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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; Chairman Ethical Committee 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

  Editorial ...

8th September, 2010, Wednesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

What can I do to prevent cataracts?

  1. About half of all people ages 65 to 74, and 70% of those ages 75 and over, develop cataracts, which are the leading cause of blindness worldwide.
  2. Fortunately, surgery is safe and effective and leads to improved vision in about 90% of cases.
  3. Cataracts aren’t made of calcium but rather of clumps of protein.
  4. The cells of the lens are composed of water and protein arranged in a way that keeps the lens clear.
  5. For reasons that aren’t fully understood, the protein molecules may clump together and start to cloud the lens. This is the beginning of a cataract. The effect has been likened to cooking an egg white.
  6. Cataracts typically progress, becoming denser or clouding more of the lens and blurring vision. Eventually, vision may be so severely affected that surgery is needed to remove the lens and replace it with an artificial one.
  7. Cataracts usually form in both eyes but may not progress at the same rate or affect vision equally.
  8. Aging is obviously a factor
  9. Other risk factors include injury to the eye, previous eye surgery, diabetes, use of corticosteroid drugs, and having a family member with cataracts. Many studies have implicated smoking and drinking as well. And a study suggests that hormone therapy may increase the risk. Cataracts also seem to be more common in people who've had long–term exposure to sunlight.
  10. We don’t know if avoiding or treating these risk factors will prevent a cataract from forming. But it can only do you good to refrain from smoking, moderate your alcohol consumption, and protect your eyes from sunlight with hats and sunglasses.
  11. Some experts believe that antioxidant vitamins might help prevent cataracts by getting rid of molecules called free radicals, which may trigger or fuel protein clumping.
  12. In a 2008 Archives of Ophthalmology study, researchers found that women ages 50 to 79 whose diets were rich in lutein and zeaxanthin had fewer cataracts. These phytochemicals are abundant in dark green leafy vegetables such as spinach, kale, Swiss chard, watercress, and dandelion greens. (Health beat: Harvard Medical School)

Dr KK Aggarwal
Editor in Chief
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  Photo Feature

Launch function of BSNL Dil Ka Darbar and Perfect Health Mela
Two major events of Heart Care Foundation of India will form a continuity with the 2010 Common Wealth Games: The 1st event BSNL Dil Ka Darbar (26th September 2010) before the Games and 17th Perfect Health Mela (23rd to 31st October, 2010) after the Games. In the photo: Mr Deepak Chanduka GM Mkt. Corporate Office MTNL, Dr. K.S. Bhagotia from DHS, Dr. Sadhvi Sadhna Ji Maharaj, Chairperson of World Fellowship of Religions, Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, Mr S Bhatnagar (GM Sales) MTNL and Mr Praveen Aggarwal from Coca Cola India Ltd.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Influenza vaccination in individuals with egg allergy

For the patient who is six months of age or older and has known egg allergy of any severity, except severe anaphylaxis, administer under observation a vaccine that contains ≤1 mcg ovalbumin per 0.5 mL as a single dose without prior vaccine skin testing.

Chung EY, et al. Safety of Influenza Vaccine Administration in egg – allergic patients Pediatrics 2010;125:e1024

  National News

IMA Election

Emedinews request all our readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association. The voters are members of Central Council of IMA, working committee members and all presidents and secretaries of IMA apart from all office bearers. Dr. Aggarwal is well-known for his work in the field of academics.

Task force to draft policy on use of antibiotics

The Union Health and Family Welfare Ministry has set up a task force for evolving a policy on use of antibiotics. The 13–member task force, chaired by the Director General of Health Services, is expected to submit a report within two months. The decision follows the controversy over the origin of the new antibiotic–resistant bacteria, named New Delhi Metallo–beta lactamase–1 (NDM–1), as reported in a study published in The Lancet Infectious Diseases journal. The NDM–1 bacterium is resistant to all antibiotics, including Carbapenems  the strongest antibiotic in the world. (The Hindu)

75 new dengue cases in Capital; total 1,370

A 25-year-old man, Suresh, died in Safdarjung Hospital here on Monday due to dengue taking the total number of deaths so far this season to four. Seventy-five new cases of dengue were also reported on Monday, taking the total of those affected to 1,370. While the Capital is facing its worst dengue epidemic in the past five years, a group of Municipal Corporation Delhi domestic breeding checkers (DBCs) went on strike on Monday demanding regularisation of their jobs. (Source: The Hindu)

  International News

(Dr Monica and Brahm Vasudev)

Exercise limits weight gain in normal–weight but not in heavier women

A research from Harvard Medical School researchers published in the March 24/31, 2010, issue of the Journal of the American Medical Association has made the following observations:

  • Among normal–weight women, the likelihood of putting on weight decreased as physical activity level increased. Among women who were overweight or obese, there was no relationship between physical activity and weight gain.
  • For women who aren’t overweight or obese, exercise can keep off excess pounds, but it must add up to about seven hours per week of moderately intense activity such as brisk walking or casual bicycling — or 3.5 hours per week of vigorous activity such as jogging or aerobic dancing.
  • For women who are already overweight or obese, increased physical activity alone is not enough to prevent further weight gain. These women also need to reduce their calorie intake. But they should still get at least 30 minutes of moderately intense physical activity most days for the sake of the many health benefits, which include a reduced risk of chronic conditions such as heart disease and stroke.

FDA releases list of harmful tobacco components

The FDA has identified more than 100 compounds that it plans to list as harmful or potentially harmful, making way for a more stringent regulation of commercial tobacco products. A list has been released in advance by the agency’s Center for Tobacco Products. The advisory committee will review recommended criteria for classifying tobacco and smoke components as harmful. The 2009 legislation empowering the FDA to regulate tobacco products requires that, by 2012, tobacco companies produce lists of harmful or potentially harmful compounds in their products. It also gives the agency authority to order the reduction or removal of any such constituent and to restrict advertising, but it bars the FDA from completely banning tobacco products. Tobacco and its smoke contain a range of organic compounds as well as elemental heavy metals including lead, cobalt, cadmium, and even uranium (including the weapons–grade isotope, U–235).

Study links heart disease to Y chromosome

A study to be presented at the meeting of European Society of Cardiology (ESC) reports that some genetic patterns carried on the Y chromosome from father to son may be the answer to why males are at a disadvantage as regards heart disease. Pooled analysis of results of two British cohorts showed that men carrying the I haplogroup within the male–specific region of the Y chromosome also carried 55% higher age–adjusted coronary artery disease risk vs all others. The study concluded that genetic variation in the Y chromosome is a new independent risk factor for coronary artery disease as the Y chromosome haplogroup did not correlate with traditional risk factors viz. age, LDL or HDL cholesterol, hypertension, or smoking status.

FDA gives go ahead to a new combination pill for high BP

A combination pill containing aliskiren (direct renin inhibitor) together with amlodipine (calcium channel blocker) has been approved by the FDA to treat hypertension or high blood pressure. The drug manufactured by Novartis would be sold under the trade name Tekamlo. The tablets will be available in four strengths of aliskiren and amlodipine, respectively: 150 mg/5 mg, 150 mg/10 mg, 300 mg/5 mg, and 300 mg/10 mg The FDA has cautioned about using it in patients with renal impairment and in patients who are already on other antihypertensive drugs, including diuretics and ACE inhibitors. It is contraindicated in pregnant women and patients taking cyclosporine.

Cell treatment best in healing of diabetic foot ulcer

A study published in the August issue of Archives of Dermatology states that engineered skin or bilayered living cell therapy (Apligraf) reduced the time to wound healing vs other advanced biologic therapies: by 31% compared to topical recombinant growth factor (becaplermin, Regranex) and by 40% compared with platelet releasate (Procuren). According to Robert S. Kirsner, MD, PhD, of the University of Miami and coresearchers, on the whole, treatment with advanced biological therapy for nonhealing wounds occurred by day 28, in accord with the Wound Healing Society guidelines

Foot ulcers are a common complication in diabetic patients and are an important cause of nontraumatic amputation.

  Respiratory Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

Is Montelukast as effective as inhaled corticosteroids in patients with persistent asthma ?

A meta–analysis of randomized trials found that children with mild to moderate persistent asthma who were treated with inhaled glucocorticoids had better pulmonary function and asthma control (eg, fewer asthma exacerbations requiring systemic glucocorticoids, less albuterol use, and lower symptom scores) than those treated with montelukast


Castro–Rodriguez JA, Rodrigo GJ. The role of inhaled corticosteroids and montelukast in children with mild–moderate asthma: results of a systematic review with meta–analysis. Arch Dis Child 2010;95:365.

  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Q: Why is there so much concern about having twins or triplets after fertility treatment?

A. Multiple births carry risks to both the health of the mother and to the health of the unborn babies. Twins or triplets are more likely to be premature and to have a below–normal birth for admission. You would need to visit the centre 3–5 times during the monitoring cycle. On the day of egg collection you would need to fast for 6 hours and come to the clinic, the procedure takes about half an hour. Studies show that the risk of death before birth, or within the first week of life, is more than 4 times greater for twins than for a single baby. For triplets, the risk is 7 times greater than for a single baby.

  ENT Update

Dr. Aru Handa MS, DNB (Department Co–ordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

What are the Predisposing Factors for Otomycosis ?

Hot and humid weather favours the growth of fungi that is why otomycosis (Fungal infection of ear) is very common in rainy season and following swimming.
Diabetes should be ruled out in patients suffering from recurrent fungal infections of the ear.

  Cardio Update: Question of the day

What is the management of hypertension associated with dyslipidemia? (Sukumar Mukherjee, Ajoy Biswas)

Dyslipidemia frequently coexists with hypertension. Lifestyle modification is of particular importance as it can both lower BP and improve lipid levels as well. Choice of antihypertensives should be made keeping in mind their impact on lipids.
Despite of the fact that low potency diuretics might cause transient rise in lipids, their protective role outweighs this risk and hence they are recommended in the elderly.

  • Beta–blockers, regardless of their protriglerydemic propensity are useful in lowering CAD–related mortality among AMI patients.
  • ACEI and CCBs are lipid–neutral drugs.
  • Beta–blockers lower serum cholesterol and TG levels.
  • Patients with hypertension and dyslipidemia warrants statins as for CV diseases/diabetes.

Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower than average cholesterol concentrations in the Angio Scandinavian cardiac Outcomes Trial Lipid Lowering Arm (ASCOT–LLA); a multicenter randomized control trial. Lancet 2003;361:1149–58.

  Medico legal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What are ordinary and extraordinary medical care?

The Pope and Catholic teachings advocate a distinction between ordinary and extraordinary care, with ordinary care being mandatory, whereas extraordinary care may be withheld or withdrawn.*

One commentator explicated this distinction in the following way. According to him,

  • Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or inconvenience…
  • Extraordinary means of preserving life mean all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer reasonable hope of benefit.

Many ethicists and courts have concluded that this distinction is too vague and has "too many conflicting meanings" to be helpful in guiding surrogate decision makers and clinicians As one lawyer noted ordinary and extraordinary are "extremely fact–sensitive, relative terms…what is ordinary for one patient under particular circumstances may be extraordinary for the same patient under different circumstances, or for a different patient under the same circumstances". Thus, the ordinary/extraordinary distinction should not be used to justify decisions about stopping treatment.

Pope Pius XII. The prolongation of life In: Ethics in medicine. Reiser, SJ, Dyck, AJ, Curran, WJ (Eds), MIT Press, Cambridge 1997.

  Medi Finance Update

Current Budget

  • Dividends to be tax free in the hands of shareholders.
  • Resident individuals having income upto Rs. 1,60,000 will not be liable to pay any tax.
  • For individuals and Hindu undivided family (HUF), no surcharge
  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation


Cosmetics Licensed as toothpaste/tooth powder containing tobacco.

GSR 444(E)

  Lab Update

Low platelet counts

Surgical bleeding due solely to a reduction in the number of platelets does not generally occur until the platelet count is < 50,000/microL.

Clinical or spontaneous bleeding does not occur until the platelet count is < 10,000 to 20,000/microL.

  IJCP Special

Dr Good Dr Bad

Situation: A 24–year–old female suffered migraine attacks after physical exertion.
Dr.Bad: It is not related.
Dr.Good: It is related.
Lesson: Migraines can be triggered by stress, worry, menstrual periods, birth control pills, physical exertion, fatigue, lack of sleep, hunger, head trauma, and certain foods or drinks that contain chemicals such as nitrites, glutamate, aspartate, tyramine.

Make Sure

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Oh My God: Why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they go to mountains.

Quote of the Day
"No man is worth your tears, but once you find one that is, he won't make you cry"
(Contributed by Dr. GM Singh)

Hypertension Alert
Hypertensive urgency

Severe hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg), with no acute signs of end-organ damage, is often called hypertensive urgency.


Case Scenario: Test your skills…

A 20–year–old engineering student is on vacation with her friends and forgets to give herself insulin for a couple of days. She presents to your emergency room with two days of vomiting and abdominal pain. Her pertinent labs are as follows:
pH 7.2, PaCO2 23, albumin 4, sodium 130, chloride 80 and bicarbonate 10.
What acid–base disorder/s does she have?

A. Anion gap metabolic acidosis and non–anion gap metabolic acidosis
B. Anion gap metabolic acidosis and non-gap metabolic acidosis with respiratory alkalosis
C. Anion gap metabolic acidosis and respiratory acidosis
D. Anion gap metabolic acidosis with appropriate respiratory compensation

(Contributed by Dr Ashish Verma)

The answer for yesterday’s Mind Teaser: "No two ways about it"

Correct answers received from: Dr Simran Singh, Dr Rawat Purushottam Singh, Dr kalpana Mohan, Dr.A.K.Saxena

Correct answers for 6th September Puzzle “Too stuck up for words”

Correct answers received from:Dr  Virender Prakash Gautam

Send your answer to ijcp12@gmail.com

  Humor Section

(Contributed by Dr. D R Nakipuria)

Interesting aspects of mathematical calculation in human life

Romance Mathematics

Smart man + Smart woman = Romance
Smart man + Dumb woman = Affair
Dumb man + Smart woman = Marriage
Dumb man + Dumb woman = Pregnancy

Funny One Liner (Dr Chandresh Jardosh)

A Man before marriage is – Superman. After Marriage – Gentleman. 5 Years Later – Watchman. 10 Years later – Apne Hi Jaal Mein fasaa hua Spiderman.

  An Inspirational Story

A boat docked in a tiny Mexican fishing village. A tourist complimented the local fishermen on the quality of their fish and asked how long it took him to catch them.
" Not very long." they answered in unison. "Why didn’t you stay out longer and catch more?" The fishermen explained that their small catches were sufficient to meet their needs and those of their families."
"But what do you do with the rest of your time?" "We sleep late, fish a little, play with our children, and take siestas with our wives. In the evenings, we go into the village to see our friends, have a few drinks, play the guitar, and sing a few songs. We have a full life."
The tourist interrupted, "I have an MBA from Harvard and I can help you! You should start by fishing longer every day. You can then sell the extra fish you catch. With the extra revenue, you can buy a bigger boat."
"And after that?"
"With the extra money the larger boat will bring, you can buy a second one and a third one and so on until you have an entire fleet of trawlers. Instead of selling your fish to a middle man, you can then negotiate directly with the processing plants and maybe even open your own plant.
You can then leave this little village and move to Mexico City, Los Angeles, or even New York City ! From there you can direct your huge new enterprise."
"How long would that take?"
"Twenty, perhaps twenty–five years." replied the tourist.
"And after that?"
"Afterwards? Well my friend, that’s when it gets really interesting, " answered the tourist, laughing. "When your business gets really big, you can start buying and selling stocks and make millions!" "Millions? Really? And after that?" asked the fishermen.
"After that you’ll be able to retire, live in a tiny village near the coast, sleep late, play with your children, catch a few fish, take a siesta with your wife and spend your evenings drinking and enjoying your friends."
"With all due respect sir, but that’s exactly what we are doing now. So what’s the point wasting twenty–five years?" asked the Mexicans.
And the moral of this story is: Know where you’re going in life…you may already be there.

(Contributed by Dr Mukul Tiwari)

  Readers Responses
  1. Respected Dr K K Aggarwal, wishing you best of luck for IMA vice president contest. OIur support is with you. Dr. Dibendujoy Verma, Treasurer IMA Hisar Distt.
  2. Thanks, Dr KK Aggarwal ji, for providing latest data that doctors of different specialty being sued. May I know what is incidence, prevalence and most common causes of doctors being sued in India?  Please comment on the question about DMC registration and state wise registration, why all it? if it is mandatory then it should be free of cost. There are many persons who are in transferable govt. job will get registration in all state? It is very funny? It is like a circus show ?  Ultrasound & Echo machine registration every five yearly fee under PNDT Act Registration fee? Now this is time where doctors, only those who are registered have to pay the fee. All these are burden ultimately to common people who are not covered by any TPA/ CGHS/ESI/ etc,... Dr KP Singh Fortis Escorts, New Delhi : drkpsingh10@gmail.com  9818110832
  3. Happy Bday sir: Dr Prashant Rampal
  4. Many many happy returns of the day, sir. Dr HP Miglani
    Thanks really very educative: dsrana39@gmail.com
  5. Dear sir, My   Cordial &   Warm Good Wishes, on UR HAPPY BIRTHDAY!!  Many many HAPPY RETURNS of   the   day... Vikram  Goyal
  6. I wish you all the best for the post of vice president: we need persons like you on IMA platform because updating the doctors with recent development and brushing of old knowledge is the only work IMA can do for its members, other jobs which IMA is doing is for the society, knowledge and technology transfer is for the members, great job, you will win. Vivek Kumar, Varanasi
  Public Forum

(Press Release for use by the newspapers)

Teach cardiac resuscitation in schools: HCFI

Children as young as 9 years old can and should learn cardiopulmonary resuscitation (CPR) said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

The usefulness of CPR training in schools has been questioned, as young students may not have the physical and cognitive skills needed to perform such complex tasks correctly.

According to a study of 147 students who received six hours of life–support training, 86 percent of the children performed CPR correctly at a follow–up session four months after the training. The study is published in the journal Critical Care. The report found that students as young as 9 years were able to successfully and effectively learn basic life–support skills.

Like in adults or the elderly, in children too the physical strength may limit depth of chest compressions and ventilation volumes, but skill retention is good. In the training program, the children were taught

  1. CPR
  2. How to use automatic defibrillators
  3. The correct recovery position
  4. How to call for emergency services.

Body mass index, not age, was the major factor in depth of CPR compressions and amount of air exhalation. That means that a well–built 9–year onwards–old child can be just as capable at CPR as an older child.

The same is true for the elderly. It is on record that even 85–year–old people have successful done CPR. The conclusion is that

  1. CPR training can be taught and learned by schoolchildren.
  2. CPR education can be implemented effectively in primary schools at all levels.
  3. CPR should added the school syllabus.
  Conference Calendar

World Drug Safety Congress Europe 2010

Date: September 14–17, 2010

Venue: Gran Melia – Shanghai, China

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday– BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi 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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