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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

24th march 2010, Wednesday

24TH IS World TB day

Messages on tuberculosis (TB)

  1. India has the largest number of cases of TB in the world.
  2. TB is a curable disease.
  3. For complete recovery, full and adequate treatment of tuberculosis is important.
  4. Most tuberculosis drugs are safe and have minimal side effects.
  5. A minimum six months of treatment is required for a patient with TB.

  6. DOTS is an effective way of controlling tuberculosis.

  7. TB is caused by bacilli spread through droplet infections.

  8. Patients with TB should dispose their sputum by burning, burying it in the soil or disinfecting them with a disinfectant.

  9. All cases of TB are not contagious. Only sputum–positive TB patients are infectious to others.

  10. Even contagious TB can become non–infectious within one week of effective treatment.

  11. Tuberculosis can be of lungs (pulmonary), or outside the lungs (extrapulmonary). In 85% of cases, lungs are involved.

  12. In TB of the lung, often an X–ray chest is the first investigation to be asked. Tuberculosis can infect people of any age or sex.

  13. Do not ignore a cough of more than two weeks.

  14. Every cough with or without sputum is not TB.

  15. Blood in sputum may be an indication of TB.

  16. Even in pregnancy, TB requires full treatment.

  17. Diagnostic tests for TB are available free of cost by the Govt.

  18. TB treatment is also available free of cost by Govt. of India.

  19. TB infection and TB disease are not the same.

  20. 90% of those infected may not develop TB in their life time.

  21. 10% of HIV–positive patients will develop TB every year.

  22. If the patient has not responded after 5 months of treatment, suspect a drug failure.

  23. Relapse or re–infections can occur in a patient with TB.

  24. TB drugs are often taken as single dose. Divided doses are not recommended.

  25. Non–healing ulcer on the skin may be an indication of skin TB.

  26. Drug–resistant TB cases should be handled by a specialist.

  27. Transient rise in liver enzymes are well–known in early weeks of TB treatment.

  28. TB can occur any time in the course of HIV infection.

  29. Corticosteroids should not be routinely prescribedin the treatment of TB.

  30. TB can cause collection of water around the heart or around the lungs.

  31. TB of the intestine is of a common occurrence in our country.
  32. TB is a common cause of infertility in women.

  33. TB of the brain is the most life–threatening of all forms of TB.


Dr KK Aggarwal
Chief Editor

The theme for the year is: ‘TB Elimination: Together We Can!’

This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that cause tuberculosis (TB).

Data and Statistics

World: Tuberculosis (TB) is one of the world’s deadliest diseases:

One–third of the world s population is infected with TB.

Each year, over 9 million people around the world become sick with TB.

Each year, there are almost 2 million TB–related deaths worldwide.

TB is a leading killer of people who are HIV infected

The Indian scenario

The TB burden in India is still staggering. Every year, 1.8 million persons develop the disease, of which about 800,000 are infectious; and, until recently, 370,000 died of it annually i.e 1,000 every day. The disease is a major barrier to social and economic development. An estimated 100 million workdays are lost due to illness. Society and the country also incur a huge cost due to TB—nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs.

‘Massive good can come from new on–line campaign’

March 4, 2010, The Millennium Foundation launched a new campaign, MASSIVEGOOD, aimed at making it easy for individuals to do their part to help fight tuberculosis, HIV, malaria and other diseases. People around with world will be able to make the choice to donate a small amount with a single click whenever they buy a plane ticket, book a hotel room or rent a car through a web site. Funds raised through the campaign will go to UNITAID, an important donor of the Stop TB Partnership. UNITAID is a major funder of EXPAND–TB, which supplies diagnostics for multidrug–resistant tuberculosis (MDR–TB) to high–burden countries. The project is led by the Global Laboratory Initiative in close collaboration with FIND and the Stop TB Partnership's Global Drug Facility (GDF).

News and Views (Dr Monica Vasudeva)

1. Fructose beverages may spur fatty liver disease progression

According to a paper published in Hepatology, drinking a lot of beverages sweetened with fructose may be the same as liquor,for those with nonalcoholic fatty liver, that is, spur disease progression. Duke researchers also found that older subjects who regularly consumed fructose beverages showed more signs of liver inflammation.

2. Four risk factors for high mortality

According to a study published in the Journal Medical Care, four factors –– high hospital occupancy, weekend admission, nurse staffing levels, and the seasonal flu –– can affect a patient’s risk of dying in the hospital.

3. FDA panel backs expanded use of Boston Scientific heart–regulating device

A panel of cardiologists for the FDA voted unanimously in favor of Boston Scientific’s heart–regulating device to treat mild heart failure, so long as the company tracks the long–term safety of patients. The cardiac resynchronization therapy defibrillator "combines a defibrillator, which shocks the heart to correct irregular beats, with a resynchronization device to coordinate the pumping action of the heart.

4. Somaxon receives FDA approval for insomnia drug

The FDA approved its delayed insomnia drug Silenor (doxepin). The agency approved the drug to treat short–term and long–term insomnia, but it "did not schedule Silenor as a controlled substance, as expected.

5. Growing number of children now extremely obese

The study of Southern California children published online Mar. 18 in the Journal of Pediatrics found in their survey of some ‘710,000 children that 7.3% of boys and 5.5% of girls were extremely obese, i.e., having a body mass index of more than 35.

Conference Calendar

AOGIN 2010 (4th Biennial Meeting of the Asia Oceania research organisation on Genital Infections and Neoplasia)
Date: March 26–28, 2010
Venue: Taj Palace Hotel, New Delhi.

What’s New: NVAF and warfarin: A large observational study evaluated the net clinical benefit of warfarin to prevent embolization in patients with nonvalvular atrial fibrillation (AF). Benefits in patients with CHADS2 scores below 2 were small, with confidence intervals that included the possibility of net harm with anticoagulation. (Singer DE, Chang Y, Fang MC, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med 2009;15:297.)

Diabetes Fact

Glucose in presence of aldose gets converted into sorbitol, which is responsible for all complications. Epalrestat, is aldose reductase inhibitor; not anti diabetes drug; reduces complications.

Question of the day

What is the natural course of melasma? Does spontaneous resolution occur?

Melasmia acquired, brown, or sometimes grey brown hyperpigmentation of the face and occasionally the ‘V’ of neck. The number of patches may range from one single lesion to multiple patches located usually symmetrically on the forehead, malar eminences, upper lip, chin and dorsum of the nose. Melasma does not involve the mucous membranes. According to the distribution, three clinical patterns are recognized: Centrofacial, malar and mandibular. Histologically, it is divided into epidermal, dermal and mixed type, often detected by woods lamp. Usually after pregnancy or with discontinuation of contraceptives the pigment fades slowly over months. In many it keeps relapsing inspite of therapy, especially in mixed or dermal variety.

Quote of the Day

Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow’.

eMedinewS Try this it Works

Two shots for one stick

If you need to give two injections, especially in the buttocks, hold both syringes together and insert both needles at the same time. Aspirate both and then deposit the medication. Your patients will love you for this one.

Dr Good Dr Bad

Situation: A diabetic with sickle cell anemia came for evaluation
Dr Bad: Get A1C done.
Dr Good: Get serum fructosamine levels done.
Lesson: Fructosamine level should be considered in all patients with red blood cell disorders or with discrepancies between glucose measurements and HbAlc values. In such patients, HbA1c does not accurately portray glycemic control and may delay treatment for poorly–controlled diabetes. It has the advantage of accurately reflecting shorter–term changes in glycemia that correspond to the half–life of albumin. In diabetic patients with HbA1c values below the lower limit of normal, a routine fructosamine level should be performed. (Tenn Med 2008;101(11):31–3.)

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn t you take him for emergency angiography and subsequent PTCA.
Make sure, to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI-2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Stock Broker Patient: Doctor, what should I do if my temperature goes up five more points?
Intensivist: Sell!

Formulae in Critical Care

Right ventricular stroke work (RVSW)
Formula: RVSW = SV (PAPm – RAP) × 0.0136
Normal value: 10–15 gm/beat.

Milestones in Orthopedics

In the early 1950s, Duncan C. McKeever theorized that osteoarthritis could be isolated to only one compartment of the knee joint, and that replacement of the entire knee might not be necessary if only one knee compartment was affected. The UKA concept was designed to cause less trauma or damage than traditional total knee replacement by removing less bone and trying to maintain most of the patient’s bone and anatomy. Also, the concept was designed to use smaller implants and thereby keep most of the patient's bone; this can help patients return to normal function faster.

Mistakes in Clinical Practice

Place adequate space between the drug name, dose, and unit of measure. Drug name and dose run together. (This is especially problematic for drug names ending in "L" such as Tegretol 300 mg)

Lab Test (Dr Naveen Dang)

AFP tumor marker is used to help diagnose and monitor therapy for certain cancers of the liver, testis or ovaries.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Lamivudine 30mg + Zidovudine 60mg + Nevirapine 50mg Oral Suspension (Tablets for oral Suspension)

For the treatment of HIV patients


(Advertorial section)


Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

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 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April). Over 400 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

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Readers Responses

  1. Dear Sir, Hope this mail of mine will find everything well at your end. Once again I heartly congratulate you for your achievements the ‘Padma Shri’ award. Dr.Lalita Chugh

  2. Dear Dr KK, Congratulations to you for doing a great service to doctors all over the country. I am regularly going through your daily e–news and find it very informative from both acdemic point of view and general awareness. Presently I am in UK on Commonwealth Fellowship and working on epidemiology of osteoporosis.I will be returning back very shortly. With increasing population of elderly India is likely to face a big challenge in bone health and it will be nice if through e–journal you can spread awareness for prevention of osteoporosis by doing simple things like increased physical activity, high calcium/vitamin D diet, sun exposure and quiting smoking and reducing alcohol intake. Regard: Prof. Dinesh Kumar Dhanwal, D.M. Endocrinology (AIIMS), Visiting Scientist, Medical Research Center (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, United Kingdom 0044 7747 433 593.

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