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Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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; Elecetd Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director, IMA AKN Sinha Institute; Past Chairman IMA Academy of Medical Specialities; Past Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

20th February 2010, Saturday

Female Genital Tuberculosis: an old problem revisited

Recently, there has much speculation in the media about Aishwarya Rai Bachchan being treated for genital tuberculosis (TB). The family has angrily denied the same.

However, this presents us an opportunity to revisit the topic of female genital TB. The incidence of female genital TB is rising and gynecologists are increasingly encountering such cases in their clinical practice.

What is female genital tuberculosis?

Female genital tuberculosis begins in the endosalpinx and can spread to the peritoneum, endometrium, ovaries, cervix, and vagina. Genital tuberculosis is almost always secondary to a focus of tuberculosis elsewhere in the body, most commonly the lungs, lymph notes, intestines, bones or joints. As per WHO, genital TB is classified as category III (extrapulmonary, sputum smear-negative, not seriously ill).

How common is genital TB in females?

Genital tuberculosis in females is found in 0.75 to 1% of all gynecological admissions in India. But, this figure varies considerably from place to place. The disease is responsible for 5% of all female pelvic infections and occurs in 10% cases of pulmonary TB.

How common is infertility in pelvic TB?

Infertility is seen in up to 60% cases.

How does genital TB present?

Most women may have no symptoms. There may be symptoms of weight loss, night sweats or malaise. Some patients may present with pelvic pain, infertility, and vaginal bleeding or discharge.

How does one diagnose?

The diagnosis of the disease is not easy. Apart from the varied clinical presentation, a past history or an evidence of tuberculous lesion elsewhere may be lacking. The abdominal and vaginal examinations may be normal. A high erythrocyte sedimentation rate and a positive Mantoux test are non-specific. The chest skiagram is normal in most cases. A pelvic ultrasound and hysterosalpingography may be of some help. Histopathological evidence in premenstrual endometrial tissue biopsy or demonstration of tubercle bacilli in menstrual blood culture or endometrial currettings can confirm the certain diagnosis of disease. Laparoscopy may often be needed.

What is the response to treatment?

The response to chemotherapy is excellent for all forms of genital tuberculosis.

What is the role of surgery?

Surgery in women is necessary for large tubo-ovarian abscesses.

What about male genital tuberculosis?

Male genital tuberculosis is usually associated with renal tuberculosis. It involves the prostate, seminal vesicles, epididymis, and testes, in that order of incidence. Patients usually present with a scrotal mass, and diagnosis is made upon surgery. Oligospermia is common and may be persistent.

Dr KK Aggarwal
Chief Editor

News and Views

1. FDA seeks to increase oversight of medical radiation

FDA’s new initiative requires all high–grade medical imaging machines to include safety controls that prevent patients from receiving excessive radiation doses. FDA’s focus is on CT scanners, and is urging manufacturers to install safeguards on their machines that automatically notify operators if they are using a higher–than–recommended dose. The agency also intends to curb excessive radiation exposure from two other types of imaging: nuclear medicine and fluoroscopy. The new safety controls come only months after a Los Angeles hospital determined that it had accidentally exposed more than 260 patients to eight times the normal dose of radiation for CT brain scans over a period of 18 months. The process of putting imaging history cards in the hands of patients will call attention to previous exposures to diagnostic radiation

2. There is a link between cardiovascular disease and the risk for AD. A study by Luchsinger and colleagues of 1138 older adults with normal cognition examined the association between cardiovascular risk factors and the risk for incident Alzheimer’s disease (AS). Their results, which were published in the August 23, 2005, issue of Neurology, found that diabetes, hypertension, heart disease, and current smoking were all independently associated with a higher risk for AD, with diabetes and smoking associated with the highest risk. In addition, the risk for AD increased with the incremental addition of more cardiovascular risk factors. Inhibitors of the renin–angiotensin system may improve cardiovascular outcomes in selected patients, and there is some evidence that angiotensin may help promote some of the changes associated with dementia. The current trial examines whether renin–angiotensin inhibitors can reduce the risk for incident dementia among a cohort of older men with preexisting cardiovascular disease.

3. Antibiotics overprescribed for ear infections (AMA News- Dr Monica Vasudeva)

Many physicians routinely prescribe antibiotics for ear infections in young children, even as current guidelines only recommend the treatment for the youngest and sickest of patients. Meanwhile, mounting research shows that many children recover well without medication.

4. Plasma devices as hand–sanitizers

Several laboratories are working to develop a plasma that is specially engineered to zap germs, including the drug–resistant supergerm MRSA. The new devices are believed to be a potential asset to hospital workers and surgeons, who could use the plasma bath as an alternative to scrubbing.

5. Botox for migraines

Botox [botulinum toxin type A], given in the doses used to reduce facial wrinkles, may stop certain kinds of migraines that patients describe as crushing or ‘eye–popping’ more than other types, according to research published in the Archives of Dermatology.

6. Diabetes drug may increase fracture risk in women

Women with type 2 diabetes on TZDs are at a higher risk of bone fractures, according to a study published in the Journal of Clinical Endocrinology & Metabolism. Taking TZDs for one year had a 50% higher chance of developing a bone fracture. Notably, men were not at increased risk of fractures if they took the diabetes drugs.

Conference Update

World Kidney Day is held every year on the second Thursday of March. MAMC along with Delhi Nephrology Society has taken the lead in celebrating this event for the last 4 years: The theme for this year is Diabetes, the major cause of chronic kidney disease. [Dr NP Singh (Nanu), Professor of Medicine, MAMC 011–23215510]

Programme for World Kidney Day: March 11, Thursday
9–12 Noon: Public Awareness programme including Screening:
Venue Individual Hospitals 1–2 PM: World Kidney Day March (Venue Jain Ashram, Darya Ganj to Raj Ghat )
7-9 PM: Panel Discussion on Preventing Kidney Disease: Role Of Physicians, Venue Auditorium, MAMC), followed by Dinner.

Diabetes Fact

Acute fulminant diabetes is a new term: viral in origin, sudden onset, occurs at any age group, serum insulin is reduced, no antibodies are present and beta cells destruction is present.

Public Forum (Press Release)

Drinking Coffee Prevents Parkinson’s disease

Nicotine present in the tobacco has been used for its medicinal value for quite sometime for diseases like Parkinson’s disease and ulcerative colitis. A new study from University of Miami School of Medicine, USA, now has shown that people from families prone to Parkinson's disease are less likely to develop the disease if they drink coffee on a regular basis.

Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS, commenting on the study said that both coffee and nicotine have a link with dopamine in the brain. Dopamine is a chemical that decreases in patients with Parkinson's disease.

It is possible that people who are going to have Parkinson’s disease have lower levels of dopamine. Those with low levels of dopamine may be more likely to enjoy caffeine.

Parkinson’s disease is caused when brain cells that produce dopamine die. The disease is progressive, affecting about one percent of people older than 65.

Symptoms start out with shaking and can progress to paralysis. There is no cure, although a number of drugs can make symptoms better for a time.

Punjab & Sind Bank
Central Bank of India

Question of the day

Is colonoscopy indicated in everyone over the age of 50 to rule out bowel cancer?

This is a controversial and a much debated issue with present practice recommending annual stool testing for occult blood (three samples with dietary restriction of meat, etc.). Colonoscopy, barium enema or sigmoidoscopy, would be limited to patients with positive occult blood results. Colonoscopy is obviously indicated for screening of high–risk patients, such as those with prior polyps or cancer, ulcerative colitis or familial polyposis.

eMedinewS Try this it Works

A less traumatic reduction for dislocated shoulders

Gently lay the patient prone with the ipsilateral arm dangling over the edge of the table. This in itself invariably reduces pain. Reassuring the patient and encouraging him or her to relax also are helpful.

Dr Good Dr Bad

Situation: A patient came with migraine with aura.
Dr Bad: It has good prognosis.
Dr Good: You also need a cardiac check up.
Lesson: Patients with migraines, especially migraines with aura, could be at greater risk for cardiovascular disease. [Source: Neurology 2010 Feb 10]

Make Sure

Situation: A–40 year–old hypertensive complains of head reeling inspite of being on antihypertensive.
Reaction: Oh my God! Her blood pressure is still 160/100 mm Hg. Why didn’t you start with 2 drugs along with lifestyle modification?
Make sure: If the BP is > 160/100 minimum 2 drugs are prescribedalong with life style modification

Laughter the best medicine

A man took his wife to a psychiatrist for an evaluation. After an examination, the doctor took the husband aside and said, "I have bad news. There is nothing I can do to help. Your wife has lost her mind completely." "I guess I shouldn't be surprised," the man responded calmly. "After all, she has been giving me a piece of it every day for the last thirty–five years."


Consent is not same as notification

Notification differs from consent in that a third party (e.g. the parent or guardian of a mature or medically emancipated minor) is simply being told of the action rather than being asked to provide consent.

Quote of the Day

Prayer may not change things for you, but it for sure changes you for things. (Samuel M. Shoemaker)

Formulae in Critical Care

Packed cell volume (PCV): Formula: PCV = Hb (g %) x 3

SMS Anemia

Moderate–to–severe maternal anemia has been associated with an increased risk of poor reproductive outcomes, including low birth weight and preterm birth deliveries.

Milestones in Neurology

Jan Evangelista Purkyn (also written Johannes Evangelists Purkinje) was a Czech anatomist, patriot, and physiologist. He is best known for his 1837 discovery of Purkinje cells, large neurons with many branching dendrites found in the cerebellum. He is also known for his discovery, in 1839, of Purkinje fibers, the fibrous tissue that conducts electrical impulses from the atrioventricular node to all parts of the ventricles of the heart. Other discoveries include Purkinje images, reflections of objects from structures of the eye, and the Purkinje shift, the change in the brightness of red and blue colours as light intensity decreases gradually at dusk.

Mistakes in Clinical Practice

MgSO4 or MSO4 or MS – The abbreviations for magnesium sulfate (MgSO4) and morphine sulfate (MSO4 or MS) can look similar or be misinterpreted. It is best to write out ‘magnesium sulfate’ or ‘morphine sulfate’.

LIST OF APPROVED DRUG FROM 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Magnesium Valproate Prolonged release tablet 600mg
1) For the treatment of generalized or partial seizures as monotherapy or adjunctive therapy.
2) For prophylaxis of migraine headache in adults.
3) For the treatment of manic episodes associated with bipolar disorders

(Advertorial section)

Silicic Acid and Herbs: A New Approach.

Various clinical studies have proved that silicic acid as sodium metasilicate, has a synergistic effect with concomitant use of relevant herbal extracts when both are used in conjunction. Silicic acid and herbs compliment each other and in fact, the Herbs potentiate the absorption, assimilation and response to sodium metasilicate. Herbal extracts are known to enhance the Bio–availability of Sodium Metasilicate at the cellular Level and thus play a significant role to be a part of silicic acid supplementation. Interestingly, The most popular brands of silicic acid health Supplements, Available in the USA Market contain Herbal Extracts along with the Silicic acid as a major Ingredient. Sodium Metasilicate is NOW available in India as ZENIMMUNE Range of Products.

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.

Stress Management Workshop

A stress management workshop with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized on April 17–18, 2010.
Organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, In association with IMA New Delhi Branch and IMA Janak Puri Branch
Venue: Om Shanti Retreat Center, National Highway 8, Bilaspur Chowk Pataudi Road, Near Manesar.
Timings: On Saturday (2pm onwards) and Sunday (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. For booking e mail to emedinews@gmail.com or sms to Dr KK Aggarwal 9811090206/ BK Sapna 9811796962

Stroke Update Workshop for GPs

Indian stroke association and International Stroke Conference is organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi SMS for free registration to 9717298178 or email to isacon2010@gmail.com

International Symposium on ‘Yogism for Healthy & Happy Living and Aging’

The 7th convocation of SVYASA Yoga University was organized on January 12, 2010. The concept Yogism was well received and we now plan to have an International Symposium on ‘Yogism for Healthy & Happy Living and Aging’ on December 6–7, 2010. There is considerable interest abroad to integrate alternate medicine with modern medicine in Medical schools. We feel Yoga, Meditation and Naturopathy should be integrated with modern medicine in promotion of positive health and healing: BC Harinath, Director, JBTDRC & Coordinator, BIC & Arogyadham Mahatma Gandhi Institute of Medical Sciences, Sevagram – 442102, Wardha, Maharashtra, India, TeleFax: +91 7152 284038, Home: +91 7152 260219, E-mail: bch@jbtdrc.org, bc_harinath@yahoo.com

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Readers Responses

  1. Dear Dr KK: you are our GOD, the avtar of Lord Dhanvantari. Govt. of India has honoured itself by honouring you with Padma Shri Award. We wish you and family all the best.  Thanks, Dr.A.K.Saxena, G.M(Medical), Jodhpur–342003, Rajasthan, Phone–01591230690, Mobile–9414468431

  2. Congratulations K K Uncle. Lots of love: Fatima, Gaurav and Azan

  3. Dear Dr Aggarwal, heartiest congrats. Feel proud of you. Keep it up: Dr. Vinay Kinra

  4. Congratulations. I am proud to attend lectures given by such learned doctor: Amrita

  5. Congratulations on receiving Padmashri award. We are feeling proud of you, Sir: Shailendra Singh

  6. Congratulations. Wish you achieve much more on this path of service of society with your sincere efforts and dedication: A K Kahar, Addl. Session Judge

  7. Great achievements are like Taj Mahal. Everybody will wonder how beautiful it is. But nobody can understand how difficult it was to build: Sanjiv Shelly Batra