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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


Dear Colleague

13h April, 2010 Tuesday

Tests confirm that ‘New’ heparin is less potent

The FDA says laboratory tests have confirmed that new heparin manufactured is 10% less effective than the blood thinner manufactured under the old one. FDA first announced the change in October, after manufacturers’ alerted the agency that new drug reference standards made heparin less effective than before.

The altered drug potency has not changed the recommended dosing or drug label for heparin, though the FDA advised healthcare professionals to exercise judgment in determining proper patient dosing. FDA said the following populations should be considered for individualized dosing regimens:

  • Pediatric patients requiring extracorporeal membrane oxygenation

  • Patients requiring cardiopulmonary bypass

  • Patients with potentially fatal thromboses

New standards were adopted after a panic in 2007, when hundreds of allergic reactions and deaths were reported from heparin that contained a contaminated ingredient imported from China. The contamination resulted in massive U.S. recalls and drug shortages. The recall expanded internationally as the contaminated Chinese ingredient made its way to heparin makers around the world. The events resulted in new USP manufacturing standards that ultimately produced "new" heparin –– a formulation now confirmed as having 10 percent less blood-thinning activity than the older drug. The FDA said the two cannot necessarily be used interchangeably.

Heparin manufacturers have developed new labeling systems to differentiate between new and old heparin. The changes in labeling indicating the "new" drug are as follows, by manufacturer:

  • APP: "N" after the expiration date

  • B. Braun: "N" after the lot number

  • Hospira: Lot numbers beginning with 82 or higher will be new heparin

  • Baxter: "N" before the lot number

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

News and views

1. Panel votes against new PDE4 inhibitor for COPD

An FDA advisory panel of pulmonology experts recommended against approval of the investigational drug roflumilast (Daxas), a phosphodiesterase 4 (PDE4) inhibitor, for treatment of chronic obstructive pulmonary disease. The safety and efficacy data are not strong enough to approve the drug as maintenance treatment for COPD patients with chronic bronchitis who are at risk of exacerbations.

2. Blood parameters may explain near-death experience

Altered blood levels of carbon dioxide and potassium may be partly responsible for the subjective sensations reported by many patients with near–death experiences. Cardiac arrest survivors in a prospective survey were more likely to report such phenomena as "life reviews," feelings of peacefulness and joy, and encounters with dead friends and relatives if they had higher–than–average blood levels of carbon dioxide and potassium during resuscitation (Dr Zalika Klemenc–Ketis, University of Maribor, Slovenia)

3. Telaprevir raises response rates in hepatitis C

Re–treating hepatitis C patients with standard therapy plus the investigational protease inhibitor telaprevir significantly improved the chances of eradicating the virus. Up to 53% of patients with genotype 1 of hepatitis C, who had failed to respond to treatment initially or had relapsed, had a sustained response when telaprevir was combined with standard treatment. In contrast, only 9% of patients re–treated only with standard therapy pegylated interferon alfa–2a and ribavirin had a sustained response. (April 8, 2010 New England Journal of Medicine.)

4. Fruits and veggies have small effect on cancer risk

Loading up on fruits and vegetables led to a "very small" effect on cancer risk, according to an analysis of data on the eating habits and health of almost 500,000 people in Western Europe. An increase in fruit and vegetable consumption of about 7 ounces a day reduced cancer risk by 3% during a median follow–up of almost nine years. A 3.5 ounce/day increase in total vegetable intake reduced cancer risk by 2%. (April 21, 2010, Journal of the National Cancer Institute.)

5. Vitamins won’t lower risk of pregnancy–related hypertension

Taking vitamins C and E during pregnancy won’t reduce the risk of serious adverse outcomes from pregnancy–associated hypertension or preeclampsia. In a randomized controlled trial, there were no differences in complications from those conditions between patients taking the vitamins and those taking a placebo. (Dr James M. Roberts, University of Pittsburgh). The findings provide no support for the use of vitamin C and E supplementation in pregnancy to reduce the risk of preeclampsia or its complications. (April 8, 2010, New England Journal of Medicine.)

Mnemonic of the Day (Dr Prachi Garg)






Orthostatic ↓BP

Potassium (↑K+)

Renal impairment



Celiac Disease (Dr Ishi Khosla)

Why worry?

Celiac disease is a significant medical condition often masked or mistaken for other diseases. Celiac disease is a huge iceberg, moving not so silently, across many of our lives.

What’s New: mild gestational diabetes update

A multicenter trial randomly assigned women with mild gestational diabetes (GDM) to a regimen of diet/blood glucose monitoring/insulin as needed or routine obstetrical care. The treatment group had a significant reduction in the rate of macrosomia, shoulder dystocia, cesarean delivery, and preeclampsia/gestational hypertension. (Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339.)

eMedinewS Fact about rheumatoid arthritis

Testing for the combination of anti–CCP antibodies and IgM RF may be better for excluding the diagnosis of RA than is achievable by testing for either antibody alone.

Quote of the day (Dr Santosh Sahi)

Happiness lies not in the mere possession of money, it lies in the joy of achievements, in the thrill of creative efforts. (Frankalin Delano Roosevelt)

Diabetes Fact

Adiponectin inhibits TNF–a and promotes insulin-simulated glucose uptake in skeletal muscle cells.

Public Forum
(Press Release for use by the newspapers)

Besan or gram flour has health benefits

If you are in doubt that your food may be the cause of your illness, try substituting one food each day. To began with, its best to use besan foods (gram flour) in place of wheat flour foods said Padma Shri and Dr B C Roy Awardee Dr. K K Aggarwal, President Heart Care Foundation of India

People suffering from celiac disease cannot digest a protein called gluten which is found in barley and wheat flour. This gluten triggers immune system in patients to damage small intestine villi. As a result, patient cannot absorb nutrients from food and remains malnourished which could lead to anemia, weight loss and fatigue. Celiac disease patients suffer from fat malabsorption.

A gluten–free diet is also recommended for patients with wheat allergy, dermatitis herpetiformis; multiple sclerosis, autoimmune disorders, autism spectrum disorders, ADHD, and some behavioral problems.

Gluten–containing cereals are wheat, barley, rye, oats and triticale. Gluten is also present as a food additive in the form of a flavoring, stablizing or thickening agent.

In these conditions one should switch over to gluten free foods. The best alternative is to shift from wheat flour to gram flour (besan)

Question of the day

Laser hair removal in dark–skinned indviduals. What are the loopholes?

The dilemma one faces during laser hair removal in dark–skinned individuals is between efficacy and safety. Concerns of safety may make one choose a longer wavelength, a greater pulse width and a lower fluence. But this may make the procedure less efficacious. Extra long pulse width (> 100 ms) combined with a higher fluence (> 40 J/CM2) may be an answer for coarse hair but there are no foolproof methods for thinner hair.

eMedinewS Try this it Works

ADHD or white–coat phenomenon?

During a clinical interview, the excess motor activity of adults who have attention–deficit hyperactivity disorder (ADHD) may be difficult to differentiate from the fidgety behavior of persons with anxiety caused by the medical setting (ie, the white–coat phenomenon).

In the case of ADHD, motor activity increases as the stimulating novelty of the interview diminishes and the patient struggles with impulses to move.

With white–coat phenomenon, however, motor activity tends to decrease as the interview proceeds and the patient becomes more comfortable.

Dr Good Dr Bad

Situation: The A1C status of a diabetic worsened in winter.

Dr Bad: It has nothing to do with winter.

Dr Good: Diabetes may worsen in winter.

Lesson: A prospective study of glycemic control during holiday time in type 2 diabetic patients demonstrated an influence of winter holidays on the glycemic control of these. The poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1C gain during the winter holidays are likely to contribute to the substantial increase in A1C that occurs every year among type 2 diabetic individuals. (Diabetes Care 2004;27(2):326–30.)

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.

Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.

Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.


Laughter the best medicine

This old man visits his doctor and after a thorough examination, the doctor tells him, "I have good news and bad news, what would you like to hear first?"

Patient: Well, give me the bad news first.

Intensivist: You have stomach cancer, I estimate that you have about two years left.

Patient: OH NO! That’s awful! In two years, my life will be over! What kind of good news could you probably tell me, after this???

Intensivis: You also have Alzheimer’s. In about three months you are going to forget everything I told you.

Formulae in Critical Care

Predicted endotracheal tube size for age

Formula: = 4 + (age/4) for pediatric age group.

Comments: Approximately size of the intubation tube is
the size of little finger of the patient.

Milestones in Medicine

1954 First successful kidney transplant performed

Lab Test (Dr Arpan Gandhi, Dr Dang lab Pvt Ltd.)

Serum Albumin: Is done to screen for liver or kidney disease or to evaluate nutritional status, especially in hospitalized patients

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Milnacipran 25/50mg Caps (Addl. Indication)

For the management of fibromylagia.


(Advertorial section)



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Contact: drkk@ijcp.com or 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 400 registrations already done.

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, IMSA (Delhi Chapter)

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

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

DMC Interaction on ‘Medical Ethics & Doctor–Pharma Relationship – New MCI Amendments’ postponed till further information

Readers Responses

  1. CONGRATULATIONS, Dr Krishan for adding another feather to your cap by becoming PADMA SHRI awardee. You have made MGIMS proud: Swaraj & Danny.

  2. Here is the link to doctors interested in 3 year residency training in Emergency Medicine at Delhi under the aegis of GWU, USA. http:// www. maxhealthcare.in/ services_facilities/ our_departments/ mer/ postgraduate.html. Thanks, Dr Vivek Chhabra

  3. Dear Doctor Aggarwal, First of all let me congratulate you for being awarded the Padma Shri. I feel honoured to receive copies of e–medinews from a Doctor of your repute and eminence. I was shocked and at the same time thrilled to read about the approval by US FDA for leech therapy. In fact Lord Dhanvantri our God of Health, thought to be an avatar of Lord Vishnu, holds a leech in his right hand. There is a temple for Lord Dhanvantri in Kerala (Nelluvaya, Trichur District). I request you to take up with the Government to bestow more recognition to our ancient system of Ayurveda by making it a part of MBBS curriculum instead of threatening to punish them if they prescribe products based on Ayurveda: K Venkita Subramanian, DY. Gen. Manager (Sales & Marketing) TTK Healthcare Ltd, Chennai. PH. 09791010895
    A: Thanks. US FDA is independent of India. We need seperate patents for each country. That is the reason why the US is geting most of the ayurvedic concepts patented as none of us are getting them patented there.