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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

22nd June, 2010, Tuesday

Cholecystectomy not always the best option for cholelithiasis patients

Cholelithiasis patients with dyspeptic symptoms report a high persistence of pre–existing symptoms after undergoing cholecystectomy. Patients with non–specific pre–operative symptoms and those with High Trait Anxiety (HTA) or who were taking psychotropic medication also have an increased risk for postoperative biliary or dyspeptic symptoms.

Laparoscopic cholecystectomy is gold standard for management of cholelithiasis, but 40% of patients report either persistence of pre-existing symptoms or emergence of new symptoms following the operation.

As per a Dutch study, published in the Journal of Gastrointestinal Surgery, Jolanda De Vries of Tilburg University investigated preoperative factors associated with persistence or emergence of postoperative symptoms in 172 consecutive symptomatic cholelithiasis patients aged 18–65 years. All patients underwent laparoscopic cholecystectomy.

Dyspeptic symptoms were defined as bad taste in the mouth, heartburn, under abdominal pain, diarrhea, and flatulence; biliary symptoms as upper abdominal pain, nausea, and vomiting. Non–specific symptoms comprised general malaise, fatigue, weight change, decrease in sexual functioning, and other complaints.

At six months post surgery

  1. About 47.8% of patients were symptom free.

  2. Persistence and emergence of symptoms were reported by 17.9% and 34.0% of the patients, respectively.

  3. Patients with only pre–operative biliary symptoms were most likely to be free of postoperative symptoms, at 62.5%.

  4. About 63.2% of patients with only dyspeptic symptoms reported persistence of their pre-existing symptoms following cholecystectomy.

  5. Use of psychotropic medication and initial dyspeptic symptoms significantly predicted persistence of initial symptoms, with multivariate odds ratios (ORs) of 5.3 and 4.5, respectively.

  6. Patients with pre–operative non–specific symptoms were 4.5–6.1 times more likely to experience postoperative biliary and/or dyspeptic symptoms than other patients, and those diagnosed.

(with inputs from Dr Varesh Nagrath)

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Make the Most of the Time

A Press Conference is a huge platform where the media is invited for interactive sessions and Statements and Announcements can be made. Heart Care foundation of India has utilized most of the time during press conferences organized by it to deliver health messages along with other announcements and event awareness. HCFI takes care to make the module more effective and interesting by involving celebrities of different fields. This not only attracts the media but also draws interest of general public since the celebrities are popular and can easily connect to the audience.

Dr k k Aggarwal

In the photo: Mr Ashok Chakradhar, Hindi poet and Mr. Veerendra Saxena, Actor, releasing a health message during a Perfect Health Mela conference

News and views

1. One in 5 teens has unhealthy cholesterol levels (Dr GM Singh)

As per a new CDC report, one in five Indian teens has unhealthy cholesterol levels, putting them on the fast track for heart disease. Researchers found that 20% of young people aged 12-19 in India have at least one abnormal cholesterol or lipid level, including low-density lipoprotein (LDL) or "bad" cholesterol, high-density lipoprotein (HDL) or "good" cholesterol, and triglycerides. The study showed 43% of obese teens had unhealthy cholesterol levels compared with only 14% of normal-weight teens and 22% of overweight teens.

2. FDA warns against giving infants more than 400 IU Of vitamin D

The FDA has cautioned parents about the dangers of giving infants more than 400 international units (IU) of vitamin D. Supplementation is recommended for those being breastfed, because a deficiency can lead to bone problems, such as thinning, soft and misshapen bones.But overdoses can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion and fatigue, as well as more serious consequences such as kidney disease.

3. Diabetic neuropathy (Dr Maj Prachi Garg)

The earliest signs of diabetic neuropathy probably reflect the gradual loss of integrity of both large myelinated and small myelinated and unmyelinated nerve fibers:
1. Loss of vibratory sensation and altered proprioception reflect large-fiber loss
2. Impairment of pain, light touch and temperature is secondary to loss of small fibers.

Decreased or absent ankle reflexes occur early in the disease, while more widespread loss of reflexes and motor weakness are late findings. Patients with prediabetes (defined by the American Diabetes Association as a fasting glucose of 100 to 125 mg/dL or a 2-hour serum glucose between 140 and 199 mg/dL on an oral glucose tolerance test) may present with intensely painful feet. Patients with frank diabetic neuropathy may also present with pain, paresthesias, or dysesthesias of their feet. Some patients, however, have few complaints but the physical examination reveals mild to moderately severe sensory loss.

4. Low-risk prostate CA survival good with watchful waiting

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed. The cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance in the national Swedish prostate cancer registry, according to Pr Stattin, MD, PhD, of Ume University Hospital in Ume, Sweden, and colleagues.

DMC Decisions

Can state medical council take complaints against the nursing homes?

No, as per order DMC/ DC/ F.14/ Comp.637/ 2010, dated 12th April, 2010, the Delhi Medical Council examined a complaint of Shri Prabhudayal r/o. B–513, Camp No. 2, JJ Colony, Nangloi, Delhi – 110041, forwarded by Directorate of Health Services, against Sharad Nursing Home, Ganesh Market, Opp. OBC Bank, Najafgarh Road, Nangloi, Delhi. On perusal of the complaint, the Delhi Medical Council observed that since the complaint pertains to allegations of irregularity in the functioning of Nursing Home and not against a particular doctor for any act of negligence or professional misconduct, the matter be referred back to Directorate of Health Services who is the appropriate authority to examine issues of such nature, for appropriate action.

Legal Column

Indian Ethics Regulation 2002 define the Character of Physician (Dr Sudhir Gupta, Ass. Professor Forensic Medicine, AIIMS)

A Doctor with qualification of MBBS or MBBS with post graduate degree/diploma shall uphold the dignity and honor of his profession and the prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who– so–ever chooses his profession, assumes the obligation to conduct him in accordance with its ideals. A physician should be an upright man, instructed in the art of healings. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession as well as in all the actions of his life………"

Expert's Views

Q: I have one query regarding one patient who is 39-yr-old female. presented with history of anorexia, intermittent fever, significant wt loss of around 20% over a period of six months with mild cough and expectoration for last 3 months. Her past history is significant as she was treated for infertility for several years and could conceive only 5 yrs back following 3 months treatment with ATT as a last resort after suspecting genitourinary TB as a cause of infertility. The treating gynecologist stopped the ATT after she conceived following 3 months of ATT. Now, patient has two daughters one aged 4 yrs and other one and half year. X–ray chest and CECT chest done for her present symptoms are consistent with diagnosis of B/L Pulmonary Koch's with both parenchymal and hilar & mediastinal lymph node involvement. She presented at AIIMS with the complaint where Category – 1 treatment with HRZE is started. Now, I have two queries–

  1. Should patient be given category–2 treatment considering her as a drug defaulter for her previous genitourinary TB?

  2. Should her two daughters’ also be given prophylactic ATT as both of them are of below 5 yrs of age?
    Dr Manoj Kr Saini (MD Medicine), CGHS Delhi, 9015353784

A: As the first episode of TB was extra pulmonary, she cannot be called as "Defaulter" as the pt needs to be smear-positive to be called a defaulter. (A TB patient who received anti–TB treatment for one month or more from any source and returns to treatment after having defaulted, i.e., not taken anti–TB drugs consecutively for two months or more, and who is found to be sputum smear–positive)

2 We do not know the status of BCG vaccine in children and also sputum positivity of this episode therefore, I do not think ATT is warranted in Children.

Expert: Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and Associated, Lok Nayak Hospital, Tel–Fax 91–11–23215510)

Interesting Tips in Hepatology & Gastroenterology

(Dr Neelam Mohan, Consultant Pediatric Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician, Sir Ganga Ram Hospital, Delhi)

Yesterday, I wrote on "Living related transplant Surgery" Today I shall address the following issues:-

Is Rejection a major issue in liver transplantation ?

Rejection could be acute / chronic.

Acute Rejection

  • Approximately 30-50% of liver transplant patients experience at least one episode of acute rejection.

  • Its associated with elevated serum aminotransferases and GGT/AlkPO4

  • Half the children show elevated serum bilirubin

  • It may be associated with fever and increased CRP.

  • Its lowest in <6 months and highest in teenagers.

  • Its less with tacrolimus than cyclosporine.

  • Diagnosis is confirmed on liver biopsy which should show at least 2 of 3 following criteria 1) Portal inflammatory infiltrate, 2) Bile duct damage, 3) Endothelitis. Rejection activity score is given to classify acute rejection into mild, moderate / severe.

  • Treatment includes steroids (IV Methylprednisolone) and increasing immunosuppression .Steroid resistant rejection is treated with IL 2 receptor monoclonal Antibodies.

  • Fortunately in liver transplant patients, acute rejection can be tackled easily and is not a major issue.

Chronic Rejection

  • With the use of tacrolimus as immunosuppression its rarely seen now both in adults and pediatrics. Its a rare complication seen now and especially more common when the drug compliance is poor in patients especially in teenager patients

Public Forum (Press Release for use by the newspapers)

Even the elderly can have diabetes

The prevalence of diabetes continues to increase steadily as more people live longer and grow heavier said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. The overall prevalence of diagnosed cases of type 2 diabetes rises from 1.4 percent between the ages 25 of 44 years to 3.6 percent between the ages of 45 and 54 years, 7.8 percent between the ages of 55 and 64 years, and over 10 percent over the age of 65 years.

The prevalence may be well over 20 percent among frail elderly people living in nursing homes. There are probably similar numbers of undiagnosed patients at all ages.

The prevalence of known cases of type 2 diabetes is likely to increase further with the adoption of new diagnostic criteria and the recommendation to screen all adults over age 45 years at least once every three years by measuring fasting blood glucose.

On the contrary, primary hypertension occur between the age of 20 and 50 and any blood pressure appearing for the first time in life after the age of 50 or before the age of 20 should be investigated for secondary causes.

IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have high ESR with normal CRP.
Dr. Bad: The lab report is wrong.
Dr. Good: We need to rule out SLE.
Lesson: Though elevated ESR observed together with a normal CRP is often a false positive value for ESR, this can also happen in acute SLE.

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully.
Lasson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.

Mistakes in Clinical Practice

Do not write ‘U’: it can be mistaken as a zero or a four (4) resulting in overdose.

eMedinewS try this it works

Formula of happiness (Dr G.M. Singh)

Happiness Formula= O+(N × S) + CPM / T + He

This means–when a value for being outdoors (O) is added to nature (N) multiplied by social interaction (S) added to childhood summer memories (CPM) divided by temperature (T) and added to holiday excitement (HE) then 3rd Friday in June comes out as a optimal day for peak happiness.
The best piece of advice I can give is work less and spend more time with people you love. That will make you happiest.

Milestones in Orthopedics

Percival Pott (1714–1788)

Best known for the fracture that bears his name, Pott's fracture, as he was the first to give a good description of this ankle fracture.


Mnemonic of the Day (Dr Prachi)

Liver failure (chronic): signs found on the arms (CLAPS)

Palmar erythema
Scratch marks

Conference Calendar

Trauma Evaluation And Management – Basic (TEAM – B)
Target Audience – Doctors & Nurses Only
Date: June 29, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the day (Paramjeet Chaddha)

Troubles in Life are like a washing machine, They twist, turn & knock us around, but in the end we come out BRIGHTER & BETTER THAN BEFORE.

SMS of the Day (Sunil Parashar)

Don’t keep on looking for special occasions because everyday you live is a special occasion

The Ten Traits of the True Spiritual Warrior (Guy Finley)

  1. The true spiritual warrior knows the only enemy she has is what she has yet to shed light upon in herself; therefore, she never postpones a battle that must be engaged.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

Contact: drkk@ijcp.com emedinews@gmail.com


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 .


Humor Section: IMANDB Joke of the Day

A new patient was quite upset when the doctor’s nurse led him to a small, curtained cubicle and told him to undress. "But I only want the doctor to look at an ingrown toenail!" he protested. "Our rule is that everyone must undress," replied the nurse as she handed him a very skimpy johnny. "That’s a stupid rule," grumbled the patient, "making me undress just to look at my toe." "That’s nothing," growled a voice from the next cubicle. "I just came to fix the phones!"

Funny Definitions

Varicose…………………Near by/close by

Medical bloopers on medical charts!

The lab test indicated abnormal lover function.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

TB Skin Test

Also known as: Purified Protein Derivative; PPD; Mantoux; Latent tuberculosis infection test. To help determine whether or not you may have been exposed to and become infected with the Mycobacterium tuberculosis bacteria.

International Medical Science Academy Update (IMSA) Update

Blood pressure control in children with chronic kidney disease

Intensified blood pressure control with a targeted goal of a 24–hour mean arterial pressure (MAP) below the 50th percentile, compared with conventional blood pressure control, results in slower progression of chronic kidney disease in children.


Wuhl E, Trivelli A, Picca S, et al. Strict blood–pressure control and progression of renal failure in children. N Engl J Med 2009;361:1639.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Nicotine Polacrilex Gum 2mg & 4mg (Addl. Indication)

To reduce the withdrawal symptoms, including nicotine craving, associated with quitting the smoking and quitting chewed tobacco and guthka containing tobacco


Readers Response

  1. Respected Boss, The article on parasympathetic personality was great. Keep it up. Regards: Varesh Nagrath.

  2. Regarding Marital activity after MI, I remember having attended one conference at a time when Angio was also unheard of in our country leave alone vascular surgery, when the speaker was asked about marital activity post MI. His reply was "his partner is equally weak or strong". This means one should not try hard at marital activity post MI. Dr KK Arora

    eMedinewS Comments: No, now marital activity after 6 wks of MI is considered normal unless the patient has resistant heart failure unstable angina.

  3. Dear Dr KK Aggarwal, This mail is for u to respond to please. Please let me know of your ideas on CPR on self, please. Dr. Majumdar (one of your ardent admirers).
    A: CPR is after clinical death or sudden cardiac arrest. It cannot be done on the self.

Forthcoming Events:

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day–long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

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

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.

HCFI Event

Invite (Wednesday, 23 June 2010, 07:00PM)

The 6th International Widows Day is being observed on 23rd June jointly by Heart Care Foundation of India and The Loomba Foundation at India Habitat Center. The Chief Guest on the occasion will be Prof. (Smt.) Kiran Walia, Hon'ble Minister of Health and Family Welfare, Women and Child Development, Languages, Govt. of NCT of Delhi.

Also, present on the occasion will be Mrs. Aruna Oswal Trustee, The Loomba Foundation, Padma Shri Dr. K K Aggarwal President, Heart Care Foundation of India and Mr. Lalit Mansingh Trustee, The Loomba Foundation.

The event will involve sharing of experiences by widowed Mothers and their Children who have been beneficiaries of The Loomba foundation. Children of the widows who participated in various competitions will also be awarded worth prizes and certificates.

Date and Timing: June 23, 2010 at 07:00pm onwards
Venue: The Theatre, India Habitat Center, Lodhi Road New Delhi

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