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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

11th June 2010, Friday

Precautions during the rainy season

Dear Colleague

How to prevent toenail fungus (as reported in Harvard Newsletter)

Fungi thrive in moist environments, so it’s important to keep toenails short and as clean and dry as possible. Here are some tips:

  • Dry the feet and toes thoroughly after showering or bathing. If you have a hair dryer, use it on a low setting to dry your toes.

  • Always wear shoes in locker rooms, in public showers, and around public pools.

  • Whenever possible, wear synthetic socks that wick moisture from your feet; if the feet sweat a lot, change the socks during the day.

  • Wear shoes that fit well and are made of breathable materials.

  • Avoid tight–fitting socks and stockings, which can trap moisture between the toes.

  • Don’t pick the skin around the toenails.

  • Use antifungal spray or powder in the shoes or on the feet.

  • Keep the pedicure instruments clean and disinfected, and if you use a pedicure salon, make sure the pedicurist does the same.

  • Don’t try to cover up the infected toenail with nailpolish. It will trap moisture and worsen the infection.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Blood Pressure Check Up of a Celebrity

Unhealthy lifestyle habits together with the highly competitive working environment contribute to lot of stress, which may manifest as high blood pressure. Heart Care Foundation of India (HCFI) recommends regular Blood Pressure (BP) Check Ups irrespective of age and has conveyed this message at various platforms. To also draw attention of the youth to this very important issue, HCFI has involved young celebrities in such efforts. In the photo: Gul Panag, Model and Actress, getting a BP check by Padma Shri Awardee Dr K K Aggarwal.

Dr k k Aggarwal

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


Trabectedin is a marine–derived antineoplastic agent which is undergoing clinical trials in the US for a variety of solid tumors, and approved in Europe for advanced soft tissue sarcoma. A report of extensive skin and soft tissue damage following subcutaneous extravasation has led to the recognition of the vesicant properties of this agent, and a general recommendation that it be administered through a central venous access device.


Theman TA, Hartzell TL, Sinha I, et al. Recognition of a new chemotherapeutic vesicant: trabectedin (ecteinascidin–743) extravasation with skin and soft tissue damage. J Clin Oncol 2009;27:e198.

Mnemonic of the Day (Dr Varesh Nagrath, M.D.)

High Anion gap metabolic acidosis


Lactic acidosis
EPilepsy /Convulsion
Diabetic ketoacidosis
Ethylene glycol toxicity
Renal Failure /CRF

News and Views (Dr Varesh Nagrath)

FDA approves the first in a new class of injectable drugs for postmenopausal osteoporosis

Denosumab, a new drug has been accorded FDA approval as the first in a new class of drugs for osteoporosis for postmenopausal women with osteoporosis at high risk for fractures. This group includes women with multiple risk factors for fracture; previous osteoporotic fracture or women who have not responded or are intolerant to other available osteoporosis treatment.

Denosumab is an injectable drug to be given by subcutaneous route by a healthcare provider once every 6 months to reduce bone destruction and to improve bone mass and strength. The drug should not be administered to patients with and may worsen particularly in patients with severe renal impairment. A calcium and vitamin D supplement should be given to these patients. There may be an increased risk for osteonecrosis of the jaw, atypical fractures, and delayed fracture healing as suppression of bone turnover with denosumab is considerable.

In the FREEDOM trial (Fracture REduction Evaluation of Denosumab in
steoporosis every six Months), denosumab (60 mg SC) was associated with lower incidence of vertebral, nonvertebral, and hip fractures in women with osteoporosis. The trial involved more than 7000 postmenopausal women between 60 to 91 years of age. Vertebral fractures reduced by 68%, hip fractures by 40% and nonvertebral fractures reduced by 20%. The most common adverse effects: Back pain, limb pain, musculoskeletal pain, hypercholesterolemia, and urinary bladder infections. Hypocalcemia, serious skin and other infections, and dermatologic conditions including dermatitis, rashes, and eczema were the serious adverse events reported.

2. Extended release naltrexone cuts down opioid use

Results of a double–blind, placebo–controlled, phase 3 presented at the 2010 Annual Meeting of the American Psychiatric Association note that a once–monthly injection of naltrexone was superior to placebo in cutting down use of opioids and also lessening opioid cravings in opioid–dependent patients. It was usually well–tolerated. The median percentage of opioid–free urine screens in patients taking extended–release naltrexone was 90% vs 35% in patients taking placebo (P < .0002).

3. Combination of medical food and antidepressants better

A combination of an L–methylfolate prescription medical food supplement (Deplin, Pamlab) with a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) greatly improves the depressive symptoms than an SSRI or SNRI given alone. Also, these improvements occurred more rapidly (by 23%) in the combination group compared with those treated with the monotherapy. The results of this retrospective medical record review study were presented at the American Psychiatric Association (APA) 2010 Annual Meeting.

News to use: Do it know

Before your mobile is lost

  1. Each mobile carries a unique IMEI i.e. International Mobile Identity No which can be used to track your mobile anywhere in the world.

  2. Dial *#06# from your mobile.

  3. Your mobile shows a unique 15 digit.

  4. Note down this no. anywhere but except your mobile as this is the number which will help trace your mobile in case of a theft.

  5. Once stolen you just have to mail this 15 digit IMEI no. to cop@vsnl.net

  6. No need to go to police.

  7. Your Mobile will be traced within next 24 hrs via a complex system of GPRS and internet.

  8. You will find where your hand set is being operated even in case your number is being changed.

Interesting tips in Hepatology & Gastroenterology (Dr Neelam Mohan)

If a newborn with jaundice passes dark urine that stains the nappy, it is always pathological. Do urgent bilirubin (total and direct). If direct bilirubin is >2mg/dl, it indicates neonatal cholestasis. One in 3 cases of Neonatal Cholestasis is due to Biliary Atresia, a condition wherein the bile duct is atretic or not formed since birth. This needs to be identified and operated early as surgery beyond 6–8 weeks has a poor outcome. Message: Consider neonatal cholestasis as an emergency.

Conference Calendar

Dermacourse 2010
Theme: "Case Discussions in Dermatology and Leprosy and sessions in Emergency Dermatology and Dermatopathology"
Date: June 19–20, 2010
Venue: Interact Lecture Hall, KMC Manipal, Udupi, Karnataka.

Quote of the day (Dr Santosh Sahi)

"Our greatest glory is not in never failing but in rising up every time we fail" Ralph Waldo Emerson

Question of the Day

Is IPV avaible in India and what is the schedule of administration? (Dr Harish Pemde)

Yes, IPV is available in India. IPV is not to be given at birth. Birth dose of OPV is given to sensitize the gut, IPV does not do this hence IPV is not useful when given at birth.

  • As a part of primary vaccination in infants, IPV can be given with DPT at 6, 10, 14 weeks of age and a booster dose at 15–18 months and at 5 years of age.

  • In previously unvaccinated children this can be given at 0, 1–2, and 6 months and booster dose after one year till 5 years of age.

The Government of India is considering the use of IPV as additional doses at 0 and 2 months in children up to 5 years of age in some district of UP

MedinewS Try this it Works

Sure–to–please low–fat cheese

Sliced fat–free cheese does not melt well because it becomes dehydrated. But, simply marinating the cheese for 2 minutes in either water or broth allows it to melt.


Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

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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A Conversation with Dr Devi Shetty… (Member MCI); News from the web

IWHTA President Mr. Naresh Jadeja with Dr. Devi Shetty, discussing indian hospitals, doctors, government support and MCI.

He is called the Henry Ford of Heart surgery. Dr Devi Shetty is the chairman of Narayana Hrudalaya, the largest cardiac hospital for children in the world. Narayana Hrudayalaya group currently has 5000 beds in India and aims to have 30,000 beds in the next 5 years. Narayana’s 42 cardiac surgeons performed 3,174 cardiac bypass surgeries in 2008, more than double the 1,367 the cleveland clinic, a U.S. leader, did in the same year. His surgeons operated on 2,777 pediatric patients, more than double the 1,026 surgeries performed at Children's Hospital in Boston. He is also planning a 2,000 bed general hospital in Cayman Island, an hour’s plane ride from Miami to attract uninsured and underinsured American patients.

Naresh Jadeja: Why do you think India is going to be the top medical tourism destination?

Dr Devi Shetty: The major factor is cost. It will be definitely lower in India compared to any other part of the world, even far cheaper than Africa. Today Medical Tourism is looked as an alternative, but it is a matter of time before people will run out of options. Health care Travel is for better outcomes and India can offer everything they need in terms of lower cost, best doctors and great infrastructure.

Naresh Jadeja: If you have to compare infrastructure, equipments in Indian hospitals and those in USA and Europe then what is the situation of Indian hospitals?

Dr Devi Shetty: The outcome of the healthcare is the outcome of the interaction between man (Doctor) and the machine. You just need a Man, Machine and the roof. There is not a big technology in building a roof. So then let’s talk about the Man or Woman behind the machine. Our specialist is ten times more experienced than medical specialists in USA and Europe. I will give you an example, In US when a heart surgeon retires after 30–35 years of active professional life he would have done around 2500–3000 heart surgeries in his whole life while we have surgeons who have done more than 3000 surgeries and they are still in their thirties. We have nurses who are 22–25 years old and have looked after more heart patients than the nurse who is about to retire in America. Now if you have ten times more experienced doctors and nurses than US and Europe and you have the same equipments that is being used in US then you can expect the healthcare outcomes. If you talk about the equipments, there are only 4 manufacturers in the world who manufacture the top line of medical equipments; it is GE, Siemens, Phillips or occasionally other specialist manufacturer. These machines are not developed here nor they are available in some specific countries. Anyone with money can buy it, in fact we are the largest buyers of medical equipments in this part of the world. So if you have expertise (Doctors and nurses) and if you have infrastructure, then anyone can understand the outcomes. It is not rocket science to understand that we can offer same or better services than the US, not that we are gifted or anything, but it is just that we see more number of patients.

Dr Good Dr Bad

Situation: An elderly patient came with low energy levels.
Dr Bad: It may be due to diabetes.
Dr Good: Get TSH done.
Lesson: Diabetes mellitus and primary hypothyroidism are common disorders in elderly subjects. Since the clinical features of hypothyroidism in the elderly are often atypical, it is recommended that elderly subjects should be screened for hypothyroidism. (Eur J Epidemiol 2000;16(1):43–6)

Make Sure

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes, to which the isolate is susceptible, are given and that one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

Humour Section

IMADNB Joke of the Day (Dr Tarun)

The teacher put a question to the class: "What does a cat have that no other animal has?"

A number cried in unison: "Fur!"

But an objector raised the point that bears and skunks have fur. One pupil raised an eager hand: "I know, teacher, whiskers!"

But another objector laughed scornfully."Haw–haw! My papa has whiskers!"

The suggester of whiskers defended her idea by declaring: "My papa ain’t got whiskers."

"‘Cause he can’t!" the objector sneered. "Haw–haw! Your pa ain't no good. My pa says…" The teacher rapped for order, and repeated her question.

A little girl raised her hand, and at the teacher’s nod spoke timidly.


Funny definitions

Anatomy – something that everybody has but somehow looks better on a girl

Formulae in Clinical Practice

Vital capacity (VC)

Formula: VC = TV + IRV + ERV
TV = Tidal volume, IRV = Inspiratory reserve volume, ERV = Expiratory reserve volume.

Milestones in Dermatology

Melanoma: William Norris, an English general practitioner from Stourbridge, in 1820, presented the first English language report of melanoma. In his later work in 1857 he remarked that there is a familial predisposition for development of melanoma.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

BCR/ABL, mRNA Detection, Reverse Transcription–PCR (RT–PCR), Quantitative, Monitoring Assay Monitoring response to therapy in patients with known e1/a2 bcr/abl fusion formsat chromosome 9q23) is detected in all chronic myelogenous leukemia (CML) patients and a subset of both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Lidocaine Lozenges 200/300mg

For single agent anesthesia in upper gastrointestinal endoscopy.



MCI News

Court extends judicial custody of ex-MCI president Ketan Desai (PTI report)

A Delhi court extended by 12 days the judicial custody of former Medical Council of India (MCI) president Ketan Desai and two Punjab-based doctors of a private medical college in an alleged graft case. Additional Sessions Judge O P Saini sent them to jail till June 19 after they were produced before him on the expiry of judicial remand. J P Singh, an alleged Delhi-based tout and fourth accused, has recently been granted bail by the Delhi High Court, which, however, rejected the plea of former MCI president saying his role was "far more serious" in the case. They have been booked under the Prevention of Corruption Act dealing with inducing a public servant to accept bribe, criminal misconduct and payment of money. Based on contents of intercepted telephonic calls made among the accused, CBI had laid a trap outside the south Delhi residence of J P Singh, which led to his arrest and that of Kanwaljit.

Public Forum (Press Release for use by the newspapers)

Guidelines on Health

In the light of the increasing incidence of various ailments, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India has released a few guidelines.

  • Keep your blood cholesterol less than 160 mg%. Even 1% reduction in cholesterol reduces the chances of heart attack by 2%.

  • Uncontrolled diabetes and blood pressure can precipitate a heart attack. Keep these under check.

  • Eat less, walk more.

  • Regular exercise is good for health. The best exercise is 'wogging' which is a brisker than brisk walking.

  • Soya products are good for health. These should form an essential ingredient of the diet.

  • Fruits are better than juices. Brown rice better than polished rice and jaggery better than white sugar. Eat high fibre diet.

  • Driving and drinking do not go together.

  • Pregnant women must not drink. It harms the baby in the womb.

  • Get your health checkup done at least once in a year.

  • Salt intake should be restricted.

  • Avoid 'APC' where A stands for achar, P for papad and C for chutney.

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

13th June Sunday IMSA Workshop with Dr KK Aggarwal Moolchand Medcity 8-0am

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 Responses

  1. It’s crucial to get your infant or child vaccinated against a host of deadly germs. But that doesn’t make it less painful for the child or concerned parents: Suggestions to help parents calm a baby or child who needs a shot: Before the shot is given, apply gentle pressure to the skin where it will be given; Keep calm and relaxed yourself. A child can pick up on a parent’s anxiety; Talk to the baby in a calm, soothing tone; Embrace your child on your lap, facing you and Offer a distraction, such as a toy. Or sing a song together: Dr GM Singh

  2. READ IT ………CAREFULLY....: An incident took place in Pune – a young girl was attacked by a man posing as a plain clothes officer; he asked her to come to the police station when she & her male friend didn’t have a driver’s license to show. He sent the boy off to get his license and asked the girl to accompany him to the police station. Took her instead to an isolated area where the horrendous crime was committed.

    The law (which most of us are not aware of) clearly states that between 6 pm and 6 am (from sunset until sunrise), a woman has the right to REFUSE to go to the Police Station, even if an arrest warrant has been issued against her. It is a procedural issue that a woman can be arrested between 6pm and 6am, if and ONLY if she is arrested by a woman officer & taken to an ALL WOMEN police station… And if she is arrested by a male officer, it has to be proven that a woman officer was on duty at the time of arrest.

    Dr C.P.Bansal, cpbansal@gmail. com