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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

8th June 2010, Tuesday

Ghulam Nabi Azad writes to Dr Sarin

Dear Colleague

As per letter dated 2nd June 2010, Shri Ghulam Nabi Azad, Union Health Minister has written to Dr S.K. Sarin, Chairman, Board of Governors, Medical Council of India, that he would expect absolute transparency and corruption free decisions by the Board of Governors. He said that the decisions to be taken by the Board of Governors should be free, fair and without fear. He said that he has already instructed officials of the health Ministry not to interfere in the functioning of Board of Governors of Medical Council of India.

He highlighted that there are a large number of touts in the field of medical education who are being used by the management of some interested institutions to get clearance for their colleges by illegal means. These touts collect money from interested institutions in the name of the government, office bearers and the members of the Medical Council of India thereby bringing bad name to Board of Governors in the Medical Council of India. He requested Dr Sarin to caution the members of the newly constituted Board of Governors that they have to be vigilant and keep their eyes open since their every step is being watched by the entire country with high expectations. He said that the selection of the members was done keeping in view the eminence, honesty, integrity and their standing in the field of medicine.

The above ordinance has come with additional responsibility with the Board of Governors granting permission for establishment of new medical colleges, opening the new or higher courses of study and increase in admission capacity in any course of study referred to in section 10(A) in the Indian Medical Council Act 1956.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)


Differently abled children from diverse organization and institutions are promoted under a special programme of Heart Care foundation of India (HCFI) known as Anmol. Their talents are nurtured and awarded under this programme. Celebrities are also roped in to give away the award that further encourages the children.

Dr k k Aggarwal
Dr K K Aggarwal, president HCFI and Chetan Chauhan, Cricketer distributing awards to the winners of Anmol

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


The heterocyclic antidepressants, including desipramine, have been associated with heart block, ventricular arrhythmias, and sudden death. United States Food and Drug Administration (FDA) has issued a safety alert specifically regarding desipramine, that clinicians should prescribe the drug with extreme caution to patients with a family history of heart disease, particularly sudden death, cardiac dysrhythmias, or cardiac conduction disturbances, and that overdose of desipramine has resulted in a higher death rate compared to overdoses of other tricyclic antidepressants.


www.fda.gov/ Safety/ MedWatch/ SafetyInformation /Safety Alerts for Human Medical Products/ ucm192655.htm. (Accessed December 10, 2009).

Mnemonic of the Day (Dr Prachi)

Miosis: causes of pin–point pupils – CPR ON SLIME:

Resting (deep sleep)
Stroke (pontine hemorrhage)
Lomotil (diphenoxylate)
Mushrooms/ Muscarinic (inocybe, clitocybe)
Eye drops

News and Views (Dr Brahm and Monica Vasudeva)

1. FDA seeks more information on Axanum, proposes new use for Nexium.

The US FDA has asked for additional information about Axanum (aspirin/esomeprazole), a new drug for ulcers. AstraZeneca sought FDA approval for Axanum to prevent ulcers of the stomach and duodenum, and also asked to market Nexium to decrease the risk of low–dose aspirin associated peptic ulcers.

2. Marshall Edwards says ovarian cancer drug failed in late–stage study.

Phenoxodiol, a potential treatment for ovarian cancer has failed in a late–stagy study. This was announced by Marshall Edwards Inc. Phenoxodiol did not significantly improve progression–free survival or overall survival in women with recurrent ovarian cancer.

3. A heart valve that would grow with a child

Ongoing research is attempting to construct a heart valve that is made up of living human tissue that would grow with a child and repair itself over time.

Conference Calendar

IV Cannulation

Basic Life Support (BLS) Provider Course American Heart Association (AHA) Accredited Target Audience – All Healthcare Personnel
Date: June 10, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the day

Kind words can be short and easy to speak, but their echoes are truly endless. –Mother Teresa–

Question of the Day

What are the inflammatory markers in type 2 diabetes mellitus? (Dr Anand Moses, Chennai)

Type 2 diabetes mellitus has been considered as an inflammatory disease with metabolic alterations leading to a cascade of events resulting in end–organ damage mediated by cytokines. This changing scenario has evolved from recent discoveries that have shown that circulating inflammatory factors such as TNF–alfa and IL–6 may cause insulin resistance and obesity.

Patients with diabetes and CVD share many common traits. They include central obesity with insulin resistance, hypertension, low HDL cholesterol, high triglycerides and increased procoagulants. In the atherosclerosis risk in community study (ARIC) it was seen that there is a strong link between obesity and diabetes. TNF– alfa is overexpressed in both conditions and is a potent inhibitor of tyrosine phosphorylation of the insulin receptor.

Thus increased levels of TNF– alfa decrease insulin sensitivity in the muscles and adipose tissue. TNF– alfa may indirectly stimulate either release or synthesis of cortisol, FFAs and suppression of insulin secretion. It was also shown that elevated levels of WBCs predicted the development of diabetes in middle aged adults.

Other studies have noted that elevation of IL–1, IL–6 and TNF– alfa can result in release of ACTH and cortisol. TNF– alfa may impair signaling and autophosphorylates the insulin receptor. It decreases GLUT–4 in muscle and increases FFA production leading to decreased insulin production and insulin resistance. The net result is the appearance of clinical hyperglycemia leading to diabetes mellitus.

Levels of TNF– alfa and IL–6 are difficult to measure in the laboratory. C–reactive protein (CRP), which correlates well with TNF– alfa and IL–6 and is also considered as its surrogate marker is relatively easy to measure. CRP also correlates with insulin levels and elevated triglycerides and very LDL levels. These inflammatory markers may therefore help in the early intervention to prevent hyperglycemia and its complications.

Liver Fact

A persistently high SGOT/SGPT more than two times normal require liver biopsy.

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

People with bipolar disorder aren’t really sick.

eMedinewS Try this it Works

Getting the hook out

The easiest, least traumatic way to remove a fishhook is to slowly numb up the area with lidocaine, using a 27– to 30–gauge needle. Then slip an 18–gauge needle on the same syringe and through the hole already made by the fishhook, cover the barb, and remove the fishhook and needle as a unit.

Dr Good Dr Bad

Situation: a diabetic patient with high blood triglyceride levels was on ayurvedic drugs.
Dr Bad: Continue ayurvedic drugs.
Dr Good: Start fenofibartes.
Lesson: Fenofibrate reduces the risk of a first heart attack and substantially reduces the risk of further clinical cardio vascular disease events after silent myocardial infarction, supporting its use in type 2 diabetes. In an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, fenofibrate reduced MI (clinical or silent) by 19%, non–fatal clinical MI by 24% and silent MI by 16%. Among those having silent MI, fenofibrate reduced subsequent clinical CVD events by 78%. Eur Heart J 2009 Sep 29. (Epub ahead of print)

Make Sure

Situation: A patient with SLE with positive CRP developed TBM.
Reaction: Oh my God! Why was positive CRP ignored.
Lesson: Make sure that all SLE patients with positive CRP are investigated for other illnesses. CRP is always negative in SLE.

IMADNB Joke of the Day (Dr Tarun)


When a certain officer of the governor’s staff died, there were many applicants for the post, and some were indecently impatient. While the dead colonel was awaiting burial, one aspirant buttonholed the governor, asking:

"Would you object to my taking the place of the colonel?"

"Not at all," the governor replied tartly. "See the undertaker."

Formulae in Clinical Practice

Acute HCO3 compensation

Formula: HCO3 will increase by 1 mmol/L per 10 mm increase in PCO2

Milestones in Diabetology

Nicolae Paulescu (Oct. 30, 1869–July 17, 1931) was a Romanian physiologist and professor of medicine. He had discovered insulin. In 1916, he succeeded in developing an aqueous pancreatic extract which, when injected into a diabetic dog, proved to have a normalizing effect on blood sugar levels.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Creatine Kinase (CK), Serum

The determination of Creatine Kinase is utilized in the diagnosis and monitoring of myocardial infarction and myopathies such as the progressive Duchenne muscular dystrophy.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Zoledronic Acid Solution for Infusion Addl. Indication

Prevention of clinical fractures after hip fracture in men and women




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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)

Pill splitting, the Indian answer

Split your pills to reduce cost but only after doctor’s advice, cautions Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

In pill splitting, patients cut the larger–dose tablets in half to double the amount of smaller–dose pills they receive in a single prescription –– for example, dividing 40–milligram tablets to create twice as many 20–milligram doses for the same price.

Drug companies don’t usually double the price of medications as the dose doubles, that can mean lower overall per–pill drug costs. The practice can also save money for insurance companies and employers.

A 6–month study from the University of Michigan involved more than 100 university health plan members who take cholesterol–reducing drugs such as statins. The study found statins to be good candidates for splitting, because they linger in the body for a long time, and any impact that splitting might have on their action did not greatly alter their effects splitting also did not adversely affect adherence to drug therapy.

But not all pills can be safely split. For example, those that pass through the body rather quickly, or have special time–release coatings, are not good candidates for splitting.

The study is published in the issue of American Journal of Managed Care’s.

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

14th June Sunday: IMSA workshop with Dr KK Aggarwal 8-10am at Moolchand Hospital

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.

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

Readers Responses

  1. Respected Editor, one of the best things in Sunday 06/06/2010 emedinews is Dr Charu Aggarwal’s quote. Over the years our attitude is exactly same but she is right if we recognize the reality well in time in this materialistic world. it is only when the God almighty comes in a man, he becomes a father. "A FATHER IS A SON & A SON IS A FATHER TOO. THY GOD APPEARED HIMSELF IN GUISE OF FATHER ONLY IF could RECOGNIZE HIM IN TIME." Regards to all & thanks to E–medinews for making our lives near to God by presenting us such great thoughts in the mechanical professional life. Once again Thanks to Dr.Charu for giving us all such a wonderful, deep, heart–touching, realistic snippet: Dibendujoy Verma.

  2. Dear Dr Aggarwal, my views regarding the rural health course is that in a country where no one can stop quacks from practising freely and at par with qualified doctors who will take care to see that the said doctors graduating out of this course will stay at subcenters, they will just complete the course run away and start practising in a new area only to add to the present problem of massive quackery. What u suggested in a previous edition to give tax-free salary of 1 lac/month to a fresh post graduate was the perfect idea and the best we can do considering the scenario in our country. Thanks. Dr Puneet Wadhwa, Pediatrician, Faridabad.

  3. Dear Dr Aggarwal: What’s your opinion on Nicosan, a phytochemical derived from herbs in Nigeria & being used in sickle cell anaemia. Can the drug be taken up for clinical trial? Dr Meera Rekhari Emedinews Response: Only one herbal agent tested to date, nicosan (Niprisan), Hemoxin, Nix–0699, has proved to have an efficacy/toxicity ratio sufficiently high to merit testing in clinical trials. Nicosan is a plant extract that has been successfully used in Nigeria to prevent painful crises associated with SCD (1–4). Although its exact mechanism of action, active ingredient(s), and long–term side effects are unknown, nicosan inhibits sickling in vitro (5), as well as in vivo in a transgenic mouse model of SCD (6). This agent is available commercially only in Nigeria. Nicosan has been granted orphan drug status by the United States FDA and the European Medicine Evaluation Agency; phase I studies are underway.


  1. Hankins J, Aygun B. Pharmacotherapy in sickle cell disease––state of the art and future prospects. Br J Haematol 2009;145:296.

  2. Wambebe C, Khamofu H, Momoh JA, et al. Double–blind, placebo–controlled, randomised cross–over clinical trial of NIPRISAN in patients with sickle cell disorder. Phytomedicine 2001;8:252.

  3. Cordeiro NJ, Oniyangi O. Phytomedicines (medicines derived from plants) for sickle cell disease. Cochrane Database Syst Rev 2004;CD004448.

  4. Fawibe AE. Managing acute chest syndrome of sickle cell disease in an African setting. Trans R Soc Trop Med Hyg 2008;102:526.

  5. Iyamu EW, Turner EA, Asakura T. In vitro effects of NIPRISAN (Nix-0699): a naturally occurring, potent antisickling agent. Br J Haematol 2002;118:337.

  6. Iyamu EW, Turner EA, Asakura T. Niprisan (Nix–0699) improves the survival rates of transgenic sickle cell mice under acute severe hypoxic conditions. Br J Haematol 2003;122:1001.