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emedinews is now available online on www.emedinews.in or www.emedinews.org
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


Dear Colleague

12th March 2010, Friday

Assay change: New cut off for PSA

A quiet switch in lab standards has artificially lowered prostate specific antigen (PSA) levels that may potentially lead to cancers being missed. Assays that have been calibrated to the WHO standards and gradually adopted since 2000 yield PSA levels 20–25% lower than those under the old Hybritech standards. About 34% of cancers would be missed if the traditional PSA cutoff of 4.0 ng/mL –– determined under the old standards –– continued to be used with assay values determined under the new standards. Hybritech was the first assay manufacturer in the 80s & the other players also followed this standard.

But not all manufacturers have switched to the new standard. Most lab reports do not indicate standard was used.

The entire literature is based on the Hybritech standard, but more than 50–60% of PSA assays around the country are now calibrated to the WHO standard. Few urologists and even fewer primary care physicians are aware of the issue. Physicians can calibrate the cut off, once they know about this and determine which standard PSA results follow. Guidelines need to clarify that approximately 3.0 ng/mL has to replace the 4.0 ng/mL PSA threshold that everyone is used to thinking of if used with the WHO standardized assays.

Dr KK Aggarwal
Chief Editor

News and Views (Dr G M Singh)

  1. Benzyl alcohol lotion 5% (BAL 5%), a non–neurotoxic topical treatment that kills head lice by suffocating them, is safe and effective in children as young as six months. It is the first non–neurotoxic compound to be FDA–approved investigators report in a study published online February 23 in Pediatric Dermatology.
  2. Patients who receive a dual–chamber or resynchronization devices, women, and patients with an enlarged left ventricle are at significantly higher risk for complications with implantable cardioverter defibrillators (ICD), according to data from the Ontario ICD Database.
  3. Medtronic developing MRI-compatible pacemaker system (Dr Monica Vasudeva) Medtronic Inc. has developed a pacemaker system that is MRI–compatible under most circumstances. Dr. Jerry Froelich, a professor of radiology who co–chairs the American College of Radiology’s Magnetic Resonance Making Safety Committee, says he’s not aware of pacemaker patients who have died after undergoing an MRI. But why risk it? It’s not something most people want to do.
  4. Regular exercise may help increase longevity and protect against heart disease

    According to research presented at the American Heart Association’s annual epidemiology and prevention conference, regular exercise may help protect against heart disease and increase longevity between the ages of 50 and 69.

Conference Calendar

Healthcare Investment Summit 2010 Date: March 16, 2010
Venue: The Claridges, New Delhi

Quote of the Day

Prayer is the coin paid to Gratitude. (Jessi Lane Adams)

Public Forum (Press Release)

Restricting salt in diet can lower heart disease risk

Restricting salt in the diet can lower the risk of developing heart disease by 25 percent and the risk of dying from heart disease by 20 percent, said Dr. K K Aggarwal, President, Heart Care Foundation of India, and Editor eMedinewS. Dietary intake of sodium among Indians is excessively high.

Quoting an Harvard Medical School study published in British Medical Journal, Dr Aggarwal said that among hypertensive individuals, lowering sodium is quite well established to lower blood pressure, but now it has been shown that reducing salt also has an effect on cardiovascular disease.

When people with ‘pre–hypertension’, reduced their salt intake by about 25–35%, they were 25% less likely to develop cardiovascular disease 10 to 15 years after the trial ended. There was also a 20 percent lower death rate from cardiovascular disease among those who cut their salt consumption.

Salt restriction is best achieved by avoiding salted, salt–cured and salt–smoked foods such as lunch meat, hot dogs, ham, olives, pickles and regular salted canned foods, and other prepared foods, which often use more salt than home–made equivalents. Foods we would never think of as salty, such as breakfast cereals, cookies, and even some soft drinks, often contain copious additions of sodium.

Question of the day

What Immunizations are recommended for patients with chronic liver disease?

Acute viral hepatitis in patients with chronic liver disease can lead to significant morbidity and mortality.

Literature suggests vaccination of all patients with chronic liver disease against hepatitis A and B unless they are already immune (Grade 1B).

However, there remains uncertainty about how chronic liver disease should be defined. It is possible, for example, that patients with fatty liver alone may not be at the same risk for serious morbidity from acute viral hepatitis as those with underlying hepatitis C. Until further data are available to better define the risks with specific forms of liver disease and the cost–effectiveness of vaccination strategies, immunization is advised for patients with all forms of liver disease regardless of its severity. The benefits of vaccination are expected to be greatest in those with relatively advanced disease or those at risk for progressive liver disease.

Literature suggests pneumococcal vaccine every five years and influenza vaccination yearly in patients with chronic liver disease, regardless of age (Grade 2B).

Patients with liver disease should receive standard immunizations that are applicable to an otherwise healthy population. This includes routine diphtheria and tetanus booster immunizations every ten years.

Hemophilus influenzae and Meningococcal vaccines should be administered to those who require a splenectomy.

Literature suggests not routinely obtaining antibody titers after immunization to determine efficacy (Grade 2B). Exceptions may be testing for response to hepatitis B virus vaccine in patients at increased risk for recurrent exposure. This includes health–care workers, patients on chronic hemodialysis, and other individuals (such as gay or bisexual men, and spouses of carriers).

eMedinewS Try this it Works

Reducing pain with lidocaine injections

The least painful method of lidocaine infiltration is deep dermal infiltration of a warm, buffered solution over 10 seconds with a 30–gauge needle. Buffering the slightly acidic lidocaine with sodium bicarbonate in a 10:1 ratio (10 mL of 1% lidocaine to 1 mEq/mL of sodium bicarbonate) has worked well.

Diabetes Fact

Abnormal regulation of these substances may contribute to the clinical presentation of diabetes.

Dr Good Dr Bad

Situation: A patient came with impaired fasting glucose (IFG). Dr Bad: You have diabetes.
Dr Good: Get an OGTT test done.
Lesson: Fasting and 2 hour glucose values are independent predictors of incident diabetes. Isolated IFG is not a high–risk condition. Lowering the diagnostic threshold increases the population–attributable risk of IFG 4–folds, but performing an OGTT captures additional diabetes progressors compared with the number identified by IFG. (Source: Diabetologia 2009 Feb 18.)

Make Sure

Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation. Reaction: Oh my God! You should do cervical swabs and consider starting antibiotics. Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis. It may respond to doxycycline and metronidazole.

Medi Finance
(BUDGET 2010–2011)


  • Interest charged on tax deducted but not deposited by the specified date to be increased from 12 percent to 18 percent per annum (this amendment is proposed to take effect from 01/07/2010).
  • No capital Gain on transfer of assets on conversion of small companies into Limited Liability Partnerships
Punjab & Sind Bank
Central Bank of India

Laughter the best medicine Actual medical record Discharge status: Alive but without permission. The patient will need disposition, and we will therefore get Dr. X to dispose of him.

Formulae in Critical Care

Calculation of blood sugar from HbA1C value Formula: HbA1C × 25 = average blood sugar (also called eag: estimated average glucose)

Milestones in Neurology

Samuel Alexander Kinnier Wilson (1878–1937) was a British neurologist who was born in Cedarville, New Jersey. In 1905 he moved to London, where he worked as registrar and pathologist at the National Hospital, Queens Square. Later he was appointed professor of neurology at King’s College Hospital. He first described progressure lenticular degeneration in 1912.

Mistakes in Clinical Practice

Avoid Latin directions for use. Write it out (eg, "every day" instead of qd).

SMS of The Day (Dr Jitendra Ingole, MD)


Be simple but look stylish!
Be tough but look soft!!
Don’t be tense; but look cool!
Be a winner; but look like a beginner!!

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

Patient of BPH, if not treated properly can develop overflow/urge incontinence, kidney failure, bladder stone, UTI and acute/chronic retention of urine.

Lab test (Dr Navin Dang)

Cervical cancer is the only cancer suggested by WHO for routine screening.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Mecobalamin 750 mg + Pyridoxine Hydrochloride1.5 mg + Nicotinamide 45 mg tablets

For the treatment of diabetic neuropathy


(Advertorial section)



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–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April) . Over 300 registrations done already.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs (Starts tomorrow)

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

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. Heartiest congratulations on being awarded Padma Shri: Vijay Srivastava, DGM P&S Bank, 9818859352
  2. Congrats for Padma Shri award: H.S. Virk, 9810403369
  3. Congratulations Sir. Great news: Madhu Jaju, 9810160036.
  4. Congratulations: Vijay Suman Maroo