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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

16th February 2010, Tuesday

Obese children more likely to die prematurely

Have you ever seen an obese man crossing 100 years. Most elderly will be thin built. A study published in the New England Journal of Medicine that tracked 4857 children through adulthood has also shown that the heaviest youngsters were more than twice as likely as the thinnest to die prematurely, before age 55, of illness or a self–inflicted injury.

Youngsters with pre–diabetes were at almost double the risk of dying before 55, and those with high blood pressure were at some increased risk.

It was obesity that was most closely associated with an early death.

Children who were the heaviest, were more than twice as likely to die early from natural causes, such as alcoholic liver disease, cardiovascular disease, infections, cancer, and diabetes, as children whose weight put them in the lowest quarter of the population.

Dr KK Aggarwal
Chief Editor

Photo Feature

Dr KK Aggarwal being felicitated by the Delhi Medical Council for being awarded with Padmashri. Also in the photos are Dr A K Aggarwal President DMC and Dr Kiran Mishra.

DMC Felicitation

News and Views

New guidelines for dangerous VT

The new statement, published online in Circulation, the Journal of the American Heart Association and the Journal of the American College of Cardiology, included the following signs of impending torsade de pointes:

  1. An increase of 60 ms in heart–rate–corrected QT interval (QTc) from the preadministration baseline
  2. Marked QTc interval prolongation of more than 500 ms
  3. The characteristic ‘twisting’ of the points on ECG as T–U wave distortion becomes more exaggerated in the beat after a pause
  4. Visible (macroscopic) T–wave alternans
  5. New–onset ventricular ectopy
  6. Couplets and nonsustained polymorphic ventricular tachycardia initiated in the beat after a pause

Prompt recognition of these ECG harbingers allows for treatment with intravenous magnesium, removal of the drug that induced the condition, and correction of electrolyte abnormalities and other exacerbating factors, including the prevention of bradycardia and long pauses with temporary pacing if necessary, according to the new statement.

Drug–eluting stents safe over long term

Using sirolimus–eluting stents for in–stent restenosis is safe and effective over four years of follow–up, a study of an Italian registry showed. Through four years, there were low rates of target lesion revascularization (11.1%) and stent thrombosis (2.8%), according to Francesco Liistro, MD, of San Donato Hospital in Arezzo, Italy, and colleagues.(Source: J Am Coll Cardiol 2010;55:617–625).

Coronary artery calcium not reliable

Absence of coronary artery calcium does not rule out coronary artery disease in symptomatic patients. In a multicenter clinical trial, 19% of patients with a coronary calcium score of 0 had stenosis of at least 50% in one or more coronary artery segments, according to Carlos E. Rochitte, MD, of the University of S?o Paulo, Brazil, and colleagues. Likewise, 20% of vessels seen to be totally occluded on revascularization had no calcium on scans. (Source: J Am Coll Cardiol 2010;55:627–634).

Vit D linked to osteoarthritis

Elderly men with low serum levels of vitamin D are at increased risk for developing hip osteoarthritis. Men whose levels of 25–hydroxyvitamin (OH)D were between 15.1 to 30 ng/mL had twice the likelihood of prevalent radiographic hip osteoarthritis than those whose levels were normal (OR 2.19, 95% CI 1.21 to 3.97), according to R. Krishna Chaganti, MD, of the University of California at San Francisco, and colleagues. (Source: Arthritis Rheum 2010;62:511–514.).

CT abdoman is equivalent to 400 conventional X rays

US FDA wants to issue new safety requirements for manufacturers of computed tomography (CT) and fluoroscopic devices to reduce unnecessary radiation from medical imaging. The FDA’s plan focuses on three procedures with high radiation doses: CT, nuclear medicine studies, and fluoroscopy. These are the greatest contributors to total radiation exposure. They require much higher radiation doses than other radiographic procedures, such as standard X–rays, dental X–rays, and mammography, said Dr Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health. While the three procedures have led to early diagnosis of disease, they expose patients to ionizing radiation that may increase lifetime cancer risk.
The Archives of Internal Medicine recently published results from two studies indicating that CT scans deliver much higher doses of radiation than previously thought. The FDA has noted that a patient would have to get 400 standard chest X–rays to be exposed to the same level of radiation as just one CT abdomen scan.

Risk factors for cancer of the cervix ( Dr G M Singh)

  1. Multiple sexual partners (or sexual partners who have had multiple partners)
  2. Starting sexual intercourse at an early age
  3. Viral infection, such as HPV, human immunodeficiency virus (HIV), or herpes simplex virus (HSV)
  4. Weakened immune system
  5. Previous cancer of the lower genital tract
  6. Smoking

Diabetes Fact
Triad of diabetes is polydipsia, polyuria and weight loss. Polyphagia is not a part of the triad.

Public Forum

Press Release

Kidney patients should not take any medicine without their doctor’s advice

New Delhi, Tuesday, February 16, 2010: People with failing kidneys often use "natural", ayurvedic, homeopathic products; over–the–counter medications and/or allopathic pain killers that could worsen their kidney function said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

A study published in the American Journal of Kidney Diseases of 87 patients with chronic kidney insufficiency found 65 instances of drug–related problems. The results suggest that routine documentation and monitoring of over–the–counter medications and natural products by community pharmacists is warranted.

Over–the–counter drugs, herbal medicines and other natural products can be particularly risky in patients with poorly functioning kidneys, known medically as "chronic renal insufficiency". These medications may directly cause kidney damage or may interact harmfully with other drugs the patient is taking.

The researchers interviewed 46 patients with moderate renal insufficiency and 41 with severe renal insufficiency. Overall, the patients were taking 66 different over–the–counter drugs and 25 different natural products, usually for pain relief or to treat coughs and colds. Forty–nine percent of the over–the–counter drugs had been recommended by a doctor or pharmacist, as had 19 percent of the natural products.

Eight patients reported using at least one over–the–counter drug that should not have been used, while 27 were using an over–the–counter drug that should have been used with caution. Three patients were using herbal medicines that should not have been used, while seven were using herbal medicines that should have been used with caution.13 percent of the potentially dangerous over–the–counter drugs were recommended by a doctor or pharmacist, as were 6 percent of the potentially dangerous natural products.

The researchers identified 65 drug–related problems. Forty–two involved at least one product, most commonly calcium or magnesium; 23 involved one or more natural products, including glucosamine, which can affect blood sugar measurements; garlic supplements, which can interact with blood–thinning drugs; and echinacea, which can directly affect kidney function.

Punjab & Sind Bank
Central Bank of India

Question of the day

What is fever? (Dr G M Singh)

Because of the normal variation in body temperature, there is no single value that is defined as fever. However, the following are generally accepted values:

  1. Rectal temperature above 100.4°F (38°C)
  2. Oral temperature above 99.5°F (37.5°C)
  3. Axillary (armpit) temperature above 99°F (37.2°C)
  4. Digital pacifier temperature above 100°F (37.8°C)
  5. Ear temperature above 100.4° (38°C) in rectal mode or 99.5°F (37.5°C) in oral mode

eMedinewS Try this it Works

Sphygmomanometer helps determine pulses : Pulsus alternans and pulsus paradoxus can be easily diagnosed with the help of a sphygmomanometer.

Elevate the mercury above the patient’s systolic pressure and then slowly deflate, bringing the mercury down. When the Korotkoff sounds appear, hold the pressure static. If the Korotkoff sounds disappear with inspiration and reappear with expiration, pulsus paradoxus is present. If pulsus alternans is present, the Korotkoff sounds initially appear at a rate that is half the pulse rate. On further lowering of the mercury, the rate of Korotkoff sounds will suddenly double and equal the pulse rate.

Dr Good Dr Bad

Situation: A diabetic patient came with tremors.
Dr Bad: It may be Parkinsonism.
Dr Good: Check your blood sugar first.
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 with severe asthma came to the emergency room.
Reaction: Oh my God! Why did you give him aspirin? You should have prescribed nimesulide.
Make sure to remember that five percent patients of asthma worsen on aspirin intake.

Quote of the Day (B.K.SAPNA)

People are often unreasonable, self–centred: Forgive them anyway. If you are honest, people may cheat you, but be honest anyway. What you spend years to build, someone could destroy overnight. Build anyway. The good you do today, people will often forget tomorrow. Do good anyway. You see, in the final analysis it is between you and God; it never was between you and them anyway. You are nice to others not because they are nice but because being nice is your true dignity and nature. Remove the darkness of the mind and the world will be illuminated

Mnemonic of the Day

Postoperative fever (formula–W) Dr G M Singh

WIND– the pulmonary system is the primary source of fever in the first 48 hours.
WOUND– there may be infection of surgical site.
WATER– check intravenous access site for sign of phlebitis.
WALK– deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue.
WHIZ– a urinary tract infection is possible if urinary catherization was required. WONDER DRUG– drug fever

Laughter the best medicine

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

Formulae in Imaging

PET scans can detect nodular cholangiocarcinomas as small as 1 cm but is less helpful for infiltrating tumors.

ENT Facts

Based on its acceptability and low cost, we typically use amoxicillin 500 mg thrice–daily for 5–7 days as initial therapy for acute otitis media (AOM) in patients without penicillin allergy.

SMS Anemia

Iron deficiency due to inadequate dietary intake is the most common type of microcytic anemia.

Milestones in Neurology

Samuel Alexander Kinnier Wilson (1878 – 1937) was a British neurologist Wilson specialized in clinical neurology, and made important contributions in his studies of epilepsy, narcolepsy, apraxia and speech disorders. He described hepatolenticular degeneration in his Gold Medal winning M.D. dissertation of 1912 titled "Progressive lenticular degeneration". He was honored for his research of the disease, and afterwards the disorder became known as "Wilson’s disease". In this treatise he is credited for introducing the term "extrapyramidal" into neurological medicine.

Wilson published several influential works in the field of neurology, and in 1920 was founding editor of the Journal of Neurology and Psychopathology, which was later to become the Journal of Neurology, Neurosurgery and Psychiatry. In 1940 his two–volume work titled "Neurology" was published posthumously.

Mistakes in Critical Care

Always write the complete name of the drugs and not their abbreviations or half names. This can lead to wrong drug being administered with often drastic consequences.

LIST OF APPROVED DRUG FROM 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Lamivudine 30mg + Zidovudine 60mg + Nevirapine 50mg Oral Suspension (Tablets for oral Suspension)

For the treatment of HIV patients


(Advertorial section)


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Advertising in emedinews

emedinews is the first daily emedical newspaper of the country. One can advertise with a singe 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 hangama and live webcast. Suggestions are invited.

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. Dear Dr Aggarwal. Indian doctors will be indebted to you for this great effort. Regards: Dr.Jitendra Kumar MD,DNB,DM (Nephrology), Consultant Nephrologist, Escorts Hospital and Research Centre Limited, Faridabad

  2. Congratulations for being conferred Padmashree. People like you deserve this: Usha Arora

  3. Sir, I congratulate Dr K.K.Aggarwal one amongst us for being conferred with Padmashree, The highest civilian award a matter of great pride to all of us. We have more expectations from him. I want that medinews should come up with more NEWS on PUBLIC HEALTH for the benefit of public at large, thus common man get the best through their treating physician: Dr Bijan Kumar Dey, MOB: 9999882644

  4. Dear Dr.K.K.Aggarwal, every morning i don’t read any other newspaper except your e-medinews. I have made a web site for creating awareness about problems of aging women http://indianwoman35plus.com/, i am sometimes by giving reference to your e–medinews loading up some of your journal scan comments. This web site i have developed as chairperson of "public awareness Committee of IMS" and chairperson of Geriatric Gynecology Committee of FOGSI, with love and regards: Dr Maninder Ahuja