Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
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

22nd February 2010, Monday

Breaking FDA NEWS: LABA Asthma Drugs Not for Solo Use

Long–acting beta agonist (LABA) drugs should not be used alone in asthma (both children and adults). Package inserts for the two single-agent LABAs approved for asthma, salmeterol and formoterol, will be changed to require that the drugs always be used in combination with an asthma controller medication such as an inhaled corticosteroid.

FDA Advice

1. LABAs should only be used long-term in patients with asthma not adequately controlled with inhaled steroids or other controller medications.

2. The agents should be used for the shortest time possible to achieve symptom control. Once patients are no longer experiencing symptoms, LABAs should be discontinued if possible with patients maintained on controller medications alone.

3. No label changes for arformoterol, approved only for COPD.

4. The label changes also won't apply to LABAs used for intermittent exercise-induced bronchospasm.

Thus far, the risks associated with LABAs have been seen only in asthma patients. Those risks include severe exacerbations of asthma symptoms, leading to hospitalizations for adults as well as children. Some of these exacerbations have been fatal. The FDA cited data from a placebo-controlled trial called SMART in which salmeterol was associated with excess deaths at an overall rate of 8 per 10,000 patients (95% CI 3 to 13). A meta-analysis of some 60,000 patients in multiple trials of salmeterol and formoterol found that the drugs were associated with a composite of hospitalizations, intubations, and deaths at an excess rate of 28 per 10,000 patients (95% CI 11 to 45). These events were markedly more frequent in adolescents (58 per 10,000) and children (148 per 10,000).

Dr KK Aggarwal
Chief Editor

News and Views

1. Botox may relieve postherpetic neuralgia

Subcutaneous injection of botulinum toxin A significantly reduced postherpetic neuralgia compared with lidocaine and saline placebo in a small randomized clinical study. Preliminary data suggest that Botox may be useful for the treatment of refractory postherpetic neuralgia. (Dr Lizu Xiao, Nanshan Hospital, Shenzhen, China)

2. Migraine may double risk of heart attack

Migraine sufferers are twice as likely to have heart attacks as people without migraine, according to researchers at Albert Einstein College of Medicine of Yeshiva University. The study, published in the February 10 online issue of Neurology, found that migraine sufferers also face increased risk for stroke and were more likely to have key risk factors for cardiovascular disease, including diabetes, high blood pressure and high cholesterol.

3. Drinking milk during pregnancy lowers baby’s risk of multiple sclerosis

Drinking milk during pregnancy may help reduce your baby’s chances of developing multiple sclerosis (MS) as an adult, according to a preliminary study released February 10 that will be presented at the American Academy of Neurology’s 62nd Annual Meeting in Toronto April 10 to April 17, 2010.

4. Diabetes drug ups risk for bone fractures in older women

After taking a thiazolidinedione (TZD) for one year, women were 50 percent more likely to have a bone fracture than patients not taking TZDs, according to a study. And those at the greatest risk for fractures from TZD use are women older than 65.

5. GZB, the polio hub (Dr G M Singh)

With India reporting the highest number of polio cases (672) in 2009 and Uttar Pradesh accounting for 544 of them, Ghaziabad's (GZB) tally of 72 polio cases makes it the polio hub of the world. In 2008, Ghaziabad had reported just five cases of polio and by the end of 2009 this number had shot up to 72. With the government, health officials and development agencies setting 2012 as the target for eradication of polio, UP and Ghaziabad, in particular, stand out as a challenge in meeting that deadline.

Conference Calendar

Meditec Clinika 2010 (The 2nd International Trade Fair for Medical Equipment and Technology)
Date: February 26–28, 2010
Venue: Chennai Trade Centre, Chennai, Tamil Nadu.

Diabetes Fact

Diabetes in malnourished children: high fasting sugar which responds to giving proteins and calories (cause: not enough proteins to make insulin)

Thought for the day (BK Sapna)

Learning to talk properly to the self is a spiritual endeavour. When you make a mistake, do you talk lovingly to yourself in your mind, or do you tell yourself off? One habit recognises your divinity; the other subtly shapes a nature of sorrow. Remove the darkness of the mind and the world will be illuminated.

Public Forum (Press Release)

Blue and Green Holi colors may be Dangerous

New Delhi: Monday, 22 February 2010: Use natural herbal colors o 'chandan ka tika' as chemical colours can cause serious health hazards, said Dr. K K Aggarwal, President, Heart Care Foundation of India, and Editor eMedinewS. 

Holis is to be celebrated to remove internal dirt from the body by spreading love and affection.

Chemical colours, bhang and the indiscriminate use of alcohol, all can lead to health hazards.

An AIIMS report has shown that green/bluish–green colors are associated with higher incidence of ocular toxicity. In fact, most ‘pleasing to eye’ colours available in the market are toxic and could cause serious disorders.

Malachite green is extensively used in Holi colors and can cause severe eye irritation with epithelial defect upon exposure, though it usually does not penetrate through the cornea.

Also, presence of cheap inorganic chemicals like mica, acids, alkalis, pieces of glass, not only induce skin disorders like abrasion, irritation or itching but can also impair vision, cause respiratory problems and also cancer. The alkaline base of these colors can cause injuries, the severity of which depends upon the area of contact and the degree of penetration.

Broadly there are three categories of colours available in the market – pastes, dry powders and water colors. The hazard increases when these are mixed with oil and applied to the skin.

Most inorganic dry colors or ‘gulals’ have two components – a colorant which may be toxic and a base, which could be asbestos or silica, both of which are capable of causing health hazards. While silica dries as well as chaps the skin, asbestos, a known human carcinogen, can result in cancer.

Punjab & Sind Bank
Central Bank of India

Question of the day

How do you differentiate between large and small bowel diarrhea?

Diarrhea usually results from malabsorption, secretory states and inflammation. Steatorrhea is suggested by pale, smelly stools which would indicate either a small bowel problem or pancreatic insufficiency. In lactose intolerance, the diarrhea tends to be watery. These two are examples of small bowel diarrhea, and for differentiating between them, the causes needs to be known since the diarrheal patterns are different. It is very important to take a good history as watery diarrhea also occurs in colonic diseases like collagenous colitis, which should be typically thought of in an older patient who is using nonsteroidal anti-inflammatory drugs (NSAIDs) and presents with watery, nonbloody diarrhea. Patient history, examination findings and investigations all play a major part in diagnosing diarrhea. A bloody diarrhea, points to colitis and cramping abdominal pain with diarrhea and vomiting points to a small bowel pathology such as Crohn’s disease.

eMedinewS Try this it Works

Auscultation for pleural effusions

Percussing the sternum with one or two fingers while listening with the diaphragm of the stethoscope over the posterior hemithorax can more easily allow the listener to hear dullness replace tympany when the level of the effusion is reached. This allows greater confidence when performing the thoracentesis.

Dr Good Dr Bad

Situation: A diabetic was found to have an A1C of 7.5%.
Dr Bad: The diabetes is not under control.
Dr Good: It’s fine.
Lesson: In adults with type 2 diabetes, the lowest mortality risk is associated with an HbA1c level of 7.5%, whereas increased mortality risk is associated with the lowest and highest deciles of median HbA1c values.

Make Sure

A patient of COPD and hypertension on atenolol developed acute bronchospasm.
Oh my God! You should have known that atenolol is not COPD–friendly. You should have given nebivolol.
Make sure to use nebivolol, a beta–1 adrenoceptor blocking agent that modulates endogenous production of nitric oxide and not conventional beta–1 blockers in hypertensive patients with airway dysfunction. (Source: Respiration 2004;71(2):159–64)

Laughter the best medicine

GP referral to a pediatrician: ‘Kindly see four–year–old James, who has had a cough since yesterday. Also, the family pet dog has had a similar barking cough for the last few days’.

Formulae in Critical Care

Stroke index (SI)
Formula: SI = SV/BSA
SV – Stroke volume
BSA – Body surface Area

Milestones in Neurology

William Benjamin Carpenter (1813–1885) was an English physiologist and naturalist. He attended medical classes at University College London, and then went to the University of Edinburgh, where he received his M.D. in 1839. The subject of his graduation thesis, "The Physiological Inferences to be Deduced from the Structure of the Nervous System of Invertebrated Animals," was the first line of research which had fruits on in his Principles of General and Comparative Physiology.

Mistakes in Clinical Practice

"U" and "IU" – The "U" can easily be mistaken as the number "0", articularly when the "U" is written too closely after the number. This can lead to tenfold overdoses. And "IU" can be mistaken for "IV" or the number "10". So instead of using "U" and "IU", use the terms "unit" and "international unit".

Eye care snippets by Dr. Narendra Kumar (OptometryToday@gmail.com)

Lens materials and coatings

Lenses are made of either glass or plastic. Glasses used for lenses are ophthalmic crown, photochromatic crown, barium, or flint. Plastics used for lenses are CR–39 or polycarbonate. Besides these standard materials, high index lenses are available both in glass and in plastic. Also available are polarizing lenses.

Optical glass: Modern optical glass was developed in the 19th century by Faraday and Schott. Clear crown glass used for ophthalmic lenses is made of 70% sand, 12% lime, 15% soda, and small amounts of potassium, borax, antimony, and arsenic. Flint glass contains lead oxide to increase refractive index. Flint is softer than crown (but is heavier with increased dispersion and specific gravity). Barium glass contains barium oxide and is similar to flint (with less dispersion). Flint and barium are both used in fused bifocals. Glass is fragile, brittle and breaks into sharp splinters. Heat–toughened lenses are usually made from spectacle crown glass (having refractive index of 1.523). For toughening, the cut lens is placed into a furnace and heated at 6370 C for 50–300 seconds. After heating, it is rapidly cooled. For chemical toughening, the pre–heated lens is lowered into a potassium nitrate solution at 4400 C for 16 hours, which results in a thin but tough compression coating.

Optical plastics: Ophthalmic lenses made of plastic are fast catching up in India. Plastic is lighter, can be moulded into aspheric shapes, fogs less in high humidity, and can be treated to absorb 100% ultraviolet (UV) rays. Made of resin, plastic lenses weigh about 50% less than glass. CR–39 lenses (developed in 1947) have good impact resistance, but their scratch resistance is not as good as that of glass. Refractive index of CR39 (Columbia resin 39) is 1.498. These lenses can be tinted and bleached. Their edges are thicker than glass lens edges. If too thin, these lenses may warp and create astigmatic effects. Scratch–resistance of these lenses can be improved with the help of anti–scratch coatings. Fresnel lenses and prisms are made of 1mm thin vinyl film. But plastic lenses, having relatively low refractive index, are thicker than equivalent glass powers, and once finished these lenses cannot be resurfaced. Plastic bifocals and progressive addition lenses (PALs) are available in various styles. Polycarbonate lenses are more impact resistant, lighter and thinner than comparable CR–39. But these require special handling in processing and surface–coating.

High index lenses: Baseline ophthalmic lens materials are (mineral) crown glass having refractive index 1.523, and (organic) CR39 having refractive index 1.498. High index lenses are made with the incorporation of lead or barium compounds, resulting in increased weight. Schott (in early 1970s) used titanium oxide for raising the index. These lenses are thinner than glass and more so than plastic lenses. Internationally, high index spectacle lenses enjoy a sizeable share as these allow ‘minus’ prescriptions in thinner and more cosmetically appealing lens forms. Further, because of the saving in lens mass, there is substantial weight saving even though higher refractive index glasses have higher specific gravity. All this leads to wearer comfort. The Corning France "Handbook of Ophthalmic Glasses" cites an 8% weight saving at –6.00D using 1.6 index instead of crown glass, and a 14% weight saving at –15.00D using 1.8 index glass.

While glass lenses of refractive index 1.6 are fast becoming the first choice for prescriptions as low as –2.00D in major European countries, the real benefit of reduced thickness and reduced weight is for prescriptions of –6.00D and beyond, for the Indian market in view of the higher cost factor. 1.7 refractive index is available in both glass and plastic materials. 1.8 refractive index, available in glass material only, offers impressive benefits for the high minus power wearer (–15.00D or above), but this patient group is small. Photochromic lenses are available in 1.6 index glass and 1.7 index plastic materials.

Since high refractive index materials have varying degrees of transverse chromatic aberration (visual blurring on oblique gaze), there is need for the application of anti–reflection (AR) coatings, especially for 1.7 or 1.8 index lenses to mask this drawback and to increase optical performance. In organic lenses, broad–band coatings provide additional advantage of improving scratch resistance. Due allowance is to be given while surfacing high index material lens blanks (plastic as well as glass) using tools meant for standard index materials. Tinting high index organic material presents a problem, but AR coating presents no problem.

Tints: Tints, or shades or colours, absorb part of the light entering the glass or plastic lens. Tints may be visible in the form of a colour of the entire lens material or invisible in the form of an extra coating.

On entering the lens, part of the light is transmitted (goes through it), and part of it is absorbed or reflected (not transmitted); 80% transmission of light through a lens means that the material is lighter in tint than a material allowing 20% transmission through it. And 80% absorption of light though a lens means that the material is darker in tint than a material absorbing 20% of light. Usual tints available in the market are Alpha or A1 (light yellow), A2 (light blue), B1 (light bluish–black), B2 (dark bluish-black), SP2, Calobar (green), SP4, Grey, and SP10.

In coloured lens blanks, the tint is permanent and increases in darkness as the thickness of the lens increases. By means of vacuum coating, cosmetically appealing, single gradient tints can be applied to a glass lens. The darker tint at the top helps reduce glare from overhead, and the lighter shade at the bottom permits easy reading. Double gradient tints are darker in shade both at the bottom and top of the lens, with a clear zone in the middle. A uniform bluish colour can also be applied by coating on the back surface of a lens. Colours can be applied to a plastic lens as well. These colours can also be removed by means of bleaching. Bleached lenses can again be coloured when desired. Usually a colour sample chart is kept by the optical dispenser for the patient to choose from.

It is important to suggest a larger frame for sunglasses for wider coverage and sun protection. Also to be remembered is that the frame should be of appropriate size according to face (neither too big nor too small) when it is to be used for prescription sunglasses especially for high powered lenses. Since the eye lens is removed at the time of cataract surgery, aphakic patients need UV protection. They should be advised brown, green, or grey coloured lenses. Constant use of sunglasses may create light sensitivity, and patients may become habitual to their use. Constant use, is, therefore, not advisable. Clear glasses may be advised for indoor use. Polaroid is not a tint. Available in grey, brown, and green, it helps absorb glare such as road and water reflections. (to be continued next week ...)

Lab Test (Dr Navin Dang)

Treat the patient and not the lab reports. Always corelate with clinicl findings.

1-7 April Prostate Disease Awareness Week: Prostate SMS of the day (Dr Anil Goyal)

The prostate produces secretions that form part of ejaculated semen and help in motility of sperms.

11th March World Kidney Day ( Dr N P Singh)

Reducing risk of developing kidney diseases : Keep regular control of blood sugar level

About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels with the help of doctors or pharmacists, who are always happy to help.

Kidney Terms (Dr G M Singh)


Inflammation of bladder. Definition of acute cystitis includes dysuria, urgency and/or frequency with only 102CFU/ml in mid–stream specimen.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Methadone Hydrochloride 5mg/10mg per ml syrup; 5mg/ 10mg/ 20mg / 40mg tablet
For the treatment of opioid dependence and in maintainence treatment for opioid dependence

(Advertorial section)

Silicic Acid

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’

International Symposium on ‘Yogism for Healthy & Happy Living and Aging’ on December 6–7, 2010. Dr BC Harinath, Director, JBTDRC & Coordinator, BIC & Arogyadham Mahatma Gandhi Institute of Medical Sciences, Sevagram – 442102, Wardha, Maharashtra, bch@jbtdrc.org, bc_harinath@yahoo.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. I was so very happy to hear about the Padma Shri being conferred on you, because you deserve all the honour and glory which the country can bestow on you. Please accept my heartiest congratulations. May God bless you always and give you a life full of fulfillment and creativity, and many more honours. You have done so much for Mummy and all of us and we always pray for your welfare. I have been traveling and missed speaking to you earlier upon hearing the good news, as my cell phone had been left behind by mistake. Good Wishes: Dr Anita Singh, Hony. Advisor Cultural Affairs, Member, Governing Council

  2. Our family congrats you for being recognized your passion and devotion for the welfare of society and even beyond humanity. Very well deserved Sir. Our best wishes for many more recognitions to follow globally: R Vij

  3. Congratulations. Padmashree is true recognition of your untiring service to lakhs of Delhites. We are sure your health tips reach millions and benefit them forever: Subhash Vatsain

  4. Hearty congs on being honoured. Sorry for wishing you late: Dr R S Kalra