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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

10th February 2010, Wednesday

Cervical cancer screening
As per the American College of Obstetricians and Gynecologists (ACOG) new guidelines, women don’t need their first cervical cancer screening – or Pap test – until they’re 21 years old. Also, they don't need follow up examinations as often as previously recommended.

According to the guidelines, women younger than 30 should be screened every two years, instead of annually. Women 30 or older can be examined once every three years.

Screening at less frequent intervals prevents cervical cancer just as well, decreases costs, and avoids unnecessary interventions that could be harmful.

The current guidelines, from 2003, recommend that women get a Pap test three years after they begin having sexual intercourse, but no later than age 21. And that women younger than 30 have an annual exam. For women 30 or older, the recommendation was every two to three years, if they'd had three consecutive negative Pap tests.

 Dr KK Aggarwal
Chief Editor

News and Views

Escitalopram may help stroke patients recover mental skills
Antidepressants may help patients recover cognitive functions, such as memory skills, that are damaged following a stroke, according to a study published in the February issue of the Archives of General Psychiatry.

MBG correlate with HbA1c
A study published in Diabetes Medicine indicates that self–monitored blood glucose (SMBG) measurements are moderately well– correlated with glycated hemoglobin (HbA1c) values in patients with type 2 diabetes mellitus. The study findings support the use of frequent SMBG measurements for assessing overall glycemic control.

Specific immune cells may help identify transplant recipients at increased risk of skin cancer
Monitoring immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, according to an Oxford study in the Journal of the American Society of Nephrology. Increased levels of T–regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin, while decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.

Low levels of vitamin D may be linked to greater asthma severity
Researchers at the National Jewish Health in Denver found that adult asthma patients with the highest levels of vitamin D in their blood had better lung function compared with people with the lowest levels in a study appearing in the American Journal of Respiratory and Critical Care Medicine. For every 1–ng/mL increase in serum levels of 25–hydroxyvitamin D (25–OH–D), forced one-second expiratory volume (FEV1) increased by 21 mL.

Does H. pylori eradication eliminate gastric cancer risk?
Helicobacter pylori, the bacterium linked to ulcers, has been implicated in stomach cancers. Still, it remains unclear if eradication of H. pylori entirely eliminates a person’s risk of gastric cancer. (Dr. Neena S. Abraham, a gastroenterologist at the Michael E. DeBakey VA Medical Center)

Chikungunya vaccine
NIAID researchers have developed a prototype vaccine that protects monkeys and mice against the emerging chikungunya virus, a major step toward the production of a vaccine for humans.

Overweight at 20 increases the risk of heart disease at 40
People who are obese and have type 2 diabetes in their 20s will be at higher risk of having a heart attack or stroke in their 40s if they do not change their lifestyle. [Dr. Dale J. Hamilton, diabetes clinical services chief at The Methodist Hospital in Houston]

Adipose tissue too can give stem cells
Researchers have found evidence that fat adipose tissue, may be a promising new source of valuable and easy–to–obtain regenerative cells called hematopoietic stem and progenitor cells (HSPCs), according to a study prepublished online in Blood, the official journal of the American Society of Hematology.

Brain scans of patients in vegetative state reveal some activity
A study published in the New England Journal of Medicine found that many patients in a vegetative state… are more conscious than previously believed. They showed brain activity when questioned about familiar names or given instructions. For the study, researchers placed 54 patients inside advanced brain scanners, finding that five patients' scans flashed exactly like any healthy conscious person's would. Of those five patients, four had received a vegetative state diagnosis, and one was thought to be only minimally conscious. While three showed signs of awareness during intensive standard bedside tests… two did not.

Forty percent of cancers may be preventable
About 40 percent of cancers could be prevented if people stopped smoking and overeating, limited their alcohol, exercised regularly, and got vaccines targeting cancer-causing infections, according to a report by officials at the International Union Against Cancer. Twenty-one percent of all cancers are due to infections like the human papillomavirus, or HPV, which causes cervical cancer, and hepatitis infections that cause stomach and liver cancer.

Lancet formally retracts paper linking vaccine to autism.
One of the world's most respected medical journals, The Lancet, is formally retracting an article that sparked a fierce debate. The 1998 study linked the vaccine for mumps, measles and rubella to autism, which led to a drop in vaccinations and a jump in measles cases. 25 studies in all have found no link between the vaccine and autism.

Love drug

  1. MDMA (3, 4-methylenedioxymethamphetamine, also called Ecstasy) is a synthetic compound with structural and pharmacologic similarities to both amphetamines and mescaline.
  2. It was developed in 1914 as an appetite suppressant.
  3. MDMA has become a common drug of abuse, particularly among young party-goers at 'raves' and 'circuit parties', due to its capacity to elicit feelings of euphoria, wakefulness, intimacy, sexual arousal, and disinhibition.
  4. MDMA shares the toxicity of amphetamine and possesses unique toxicities, both acute and chronic.
  5. MDMA increases alertness, reduces fatigue, and leads to feelings of increased physical and mental powers, and euphoria.
  6. One typically begins to experience the desired effects of MDMA approximately one hour following oral administration.
  7. Minor adverse reactions such as agitation, nausea, bruxism (grinding teeth), ataxia, diaphoresis, blurry vision, tachycardia, and hypertension can also occur at typical MDMA doses. These effects are usually self-limited and resolve within hours.
  8. MDMA can cause hypertension, tachycardia, and hyperthermia.
  9. Peak effects of MDMA toxicity occur within two hours of ingestion and typically last four to six hours. Concentrations of MDMA contained in illicitly produced pills vary widely. Major toxicity and death may occur after ingestion of a single tablet.
  10. For a recent ingestion (less than one hour) of MDMA, one should give a single dose of activated charcoal (1 g/kg; maximum dose 50 g).
  11. MDMA usually is sold as a capsule or tablet but sometimes is found in a powder form that can be snorted or smoked.
  12. MDMA causes serotonin release into the synaptic cleft, inhibits its synthesis, and blocks its re–uptake.
  13. MDMA’s effects begin within the first hour after ingestion of an oral dose and usually last three to six hours. Some users self–administer a ‘booster dose’ when the effects of the initial dose wane. The effects appear to begin earlier (20 to 30 minutes) when the drug is accidentally ingested by infants and toddlers.
  14. Chronic use of MDMA in typical recreational doses can lead to a paranoid psychosis that is clinically indistinguishable from schizophrenia; usually, it is reversible after a prolonged drug-free state.
  15. MDMA use (possibly in conjunction with cannabis) can lead to cognitive decline in otherwise healthy young people.

Conference Calendar
Ramachandra Advanced Radiology Education 2010
11-14, 2010 February
Venue: Sri Ramachandra University, Porur, Chennai, Tamil Nadu.

Public Forum
Press Release

Being an Indian: Risk Factor for Heart Disease

Being an Indian today is considered as a risk factor for heart disease. International studies have shown that an Indian doctor settled in US is 17 times more prone to get a heart attack than an American doctor settled in America, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Indian also get the disease at an earlier age. One should take lessons from the sudden deaths of prominent people like Vinod Mehra, Dewang Mehta, Amzad Khan, Sanjiv Kumar. They all died with massive heart attack within hours of the onset of symptoms while they were young and at the peak of their career. Saif Ali Khan also suffered a similar coronary attack but could be revived because of the modern gadgets and drugs available. Coronary artery disease in people less than 45 years of age is quite common in the country and needs aggressive management. Their first degree relatives should also be evaluated to prevent future heart disease in them.

Children whose fathers had suffered a heart attack before the age of 55 or mothers before the age of 65 should also be subjected to vigorous investigations to rule out underlying heart disease. In men less than 45 years of age and all pre menopausal women, one should look for possible heart blockages if they have associated risk factors. it is ironical that women who are normally protected from getting a heart attack are getting it today because of a continued faulty lifestyle. Heart attack in women is more serious, severe and fatal. Deaths due to heart disease in women outgrow all the combined deaths due to all cancers in women in the country today.

Younger patients with heart blockages have more abnormal atherogenic lipid profile, higher prevalence of smoking and more frequent single vessel coronary blockage disease. In a data of 1000 patients undergoing angiography, it was shown that 84% of patients undergoing angiography were males. Only 16% women underwent angiography. Amongst those who underwent angiography diabetes was present in 47% men, 52% women; hypertension in 71% of patients (male & female equal); abnormal lipid profile in 94% women and 85% men; family history of heart disease in 30% women and 19% men; and one more family member having heart blockage was present in 63% women and 54% men. Only 10% of patients were smokers and 6% of them were younger than 45 years of age.

The risk factors for Indians are different from that of the West. Dr. Enas Ea from Florida has shown that Asian Indians all over the world have the highest rate of heart blockages despite the fact that nearly 50% of them are vegetarians. The disease in them not only occurs earlier, but also takes a more malignant course. The classical risk factors like smoking, blood pressure and diabetes are present in less number than in their Western counterparts. The main risk factors in Indians are high triglycerides, low HDL and good cholesterol, high insulin levels, apple–shaped abdominal obesity and high Lp (A) cholesterol levels.

Many studies have shown that the relations of heart patients also demonstrate metabolic blood abnormalities. Children from 5 to 18 years of age group of young parents of less than 45 years of age with coronary blockages, showed significant cholesterol, sugar, blood pressure and insulin level abnormalities in the relatives. The levels were significantly higher as compared to controls. Aggressive modification of lifestyle, therefore, should begin in adolescents in view of malignant nature of coronary blockages in this population.

Coronary blockages also follow different incidence patterns in different areas in the country. Kerala has one of the highest incidences. In north, it is highly prevalent in Punjabi Bhatia family. Dr. R Gupta from Jaipur has shown high prevalence of abdominal obesity, blood pressure, diabetes, metabolic syndrome in Punjabi Bhatia community. Asian Indian women also have a higher rate of coronary blockages than other ethnic groups, despite similar conventional risk factors. Bhalodkar and coauthors from New York have shown that Asian Indian women have smaller particle size of good cholesterol and high levels of triglyceride.

Question of the day
What is the treatment of malaria in lactating women?

The amounts of antimalarials that enter breast milk and are therefore likely to be consumed by the breastfeeding infant are relatively small. The only exception to this is dapsone, relatively large amounts of which are excreted in breast milk (14% of the adult dose). Tetracyclines are also contraindicated because of their effect on the infant’s bones and teeth.

Punjab & Sind Bank
Central Bank of India

eMedinewS Try this it Works
Clues to acute mesenteric embolism
Consider this diagnosis in patients who present with three A’s:
          A    trial fibrillation
          A    bdominal pain
          A    cidosis

Dr Good Dr Bad
Situation: A child with type 2 diabetes came for prescription.
Dr Bad: Start with insulin.
Dr Good: Start with Metformin.
Lesson: In children with type 2 diabetes, metformin is a safe and effective oral hypoglycemic medication. [Diabetes Care 2002;25:89.]

Make Sure
Situation: A patient intolerant to penicillin and sulfa was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on azithromycin.
Make sure that patients who cannot tolerate penicillin or sulfa are given azithromycin.

Laughter the best medicine
An 80 year old couple were having problems remembering things, so they decided to go to their doctor to make sure nothing was wrong with them. When they arrived at the clinic, they explained to the doctor about the problems they were having with their memory. After checking the couple out, the doctor told them that they were physically okay but might want to start writing things down and make notes to help them remember things. The couple thanked the doctor and left. Later that night while watching TV, the man got up from his chair and his wife asked,

"Where are you going?"
He replied, "To the kitchen."
She asked, "Will you get me a bowl of ice cream?"
He replied, "Sure."
She then asked him, "Don’t you think you should write it down so you can remember it?"
He said, "No, I can remember that."
She then said, "Well I would also like some strawberries on top. You had better write that down because I know you’ll forget that."
He said, "I can remember that, you want a bowl of ice cream with strawberries."
She replied, "Well I also would like whipped cream on top. I know you will forget that so you better write it down."
With irritation in his voice, he said, "I don’t need to write that down! I can remember that." He then fumes into the kitchen.
After about 20 minutes he returned from the kitchen and handed her a plate of bacon and eggs.
She stared at the plate for a moment and said angrily: "I TOLD you to write it down! You forgot my toast!

Formulae in Imaging
Liver Cysts: For percutaneous management of single pyogenic liver abscesses with diameter >5 cm, catheter drainage is preferred over needle aspiration. (Source: AJR Am J Roentgenol 2007;189:W138.)

ENT Facts
Otoscopy reveals fluid and an immobile retracted membrane; tympanometry is the best means of diagnosis.

SMS Anemia
Anemia should be considered when the hemoglobin is <13.0 g/dL in elderly men and <12.0 g/dL in elderly women.

Milestones in Neurology
Alfons Maria Jakob (1884–1931) was a German neurologist with important contributions on neuropathology. Jakob published five monographs and more than 75 papers. His neuropathological studies contributed greatly to the delineation of several diseases, including multiple sclerosis and Friedreich’s ataxia. He first recognized and described Alper’s disease and Creutzfeldt–Jakob disease (the latter with Hans Gerhard Creutzfeldt). He accumulated immense experience in neurosyphilis, having a 200–bedded ward devoted exclusively to that disorder.

Mistakes in Critical Care
Place adequate space between the drug name, dose, and unit of measure. If the drug name and dose run together (especially problematic for drug names ending in "L" such as Tegretol300 mg) one can end up in problem. For example Tegretol300 mg may be misread as Tagretol 1300 mg.

LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009

Drug Name Indication Approval Date
Retapamulin Ointment 1%
For the topical treatment of bacterial skin and skin structure infections:– Primary impetigo, secondarily infected traumatic lesions, secondarily infected dermatoses.


(Advertorial section)

Green Tea (Camellia sinensis) when used along with Unique Health Supplements like Sodium Metasilicate, Sodium,
Phosphate and Ammonium Chloride may help boost Body Metabolism to aid weight loss, block allergic response, slow down the growth of tumours, protect bones, fight bad breath, improve Skin, protect against Alzheimer's and Parkinson's disease and even delay the onset of Diabetes. The Combination is known to reduce the VLDL and LDL Levels and thus reduce the incidence of Stroke and Heart disease.

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

eMedinewS–PadmaCon 2010 
Will be organized at MAMC on July 4, 2010, Sunday to commemorate Doctors' Day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

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 hangama and live webcast. Suggestions are invited.

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 KK we are proud of you: Dr Jagjit Singh and medical fraternity, West Delhi
  2. Respected Dr Aggarwal, Kindly accept my congratulations for the well deserved award of Padamshri received by you. We all feel honoured about it. With regards: Meera Batra
  3. Heartiest congratulations to have won a great national honour. A matter of pride for medical fraternity: Dr. Manish
  4. Proud to be your student and congrats: Dr. Khanna, 9818912043
  5. Anger and aspirin (Dr Vishnu Singhal)
    Low dose aspirin can prevent anger precipitating heart attack.
  6. Nanotechnology and size of a nano particle (Dr Vishnu Singhal)
    1 Km = 1000 m
    1 m = 1000mm
    1 micron = 0.000001 m
    1 nano meter = 0.000000001 m
    1 pico meter = 0.000000000001 m