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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 June 2010, Monday

What is cuff inflation hypertension and how to avoid it?

Dear Colleague

A possible problem using a sphygmomanometer is that the muscular activity used to inflate the cuff can acutely raise the BP by as much as 12/9 mmHg, an effect called cuff inflation hypertension that dissipates within 5 to 20 seconds (average 7 seconds ). Thus, inflating the cuff to at least 30 mmHg above systolic and then allowing the sphygmomanometer to fall no more than 2 to 3 mmHg per heartbeat is desirable both for accurate measurement and to permit this exertional to disappear.

Definitions of factors contributing to resistant hypertension are (including cuff inflation HT)

  1. Office hypertension (clinic systolic blood pressure at least 20 mm Hg higher than home systolic blood pressure)

  2. Pseudohypertension (cuff diastolic blood pressure at least 15 mm Hg higher than simultaneously determined intra-arterial pressure)

  3. Cuff-inflation hypertension (intra-arterial diastolic blood pressure rise of at least 15 mm Hg during cuff inflation).


Reference: Artefacts in measurement of blood pressure and lack of target organ involvement in the assessment of patients with treatment-resistant hypertension.AUMejia AD; Egan BM; Schork NJ; Zweifler AJSOAnn Intern Med 1990 Feb 15;112(4):270-7.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (Past events)

Heart Care foundation of India (HCFI) emphasizes on absolute health. In this regard, it has revised the definition of health as ''Health is not mere absence of disease but a state of physical, mental, social, spiritual, emotional and financial well-being." This message was released by His Holiness The Dalai Lama, who has a huge following throughout India and worldwide, which led to the new health definition becoming exceptionally popular and now well known.

Dr k k Aggarwal
His Holiness The Dalai Lama releasing the new definition of health as re-defined by HCFI. Also, in the picture, Dr K K Aggarwal, President HCFI, Dr Naresh Trehan

International Medical Science Academy Update (IMSA): New FDA Drug Update


Exenatide, a GLP–1 (glucagon–like peptide–1) analog used for the treatment of type 2 diabetes, has been associated with acute kidney injury. Exenatide should not be used in patients with a creatinine clearance below 30 mL/min. In patients with moderate renal impairment (creatinine clearance 30-50 mL/min), monitoring of serum creatinine is warranted when initiating therapy and after the usual dose increase from 5 to 10 mcg.


  1. www.fda.gov/ Safety/ MedWatch/ SafetyInformation/ Safety Alerts for Human Medical Products/ ucm 188703.htm Accessed December 2, 2009.

  2. Weise WJ, Sivanandy MS, Block CA, et al. Exenatide–associated ischemic renal failure. Diabetes Care 2009;32:e22.

Mnemonic of the Day (Dr Prachi)

Vertebrae: recognizing a thoracic from lumbar

Examine vertebral body shape
Thoracic is heart–shaped body since your heart is in your thorax.
Lumbar is kidney-bean shaped since kidneys are in lumbar area.

News and Views

1. APA: Sleep disorders set for overhaul in DSM–5

Sleep disorders are one category that is likely to undergo extensive changes, at least in nomenclature, in the forthcoming fifth edition of Diagnostic and Statistical Manual of Mental Diseases (DSM). At least 10 new disorder names have been proposed to be included in the DSM–5, while nine disorders currently listed are scheduled to be removed.

2. APA: Obesity rejected as psychiatric diagnosis in DSM–5

The DSM–5 will exclude obesity and simple overeating from its list of disorders. However, binge eating may become a formal psychiatric diagnosis. According to B. Timothy Walsh, MD, of Columbia University in New York City, who heads the DSM–5 work group in this clinical field, addition of binge eating is one of many changes planned within the category of eating disorders.

3. Elena Myasoedova, MD, PhD, and colleagues from the Mayo Clinic, in Rochester, Minn have reported that the incidence of rheumatoid arthritis (RA) is increasing, at least among white women. The incidence of RA increased by a modest but significant 2.5% per year (95% CI 0.3% to 4.7% per year, P=0.02) between 1995 and 2007 among women residing in Olmsted County, Minn, they note in the June 2010 issue of Arthritis & Rheumatism.

4. According to the results of a trial reported in the Journal of Clinical Oncology, the frequency and severity of hot–flashes decreased by 50% in postmenopausal women with frequent hot flashes who were treated for six weeks with the antidepressant drug, citalopram. Of the three doses of citalopram studied, 10, 20, or 30 mg, the lowest of three doses was as effective as the highest for dousing hot flashes. But, the midrange dose appeared to have broader activity against symptoms.

Conference Calendar

IV Cannulation : Target Audience – Nurses only
Date: June 8, 2010
Venue: 142, Bharathiyar Road, Papanayakan Palayam, Coimbatore, Tamil Nadu

Quote of the day

‘COMMEND while others are criticizing. PERSIST while others are quitting.’ William Arthur Ward

Question of the Day

Does red pepper exhibit antiatherogenic activity? (Dr. Vinod Sharma, New Delhi)

Kwon MJ and collegues from the Dept. of Food Science and Nutrition, Pusan National University, South Korea have published data in Clin Chim Acta 2003 June;332(1–2):37–44, which has shown that red pepper attenuates atherosclerosis. They also showed that plasma cholesteryl ester transfer protein (CETP) is a risk marker of atherosclerosis in cholesterol–fed rabbits. They studied the effect of red pepper supplementation on CETP activity, along with its anti–atherosclerotic effect in cholesterol-fed rabbits. In the study, rabbits were fed a 1% cholesterol diet for 12 weeks, including a 1% red pepper powder supplement.
The red pepper supplemented group exhibited significantly lower CETP activity than the control group during the experimental period. The total cholesterol, TG, LDL–C, VLDL–C, and VLDL–TG levels and atherogenic index (AI) were all significantly lower in the red pepper group than in the control group whereas the HDL–C level was significantly higher in the red pepper group than in the control group during the experimental period.
Red pepper supplementation increased the fecal TG excretion. Based on a morphological examination, the red pepper supplemented group exhibited fewer fat droplet deposits than the control group.

Liver Fact

SGOT/SGPT may also be high in thyroid disorders.

Women Safety Tips

If you wake up in the middle of the night to hear all your taps outside running or what you think is a burst pipe, DO NOT GO OUT TO INVESTIGATE! These people turn on all your outside taps full ball so that you will go out to investigate and then attack.

Stay alert, keep safe, and look out for your neighbours!

This should probably be taken seriously because the Crying Baby Theory was mentioned on America’s Most Wanted when they profiled the serial killer in Louisiana.

7 Myths about Bipolar Disorder (6) (Dr GM Singh)

Bipolar disorder is curable.

eMedinewS Try this it Works

Iced saline lavage for acute epistaxis

In cases of acute epistaxis, iced saline lavage of each nostril with the patient leaning forward may help decrease or stop bleeding and allow better assessment of bleeding sites.

Dr Good Dr Bad

Situation: A diabetic with A1C 8% was on oral antidiabetic drugs.
Dr Bad: Continue these drugs.
Dr Good: Add high fiber diet.
Lesson: Increasing consumption of fiber–rich foods or use of fiber supplements may have an important role in managing diabetes with positive outcomes on vascular complications and reduced cardio–vascular disease risk. In randomized controlled trials, viscous soluble fibers have demonstrated acute and long–term metabolic improvements in type 2 diabetes, such as reductions in HbA1c, fasting and postprandial glycemia, insulinemia, and cardiovascular risk factors. They may also be helpful in weight control through promoting feelings of fullness. (Curr Diab Rep 2009;9(5):405–11)

Make Sure

Situation: A patient with joint pains and high platelet counts was watched for one year. She developed joint deformation.
Reaction: Oh my God! Why was inflammatory arthritis not suspected? Lesson: Make sure that all patients with joint pains with high platelet counts are investigated for inflammatory arthritis including rheumatoid arthritis.

IMANDB Joke of the Day (Anuj Goyal)


One foot in the grave, and the other slipping.

Formulae in Clinical Practice

Predicted A–a Gradient for Age

Formula: A–a = 10 + (age/10)
Comment: There is no known correction for smoking.

Milestones in Gastroenterology

In 1805, Philip Bozzini from Italy built a tube that could be introduced in the human body to observe inside the living human body and to examine the urinary tract, rectum and pharynx. He named this instrument ‘Lichtleiter’ or light guiding instrument. This is the earliest description of endoscopy.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Monoclonal Protein Study, Serum

Diagnosis of monoclonal gammopathies, when used in conjunction with urine monoclonal studies, protein electrophoresis alone is not considered an adequate screening for monoclonal gammopathies.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Lidocaine Patch 700mg in aqueous base. (50 mg per gram adhesive)

For the relief of pain associated with post–herpetic neuralgia. It should be applied only to intact skin.




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Contact: drkk@ijcp.com emedinews@gmail.com


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)

Hazardous drinking

Hazardous drinking or drinking more than that recommended by guidelines is common and is a public health problem, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Currently, alcohol–use disorders are divided into two categories: alcohol abuse/harmful use and alcohol dependence.

Hazardous drinking is when a person drinks too much and is at risk but is not alcohol dependent.

In a study published in Alcoholism: Clinical and Experimental Research, Aalto and his colleagues analyzed data on 4,477 Finns, aged 30 to 64, who took part in a national health survey in 2000 and found the prevalence of hazardous drinking was 5.8 percent.

Men were defined as hazardous drinkers if they had 24 or more standard drinks a week during the preceding year, while women were hazardous drinkers if they had 16 or more standard drinks a week.

Hazardous drinking is more common among men, people older than 40, unemployed people versus the employed, and those who were cohabiting, divorced or separated, or unmarried.

One Should Give his/her Liver a Holiday

The widespread Japanese social belief of giving the liver a holiday, a few days off from drinking each week, has been given credibility by a report published in American Journal of Epidemiology. According to the published report, for men who drink regularly and heavily, taking a break from alcohol for a couple of days each week may benefit their health,

In the study, men who drank heavily on all days of the week had a high mortality. In contrast, men who drank heavily the same amount of alcohol every week but less frequently had low mortality rates.

However, Dr. Aggarwal cautioned that the study does not mean that one can drink as long as he takes a ‘liver holiday’. Binge alcoholism is hazardous to health. Binge alcoholism is defined as having five or more pegs in one sitting.

Heavy drinking is defined as having more than 300 gm of alcohol per week. Benefit of liver holiday is only seen in people who are heavy drinkers.

Giving liver a holiday may help regeneration of the liver damage caused due to heavy drinking.

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

13th June: IMSA Workshop with Dr KK Aggaral Moolchand Medcity 8-10am

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.


Readers Column

Dear Dr Aggarwal, As a matter of fact IMA and Gujarat Medical Council by now should have removed Dr Ketan Desai from their lists. All the 5 members of Working Committee of IMA met in Ahmadabad and are known close to Dr Desai. Had it been some body else strictest possible action would have taken place, leave aside a suggestion. Secondly, why observe Black Day on 28th June and not on 29th June?  What is the role of IMA in Medical education?  Sanjay


Emedinews response: I am not a member of WC this year. The yesterday news item was based on what transpired at the meeting conducted by the National President and the Secretary of IMA. Gujarat Medical Council is an independent body and not under IMA. We only report what is being discussed without our own views. Regarding the legal options in the yesterdays column these were the views of the people attending the meet and not of the newspaper. Most of us expected a discussion on Dr Desai in the meeting but the same was not done on the grounds that the matter is still under court and Dr Desai is under police custody and not convicted yet.

MCI News (from around the nation as reported by others)

9 MCI-approved state colleges under scannerJune 7th, 2010 ( DC)

As many as nine medical colleges in the state that were recommended for approval by the MCI are under the scanner. Of the said colleges, six are existing colleges which got renewal of permission and the remaining three got approval to set up new colleges during the MCI president, Mr Ketan Desai's tenure. The board of governors comprising a six-member that replaced the MCI has decided to reinspect these colleges. The nine colleges are among 93 institutions that were recommended across the country by the MCI with regard to renewal of permission and setting up of new colleges.

The six existing colleges that figured in the reinspection list are Bhaskar Medical College, Yenkapalli; Moinabad, R.R. district; Mamata Medical College, Khammam; Santhiram Medical College, Nadyal; Rajiv Gandhi Institute of Medical Sciences, Srikakulam; Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram and the Rajiv Gandhi Institute of Medical Sciences, Adilabad. The three institutions that got approval for setting up new colleges are the Aditya Educational Society, Rajolu, Srikakulam; Dr V.R.K. Educational Society, Aziznagar, R.R. district and the Mohammadiya Educational Society, Kadapa.

MCI is alleged to have granted recognition to many medical colleges ignoring serious irregularities such as fraudulent faculty. For instance, the Santhiram Medical College is alleged to have shown fraudulent faculty to get approval during an MCI inspection in May 2008. There were reports that it showed Dr Nagaraja Rao as one of the faculty members in the department of forensic medicine. The college officials submitted appointment letters and salary slips to the MCI team and informed them that the doctor was residing on campus. But later, it was found that Dr Rao had been dead for five years. Despite this, the college got approval for both 2008 and 2009 academic years.  In another instance, the Bhaskar Medical College was alleged to have shown a student as a faculty member during an MCI inspection in 2009. The student is alleged to have posed as Dr Xavier R. Packianathan, a radiologist, who left the country five years ago. This college was also approved by the MCI last year. (Source Deccan Chronicle)

Health ministry to finalise rural medical course soon

The health ministry will soon finalise the syllabus for the proposed short-term medical course for training doctors especially for rural areas. “The course is now in its advanced stage of finalisation,” a senior official from the health ministry said.  The official said almost all state governments have given their nod to the syllabus. The three-year bachelor of rural medicine and surgery course has been proposed by the health ministry to cope with shortage of doctors in rural areas. Officials said the course will be conducted at district level medical schools in notified rural areas. The schools will be set up by the central government and will take 20 to 25 students each.  These students will be given basic medical training for three years and will get a license to work in rural areas with a population of less than 5,000. There will not be any specialisation for these doctors. The official, however, added that the doctors trained under this course may be allowed only to work in sub-centres of primary health centres following objections from the Indian Medical Association (IMA). The course has been widely criticised by the IMA, which has held that it will produce half-baked doctors. The health ministry official clarified that the course will not affect the quality of health care in the country. “It will not dilute the medical profession in any manner. These doctors will be there to provide basic health care in the areas where we at present have only midwives or auxiliary nurses,” the official said. There are nearly 25,000 primary health centres in the country with four or five sub-centres under them. According to the Planning Commission, India faces a shortage of about six lakh doctors. (Source Indo Asian News Service)