their risk of overall death compared with non smoker women. Current smokers also have a 63 percent increased risk for colon cancer compared with never–smokers, while former smokers have a 23 percent increased risk. There was no significant association between smoking and ovarian cancer.

Women who started smoking earlier in life are at a higher risk for overall mortality, of dying from respiratory disease and from any smoking–related disease. However, a smoker's overall risk of dying returns to the level of a never–smoker 20 years after quitting. The overall risk decline by 13 percent within the first five years of abstaining. Most of the excess risk of dying from coronary heart disease vanishes within five years of quitting.

For chronic obstructive pulmonary disease, the return to normal takes 20 years, although there is an 18 percent reduction in the risk of death seen within five to 10 years after quitting.

And the risk for lung cancer does not return to normal for 30 years after quitting, although there is a 21 percent reduction in risk within the first five years.

MCI Update

Dr J P Singh in the MCI case filed a bail application in the high court which will come for hearing on 24th May. It is likely that the bail application for Dr Ketan Desai once filed will also be heard not before 24th May unless a relief is given in the Patiala House Court on 14th when the regular matter comes for hearing.

Readers Responses

  1. Dear Dr KK, I have been in MCI since 1992, and know very deeply what it is about. You as an ousider have only superficial knowledge/information. I suggest you desist from making appeals/requests you have made in emedinews dated 5th May. You are not aware of what goes behind the curtain. I do not want to write/disclose more than this at this time. Dr KK Arora
  2. Feedback of Manesar workshop: Wonderful experience, beyond expectations! would like to have such events more frequently. Some comments: 1. the resonance produced by lum, vum, rum, yum, hum, om is the same everytime and is because of ---m which is common for all. Please explain usage for different sites for these sounds. 2.Do these sites relate to the chakras as quoted in kundalini reference or you avoided corelating them for some reasons?: Lokesh Gupta

    eMedinewS Responds: UM provides relaxation and localizing them to various locations helps in emotional healing. Each yogic chakra is equivalent to an autonomic plexus located in that area.