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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 ...

13th September, 2010, Monday

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

Frog skin may provide future source for NDM1

Frog skin contains natural substances that could be the basis for a powerful new genre of antibiotics. In a report at the 240th National Meeting of the American Chemical Society on August 26, the team of stalwart frog–fanciers described that using the frog skins they have identified more than 100 antibiotic substances in the skins of different frog species from around the world.

Scientists have known for years that the skin of frogs is a rich source of chemicals capable of killing bacteria, viruses, and fungi. Researchers have attempted to isolate those germ–fighting chemicals and make them suitable for development into new antibiotics. Success, however, has been elusive because froggy antibiotics tend to be toxic to human cells and certain chemicals in the bloodstream easily destroy them.

Conlon discovered a way to tweak the molecular structure of frog skin antibiotic substances, making them less toxic to human cells but more powerful germ killers. Similarly, the scientists also discovered other tweaks that enabled the frog skin secretions to shrug off attack by destructive enzymes in the blood. The result was antibiotics that last longer in the bloodstream and are more likely to be effective as infection fighters.
The skin of the mink frog, likewise, contains secretions that show promise for fighting Acinetobacter baumanii, an extremely antibiotic resistant bacterium.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

  Photo Feature (from the HCFI Photo Gallery)

Release of a campaign by a dignitary  always helps in reaching out to people.

Smt. Sheila Dikshit, Chief Minister Delhi launched a Campaign for Anemia–free India at a DMA function.
In the photo: Smt Sheila Dikshit, Chief Minister Delhi, Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President HCFI along with eminent doctors from DMA

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Among patients age 66 and above taking warfarin who require antimicrobial therapy for treatment of urinary tract infection, trimethoprim–sulfamethoxazole and ciprofloxacin appear to be associated with increased risk of upper gastrointestinal tract bleeding. In such patients an alternative antibiotic agent of a different class should be prescribed if feasible.

Fischer HD, Juurlink DN, Mamdani MM, et al. Hemorrhage during warfarin therapy associated with cotrimoxazole and other urinary tract anti-infective agents: a population–based study. Arch Intern Med 2010;170:617.

  National News

Dr Ashok Gupta has been nominated to receive the ‘Sheikh Hamdan Bin Rashid Al Maktoum International Award for Volunteers in Humanitarian Medical Services’ for the year 2009-2010. The award is given by Sheikh Hamdan Bin Rashid Al Maktoum Foundation, UAE. The award ceremony will be held on December 13, 2010 in Dubai, UAE.

IMA Election

Emedinews requests all its readers to support Padma Shri and Dr. B C Roy National Awardee Dr. K.K. Aggarwal, Sr Consultant and Dean Medical Education, Moolchand Medcity,who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well-known for his work in the field of public health and academics.

IITs to offer medical courses

IITs will now be able to offer medical education, permanent faculty positions to foreign nationals and admit foreign students at the post–graduate level. These decisions were taken at a meeting of the IIT Council headed by human resource development minister Kapil Sibal on Friday. The Institute of Technologies Act will have to be amended to enable IITs to offer medical courses. (Source: The Economic Times)

  International News

(Dr Monica and Brahm Vasudev)
Genetic factors may predict age of asthma onset

A study of more than 30,000 Danish twins suggests that genetic factors may play a significant role in the age of asthma onset. According to the authors, the study results can possibly be used to predict at what age an individual is most vulnerable. Asthma risk in the co–twin was significantly higher in monozygotic than in dizygotic twins (hazard ratio, 2.59). The risk of asthma in the co–twin decreased with increasing age at onset of asthma in the index twin. The study is reported online in the Journal of Asthma and Clinical Immunology.

New tool identifies frailty risk in elderly patients

A new study published online August 24 in BMC Geriatrics has found that the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE–FI), a new assessment tool, is a reliable and practical way of assessing risk for frailty in an elderly person. The variables used by the researchers for their definition of frailty included:

  • Exhaustion, identified after the question: "In the last month, have you had too little energy to do the things you wanted to do?"
  • Weight loss, identified by reporting a "Diminution in desire for food" in response to the questions: "What has your appetite been like?" "Have you been eating more or less than usual?"
  • Weakness, as assessed by handgrip strength using a dynamometer.
  • Slowness, identified as a positive answer to either of the following questions: "Because of a health problem, do you have difficulty that is expected to last more than 3 months walking 100 metres?" or "…climbing one flight of stairs without resting?"
  • Low activity, assessed by the question: "How often do you engage in activities that require a low or moderate level of energy such as gardening, cleaning the car, or doing a walk?"

CDC no longer recommends delaying influenza vaccine for elderly

The US Centers for Disease Control and Prevention (CDC) has stated that physicians should no longer delay vaccinating elderly patients against seasonal influenza until October or November, but instead encourage all patients aged 6 months and older to get immunized as soon as vaccine is available in their community. According to Carolyn Bridges, MD, associate director for science in the agency’s influenza division, contrary to past CDC guidance, seasonal influenza vaccine provides effective protection all through the entire influenza season, even for the elderly.

EINSTEIN DVT Data show promise

Data from the Phase 3 EINSTEIN–DVT trial presented at the European Society of Cardiology (ESC) Congress has shown rivaroxaban, an investigational oral anticoagulant to be as effective and safe as treatment with enoxaparin (Lovenox) plus warfarin (Coumadin) to prevent recurrent deep vein thrombosis. According to Harry R. Buller, MD, of the Academic Medical Center in Amsterdam, 2.1% of the rivaroxaban patients experienced recurrent DVT vs 3.0% of controls. Also, the net clinical benefit i.e. the primary efficacy endpoint of symptomatic DVT (a composite of recurrent DVT, nonfatal pulmonary embolism, or fatal PE) plus major bleeding also favored rivaroxaban, HR 0.67 (95% confidence interval 0.47 to 0.95).

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

  • Continue frequent, on-demand breastfeeding, including night feeding for infants
  • Introduce complementary foods beginning at six months of age
  • Increase food quantity as the child ages– while maintaining frequent breastfeeding
  • Provide 6– 8 month old infants approximately 200 kcal per day from complementary foods.
  • Provide 9– 11 month old infants approximately 300 kcal per day from complementary foods.
  • Provide 12– 24 month old children approximately width="550" kcal per day from complementary foods.
  • Local research is needed to determine the best combinations of foods and practices to achieve these levels of energy intake.


  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/ WHO, 2003.
  3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.
  Infertility Update

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

Q: We have been trying for a baby for three years and I was diagnosed as having endometriosis. Will test–tube baby treatment solve my problem?

A. IVF is the treatment of choice in women with severe or moderate endometriosis. However, depending on the severity of the endometriosis, surgery, intrauterine insemination can also be used.

Q: What is ICSI? How safe is it?

A.  ICSI is Intracytoplasmic Sperm Injection and is indicated for couples with very low sperm count. It is a safe procedure. However, in men who have a genetic defect, there is a small risk of transmission to the male offspring.

  Diabetes Update: Question of the day

What intervention is easiest, most beneficial and cost–effective in prevention of complications in diabetes mellitus? (Dr AK Jhingan, New Delhi)

At the time of the diagnosis of diabetes mellitus, about 50% of patients already have evidences of both micro and macrovascular diseases. The main factor is, persistently raised blood sugar levels. Other factors responsible for these complications are high blood pressure and high levels of LDL cholesterol and triglycerides, obesity.

  • Good control of blood sugar by maintaining both fasting as well as post–prandial blood sugar levels by lifestyle modification, oral hypoglycemic agents and by early initiation of insulin therapy can prevent the progression of disease. Aim of treatment is to keep HbA1C level around 6.5%.
  • Hypertension is the other factor which is responsible for both macro and microvascular complications. Aim should be to keep systolic blood pressure below 130 mmHg (preferably 120 mmHg) and diastolic blood pressure below 80 mmHg (preferably below 70 mmHg). Use of ACE inhibitors in type 1 diabetic patients and use of AR blockers in type 2 patients have shown good results in prevention of complication of diabetes. If one group of antihypertensive is not effective then combination of one or two groups or even three would help in control of hypertension.
  • LDL levels should preferably be kept below 100 mg. Triglycerides levels should be kept below 150 mg. Statins are very useful in bringing down the LDL levels and their role is very well established as a pleotropic agents to keep anti–inflammatory markers under control. Fibrates can be added to control high levels of triglycerides. Role of aspirin is also very well established in prevention of coronary events and should be a part of prevention strategy.
  Medicolegal Update

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

Can medical care be refused? Euthanasia and doctor assisted suicide

Seizing on the broad recognition of a right to refuse medical care, some have advocated expanding the right to include euthanasia and doctor–assisted suicide. In India, there is no provision of law/ethics, which permit doctor assisted suicide even for terminally ill/untreatable patient of carcinoma. In June 1997, the US Supreme Court ruled unanimously that there is no constitutional right to euthanasia or physician–assisted suicide. The majority view, written by Chief Justice Rehnquist, drew a distinction between the right to withdraw or withhold life–sustaining treatments as a liberty interest in being free of unwanted bodily invasion vs the right to physician–assisted suicide, which does not contain a liberty interest. The unanimity of the ruling suggests that it is unlikely to be overturned in the near future. Importantly, the Supreme Court did permit individual states to legalize these interventions.

  Medi Finance Update

Money Market Funds

Money market funds invest primarily in short–term (less than one year) government Treasury Bills (also called T–Bills) and corporate notes which pay a fixed rate of interest.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Phenobarbitone with any anti–asthmatic drugs.

Jan 1,2002

GRS 170(E)

  Lab Update

Prostate specific antigen (PSA)

Digital rectal examination (DRE) has minimal effect on PSA levels, leading to transient elevations of only 0.26 to 0.4 ng/mL, and PSA can be measured immediately after DRE.

  IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient came with tremors.
Dr Good: Check your blood sugar first.
Dr Bad: It may be Parkinsonism.
Lesson: Older adults may have more neuroglycopenic manifestations of hypoglycemia (dizziness, weakness, delirium, confusion) compared with adrenergic manifestations (tremors, sweating). These symptoms may be missed or misconstrued as primary neurological disease (such as a transient ischemic attack), leading to inappropriate reporting of hypoglycemic episodes by the patients. Hypoglycemic episodes in these individuals also increase the risk of adverse events with cardiovascular and coronary disease. (Diabetes Care 1997; 20:135.)

Make Sure

Situation: A patient on binasal oxygen developed Nasal Mucosal damage.
Reaction: Oh My God! Why was the oxygen given at 4 liter per minute?
Lesson: Make sure that oxygen via nasal catheter, is not given at a rate of more than 3 liter per minute.

Quote of the Day

"Faith is taking the first step, even when you don’t see the whole staircase" Martin Luther King Jr
(Contributed by Dr Prachi)

Hypertension Alert


  • Even with effective antihypertensive therapy, most patients who have had malignant hypertension still have moderate to severe chronic and acute vascular damage and are at continued risk for coronary, cerebrovascular, and renal disease.
  • Overall survival appears to have improved over time.
  • Patients with renal insufficiency tend to have a lower survival rate.
  Mind Teaser

Read this…………………


The answer for yesterday’s Mind Teaser: "Yesterday, Today, and Tomorrow!"

Correct answers received from: Dr. A. K. Saxena, Dr Abha Bhatnagar, Dr. R. K. Goel, Dr Rawat Purushottam Singh, Dr. Dinesh Kumar S, Dr Virender Prakash Gautam, Dr Nidhi Rawal, Dr. Anupam Sethi Malhotra, Dr.Susheela Gupta, Dr Antara Sablok, Dr Rashmi Chhibber, Dr Deepesh Agarwal, Dr Dinesh yadav, Dr R S Bajaj, Dr Meera Rekhari, Dr. Nagendra Gupta, Dr Deepak Bhardwaj, Dr. Vishal Bansal, Dr Anurag Jain, Dr Rajiv Dhir, Dr Kalpana Mohan, Dr Simran Singh, Dr.T. Samraj Dr.P.S.Sarma, Dr Neelam Nath, Dr. Manjesha

The answer for 11th September Puzzle: "Charcoal"
Correct answers received from: Dr. Akshat Bhargava, Dr.Satish Gunawant, Dr Mohit, Dr Shashi Saini, Dr S. Upadhyaya, Dr. G. Padmanabhan
Send your answer to ijcp12@gmail.com

  Humor Section

A toddler surprised his father by announcing one day that he was going to join the Army.
“But you can’t”, said his father. “you’re only an infant.”
“I’m going to join the Infantry

Funny But True Fact
Why love marriage is better than Arranged?? B’coz a "known devil" is better than an "unknown ghost".
(Dr Chandresh Jardosh)

  An Inspirational Story

The Echo of Life…

A son and his father were walking on the mountains. Suddenly, the son falls, hurts himself and screams: "AAAhhhhhhhhhhh!!!" To his surprise, he hears the voice repeating, somewhere in the mountain: "AAAhhhhhhhhhhh!!!"

Curious, he yells: "Who are you?" He receives the answer: "Who are you?" Angered at the response, he screams: "Coward!" He receives the answer: "Coward!" He looks to his father and asks: "What’s going on?" The father smiles and says: "My son, pay attention." And then he screams to the mountain: "I admire you!" The voice answers: "I admire you!" Again the man screams: "You are a champion!" The voice answers: "You are a champion!"

The boy is surprised, but does not understand. Then the father explains: "People call this ECHO, but really this is LIFE. It gives you back everything you say or do.

Our life is simply a reflection of our actions. If you want more love in the world, create more love in your heart. If you want more competence in your team, improve your competence. This relationship applies to everything, in all aspects of life. Life will give you back everything you have given to it.

  Readers Responses
  1. Dear Sir, I wish you many many happy returns of the day. I know I am a bit late but Happy belated birthday. I hope you had a great day and a very bright year ahead. Apurva Koirala.
  2. Dear Dr. K K, Four Way Test is really nice.........but how many those who profess to be most dedicated to this philosophy follow it in true sense in their own lives............I have not seen a single one so far??? Regards and regrets...Dr. Bhatia
  Public Forum

(Press Release for use by the newspapers)

Even children can have acidity

Children who have continuing recurrence of cough and croup could be suffering from stomach acid reflux problems 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.

Croup or ‘Kali Khansi’ as it is called in local parlance, is recognized by a loud cough that often sounds like the barking of a seal. The condition can cause rapid or difficult breathing, and sometimes wheezing. It is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger.

In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can trigger more swelling with any kind of viral or respiratory infection.

Identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated.

The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.

  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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