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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

16th June 2010, Wednesday

Tuning fork test for diabetic neuropathy

Dear Colleague

A simple test using a 128 Hz tuning fork to examine vibration perception can be used to screen for diabetic polyneuropathy. A 128 Hz tuning fork is placed on the interphalangeal joint of the right hallux.

The score is 2 points, if the patient feels no vibration. When the patient feels vibration at the hallux, the still vibrating tuning fork is immediately placed at the dorsal wrist, and the patient is asked to compare the strength of vibration at the two sites.

The score is 1 point, if the vibration feels stronger at the wrist.

The score is 0 points, if the vibration feels no different at the wrist. A normal score is 0 points, a mild to moderate deficit is 1, and a severe deficit is 2. This tuning fork test has widespread utility in clinical practice because it is simple, brief, valid and reliable.


Meijer JW, Smit AJ, Lefrandt JD, et al. Back to basics in diagnosing diabetic polyneuropathy with the tuning fork!. Diabetes Care 2005;28:2201.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Folk Forms As A Powerful Means For Health Awareness

Folk artists can be effectively utilized for health communication. Heart Care Foundation of India (HCFI) has utilized a vide range of folk forms like puppet shows, street theatre, folk songs, folk dances, drummers etc. for social purposes and as a support to its various health campaigns, folk being a powerful medium for creating public awareness. VIPs, celebrities and media also find folk forms interesting and it captivates attention of the crowd.

Dr k k Aggarwal

In the photo: Mr. Raj Babbar, Film Star and Politician with various folk artists during Perfect Health Mela in 1996

International Medical Science Academy Update (IMSA): New Drug Update

Human papillomavirus vaccine

US FDA approved the use of quadrivalent HPV vaccine in males. The Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention revised its guidelines in 2010, stating that "the quadrivalent vaccine may be given to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts".


Recommended adult immunization schedule: United States, 2010. Ann Intern Med 2010; 152:36.

Mnemonic of the Day (Dr Prachi)

Causes of exacerbation of CHF–FAILURE

Forgot medication
Arrhythmia/ Anemia
Ischemia/ Infarction/ Infection
Lifestyle: too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism (pulmonary)

News and views

1. Wear a ‘tattoo’ to monitor blood glucose (Dr G M Singh)

A new type of continuous glucose monitor, tattoo, which makes use of a fluorescent nanoparticle ink injected under the skin to detect blood sugar levels with a watch–sized or smaller monitor worn over the skin, is currently under development. Researchers from the Massachusetts Institute of Technology are working on this device. The ink to be used in the glucose ‘tattoo’ would be made from carbon nanotubes that can reflect infrared light back through the skin to the monitor

2. Echo may enable early recognition of heart damage in breast cancer therapy

It may now be possible to detect heart damage incurred during breast cancer therapy early with the help of echocardiography. This could help guide clinicians in optimizing chemotherapy.

Presenting the results, Heloisa Sawaya, MD, PhD, of Massachusetts General Hospital and Harvard in Boston said that reduction in longitudinal strain measured on echocardiography performed at three months predicted cardiotoxicity of anthracycline and trastuzumab (Herceptin) treatment (P=0.01) before any significant changes appeared in tests for left ventricular ejection fraction (LVEF). High–sensitivity troponin 1 also significantly predicted cardiotoxicity at 6 months (P=0.006). The study results were presented during the American Society of Echocardiography meeting, June 12–15, San Diego, California.

3. Gabapentin may ease pain of RLS

In a post hoc analysis of a phase III clinical trial, reported in a poster session at the annual meeting of the Associated Professional Sleep Societies, gabapentin enacarbil, administered in its highest dose (1200 mg) for 3 months, led to significant improvement (approx. 60%) in the pain associated with restless legs syndrome (RLS).

4. Off–Label bevacizumab improves ARMD

An off–label use of bevacizumab (Avastin) in age–related macular degeneration (ARMD) resulted in considerable improvement. In a randomized clinical trial, reported online in BMJ, 10 times as many patients had at least a 15-letter improvement in visual acuity at one year compared with patients treated with standard therapy; > 90% of patients treated with bevacizumab reported less than a 15–letter decline in visual acuity vs 67% of the control group. The drug was well–tolerated. Encouraged by their study findings, the researchers have recommended acceptance of bevacizumab as standard care for neovascular ARqMD.

Food Rules (Dr G M Singh)

Know what’s in your Food
Would Grandma recognize It?
Look for sugar by every other name
Avoid products that make health claims
Stick to the sides of the Supermarket
Eat the leaves
Save meat for special occasions
Don’t overlook the oily little fish
Have a glass of wine with Dinner
Stop eating before you’re full
Eat only when you’re hungry
Eat slowly
Eat small Portions and skip Seconds

Interesting tips in Hepatology & Gastroenterology

(Dr. Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant physician Sir Ganga Ram Hospital, Delhi)

We have only one liver. How can a person donate liver?

Liver is the only organ in body which Regenerates. Therefore one can donate a part of his/her liver and the healthy liver would soon regenerate. Liver is divided into 2 lobes – right and left and into a total 8 segments. Each lobe has a separate arterial (hepatic artery – right and Left branch) venous (Portal vein – right & left branch) ductal (bile duct – right and left) supply.

Dr k k Aggarwal

What is the time taken by the liver to regenerate back?

Well, it takes less than 3–4 weeks for more than 80–90% of the liver to regenerate.

Tomorrow I shall write on "Who can be a living liver donor

Conference Calendar

GCLP 2010 – Workshop on "Good Clinical Laboratory Practices"
Date: June 18-20, 2010
Venue: Ticel Bio–Park, Taramani, Chennai, Tamil Nadu.

Quote of the day (Dr Santosh Sahi)

"Failure is the opportunity to begain again more intelligently." Henry Ford

Question of the Day (Dr Shabina Ahmed)

How should one treat coexisting hypertension and CAD?
(Dr H. C. Sathya, Bangalore)

HT is one of the major risk factors for CAD. It is likely that in a majority of situations both may be present in the same patient. To treat, we would need to identify hypertensive drugs with anti–anginal activities. There are number of drugs available like CCBs and beta–blockers. Monotherapy may not be sufficient in such patients to control either BP or CAD. Amlodipine often is the drug of choice in such clinical situations. It has effective antihypertensive and anti–anginal effects. The drug can be given in single dose, is cost–effective and safe. In absence of contraindications, it can be combined with atenolol and the combination is freely available in a tablet form. In poor elderly patients with high chances of underlying CAD who otherwise cannot even afford the treadmill test, this combination may be the best combination for treating high BP. Effective control of BP in presence of CAD would also reduce long–term CAD mortality and morbidity. In such patients efforts should be made to keep the BP lower than 120/80 mmHg.

eMedinewS try this it works

Check the teeth to view the throat

If a patient, adult or child, needs a throat examination, start by asking to look at the teeth. After a few seconds, the tongue relaxes and the pharynx can be easily examined as well.


Advertising in eMedinewS

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Contact: drkk@ijcp.com emedinews@gmail.com


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 .


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Dr Good Dr Bad

Situation: An uncontrolled diabetic came with hearing loss.
Dr Bad: Go for a hearing aid.
Dr Good: Get your sugar controlled first.
Lesson: Lack of glycemic control shows a positive correlation with extent of hearing loss when compared to those diabetics with good glycemic control. (Source: Int J Diab Dev Ctries 2008;28:114–20)

Make Sure

Situation: A hypertensive patient on atenolol developed erectile dysfunction (ED). Atenolol was stopped.
Reaction: Oh my God! Why did you stop beta-blocker. You should have just switched over to nebivolol.
Lasson: Make Sure that nebivolol is used as the beta–blocker of choice in a hypertensive patient with ED. (Source: Asian J Androl 2006;8(2):177–82.)

Humor Section

IMANDB Joke of the Day

The doctor was off teaching a class, so one of his new students answered the phone in his office. The call was from the school's football coach.
"Doc, it’s Johnny Brown, he is in extreme pain" said the coach, "He broke his arm in the fourth quarter."
"I see," said the aspiring doctor. "Exactly what part of the arm is that?"

Funny Definitions

Gynecologist – a man who works and operates in another man’s field

Formulae in Clinical Practice

Predicted A–a Gradient for Age

Formula: A–a = 10 + (age/10)
Comment: There is no known correction for smoking.

Milestones in Urology

1855–1937: Ustav G�rtner is remembered for his work in experimental pathology, including the study of kidney functions, experiments concerning electrical skin resistance and his work with innervation of cerebral vessels.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)


To screen for, detect, and monitor treatment for congenital adrenal hyperplasia (CAH); sometimes to help rule out other conditions. It is a part of a routine newborn screen, when an infant has ambiguous genitalia, when a young female has hirsutism or other symptoms of virilization, when a male child has premature sexual development, and periodically to monitor CAH treatment.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Ketoconazole 2% + Zinc Pyrithone 1% Lotion

For the treatment of pityriasis and dandruff of the scalp


MCI News

1. Will the varsity revoke Desai’s degree? (DECCAN Chronicle)

wILL Dr Ketan Desai, lose his honorary doctorate from the Tamil Nadu Dr M.G.R. Medical University? as per the sources the university is planning to revoke the degree. The university had conferred an honorary Doctor of Science (DSc) on the Ahmedabad-based urologist in November last year, at the 19th convocation where Dr Desai was the guest of honour. “It is up to the governing body that has replaced the MCI and the vice-chancellor of the university to make the decision and work out the details. As of now, it is not official that the doctorate will be revoked. Discussions are still on,” said Dr Sudha Seshayyan, registrar of the university.

2. Delhi HC grants bail to two accused

The Delhi High Court granted bail to the owner of a Patiala-based College who had allegedly offered Rs two crore to former Medical Council of India (MCI) president for recognition of the institution. Justice Manmohan Singh granted bail to Sukhwinder Singh, owner of Gyan Sagar Medical College, as also to Kanwaljit Singh, one of the professors of the college involved in the scam. Both the accused have been in custody since April 22 when CBI had arrested them along with president MCI and an alleged Delhi-based tout J P Singh. The High Court had already granted bail to J P Singh but refused to give relief to Desai. Now, Desai is the only accused in judicial custody.

3. Rumors about Dr Sudhir Gupta

There was a rumor in the city that AIIMS's Dr Sudhir Gupta was questioned in the CBI office for one hour regarding MCI in the morning. Details could not be verified. 

4. Dr Desai still at AIIMS

Dr Desai who was operated for ano rectal abscess spent his fourth day at AIIMS private room today. 

For readers information

eMedinews regrets to inform the sad untimely demise of Dr. Meenakshi Sandhir wife of  Dr. R K Sandhir in a road accident on 13th June. Cremation will be held at Lodhi Road Electric Crematorium at 2 pm on Wednesday, 16th June.

Public Forum (Press Release for use by the newspapers)

Watch What You Eat

There’s little hard evidence that a diet rich in tomatoes and the tomato antioxidant lycopene can ward off cancer said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Reporting in the issue of the Journal of the National Cancer Institute, FDA experts lay out in great detail the evidence that tomato consumption is not linked to any reduction risk of tumors of the prostate, ovary, stomach and pancreas.

People who manage to reduce their waistlines may also lower their risk for diabetes and heart disease.

A French study published in Diabetes Care has shown that men and women whose waistlines expanded by 3 inches or more over nine years were at increased risk of developing metabolic syndrome. In contrast, women who shed just an inch or more from their midsections had a lower risk of developing metabolic syndrome than women whose waistlines stayed the same. However, people can be normal weight based on BMI yet have a large waist, and these individuals are at risk of metabolic syndrome.

Too many older people are being prescribed too many medicines or the wrong drugs.

As per The Lancet medical journal, inappropriate drug use among older patients includes being prescribed drugs they don’t need, being under–prescribed medications they do need or being given inappropriate drugs. Older patients are at high–risk for having drug interactions. An European study of 1,601 elderly outpatients in six countries found that 46 percent of them had experienced at least one significant drug interaction, and that 10 percent of these interactions were severe. Another study found that 37 percent of patients were taking drugs without their doctor’s knowledge, and six percent were taking drugs not on their doctor’s lists.

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Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Response

1. Dear Dr Aggarwal, Congratulations on the new initiative. I am sure this will help reach out to many doctors and public health professionals, who are serving in remote areas or have no accesss to libraries and medical journals.  I also see this newspaper as an avenue for CME and other learning initiatives. There are may new areas of health concern that we doctors are not completely sensitized to. The challenges in tackling NCDs, tobacco control, Mental Health etc. In case you feel, it is possible to incorporate progress/stories/initiatives, we could ask colleagues to contribute. I would be happy to write on tobacco control issues in India, that doctors and public health pesonnel must be aware of. Best regards: Dr Vinayak M Prasad, Sr Adviser, WHO Tobacco Free Initiative, Geneva

2. What was the reference for the yesterday's data of Bhopal Gas tragedy? Dr Maj Prachi Garg. A: emedinews: ICMR