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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 ...

18th October 2010, Monday

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

Statins cost-effective for lower-risk populations

Statins may be a cost-effective way to prevent cardiovascular events in moderate- to low-risk populations without testing for high-sensitivity C-reactive protein (hs-CRP).

A study in Sept 27 issue of the journal Circulation used a decision analytic Markov model to test three treatment strategies in hypothetical patients who had normal lipid levels and no coronary artery disease, peripheral arterial disease or diabetes mellitus. The treatment strategies tested were statin therapy according to existing ATP III guidelines (10-year predicted risk for coronary events >20%, or diabetes mellitus), statin therapy in patients with elevated hs-CRP levels but no other risk factors, and statin therapy in patients at predicted risk thresholds without hs-CRP testing. All three hypothetical cohorts were assumed to have lipid levels that matched the median levels in the JUPITER study: total cholesterol, 186 mg/dL; low-density lipoprotein cholesterol, 108 mg/dL; and high-density lipoprotein cholesterol, 49 mg/dL.

Treating with statins based on predicted risk thresholds but not hs-CRP testing was the most cost-effective strategy when statins were assumed to work equally well, regardless of hs-CRP level. Statin therapy based on hs-CRP testing was most cost-effective when normal hs-CRP levels were assumed to identify patients whose relative risk reduction on statins was less than 20%. ATP III guidelines were the optimal strategy if statin use was assumed to be associated with significant harms.

Dr KK Aggarwal
Editor in Chief
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  Chikungunya Update

(RP Vashist, Consultant and Head Public Health, Govt. of Delhi)

Chikungunya Virus

  • Causative agent -an RNA Virus
  • High viral concentration >109
  • Early appearance IgM and IgG
  • Potential risk for nosocomial transmission
  • Chikungunya is closely related to O'nyong'nyongviruswhich can cause human death.


  • In India, the disease spreads by bites from infected Aedes aegypti mosquitoes with Incubation Period ranging from 2 days to 12 days.
  • A research from the Pasteur Institute Paris claims the virus has suffered a mutation that enables it to be transmitted by Aedes albopictus (Tiger mosquito)
  Photo Feature (from the HCFI Photo Gallery)

eMedinewS Revisiting 2009

A day-long CME was organized on January 10, 2010. The CME recapitulated Top health stories of the Year 2009. It was the first CME organized by the IJCP group under the purview of eMedinewS and HCFI. Dr. Naresh Trehan, Chairman Medanta – The Medicity was conferred the eMedinewS Eminent Medical Statesman of the year 2009.In the photoDr.Naresh Trehan, Shri S.Y. Quraishi, Election Commissioner of India, Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal and Acharya Dr. Sadhvi Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Atrial fibrillation: Lenient versus strict rate control

A randomized trial in patients with atrial fibrillation compared a lenient rate control strategy (resting heart rate <110 beats per minute) with a strict rate-control strategy (resting heart rate <80 beats per minute and heart rate during moderate exercise <110 beats per minute). There was no significant difference in the primary composite outcome at three years, but nearly nine times as many visits were required to achieve the strict rate control targets.

(Ref: Van Gelder IC, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010;362:1363).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee 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 academics.

25% traffic cops have less than 80% lung efficiency

Jaipur: The rising pollution levels are left police persons short of breath. Of the 109 traffic policemen who underwent a spirometry test, 26 were detected with weak lungs. The tests on Thursday were held at the police control room by doctors from SMS hospital. "These cops have lung efficiency of less than 80%, this could be because of a respiratory disease or may be an early indication. However, precaution and treatment is a must for such patients," said Dr Virendra Singh, professor, department of medicine, SMS medical college. (Source: The Times of India)

5-in-1 vaccine to be introduced in Kerala, TN

In a big boost to immunisation efforts, a high-level technical advisory group has recommended expansion of the costly Hepatitis B vaccine throughout the country and its inclusion in the Universal Immunisation Programme (UIP) and a limited introduction of pentavalent vaccine in the vaccination programme of Tamil Nadu and Kerala. The decisions were taken at a recent meeting of the National Technical Advisory Group on Immunisation (NTAGI), chaired by Union Health Secretary K Sujatha Rao and co-chaired by Director General of Indian Council of Medical Research (ICMR) and Secretary of Department of Health Research VM Katoch.  NTAGI recommended that pentavalent vaccine, a combination of Hepatitis B, Hib and DPT vaccines, be introduced in the immunisation programmes of Tamil Nadu and Kerala as these States have better vaccine delivery systems and Adverse Events Following Immunisation (AEFI). The group also recommended that the data gathered after immunisation in these two States be analysed after a year before its expansion in other States. (The Pioneer)

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)

EGFR may be a therapeutic target in triple-negative breast cancer

A randomized trial assessing a new target for triple-negative breast cancer has for the first time shown that the epidermal growth factor receptor (EGFR) is a therapeutic target for women with triple-negative breast cancer. When combined with cisplatin, the anti-EGFR antibody cetuximab significantly improved the overall response rate and progression-free survival rate in this subset of breast cancer patients. The study findings were presented at the 35th European Society for Medical Oncology (ESMO) Congress.

Elevated chloride levels predict 30-day mortality in C. difficile infections

A study presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy reports that hyperchloremia in patients with Clostridium difficile infections is an indicator of disease severity and a risk factor for death within 30 days. According to the study author, Dr. Anilrudh A. Venugopal, hyperchloremia was the only electrolyte abnormality associated with severe C. difficile infection as determined by using two C. difficile infection scoring systems.

Early progression from cutaneous LE to SLE occur more often, says study

According to a comprehensive nationwide Swedish study, rapid progression of cutaneous lupus erythematosus (CLE) to SLE is more common than previously recognized. The population-based study, which included all 1,088 patients diagnosed with CLE in Sweden from 2005 to 2007, found that the risk of being diagnosed with SLE during the first year of CLE diagnosis was 12%. The 3-year rate of progression to SLE was 18%. Patients with the subacute form of CLE had the highest rate of early progression to SLE, with a 3-year incidence of nearly 25%.

Hemoglobin test printed on paper

VTT printed the paper with antibodies that react to the sample. The test result can be read in the form of a line, for example, which either does or does not appear depending on the sample -- just like in the pregnancy tests. The result is part of a series of projects over the period 2007–2011 aimed at developing bioactive paper. According to Tomi Erho, who is in charge of the Bioactive Paper project, the ongoing aims of the study are to apply new technology to different samples, and to identify new areas of application. The technology also presents new opportunities in terms of product design in comparison with the traditional diagnostic tests.

  Hepatology Update

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

How is biliary atresia diagnosed?

There are many liver diseases which cause symptoms similar to those of biliary atresia. Consequently, many tests may have to be performed before biliary atresia can be diagnosed conclusively.
  • Serum bilirubin: Conjugated hyperbilirubinemia, defined as any level exceeding either 2 mg/dL or 20% of total bilirubin, is always abnormal. Interestingly, infants with biliary atresia typically show only moderate elevations in total bilirubin, which is commonly 6-12 mg/dL, with the direct (conjugated) fraction comprising 50-60% of total serum bilirubin. 
  • GGTP levels may be within the reference range in some forms of cholestasis of hepatocellular origin.
  • Aminotransferase levels are not particularly helpful in establishing a diagnosis, although a markedly elevated alanine aminotransferase level (>800 IU/L) indicates significant hepatocellular injury and is more consistent with the neonatal hepatitis syndrome.
  • Ultrasonography may demonstrate absence of the gallbladder and no dilatation of the biliary tree. Unfortunately, the sensitivity and specificity of these findings, even in the most experienced centers, probably do not exceed 80%. 
  • Hepatobiliary imaging, using technetium-labeled di-isopropyl iminodiacetic acid (DISIDA) nuclear scintiscan, is useful in evaluating infants with suspected biliary atresia. Unequivocal evidence of intestinal excretion of radiolabel confirms patency of the extrahepatic biliary system. It is important to keep the following two in mind: First, reliability of the scintiscan is diminished at very high conjugated bilirubin levels (>20 mg/dL). Second, the test has been associated with a 10% rate of false-positive or false-negative diagnostic errors.
  • Percutaneous liver biopsy is widely regarded as the most valuable study for evaluating neonatal cholestasis. Morbidity is low in patients without coagulopathy. When examined by an experienced pathologist, an adequate biopsy specimen can differentiate between obstructive and hepatocellular causes of cholestasis, with 90% sensitivity and specificity for biliary atresia.
  • Intraoperative cholangiography definitively demonstrates anatomy and patency of the extrahepatic biliary tract.
  Infertility Update

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

Are there any symptoms a woman/couple may notice that might indicate an inability to conceive?

Women who have extreme pain associated with ovulation or menstruation may be at risk for endometriosis and should seek expert care. Women who are annovulatory (don't ovulate) or who have very irregular cycles may be at risk for polycystic ovarian disease and should seek expert care. Unmanaged, these diseases can cause serious barriers to fertility. However, early treatment and expert management can preserve a woman's fertility.

  Diabetes Update: Question of the Day

Is HbA1C really an adequate measure of overall glycemic control? (Dr C Snehalatha)

HbA1C is a measure of the degree to which hemoglobin is glycosylated by glucose in RBCs. It reflects the exposure of erythrocytes to glucose over a period of time in a concentration dependent manner. Normally 4-6% of Hb is glycosylated. In diabetes, elevated levels of Hb are glycosylated and hence higher values of HbA1C. RBCs which contain Hb have a life span of 120 days. Therefore, HbA1C levels provide an indication of the average blood glucose concentration during the preceding 2-3 months.

HbA1C levels have been reported to be statistically higher in subjects with prediabetic stages namely, IGT and IFG than healthy control subjects. The DCCT in patients with type 1 diabetes and the UKPDS in type 2 diabetes provided ample evidence that the likelihood of developing long-term complications of diabetes may be reduced by improving long-term glycemic control. The most accepted assessment of long-term glycemic control is measurement of HbA1C. HbA1C values are used to assess the risk of developing chronic complications of diabetes and the quality of diabetes care. However, HbA1C values can be used for monitoring the glycemic status and not as a diagnostic tool for diabetes.

The recommended goal for HbA1C in diabetes is <7.0%. ADA recommends measuring HbA1C atleast twice a year in diabetic patients with stable glycemic control and more frequently in patients who do not meet the desired goals.

  Medicolegal Update

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

What is Pesticide Poisoning?

Most pesticides are poisonous and harmful to humans

Pesticides are chemicals made to destroy insects, weeds or other pests. They are also poisonous or harmful to humans if they get on the skin, or are breathed into the lungs in the form of gases, fumes, dust or fine spray droplets, or if they are swallowed. Pesticide poisoning may occur in various ways.

  • If pesticides are used incorrectly e.g. children may be poisoned if pesticides are sprayed on their bedclothes
  • Protective equipment are not used; failing to do so may splash pesticide on clothes or skin, or they may be breathed in
  • Eating, drinking or smoking after working with pesticides without washing hands
  • Empty pesticide containers used to store food or drink: it is impossible to wash all the pesticide out of an empty can, and some pesticide may get into the food or drink
  • Pesticides stored in food containers or drink bottles may be consumed accidentally
  Medi Finance Update

Current Budget

  • Tax rebate under Section 88 on Tuition Fee to the extent of Rs.12,000 per child for two children.
  • Direct crediting of all refunds to the bank account of the tax payer through electronic clearance system (ECS). Electronic filing of return
  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification


  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • To determine whether muscle, particularly heart muscle, has been injured
  • To detect high levels in the urine that can cause kidney damage after extensive muscle damage
  IJCP Special

Dr Good Dr Bad

Situation: Embolization occurs in how many patient of DVT? (JR to SR)
Dr Bad:
Dr Good:
Embolization occurs in about 50% of patients having proximal vein DVT.

Make Sure

Situation: A 7-month-old infant presented with grunting respiration, fever, anorexia and irritability. On chest x-ray, pneumatoceles was present.
Reaction: Oh my God! Why did you not start erythromycin immediately?
Lesson: Make sure to remember that erythromycin is an effective drug for Staphylococcal acquired pneumonia.

Quote of the Day (Dr.G M Singh)
"Stormy life can be braved only by the heart's sunny Meditations." Sri Chinmoy

  Mind Teaser

Read this…………………


Answer for yesterday’s eQuiz: "A home away from home"

Correct answers received from: Dr. G. Padmanabhan, Dr. Shashi Saini, Dr.Satish Gunawant

Answer for 16th October Mind Teaser is
: "The correct answer is B. CT scan of the abdomen."
Correct answers received from: Dr. Anjani, Dr Sukanta Sen

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)
Interesting 911 Calls

Dispatcher: Nine-one-one
Caller: Hi, is this the police?
Dispatcher: This is 911. Do you need police assistance?
Caller: Well, I don't know who to call. Can you tell me how to cook a turkey? I've never cooked one before.

  An Inspirational Story

Positive Thinking

God won't ask what kind of car you drove, but will ask how many people you drove who didn't have transportation.
God won't ask the square footage of your house, but will ask how many people you welcomed into your home.
God won't ask about the fancy clothes you had in your closet, but will ask how many of those clothes helped the needy.
God won't ask about your social status, but will ask what kind of class you displayed.
God won't ask how many material possessions you had, but will ask if they dictated your life.
God won't ask what your highest salary was, but will ask if you compromised your character to obtain that salary.
God won't ask how much overtime you worked, but will ask if you worked overtime for your family and loved ones.
God won't ask how many promotions you received, but will ask how you promoted others.
God won't ask what your job title was, but will ask if you reformed your job to the best of your ability.
God won't ask what you did to help yourself, but will ask what you did to help others.
God won't ask how many friends you had, but will ask how many people to whom you were a true friend.
God won't ask what you did to protect your rights, but will ask what you did to protect the rights of others.
God won't ask in what neighborhood you lived, but will ask how you treated your neighbors.
God won't ask about the color of your skin, but will ask about the content of your character.
God won't ask how many times your deeds matched your words, but will ask how many times they didn't.

  Readers Responses
  1. I read the news story ‘India leads Commonwealth tally in underweight children’ and wondered at the paradox. India staged a grand Commonwealth Games, though after many hiccups, which has cost the nation crores of rupees. Yet, we have the largest number of underweight children. This is one ‘medals tally’, which India should aim to be at the bottom.  Its time to take a reality check. Dr Anupam
  Public Forum

 (Press Release for use by the newspapers)

 Air pollution can raise blood pressure

Breathing polluted air for even two hours can boost blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog, said Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

The 17th Perfect Health Mela, held from 23rd to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi, would provide facilities for free consultation with senior Cardiologists will also be available at the mela.

In susceptible patients, this small increase may actually be able to trigger a heart attack or stroke. In the study, which appeared in an issue of the journal Hypertension, researchers tested 83 people as they breathed levels of air pollution similar to those in an urban city near a roadway. The air pollution caused diastolic pressure -- the lower number in a blood pressure reading -- to rise within two hours. Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. Individuals with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity if air pollution levels are forecasted to be high.

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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