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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

21st July, 2010, Wednesday

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

Dengue Watch (CW Games update)

  1. Dengue is a notifiable illness. The local municipal body must be notified. If dengue is reported in one house it becomes customary for the State Health Department to search for the breeding sites around 100 houses so that the disease can be curtailed there and then.

  2. There are four different types of dengue fever: Den 1, Den 2, Den 3, and Den 4. A person during his life can have dengue 4 times. Same dengue virus cannot infect again. Infection from one virus produces life long immunity only for that strain. Second dengue is usually more serious than the first one.

  3. A person can suffer from undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome (four dengue-related illnesses).

  4. Retro-orbital pain presenting as pain in the eyes or pressure on eye movement is characteristic of dengue-related fever. Other features are unexplained itching, nausea and vomiting suggestive of gall bladder inflammation or liver inflammation.

  5. Presence of restlessness (oxygen deficiency in the brain), abdominal pain (indicating internal hemorrhage) and black stools (GI bleeding) signifies urgency. The two dangerous clinical signs are falling systolic (upper) blood pressure and fall in pulse pressure.

  6. The mortality for dengue hemorrhagic fever and dengue shock syndrome is around 1%. There is no mortality seen in undifferentiated fever and dengue fever.

  7. During epidemics, people of all ages are involved otherwise the disease is more common in children.

  8. Dengue and malaria are not the indices of the hygiene status of a city. Cholera and typhoid represent the hygiene indices.

  9. The dengue mosquito, aedes, grows in fresh water collected in any place within or outside the house. Dengue mosquito is a day biter, prefers to bite before breakfast and after lunch, prefers human sites below elbow and below knee. Unlike anopheles (mosquito causing malaria) which bites every 3rd day, a dengue mosquito bites 4–5 times in a day. While anopheles infects one person in 3 days, aedes mosquito can infect 15 persons in 3 days.

  10. IgM blood test may take 5 days to become positive. Therefore in the first 5 days, all dengue tests may be negative.

  11. A platelet count of less than one lakh signifies dengue hemorrhagic fever or dengue shock syndrome.

  12. Do not give aspirin in a suspected case of dengue as it can further disturb the platelet functions.

  13. Never panic. There is no need for platelet transfusion unless platelet count is less than 10,000 or there is presence of spontaneous bleeding.

  14. The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever.

  15. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after fever is over. Often people insist on a discharge from the hospital when the fever is over or do not want to get admitted once the fever is over.

  16. Physicians should remember the formula of 20 and that is rise in pulse by more than 20, fall of BP by more than 20, difference between lower and upper BP less than 20, platelet count less than 20 thousand and presence of more than 20 hemorrhages of blood on the arm after tourniquet test suggests high risk people who need medical attention. The treatment is 20 ml/kg body weight of fluid replacement every hour.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

"Laughter is the Best Medicine" This was the message highlighted in a drawing by renowned Cartoonist Sudhir Tailang at a press conference organized by Heart Care Foundation of India on April 15, 2004

In this Photo: Cartoonist Sudhir Tailang drawing the cartoon at the Press Conference. Also in the photo: Padma Shri and Dr B C Roy National Awardee Dr K.K. Aggarwal, President HCFI

Dr k k Aggarwal


News and Views


CBI court rejects anticipatory bail plea of Ketan Desai’s wife (Ahmedabad Mirror, DNA)

The CBI court on Monday rejected the transit anticipatory bail petition filed by Alka Desai, wife of former Medical Council India President Ketan Desai, in the disproportionate assets case. Alka had earlier filed for transit anticipatory bail in High Court of Gujarat. At that time the HC directed her to move special CBI court in the city first. Following this, she filed a transit anticipatory bail application in the CBI court on July 2.

In her petition Alka stated that she runs her own clinic, has two children to look after and that her in-laws are dependent on her. She stated that the entire responsibility of running the house was on her shoulders and should therefore be granted bail. However, after hearing arguments from both sides on Monday, CBI judge G K Upadhyay rejected her bail application.

She asked for transit anticipatory bail as she has to file anticipatory bail before the court in Delhi. In her application filed through advocate RJ Goswami, she has stated that she should not arrested by the CBI for a month until she files regular anticipatory bail application before the Delhi court. Desai has also stated that as a gynaecologist she has to take care of number of patients who are under her treatment. Desai has made the plea following the linking of her name in the case registered in the Delhi. 

Ex-MCI president Dr Ketan Desai sent to 6 days JC in assets case

A Delhi court on Tuesday remanded former Medical Council of India president Dr Ketan Desai to 6 days in judicial custody for allegedly possessing assets disproportionate to known sources of his income. Special CBI Judge O P Saini sent Dr Desai to jail till July 26 after he was produced at the end of his eight-day custodial interrogation.

Dr Mahesh Verma new DCI Chief

Dr Anil Kohli President DCI has given charge to Dr Mahesh Verma as the President DCI ( as per sources).

US warns India about steroid–containing supplements

The US FDA has warned the Indian Health Ministry about the probable introduction of health-damaging steroids in the Indian market as ‘dietary supplements’. Several of these supplements, contain heavy amounts of steroids. Dietary supplements have recently become popular as a means to stay fit and healthy. The Health Ministry confirms that steroid-containing drugs can put the liver in danger. Besides this, steroids also pose other health risks such as male infertility, growth defect in children, large breasts in men and masculinization of women. Moreover, it increases the risks of heart attacks and has negative effects on blood-lipid profiles.

No new dental college for next 5 yrs

Union Health Ministry is planning to disallow any new dental college in the country for the next five years. The Dental Council of India is on the radar of the investigative agencies for allowing mushrooming of low grade private dental colleges. Health Ministry is planning a five-year moratorium on establishment of new dental colleges.


Too much or too little sleep may increase risk of developing chronic conditions

Too much or too little sleep may increase chances of developing chronic conditions such as diabetes, high BP, obesity and cardiovascular disease. This was the conclusion drawn by researchers at the Brigham and Women’s Hospital who examined data on 56,507 American adults. Specifically, sleeping "less than 6 hours and more than 9 hours" elevated one's chances of developing those risks.

FDA approves Mylan’s generic version of nabumetone

Food and Drug Administration approved the generic version of Nabumetone, a nonsteroidal anti–inflammatory drug (NSAID) used in osteoarthritis and rheumatoid arthritis. The company is now cleared to sell 500 mg and 750 mg tablets of Nabumetone.

Insulin given as nasal spray may benefit patients with Alzheimer’s.

Insulin given as nasal spray through the nose might benefit Alzheimer’s patients. Research presented at the International Conference on Alzheimer’s Disease states that in the insulin–taking groups, cognitive and functional test results improved significantly, compared with those who received placebo. In the study, 109 adults with either mild cognitive decline or early Alzheimer’s received either placebo or 20 or 40 IU daily intranasal insulin treatments over the course of four months.

Firstvoid urine predicts renal events

The albumin:creatinine ratio from a first–void urine sample significantly outperformed other parameters for predicting future renal events in patients with diabetic nephropathy. A multinational study has shown that measuring albumin:creatinine ratio from a first–void urine sample is more accurate for predicting progression of kidney disease in type 2 diabetes than are other commonly used measures. These results are clinically important because they imply that collection of first–morning voids, which is clearly more convenient than collecting a 24–hour urine, can be used for assessment of proteinuria. The study is published online in the Journal of the American Society of Nephrology.

(Dr Brahm and Monica Vasudeva)


Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medical Testimony of Doctor in the Court of law

The media/general public is fast becoming aware of the law and modern diagnostic/therapeutic methods. As a result, doctors/hospitals are being sued from time to time in a Court of law for their acts of omission or commission. Therefore, it is incumbent upon doctors to have good knowledge of the law governing their profession, in order not to transgress the law. Doctors should totally avoid attempts to "cover up" alleged medical negligence or intentional wrongdoing or inevitable medical accident. It is an accepted fact that "Medicine is not mathematics but is a science of uncertainty and an art of probability. Absolute diagnoses are unsafe and are made at expense of the conscience".


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Gastroesophageal Reflux Disease in Children

Prevalence and Pathophysiology (part 1)

Prevalence of GERD in children is not well defined, but community based studies suggest that symptoms may be present in 1.8 to 22% of children aged 3 to 18 years. A prevalence of 10% was found among Indian children in the age group of 1 month to 2 years.

The pathophysiology of GERD differs according to age. Older children manifest similar to adults and infants have more regurgitation and respiratory manifestations due to decreased gastric compliance and delayed gastric emptying. A minor proportion of reflux episodes occur when the LES pressure fails to increase during a sudden increase in intra-abdominal pressure or when LES resting pressure is chronically reduced. Reflux episodes occur most often during transient relaxations of the lower esophageal sphincter (LES) unaccompanied by swallowing, which permit gastric contents to flow into the esophagus. Gastric acid content moves proximally through the esophagus after rising from the LES and may enter the hypopharynx and potentially the trachea where it is responsible for the laryngeal, ear and respiratory symptoms. Irritation of the esophageal mucosa may initiate a reflex through the vagus which causes cough or bronchospasm. Even a single episode of reflux beyond the esophagus may be sufficient to cause pharyngeal, laryngeal, and respiratory symptoms.

Question of the Day

What are the contraindications of use of cisapride? (Dr Jyotsna M Kirtane)

Cisapride is an excellent prokinetic drug, but unfortunately not used frequently due to its reported cardiac complications. It is contraindicated in children with arrythmias.


Public Forum (Press Release for use by the newspapers)

Safe limit of alcohol varies with countries

One to two drinks a day in women, and two to four drinks a day in men, are inversely related to mortality. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

The definition of a "standard drink" varies in different countries. A standard drink in the US is approximately 0.5 to 0.6 fl oz, or 12 to 14 g alcohol, equivalent to 12 oz beer, 5 oz wine, and 1.5 oz of 80 proof liquor. In Great Britain, a standard drink is 8 g alcohol. In Japan it is 19.75 g and in India is 10 grams of alcohol.

The serum blood tests: AST (SGOT), ALT (SGPT), and gamma-glutamyl transferase (GGT) are often abnormal in alcoholic liver disease. The most common pattern of abnormalities is a disproportionate elevation of serum AST (SGOT) compared to ALT (SGPT). This ratio is usually greater than 2.0, a value that is rarely seen in other forms of liver disease.

The absolute values of serum AST and ALT are almost always less than 500 IU/L (and typically less than 300 IU/L). Higher levels should raise the suspicion of concurrent liver injury due to viral or ischemic hepatitis or acetaminophen use, even at therapeutic doses.

Alcoholic liver damage can range from asymptomatic fatty liver to alcoholic hepatitis to endstage liver failure with jaundice, coagulopathy, and encephalopathy. Many alcoholics first become symptomatic only when severe, lifethreatening liver disease is already present. Even at this stage, abstinence can result in significant reversal in some patients.

Alcohol can lead to a variety of histopathologic changes in the liver ranging from steatosis to cirrhosis. Steatosis, alcoholic hepatitis, and possibly cirrhosis are reversible. A high prevalence (25 to 65 percent) of hepatitis C virus infection has been recognized in alcoholics, which can greatly accelerate fibrosis and associated morbidity. These patients tend to have more severe disease, decreased survival, and an increased risk of hepatocellular carcinoma. Fatty liver, or alcoholic steatosis, can occur within hours after a large alcohol binge.


Evidence–Based Medicine

B–type natriuretic peptide signal peptide circulates in human blood: Evaluation as a potential biomarker of cardiac ischemia

The clinical diagnosis of acute coronary syndromes relies heavily on circulating diagnostic biomarkers such as troponin. However, delays in detectable changes in circulating troponin, combined with their absence in ischemia short of infarction, result in clinical uncertainty in a significant number of patients presenting with suspected acute coronary syndromes. Thus, identification of novel biomarkers that may provide early information on acute myocardial infarction and cardiac ischemia is of major importance. We provide here the identification of a novel potential biomarker of acute coronary syndromes, namely a peptide fragment derived from the signal peptide region of B-type natriuretic peptide (BNPsp). BNPsp is present as a distinct peptide in explant human cardiac tissue and is secreted into the circulation in normal health. Furthermore, detectable elevations in BNPsp were observed in ST–elevation myocardial infarction patients significantly earlier than myoglobin, creatine kinase–MB, and troponin. BNPsp thus presents as a novel class of potential biomarker in acute coronary syndromes, and further studies to determine its assay specificity and diagnostic potential in the complete spectrum of acute coronary syndromes are clearly warranted.

(Contributed by Dr. V Nagrath)


An Inspirational Story

The Obstacle in our path

In ancient times, a king had a boulder placed on a roadway. Then he hid himself and watched to see if anyone would remove the huge rock. Some of the king's wealthiest merchants and courtiers came by and simply walked around it.

Many loudly blamed the king for not keeping the roads clear, but none did anything about getting the big stone out of the way. Then a peasant came along carrying a load of vegetables. On approaching the boulder, the peasant laid down his burden and tried to move the stone to the side of the road. After much pushing and straining, he finally succeeded.

As the peasant picked up his load of vegetables, he noticed a purse lying in the road where the boulder had been. The purse contained many gold coins and a note from the king indicating that the gold was for the person who removed the boulder from the roadway. The peasant learned what many others never understand.

Remember, every obstacle presents an opportunity to improve one’s condition.


IJCP Special

Dr Good Dr Bad

Situation: A diabetic came with UTI.
Dr Bad: Get routine culture done.
Dr Good: Also get fungal culture done.
Lesson: It is important to search routinely for yeast in the urine of patients with type 2 diabetes to detect candidiasis, and to perform antifungal susceptibility tests to Candida isolates in order to establish antifungal therapy for these patients. (Rev Med Inst Mex Seguro Soc 2008;46 (6):60310.)

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on sulfa?
Lasson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

Quote of the Day

‘Argument is the worst sort of conversation’: Jonathan Swift.

Mnemonic of the day

Agents that may appear radiopaque on plain X–ray : CHIPES

Chlorinated hydrocarbons (e.g, chloral hydrate, carbon tetrachloride) / Calcium salts (e.g, calcium carbonate) / Crack vials
Heavy metals (e.g, iron, arsenic, mercury, thallium, lead)
Iodinated compounds (e.g, thyroxine)
Psychotropics (e.g, phenothiazines, lithium, cyclic antidepressants) / Packets of drugs (e.g, cocaine and heroin "body packers") Play–Doh / Potassium salts
Enteric–coated tablets (e.g, aspirin)
Salicylates / Sodium salts / Sustained–release preparations

Are you fit to fly?


  1. Patients with ful–leg casts, for safety reasons, may be required to travel by stretcher, purchase an extra seat, or fly business or first class.
  2. Casts applied within 48 hours should be split lengthwise along each side (ie, bivalved) to avoid injury from the expansion of air trapped between the skin and the cast if the limb swells.
  3. Pneumatic splints should be partially deflated to avoid rupture from expanding gas.

Milestones in Cardiology

John Heysham Gibbon built the first heart–lung machine in 1937.


International Medical Science Academy Update (IMSA)

Weight loss surgery

Accumulating evidence supports the efficacy of weight loss surgery for severe obesity in adolescents. The nadir postoperative BMI tends to be lower in patients with less severe obesity preoperatively as compared to those with more severe obesity, although the percent BMI change is similar.


Inge TH, Jenkins TM, Zeller M, et al. Baseline BMI is a strong predictor of Nadir BMI after adolescent gastric bypass. J Pediatr 2010;156:103.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Rifaximin 400mg (additional Indication)

For the treatment of hepatic encephalopathy



Medi Finance

Q. Are trusts required to file return of income?

Ans. Trusts are also required to file return of income, if the voluntary contributions or other income exceeds the exemption limit.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Polymerase Chain Reaction (PCR) Technique

It is a technique in molecular biology to amplify a single or few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence. The method relies on thermal cycling, consisting of cycles of repeated heating and cooling of the reaction for DNA melting and enzymatic replication of the DNA. Primers (short DNA fragments) containing sequences complementary to the target region along with a DNA polymerase (after which the method is named) are key components to enable selective and repeated amplification. As PCR progresses, the DNA generated is itself used as a template for replication, setting in motion a chain reaction in which the DNA template is exponentially amplified. PCR can be extensively modified to perform a wide array of genetic manipulations.


Humor Section



One afternoon, a man went to his doctor and told him that he hadn't been feeling well lately. The doctor examined the man, left the room, and came back with three different bottles of pills.

The doctor said, "Take the green pill with a big glass of water when you wake up. Take the blue pill with a big glass of water after you eat lunch. Then just before going to bed, take the red pill with another big glass of water." Startled to be put on so much medicine, the man stammered, "Jeez Doc, exactly what is my problem?"

The doctor replied, "You’re not drinking enough water."

Medical bloopers on medical charts!

Pelvis…………………………Second cousin to Elvis


Readers Responses

  1. Dear Dr Aggarwal, thanks... this is not only a medical journal/letter but it is also a medium for receiving latest and updated current news of rail mishap, news of surroundings, news from other newspapers, highlights etc. along with the current season/weather diseases topics ie malaria/dengue. Really it is a boon for all medicos, everybody can access it easily according to time schedule, even review the back dated news any time any where. Thanks lot sir: Dr.
    K P Singh, Cardiologist, Fortis Escorts Heart, Okhla road New Delhi

  2. Respected Sir, I highly appreciate the abundance of information which we get regularly through emedinews and i do not have even a pinch of doubt to say that it’s contents are at par with high international standards. There is one suggestion from my side also and that is to include selected Case reports that are concise yet adequate to make us understand how that particular case was approached and managed. In the same we can share various interesting X–ray’s, CT & MRI films in emedinews with expert Radiologist comments on that. With all your permission i would like to appeal all readers of emedinews to send various interesting and challenging case reports that they feel worth sharing with whole medical community of emedinews. Thanks: Dr Manoj Kr Saini

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