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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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


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  Editorial …

14th September 2011, Wednesday

Bisphosphonate Update

  • A FDA advisory committee wants FDA to limit the duration of bisphosphonate therapy for treatment of osteoporosis, but the committee could not agree on what that time limit should be.
  • FDA wants bisphosphonates use warning on the label that optimal duration of use hasn’t been determined, and that all patients on bisphosphonate therapy should have their need for continued therapy re–evaluated periodically.
  • The issue has become a hot potato for the FDA as reports have emerged linking long–time bisphosphonate therapy with increased risk of atypical fractures.
  • Placebo–controlled trials typically provide data for only five years of therapy, but there is no strong clinical evidence that bisphosphonates work better after they’re used for a long period of time, nor is there firm evidence that long–term use causes harm.
  • Bisphosphonates have been shown to reduce the risk of breaking a hip by 40% to 50% and fracturing a vertebra by between 40% and 70% by inhibiting bone resorption to prevent loss of bone mass.
  • In 2010, the FDA required makers of bisphosphonate drugs to add a warning to their labels about a small increased risk of atypical femur fractures after an American Society for Bone and Mineral Research task force concluded that the risk, although it is small, is real.
  • The panel was also concerned with the drug's link to deterioration of the jawbone. In 2005, the FDA added a warning on bisphosphonates about osteonecrosis of the jaw, a rare disease in which the bone in the jaw dies.
  • There are also some data suggesting a link to long–term use of bisphosphonates and esophageal cancer. A study in the New England Journal of Medicine used data from FDA’s Adverse Event Reporting System to identify and describe 23 patients taking alendronate who were diagnosed with esophageal cancer.
  • There’s no doubt that these are very efficacious drugs that reduce fractures and mortality. But the issue is that should this drug be used for more than three years.
  • Some suggest taking a "drug holiday" or taking a break for bisphosphonate treatment in order to minimize risks.

For More editorials...

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Bisphosphonate Update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Anmol - A Health Festival for Children with Special Needs. The special children are not disabled but differently abled. If they lose one of the senses, other senses invariably become predominant. Students in the poster making competition.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Govt suspends AIDS vaccine trial

Further trials on prime–boost AIDS vaccine being tested in Pune and Chennai have been suspended after Phase I trial results showed that the vaccine candidate is too unstable to be scaled up. "The vaccine is safe and elicits a modest immune response against HIV, the virus that causes AIDS, but simulated large–scale manufacturing studies of the gene insert (TBC–M4) made the vaccine unstable, which means it cannot be mass produced," Rajat Goyal, country director, International AIDS Vaccine Initiative (IAVI), told Hindustan Times. IAVI is the research partner for the vaccine trials that took place at the National AIDS Research Institute (NARI), Pune, and National Institute for Research in Tuberculosis, Chennai. Phase I trials are conducted on healthy people between the ages of 18 and 50 years to establish safety for human use The findings will be presented on September 14 at the AIDS Vaccine 2011 conference in Bangkok. (Source: Hindustan Times, September 12, 2011)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

Insulin nasal spray may slow Alzheimer’s disease

Intranasal insulin therapy may have beneficial effects on cognition and function among patients with Alzheimer’s disease, a pilot study suggested. Patients who received 20 IU of intranasal insulin daily for four months had improvements on delayed story recall tests (P=0.02, Cohen f effect size=0.36), according to Suzanne Craft, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues. (Source: Medpage Today)

For comments and archives

Implanted heart device infections deadly, costly

Infections associated with cardiovascular implantable electronic devices are tied to higher rates of death during hospital stay and over the long term, researchers found. In adjusted analyses, patients with infection had significantly increased inpatient mortality compared with those who didn’t have an infection, and the rate ratios varied by device type (RR 4.8 for CRT–D to 7.7 for CRT–P, P<0.001 for all), Muhammad Sohail, MD, of the Mayo Clinic in Rochester, Minn., and colleagues reported online in Archives of Internal Medicine. (Source: Medpage Today)

For comments and archives

Algorithm improves asthma care in pregnancy

The number of asthma exacerbations was cut in half among pregnant women when treatment decisions were guided by measurements of their fraction of exhaled nitric oxide (FENO), a randomized trial found. The rate of exacerbations was 0.288 per pregnancy in a group of women who had routine testing of FENO, and doses of inhaled steroids and long–acting β–agonists adjusted according to the results, reported Peter G. Gibson, MBBS, of the University of Newcastle in New South Wales, Australia, and colleagues. (Source: Medpage Today)

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

The most effective form of exercise to get rid of fat in the abdominal area.

Researchers at Duke University Medical Center conducted a study that involved following 296 overweight and sedentary adults for eight months. Participants were randomized to one of three groups: aerobic training exercise, resistance training exercise or a combination of the two modes of exercise. The aerobic group performed exercises equivalent to 12 miles of jogging per week at 80% maximum heart rate. The resistance group performed three sets of 8 - 12 repetitions of various strength exercises, three times per week. The research clearly indicated that although both forms of exercise were effective at reducing body fat, aerobic exercise reduced abdominal fat more than weight training alone did.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJOR Inadequate exercise is a leading cause of increased medical costs You’ve heard it before – exercise... fb.me/DdY3LkgK

@DeepakChopra: Rewire your brain for higher consciousness by paying attention to love, compassion, and joy.

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Can the risk of heart attack after sexual act be minimized?

a. The triggers to acute heart attack are increase in heart rate, blood pressure, and myocardial oxygen demand, as well as increased platelet agreeability and coagulation in combination with a vulnerable coronary plaque1.
b. Drugs that reduce heart rate or blood pressure or inhibit platelet aggregation reduces the risk of triggers of heart attack.
c. Beta blockers minimize or eliminate angina heart pain during sexual act.
d. The Determinants of Myocardial Infarction Onset Study showed that beta blockers reduced the risk of MI following anger2 but not sexual act3.
e. Aspirin lowers the risk of heart attack following anger3and the morning waking hours4.


  1. J Am Coll Cardiol 1994; 23:809.
  2. Circulation 1995; 92:1720.
  3. JAMA 1996; 275:1405.
  4. Circulation 1990; 82:897

For comments and archives

    Spiritual Update

Fast food is good for health but not junk food

Natural Fast food means which is available readymade and does not require any preparation. The examples are milk, fruits, salad, dry fruits etc. There are also semi-fast foods which need preparation but once prepared are ready to eat in future. The examples are curd, roasted cereals, roasted rice, roasted gram and sattu.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)


Alas. It is good to reminisce. But how come when you reminisce, you can’t help but to remember the not so good ones? How can you prevent the feeling from even entering your mind? You can never tell…

To reminisce is to understand. When you reminisce, you understand things you never understood before. To understand different thoughts and ideas, to understand the value of friendship and especially to understand the value of loyalty. I have experienced reminiscing. Now I ask myself, WHY? Does it have to do anything about me? Maybe God wants me to change something. To change things that are wrong. Quoted from Lion King III: "You won’t change the past, so why worry?"

Again, why worry? Because it is our responsibility to change things we feel wrong. We have to make sure that everything is right in order to have a beautiful and peaceful life. But on the other side, we cannot remove the obstacles and trials in our lives. It is part of the tapestry of living and cannot be broken and scratched out by any means at all. To reminisce is to remember good times. To remember the unforgettable days and wished you were back in time. Again, I say to myself over and over again, I cannot turn back time. I just can’t. I also say to myself that it is not good to dwell in those memories forever because you have to move on. There is a big world waiting for you out there-waiting for you to change it, waiting for you to unfold and reveal its mysteries.

But then again, it is not good to reminisce forever. You must face and take the world in your hands and with the help of our Lord, you must overcome any trials and obstacles ahead for you to be worry–free in your life.

For comments and archives

    Gastro Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

How common is Allagille’s?

Allagille’s occurs approximately once in every 100,000 live births with equal incidence between boys and girls. For a couple who already have an affected child, the risk of a further child being affected are 1 in 30 if neither parent has any signs, and 1 in 10 if one of the parents has signs of the syndrome.

For comments and archives

  Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist, Max Hospital)

CUPART 2011 (Current Practices and Recent Advances in ART)

Interesting Highlights

Breakfast with Experts

This one hour breakfast session will allow personal interaction with Experts.

Topics: Polycystic ovaries and ovarian stimulation, Optimum utilization of consumables and media and Optimizing pregnancy outcomes – a lab perspective, Oocyte Donation, Embryo Transfer, Endoscopy in Fertility, Complications in IVF and Fertility Preservation – Indications and Methods Experts: Dr Neena Malhotra (AIIMS), Dr Kuldeep Jain (New Delhi), Dr Mangla Telang (New Delhi), Dr Srikanth Yatnale (Pune), Dr Sudesh Kamath (Mumbai), Dr Alok Teotia (New Delhi), Dr Alison Taylor (UK), Dr Parul Sehgal (New Delhi), Dr Nalini Mahajan (New Delhi), Dr Yakoub Khalaf (UK), Dr KD Nayyar (New Delhi), Dr Anjila Aneja (New Delhi), Dr Meena Naik (New Delhi), Dr Pradeep Garg (AIIMS), Dr Adrian Shulman (Israel), Dr Anoop Gupta (New Delhi), Dr Rajesh Balakrishna (Pune), Dr Neerja Bhatla (New Delhi), Dr Harit Chaturvedi (New Delhi), Dr Mahiraj Singh Gaur (Assam) and many more

Session 5 – Fertility and Endoscopy

All endoscopic techniques which enhance ART outcomes will be highlighted by authorities in gynecological endoscopic surgery.

Speakers: Dr Urvashi Jha, Dr Alka Kriplani, Dr Anjila Aneja, Dr SS Trivedi (New Delhi)

Key note Address

Highlights: This important key note address will cover all aspects from superovulation to luteal support and highlight what factors play a key role in affecting outcome.

Factors Influencing IVF Outcome – Prof Adrian Shulman, Director, IVF Unit, Meir Medical Unit, Israel

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  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Anticardiolipin antibodies

Anticardiolipin antibodies are used to help investigate inappropriate blood clot formation, to determine the cause of recurrent miscarriage, or as part of an evaluation of antiphospholipid syndromes.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with cardiomyopathy.
Dr. Bad: It is primary cardiomyopathy.
Dr. Good: Rule out atherosclerosis.
Lesson: Cardiac atherosclerosis is the most common cause of cardiomyopathy (in 50–70% of patients of heart failure).

For comments and archives

Make Sure

Situation: A patient having 106 degree fever with dry axillae died.
Reaction: Oh my God! Why was aggressive management not given?
Lesson: Make sure that patients with high fever with dry axillae are treated on the lines of heat stroke.

For comments and archives

  Quote of the Day

(Dr Chandresh Jardosh)

On the path of success always lies big O’s, Many read them as "Obstacles". Only few read them as "Opportunities". Always be one among the few.


Icing on the Cake: When you already have it good and get something on top of what you already have.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Rape victim and medical examination

  • A woman who has been raped often encounters painful and humiliating procedures when she reports her sexual assault even in hospital emergency room where she may wait a long time for a medical examination and the collection of evidence that is needed to convict a suspect. She often has little privacy while she waits.
  • The offence of rape is not only a brutal and crime against human body, it also affects mind and soul of victim and causes rape crisis syndrome. The Doctor examining a rape victim in hospital should listen and act fast as counselor to release some of the emotions to feel victim calm and comfortable.
  • A program called SANE (Sexual Assault Nurse Examiners), established in Tulsa, Oklahoma and several other US cities, and seeks to treat the emotional, physical, and legal needs of rape victims with greater consideration and sensitivity
  • A medical professional should test you for STDs, including HIV/AIDS to start treatment courses for protection against developing these diseases, including treatment to prevent an unwanted pregnancy.
  • A medical examination is done to check for any internal injury that might have been caused by the rape.
  • A medical professional or trained technician may look for and take samples of the rapist’s hair, skin, nails, or bodily fluids from victim clothes or body.
  • If you think you've been given a rape drug, a doctor can test for this, too. Be aware that this toxicology test covers any and all illegal drugs.
  • At any time during the medical exam, the victim can say that she does not want a certain test performed or evidence collected. All procedures are being done to help victim and can only be done by valid consent of victim.
  • Victims must be seen in private rooms that are decorated to avoid the look of a sterile, hospital waiting room.
  • The nurse examiner allows the victim to complete the examination at her own pace, from 1 to 5 hours.
  • A police officer should be requested to be available to transport the evidence to laboratory for analysis.

(Ref:TC Carmody. 2002. A Feminist Repudiation of the Rape Shield Laws. Drake Law Review 51 Octobe).

For comments and archives

    Mind Teaser

Read this…………………

1. Which of the following chemotherapy drug is likely to be toxic to gonads?

a. Adriamycin
b. Vinblastine
c. Paclitaxel
d. Procarbazine

Yesterday’s Mind Teaser: Helicobacter pylori (H. pylori) is a known cause of peptic ulcer disease. It was discovered in Australia in 1987. Which of the following statements is not true regarding H. pylori.

a) Its infectivity is highest in developed world.
b) Person to person transmission is common.
c) It is seen in populations with low socioeconomic status.
d) H. pylori is a gram negative microaerophilic bacteria.

Answer for yesterday’s Mind Teaser: a) Its infectivity is highest in developed world.

Correct answers received from: Dr YJ Vasavada, Dr Rajshree Aggarwal, Dr Shikha Jain, Dr Rawat Purushottam Singh, Dr Chandresh Jardosh, Dr K Raju, Dr Neelam Nath, Dr Jainendra Upadhyay, Anil Bairaria.

Answer for 11th September Mind Teaser: 3. Flexor carpi radialis
Correct answers received from: Dr Avtar Krishan, Dr KV Sarma, Dr Anjani, Dr Anil Kumar Jain,
Dr K Raju, Dr Dilip Kumar Jha, Dr BB Aggarwal, Dr Atul Kumar Heda, Dr Sukanta Sen.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. Chandresh Jardosh)

A man by court order had been seeing a psychiatrist for over a year. One day he walks into the doctor’s office, takes a seat, and is ready to start their session. The doctor looks at him, smiles and says: "The therapy must be working. You seem happy, well adjusted, and enjoying your life." The man smiles back and says: "I haven’t felt better!!! I owe it all to you. But it’s my brother I’m really worried about…he thinks he’s a chicken." The doctor’s face drops and with a solomn look he says: "My god, why don’t you have him committed?!" The man, in deep thought replys: "I would…but I really need the eggs!"

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Gatifloxacin Eye drops 5 mg/ml

For the treatment of bacterial conjunctivitis caused by susceptible strains


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Controlling five lifestyle risk factors can prevent diabetes

Being an Asian is a genetic risk factor for developing diabetes but modifying risk factors can prevent diabetes. In Vedic era, diabetes was not so rampant even though the genes were the same genes.

A new study of over 200,000 adults published in the September issue of Annals of Internal Medicine has shown that a combination of five healthy lifestyle factors is associated with a reduced risk of developing diabetes, said Padma Shri and Dr B C Roy National awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela. Each factor one incorporates into the life style can lower diabetes risk by 31 percent for men and 39 percent for women and all five risk factors together can lower risk by 80 percent.

The lifestyle factors are:

  1. Following a healthy diet (high fiber, low saturated fat, zero trans fats, low refined carbohydrate, low salt, high in fruits). Refined carbohydrates are white rice, white maida and white sugar.
  2. Optimal body weight (less than 23 × height in meters × height in meters for Asians)
  3. Engaging in recommended amounts of physical activity (minimum 80 minutes of moderately strenuous exercise per week). Our recommendation is to walk 80 minutes a day and for 80 minutes per week the speed should be 80 steps per minute
  4. Those who drink, do not want to stop and there is no contraindication, limit alcohol use to no more than one drink per day for women and two drinks per day for men. Definitions of a "standard drink" differ. For different countries, a standard drink is generally considered as follows: United States: 14 to 15 g alcohol (0.5 to 0.6 fl oz), equivalent to 12 oz beer, 5 oz wine, and 1.5 oz of 80 proof liquor; Great Britain: 8 g alcohol; Japan: 19.75 g alcohol and India 10 g alcohol. 10 grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor.
  5. Not smoking.

Being overweight or obese is the strongest lifestyle determinant for whether a person develops diabetes, but those who are already overweight or obese may still be able to reduce their risk by adopting other healthy lifestyle factors.

While family history of diabetes is strongly linked to the disease, people may be able to largely prevent or delay diabetes by leading a healthy lifestyle.

For comments and archives

    Readers Responses

Hi, We all do hysterectomies.. some do for valid indications.. some do just for money without any indication.. its become common practice to do hysterectomy in some parts of our country including my state (Kerala) without valid indications. After central government and state government started RSBY scheme for BPL patients, some doctors started doing hysterectomies without any indications. Common indications I have observed –– retrospective history from patients –– are:

  • Menorrhagia single episode – did hysterectomy without trying medical line in single cycle also
  • DUB – not done any medical management – single episode of bleeding also underwent hysterectomy
  • Leg pain, low back ache, ankle joint pain are the commonest reasons for hysterectomy– is all justified?

I came across 21 – 25 year old women who underwent hysterectomies for leg pain. FOGSI and KFOG should take up this issue and we should start auditing for hysterectomies. I know few doctors –– they go to villages and do camps and do hysterectomies saying that uterus and ovaries causes cancer if you keep them after completing family. Is this justified? General surgeons do hysterectomies for any pain abdomen and non gynecological indications. Is this justified? Why do they have to do these surgeries. There should be valid indications. Removing uterus and ovaries in young age is not at all justified when done without indications. The RSBY schemes is not audited properly. Hope someone will take up this issue one day or other. Dr Biju. P, Hon Secretary, Kollam Obstetrics and Gynecological Society, Kerala.

    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta