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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

17th June, 2010, Thursday

Scientists created the first synthetic cell

Dear Colleague

Mera Bharat Mahan. What ever we have read in the Vedic era is now gradually being proved by the western science. Lord Ganesha was born out of skin cells, Kartikeya out of IVF, Karan out of asexual reproduction etc. Clones of people were also produced without any cells.

Now world renowned geneticist Craig Venter and a team of researchers at the J Craig Venter Institute have created life from nonliving parts (the first synthetic cell). Dr Venter explained, Instead of having a genetic relative that it evolved from, the parent of this cell is a computer.

It is possible that one day, such cells will make up designer organisms that can be programmed to do specific tasks like creating new biofuels or breaking down oil. The breakthrough stems from a step that was taken approximately three years ago, when Dr. Venter was able to show that the natural DNA from one bacterium could be inserted into another and that it would take over the host cell’s operation.

His team synthesized a piece of DNA with 1,080,000 bases. Now, according to the paper in Science, the team has found that the synthetic DNA takes over a bacterial cell just as the natural DNA did, making the cell generate the proteins specified by the new DNA’s genetic information in preference to those of its own genome.

In other words, the donor genome reprogrammed the recipient cell, which went on to replicate and divide. The result was new colonies of Mycoplasma mycoides. Notably, the man–made copy of the genome that Mycoplasma mycoides produces naturally was not an exact duplicate, as 14 of the bacterium’s 850 genes were altered or deleted during the experiment –– 12 intentionally, two accidentally.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Chak De Extra Pounds

Heart Care Foundation of India strongly recommends maintaining fitness and Body Mass Index. It has used numerous modules to convey this health message to the society. Mostly, celebrities and popular public figures were involved repetitively in this module to ensure widespread and to enhance the impact.

Dr k k Aggarwal

In the photo: Ms Shilpa Shukla film actress of "Chak de India fame" releasing a Message promoting weight loss. Also in the photo Padamshree & B C Roy Awardee Dr K K Aggarwal

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

13–valent PCV

US Food and Drug Administration (FDA) Advisory Committee on Vaccines has recommended approval for a 13–valent pneumococcal conjugate vaccine (PCV13), but final FDA approval is pending. PCV13 adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7–valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F) [33,34]. The six additional serotypes accounted for 63 percent of invasive pneumococcal disease among children younger than five years of age in the United States during 2006 to 2007.


Lowry F. FDA panel recommends prevnar 13 vaccine for approval. Available at: www.medscape.com/ viewarticle/ 712717. (Accessed on January 20, 2010).

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Dr KK Aggarwal

Mnemonic of the Day (Varesh Nagrath)

Principles for treatment of chronic renal failure

A: Anemia & other haematological abnormality (correction)
B: BP (correction)
C: Calcium & Phosphorus metabolism (correction)
D: Diet modification
E: Electrolyte balance
F: Fluid balance
G: Gout & Hyperuricemia symptoms
H: Heart disease (associated)
I: Infection & Obstruction to urinary tract (correction).

News and views

1. Data from two olmesartan trials undergoing FDA safety review

Data from the Randomized Olmesartan and Diabetes Microalbuminuria Prevention Study (ROADMAP) trial and the Olmesartan Reducing Incidence of End Stage Renal Disease in Diabetic Nephropathy Trial (ORIENT) study are undergoing safety review by the FDA. These trials had reported a higher mortality rate due to a cardiovascular event with olmesartan (Benicar) in hypertensive patients with type 2 diabetes.

2. Diclofenac most unsafe among NSAIDs

A Danish study has found diclofenac (Cataflam, Voltaren) to cause 91% increase in the relative risk of a fatal heart attack or stroke in healthy adults. The risk was greater with higher doses of the drug. Diclofenac and rofecoxib (Vioxx; which was withdrawn from the market in September 2004) were the two NSAIDs with the most increased risk of cardiovascular events. Naproxen (Aleve, Naprosyn) had the lowest cardiovascular risk. These observations were based on registry data from more than a million users of nonsteroidal anti–inflammatory drugs (NSAIDS) from 1997 through 2005. The study is published online in Circulation, Cardiovascular Quality and Outcome.

Among the notable observations were:

  • Diclofenac: Relative risk of cardiovascular death 1.91 (95% CI 1.62 to 2.42).

  • Rofecoxib: 66% increase in risk of cardiovascular death (OR 1.62, 95% CI 1.06 to 2.59).

  • Both rofecoxib and diclofenac had a "dose–dependent increase in risk."

  • Ibuprofen: 29% increase in relative risk of fatal or nonfatal stroke (OR 1.29, 95% CI 1.02 to 1.63).

  • Naproxen: No increased risk (OR 0.84, 95% CI 0.50 to 1.42).

3. Study finds causal link between food choices and risk of asthma

A large observational study reported in the June issue of Thorax has linked the Mediterranean diet, rich in fruits, fish, and vegetables and low in saturated fat with a reduced probability of childhood asthma. Gabriele Nagel, MD, MPH, of Ulm University in Germany, and colleagues noted that children who ate burgers at least three times a week had increased odds of having asthma (OR 1.42, 95% CI 1.08 to 1.87). Dietary intake of trans–fatty acids has been shown to be associated with asthma and atopy. Overall, selecting foods that were more similar to a Mediterranean diet was associated with a lower prevalence of both wheeze and asthma. Data from the second phase of the International Study on Allergies and Asthma in Childhood (ISAAC), a collection of cross–sectional studies performed at 29 centers in 20 countries was evaluated.

4. Omalizumab as add–on therapy reduces asthma exacerbations

According to the EXTRA study presented at the 2010 Annual Meeting of the American Thoracic Society, addition of omalizumab (Xolair) to current therapy significantly reduced exacerbations in patients with poorly controlled moderate–to–severe asthma. The Study of Xolair in Subjects with Moderate to Severe Persistent Asthma (EXTRA) examined the safety and efficacy of giving omalizumab to asthmatic patients already taking two or three asthma medications (inhaled corticosteroids; a long–acting beta–agonist, and/or oral corticosteroids). A 25% reduction in the rate of asthma exacerbations during 48 weeks of follow–up was noted with omalizumab. Total asthma score also reduced with a trend toward less use of short–acting inhaled bronchodilators. The guidelines of the National Heart, Lung, and Blood Institute (NHLBI) for step–care treatment of asthma include a recommendation to add omalizumab to existing therapy for patients at steps 5 and 6

Ways to Get Better Sleep (Dr G M Singh)

1. Build Better Habits

2. Create a Schedule

3. Don’t Misuse Your Bed

4. Careful of Caffeine

5. Relax!

6. Avoid Alcohol and Nicotine

7. Don’t Eat or Drink Before Bedtime

8. Time Your Exercise

9. Lighten Up

10. Be Comfortable


1. Rumors about Dr Sudhir Gupta:  Dr Sudhir Gupta denial:

I wish to convey that I have been (not only yesterday/today) how ever never/ever questioned/called/asked by CBI in relation to MCI or any case in 18 years of professional job or whole of my life. it was only a rumor not based on facts. I always believe in maintaining transparency in my forensic medicine practice in the interest of truth, justice and public interest with highest regards of medical ethics. We should maintain of our oldest heritage of medical of this great indian nation from the time of shusruta,charak and Dhanwantri who said the service which medical professionals render to people/society and nation is the noblest. Aryans embodied the rule that, Vidyo narayano harihi (which means doctors are equivalent to Lord Vishnu).

DR SUDHIR GUPTA MBBS (Gold Medal),MD(BHU), DNB, MNAMS; Associate Professor,Forensic Medicine & Toxicology, All india Institute of Medical Sciences (excerpts from his email)

Team visits GMC

A team of Medical Council of India (MCI) comprising N.N. Mathur, D.B. Thukral and Devarshi Sarma visited Guntur Medical College (GMC) on Tuesday and verified the infrastructure, equipment and availability of manpower for the purpose of implementing the Health and Family Welfare Ministry's scheme of strengthening and upgrading medical colleges during the 11th Plan period.

Probe team visits two institutes ( Source Indian Express)

A team of eight CBI officers, two doctors verify records of Sumandeep Vidyapeeth and C U Shah Medical College. A special panel of doctors and officers from CBI Gandhinagar started preliminary probe at Sumandeep Vidyapeeth University (SVU), Waghodia and C U Shah Medical College, Surendranagar, on Wednesday 12.30pm. The 10-member team of two medical experts and eight CBI officers — are verifying the documents of SVU.

Interesting tips in Hepatology & Gastroenterology

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

Who can be a living liver donor ?
  • Willing, family donor with matching blood group

  • HLA matching is not required for liver donation, unlike kidney transplantation

  • 18–55 year old, weighing 55 – 85 kg but not fat

  • Healthy, normal liver function.

  • No major health issues related to heart, kidney, brain, malignancies etc.

  • HBsAg, HCV, HIV–negative

  • Informed consent, psychological evaluation

How much liver can one donate ?

One can donate 60–70% of his/her liver volume. For example a normal adult with, for example, 1500 gms of liver could donate 900 –1000 gms of his / her liver. This is provided, the liver is not fatty. If the liver is fatty then an extra 10–20% of liver is left behind with the donor.

Tomorrow I shall write on "How much liver does a receipient need?"

Conference Calendar

Workshops on Chronic Pain Assessment and Management for Health Professionals
Date: June 19 to 21, 2010
Venue: Lecture Hall, Dept of Psychiatry, NIMHANS, Bangalore, Karnataka.

Quote of the day (Dr Chanderkanta Suri)

By the time you realize what your parents said was right………You have a kid who thinks you are wrong.

Evidence Based Medicine

Abstract to read:

Neck Circumference as a Novel Measure of Cardiometabolic Risk: The Framingham Heart Study (Dr Varesh Nagrath)

Neck circumference, a proxy for upper–body Sc fat, may be a unique fat depot that confers additional cardiovascular risk above and beyond central body fat.

Participants with neck circumference measures who underwent multidetector computed tomography to assess visceral adipose tissue (VAT) were included (n = 3307, 48% women; mean age = 51 yr; mean body mass index (BMI) = 27.8 kg/m2; mean neck circumference = 40.5 cm (men) and 34.2 cm (women)). Gender–specific linear regression models were used to assess the association between SD increase in neck circumference and cardiovascular disease (CVD) risk factors (systolic and diastolic blood pressure; total, LDL, HDL cholesterol and triglycerides; and fasting plasma glucose, insulin, proinsulin, and homeostasis model assessment of insulin resistance). Neck circumference was correlated with VAT (r = 0.63 (men); r = 0.74 (women); P < 0.001) and BMI (r = 0.79 (men); r = 0.80 (women); P < 0.001). After further adjustment for VAT, neck circumference was positively associated with systolic blood pressure, diastolic blood pressure in men only, triglycerides, fasting plasma glucose in women only, insulin, proinsulin, and homeostasis model assessment of insulin resistance and was inversely associated with high–density lipoprotein (all P values <0.01). Similar results were observed in models that adjusted for both VAT and BMI.

Conclusions: Neck circumference is associated with CVD risk factors even after adjustment for VAT and BMI. These findings suggest that upper–body SC fat may be a unique, pathogenic fat depot.

Preis SR, Massaro JM, Hoffmann U, et al. J Clin Endocrinol Metab 2010, May 19 (Epub ahead of print).

Question of the Day

What is the pathogenesis of a diabetic foot? (Dr Sharad Pendsey, Nagpur)

Diabetic foot is a chronic complication of diabetes mellitus resulting from symmetrical, progressive neuropathy and peripheral vascular disease.
In diabetic polyneuropathy, all the three nerve fibers are affected (sensory, motor and autonomic). Of this, sensory neuropathy is the most important prerequisite for foot ulcerations, which leaves the foot with loss of protective sensations (LOPS). Any damaging stimuli or external trauma are either perceived less or not at all, resulting in an ulcer. Motor neuropathy leads to atrophy and weakness of the intrinsic muscles of the foot (intrinsic minus foot), results in clawed toes and prominent metatarsal heads, leading to increased plantar pressure. Autonomic neuropathy results in reduced or absent sweating causing plantar xerosis with cracks and fissures. Limited joint mobility, foot deformities and abnormal gait result in an altered biomechanical loading of the foot with elevated plantar foot pressures.

Loss of protective sensations coupled with the repetitive trauma of walking, in presence of raised plantar pressures, results in a plantar callus.
Neuropathic foot ulceration results from factors extrinsic to insensitive foot such as an external trauma, often together with intrinsic factors such as increased plantar pressure. Plantar ulcers do not occur overnight but are a result of repetitive stress of walking and abnormal weight bearing, resulting in chronic tissue damage. Peripheral vascular disease involving lower extremities, specifically affects infra–popliteal vessels. Decreased circulation leads to poor healing and increases the risk of gangrene.

eMedinewS try this it works

Calming the crying infant

While examining a crying infant, turn him onto his belly while keeping his head elevated.


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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: A diabetic patient with uncontrolled diabetes came with cognitive impairment.
Dr Good: Get your blood sugar controlled first.
Dr Bad: Its dementia and nothing can be done.
Lesson: An analysis of over 3,000 individuals with established type 2 diabetes demonstrates a clear age–adjusted inverse relationship between cognitive function and the degree of chronic hyperglycemia as measured by A1C level. (Diabetes Care 2009;32:221–226.)

Make Sure

Situation: A patient developed dangerous arrthymias in his immediate post CABG procedure. Reaction: Oh My God! Why you did not correct his K+ value of 3.4 pre–operatively?
Lesson: Make Sure that pre–operative K+ value of <3.5 is corrected. Cardiac surgery patients who have serum potassium levels below 3.5 mmol.L are at high risk for peri–operative arrhythmia.

Humor Section

IMANDB Joke of the Day

This old woman visits her 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 ovarian 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.

Funny Definitions

Benign…………………What you will be after you are eight

Formulae in Clinical Practice

Minute Volume (VE)

Formula: VE = K × Vrn9/PaCO2 = 0.863 × VcO2/PaCO2 (1 – VDA/T)
VDA/T (Physiological dead space) = PaCo2 – P expiratory CO2/PaCO2
Normal values – 4–6 l/min
Normal value of physiological dead space is 0.2–0.3 liter.

Milestones in Gastroenterology

1811–1888: Thomas B. Curling was an English surgeon who became a member of the Royal College of Surgeons at 21 years of age. In 1834 and then in 1842 he published papers on acute duodenal ulcers and their association with burns. These were eponymously named "Curling ulcers".


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Tumor marker tests

Tumor markers are chemicals made by tumor cells that can be detected in your blood. But tumor makers are also produced by some normal cells in the body and levels may be significantly elevated in noncancerous conditions. This limits the potential for tumor marker tests to help in diagnosing cancer.The best ways to use tumor markers in diagnosing cancer hasn’t been determined. And the use of some tumor marker tests is controversial. Examples of tumor markers include prostate–specific antigen (PSA) for prostate cancer, cancer antigen 125 (CA 125) for ovarian cancer, calcitonin for medullary thyroid cancer, alpha–fetoprotein (AFP) for liver cancer and human chorionic gonadotropin (HCG) for germ cell tumors, such as testicular cancer and ovarian cancer.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Hydroquinone 20mg + Tretinoin 0.25mg + Fluocinolone Acetonide 0.1mg per gm Cream

For the treatment of melasma of face in adults


Public Forum (Press Release for use by the newspapers)

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management joined with empirical treatment is unsuccessful or who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. The examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

Hurry, worry and curry are the three main factors for causing acidity apart from alcohol and smoking. People with acidity should consume less of fermented, sour, salty and pungent food.

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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

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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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Readers Responses

An excellent article on Personalised Med http:// content.nejm.org/ cgi/ reprint/ NEJMp1006304v1.pdf, Dr N P SINGH (Nanu), Professor of Medicine,Maulana Azad Medical College and associated, Lok Nayak Hospital,New Delhi