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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


Dear Colleague

21st April, 2010 Wednesday

Statins and liver dysfunction

  1. In 0.5 to 3% pts receiving cholesterol lowering drug statin have persistent elevations of liver enzymes.

  2. This is common during the first three months of therapy and is dose–dependent.

  3. A meta–analysis of 35 randomized trials has shown an excess risk of liver enzyme ( SGOT SGPT) elevation with statins  therapy versus placebo is 4.2 cases per 1000 patients 1.

  4. A review of 1014 patients taking statinshas shown that one percent of patients had transaminase elevations more than three times normal, and 0.5 percent had transaminase elevations two to three times normal 2.

  5. The US FDA labeling information includes liver function testing before and at 12 weeks following the initiation of statins, and at any elevation of dose and periodically thereafter.

  6. Recommendation: change the drug or lower the statin dose in patients who are found to have an SGPT level more than three times the upper limit of normal that is confirmed on a second occasion.


  1. Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation 2006;114:2788.

  2. Smith CC, Bernstein LI, Davis RB, et al. Screening for statin–related toxicity: the yield of transaminase and creatine kinase measurements in a primary care setting. Arch Intern Med 2003;163:688.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

National seminar on stress prevention, at ORC Near Manesar, Organized by Heart Care Foundation of India and Brahma Kumaris with IMA (NDB, Janakpuri and SDB); IMSA Delhi.  Seen in the picture are BK Sapna, BG Asha, Chief Secretary Rakesh Mehta, BK Brij Mohan, Padmashri Awardee Dr K K Aggarwal, Dr Narender Saini and Dr A K Kansal.)

Dr k k Aggarwal

News and views

Anti–cancer drug triggering viral infection

A study, conducted by a team of UNC School of Medicine scientists and the UNC Project in Malawi, demonstrated for the first time in humans that a common drug (cyclophosphamide) used to treat Burkitt lymphoma can activate infection by the Epstein–Barr virus (EBV), a virus which typically lies latent inside the tumor cells of affected patients. The finding paves the way for a future study using both a cancer drug and an antiviral agent to eradicate both the active virus infection and the tumor. The findings are reported in the April 1 issue of the journal Clinical Cancer Research.

Dance as treatment

Creative interventions such as dance–based therapy have the potential to significantly reduce falls in older persons, said Jean Krampe, a registered nurse and doctoral student in the Sinclair School of Nursing.

Diet high in B vitamins lowers heart risks in Japanese study

Eating more foods containing the B–vitamins folate and B–6, lowers the risk of death from stroke and heart disease for women and may reduce the risk of heart failure in men, according to Japanese research reported in Stroke: A journal of the American Heart Association.

Women who eat foods with high glycemic index may be at greater risk for heart disease

Consuming carbohydrates with high glycemic index –– an indicator of how quickly a food affects blood glucose levels –– appears to be associated with the risk of coronary heart disease in women but not men, according to a report in the April 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

No pregnancy issues in early natalizumab review

An early check of registry data from women with multiple sclerosis who became pregnant while taking natalizumab does not appear to raise concerns of miscarriages or abnormalities. (Dr Lynda Cristiano, medical director of drug safety Biogen Idec, Cambridge, Mass at Annual Meeting of the American Academy of Neurology).

Mnemonic of the Day (Dr Prachi Garg)

Cerebellar signs – VANISH DDT




Intention tremor

Slurred speech





What’s New

Unfractionated heparin

Unfractionated heparin (UFH) manufactured in the US and shipped after October 8, 2009 will be less potent than previous products, with a 10 percent lower activated partial thromboplastin time (aPTT) per USP unit of heparin. Children who receive UFH should be monitored by both aPTT and heparin levels.

Quote of the day

"Do not be desirous of having things done quickly. Do not look at small advantages. Desire to have things done quickly prevents their being done thoroughly. Looking at small advantages prevents great affairs from being accomplished." (Confucius)

Diabetes Fact

CKD commonest cause is diabetes.

Public Forum (Press Release for use by the newspapers)

Its World Earth Day on 22nd April

Mercury is Hazardous to Health

One should not use mercury thermometers and mercury based BP instruments said Padma Shri and Dr B C Roy Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Two thermometers are broken each year for one bed in a hospital. For 40,000 beds in Delhi alone, 80,000 thermometers get broken and mercury released in the atmosphere. Each thermometer contain half gram of mercury. Thus four kgs of mercury is released only by hospital beds and only from thermometers. The other sources are mercury BP instruments and mercury dental fillings.

Mercury is toxic by ingestion, inhalation and skin absorption with acute and chronic exposure effects including central nervous system and kidney damage.

Acute exposure includes nausea, blurred vision, painful breathing, excessive salivation and pneumonitis, while chronic or longer–term exposure includes memory disturbance, hypertension, vision problems, hallucinations, tremors and personality changes.

The two properties that make mercury extremely unmanageable are bioaccumulation and biomagnification. Because mercury can cross the blood–brain barrier, and because it can affect brain development, its effects are of special concern to pregnant or lactating women and young children.

The most common exposure routes involve food and diet. Additional exposures may be contributed through air and water, either directly or again through the route of food. Methyl mercury is the most toxic form. Once released, mercury persists in the environment where it circulates between air, water, sediments, soil and biota in various forms.

  1. Mercury is not mined in India.

  2. Mercury–containing instruments, mercury compounds, electrical and electronic substances containing mercury and mercury compounds etc are also imported in large quantities.

  3. India is one of the world’s mercury hotspots, with mercury being released into the air uniformly at a rate of 0.1–0.5 tonnes per year, with coastal areas having an even higher emission rate ranging between 0.5 to 2.0 tonnes per year.

  4. Estimates place release of mercury into India's environment between 172.5 – 200 tonnes annually.

Question of the day

Lasers for warts. When and how?

Lasers can be used in recalcitrant palmar/plantar warts with significant hyperkeratosis. Flash lamp pump pulsed dye laser is more effective as it destroys the blood vessels, thus cutting nutrition supply to the warts.

eMedinewS Try this it Works

Hugs for a frightened child

To help comfort infants or small children, ask the parent to hug the child, chest–to–chest. The baby’s arms are down at the sides, held by one of the parent’s arms, and the head is held by the parent’s other arm. This makes for easy examination of the ears.

Dr Good Dr Bad

Situation: A diabetic patient had an A1C of 12 % with a fasting sugar of 90 mg%.

Dr Bad: The report is wrong.

Dr Good: Get hemoglobinopathy ruled out.

Lesson: If a HbA1c value is obtained that does not correlate with clinical expectations i.e. HbA1c higher or lower than expected, hemoglobinopathy should be considered as a possible cause. Failure to do so may contribute to mismanagement of diabetic patients due to false HbA1c results. (Diabetes Care 2000;23(8):1197–8.)

Make Sure

Situation: A patient on ampicillin developed persistent diarrhea.

Reaction: Oh my God! You should have suspected Clostridium difficile-colitis.

Make sure: No antibiotic is safe. All antibiotics can predispose to Clostridium difficile- colitis, and ampicillin is a commonly implicated beta-lactam. (N Engl J Med 1994;330:257.)


Laughter the best medicine

Two days in the Intensive Care

A doctor has come to see one of his patients in a hospital. The patient has had major surgery in both of his hands.

"Doctor," says the man excitedly and dramatically holds up his heavily bandaged hands. "Will I be able to play the piano when these bandages come off?"

"I don’t see why not," replies the doctor.

"That’s funny," says the man. "I wasn’t able to play it before."

Formulae in Critical Care

Urine anion gap (UAG)

Formula: (Na + K)u – (Cl)u

Comment: If negative, is suggestive of high ammonium
ion excretion indicating extra renal cause of acidosis.
If positive then urine osmolar gap has to be calculated
to detect ammonium ion in urine.

Milestones in Medicine

Alexander Fleming reported on penicillin's potential to kill bacteria in 1929.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Allergy testing

Allergies are hypersensitivities, overreactions of the immune system to substances that do not cause reactions in most people. Allergen specific IgE testing: Immunoassay and LINE BLOT TESTS are blood tests that are used to screen for type I allergen–specific IgE antibodies.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Colistimethate Sodium powder for solution for inhalation 500000IU/ 1000000IU/ 2000000IU

Treatment by inhalation of Pseudomonas aeruginosa lung infection in patients with cystic fibrosis


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Contact: drkk@ijcp.com or 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 hungama and live webcast. Suggestions are invited.

IMANDB Annual Day Meet : Scientific feast, in association with Borad of Medical Education Moolchand Medcity, emedinews and IMSA (Delhi) ; No fee SMS 9811090206 for registration

Date: Sunday April 25, 2010,

Venue: Moolchand Medcity Auditorium, New Delhi

Scientific Program: 4–7 PM

4.00 PM-5.00 PM: Fatty Liver, Workshop for GPs: Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal

5.00 PM–6.00 PM: Cardiac Update (Max Hospital)

a. Dr JJ Sood Oration: Cardiac Interventions: Dr Mohan Bhargava

b. Dr K L Chopra Oration: Endovascular Approach to Aortic Aneurysm Dr Kumud Mohan Rai ( Max Hospital)

6.00 PM - 6.30 PM

Dr Sheila Mehra Oration: Management of osteoporosis: Dr Ramneek Mahajan

6.30 PM -7.00 PM

Medical Ethics: A panel discussion: Dr Ashok Seth, Dr Sudesh Ratan, Dr Rajiv Khosla, Dr KK Aggarwal, Dr Girish Tyagi, Dr Sanjiv Malik, Dr H K Chopra, Dr Madhu Handa, Dr Kumud Mohan Rai, Dr Archna Virmani

Annual Day Function: 7-8 PM

Eminent Guests: Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, Dr Narender Saini (President DMA), Dr Vinod Khetrapal (PE DMA), Dr Girish Tyagi (Registrar DMC), Dr Ashwini Dalmiya (Secretary DA), Dr Naresh Chawla ( IPP DMA)

Dinner: 8.00 PM onwards...

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Readers Responses

  1. Dear sir, You might remember that I had forecast (and expressed to you) a great national prize for you after attending your CME lectures at Janak Puri, and now find myself so astonished that there are so many colleagues who feel the same way as I go through every newsletter of yours. I wanted to send a congratulatory letter much earlier but thought it would get drowned among the millions you are getting. May God bless your efforts always!!! Fondly yours: Dr. Gurdev Singh
  2. Hello Dr KK, Congrats for National Honour. Makes us proud to know a national awardee. I am expressing my concerns as regard inclusion of MBA’s in health care with no medical background being employed and gaining great say in our corporate hospitals, earning more than senior Docs too!!

They have no knowledge of medical field and are not under obligation to be under MCI licensing procedures. Yet they are playing great commercial roles like even approving or making various tests and treatment packages, contacting patients, managing their feedbacks, even approving certifications for death in some cases!! This can lead to mistakes,as they expect docs to be like sellers of medicine and patients to be buyers, to describe an extreme scenario.

Many are calling shots in the boardrooms of medical chains. Is there anything on the cards to curb the educated Quackery in the name of commercialisation of medicine. Why aren’t they too expected to have a licencing exam like MHAs, in medical colleges? Recent CII conference on healthcare was attended less by docs than these MBAs in the name of improving the hospitals around the country. Hope my voice will be heard by other MCI members too through U or by me directly if I am given a chance or hearing on the subject. Thanks regards Manisha Kukreja Bhatla