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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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

  Editorial …

24th April, 2011, Sunday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Bromocriptine and type 2 diabetes

Bromocriptine an ergot–derived dopamine agonist has been used for over two decades for the treatment of hyperprolactinemia and Parkinson’s disease. A quick–release formulation of bromocriptine has been approved by the US FDA for the treatment of type 2 diabetes mellitus. In short–term clinical trials in patients with type 2 diabetes mellitus, quick–release bromocriptine (up to 4.8 mg daily) as monotherapy or as adjunctive therapy to sulfonylureas was minimally effective in reducing A1c compared with placebo. Common side effects include nausea, vomiting, dizziness, and headache. The mechanism of action in reducing blood sugar is unknown.

eMedinewS Comments: Given its modest glucose–lowering effect, very frequent GI side effects, and the availability of more effective drugs, there is no recommendation to use bromocriptine for the treatment of type 2 diabetes.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

    Changing Practice – Evidence which has changed practice in last one year

Initial chemotherapy for metastatic pancreatic cancer

Start Folfirinox rather than gemcitabine for patients with metastatic pancreatic cancer who have a good ECOG performance status and a serum total bilirubin level that is <1.5 times the upper limit of normal. (October 8, 2010)


  1. Conroy T, Desseigne F, Ychou Y, et al. Randomized phase III trial comparing Folfirinox (F: 5FU/leucovorin (LV), irinotecan (I), and oxaliplatin (O)) versus gemcitabine (G) as first–line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial (abstract 4010). J Clin Oncol 2010;28:303s. (abstract available online at
    74&abstractID=41562, accessed August 18, 2010).
    eMedinewS Audio PostCard

 CKD Update

Dr KK Aggarwal Speaks on
‘Key points on CKD’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery) 

World Earth Day 2011 Observed

Students of Delhi Public School, Mathura Road performed a lively composition on the eve of World Earth Day 2011 in a function organized by Heart Care Foundation of India jointly with World Fellowship of Religions on 21st April 2011.

Dr K K Aggarwal
    National News

Poverty rate declines from 37.2% to 32%

The latest data of the Planning Commission indicates that poverty has declined to 32 per cent in 2009–10 from 37.2 per cent five years ago. The preliminary estimates are based on the formula suggested by the Tendulkar Committee for computing the number of poor. Planning Commission Deputy Chairman Montek Singh Ahluwalia on Wednesday told reporters that the 2009–10 data shows a decline in poverty from 37.2 per cent in 2004–05 to 32 per cent in 2009–10 as the per the preliminary data worked out by the Planning Commission member Abhijit Sen. (Source: The Hindu, Apr 21, 2011)

Centre seeks to make health sector more transparent

Dissatisfied with the quality of data in the health sector and its non–availability for knowledge generation, the Centre proposes to develop a database of research resources in this field. The Department of Health Research is drafting a Knowledge Management Policy for Health Service, which proposes to disseminate data relating to the manpower and equipment available with different laboratories, medical and dental colleges and universities across the country. The final draft document of the Policy also focuses on enhancing the role of public–private partnership and preparing a national information system of research funding. The draft document advocates developing a database of all diseases — including clinical, epidemiological, genetic, biological and social parameters — with a focus on effectively communicating the research outcome. Importantly, it aims to empower health research institutions with respect to using the tools of knowledge management so as to improve the quality of research as per the guidelines of medical authorities and regulatory bodies. (Source: The Hindu, Apr 21, 2011)

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Exercise improves quality of life and prognosis in cystic fibrosis patients

Cystic fibrosis is a severe, often terminal disease that affects over 30,000 people in the United States. The disease is caused by a genetic mutation that interferes with the respiratory, digestive and reproductive systems. However, there is hope for people with cystic fibrosis, as described in a review article written by researchers at the University of Arizona in collaboration with Nike. The article reviews recent research on exercise in cystic fibrosis patients. The article discusses the benefits of exercise that most patients see – improved strength and endurance, which positively impact quality of life. However, the article also reviews recent findings that occur at the cellular level. Cystic fibrosis patients who have a higher cardiovascular fitness level (resulting from regular exercise) were significantly more likely to survive then their less fit counterparts. The article also states that exercise causes cellular changes that improve pulmonary capacity, respiratory function, fluid balance and sweat gland function in people who suffer from cystic fibrosis.

(Dr Monica and Brahm Vasudev)

‘Good Cholesterol’ nanoparticles seek and destroy cancer cells

High–density lipoprotein’s hauls excess cholesterol to the liver for disposal, but new research suggests "good cholesterol" can also act as a special delivery vehicle of destruction for cancer. Synthetic HDL nanoparticles loaded with small interfering RNA to silence cancer–promoting genes selectively shrunk or destroyed ovarian cancer tumors in mice, a research team led by scientists from The University of Texas MD Anderson Cancer Center and the University of North Texas Health Science Center reports in the April edition of Neoplasia.

Breast milk may hold clues to a woman’s future breast cancer risk

Exfoliated epithelial cells in breast milk revealed increased DNA methylation in the biopsied breast of women who had cancer. DNA methylation for two of three genes analyzed did not differ between the biopsied and unbiopsied breast of women who had nonproliferative, low–risk lesions, but mean methylation for the third gene was significantly increased in the biopsied breast. Although preliminary, the findings are "sufficient to tell us that we can use the cells in breast milk to assess breast cancer risk," Kathleen F. Arcaro, PhD, of the University of Massachusetts in Amherst, reported at the American Association for Cancer Research meeting.

Frozen donor eggs may work as well as fresh

For women undergoing fertility treatment, frozen donor eggs may work as well as fresh ones, a study at one fertility clinic suggests. Researchers found that of 77 women treated at a clinic in Cyprus, those who received eggs that had been donated by another woman and then frozen were just as likely to have a baby as women given fresh donor eggs.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with high grade fever with low platelet count came for evaluation.
Dr Bad: Treat him for dengue.
Dr. Good: Also do a Tourniquet test and check his PCV.
Lesson: Low platelet count is not the only diagnostic criteria for severe dengue. The classical triad is low platelets, positive tourniquet test and 20% increase in hematocrit.

Make Sure

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

    An Inspirational Story

(Dr Anupam Sethi Malhotra)

He met her at a party. She was so outstanding, many guys chased after her, while he was so ordinary, nobody paid attention to him. At the end of the party, he invited her to have coffee with him, she was surprised, but being polite, she promised. They sat in a nice coffee shop, he was too nervous to say anything, she felt uncomfortable, she thought, please, let me go home. Suddenly he asked the waiter: "Would you please give me some salt? I’d like to put it in my coffee."

Everybody stared at him, so strange! His face turned red, but, still, he put the salt in his coffee and drank it. She asked him curiously: Why do you have this hobby? He replied: "When I was a little boy, I was living near the sea, I liked playing in the sea, I could feel the taste of the sea, just like the taste of the salty coffee. Now every time I have the salty coffee, I always think of my childhood, think of my hometown, I miss my hometown so much, I miss my parents who still live there". While saying that tears filled his eyes. She was deeply touched. That was his true feeling, from the bottom of his heart. A man who can speak outloud about his homesickness, he must be a man who loves home, cares about home, has responsibility of home. Then she too started to speak, spoke about her faraway hometown, her childhood, her family.

That was a really nice talk, also a beautiful beginning of their story. They continued to date. She found that actually he was a man who met all her demands; he had tolerance, was kind hearted, warm, careful. He was such a good person that she almost missed him. Thanks to his salty coffee! Then the story was just like every other beautiful love story, the princess married the prince. They lived a happy life… And, every time she made coffee for him, she put some salt in the coffee, as she knew that was the way he liked it.

After 40 years, he passed away, left her a letter which said: "My dearest, please forgive me, forgive my whole life lie. This was the only lie I said to you–––the salty coffee. Remember the first time we dated? I was so nervous at that time, actually I wanted some sugar, but I said salt It was hard for me to change so I just went ahead. I never thought that could be the start of our communication! I tried to tell you the truth many times in my life, but I was too afraid to do that, as I have promised not to lie to you for anything. Now I’m dying, I afraid of nothing so I tell you the truth: I don’t like salty coffee, what a strange bad taste. But I have had the salty coffee for my whole life! Since I knew you, I never feel sorry for anything I do for you. Having you with me is my biggest happiness for my whole life. If I can live for the second time, still want to know you and have you for my whole life, even though I have to drink the salty coffee again".

Her tears made the letter totally wet. Someday, someone asked her: "What’s the taste of salty coffee?" "It’s sweet." She replied.

    Pediatric Update

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

What are the features of appendicitis in neonates?

Clinical features of appendicitis in neonates are:

  • Nonspecific with irritability or lethargy in 22%
  • Abdominal distention and vomiting in 60–90%
  • Other features include a palpable mass in 20–40%
  • Hypotension, hypothermia, and respiratory distress
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Aruna lives in her own world for last 37 years

It appears that she relishes fish and occasionally smiles.

In his submission to the Supreme Court, Dr. Sanjay Oak, Dean KEM Hospital, said, she is lying in a bed in a single room for 33years. She has not been able to stand or walk, nor have we attempted to do that of late because we fear that she is fragile and would break her bones if she falls. Her extremities and fingers have developed contractures and subsequent to non–use; there is wasting of her body muscles.

  • Her eyes are open and she blinks frequently; however, these movements are not pertaining to a specific purpose or as a response to a question.
  • At times she is quiet and at times she shouts or shrieks. However, I must say that her shouts and shrieks are completely oblivious to anybody’s presence in her room.
  • It is not true that she shouts after seeing a man. I do not think Aruna can distinguish between a man and a woman, nor can she even distinguish between ordinate and inordinate object.
  • We play devotional songs rendered by Sadguru Wamanrao Pai continuously in her room and she lies down on her bed listening to them. She expresses her displeasure by grimaces and shouts if the tape recorder is switched off.
  • All these years she was never fed by tube and whenever a nurse used to take food to her lips, she used to swallow it. It is only since September 2010 she developed Malaria and her oral intake dropped. In order to take care of her calorie make need, Nurse’s cadre resorted to nasogastric tube feed and now she is used to NG feeding. However, if small morsels are held near her lips, Aruna accepts them gladly.
  • It appears that she relishes fish and occasionally smiles when she is given non–vegetarian food. However, I am honest in admitting that her smiles are not purposeful and it would be improper to interpret them as a signal of gratification.
  • I must put on record that in the world history of medicine there would not be another single case where such a person is cared and nurtured in bed for 33 long years and has not developed a single bed sore. This speaks of volumes of excellence of nursing care that KEM Nursing staff has given to her. This care is given not as a part of duty but as a part of feeling of oneness.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Role of weight loss in the prevention and treatment of type 2 diabetes

Obesity is the cornerstone of type 2 diabetes pathophysiology, inducing both insulin resistance and pancreatic beta–cell dysfunction. These underlying disease mechanisms usually progress for several years before the clinical onset of type 2 diabetes, and if the excess fat mass is maintained or increases over time, hyperglycemia is likely to become progressively worse. Thus, weight loss is crucial in preventing the progression of pre–diabetes to frank type 2 diabetes. Furthermore, in patients who have already been diagnosed with type 2 diabetes, weight loss may help slow the natural history of the disease and delay the need for intensification of therapy to insulin. However, weight reduction in overweight and obese patients with type 2 diabetes can prove challenging. Typically these patients lose less weight and at slower rates than non–diabetic individuals, due to metabolic dysregulation, potential comorbidities that restrict physical activity and a lack of dietary adherence. This problem is further complicated by weight gain associated with many antidiabetic therapies, including some oral glucose–lowering agents (i.e. sulfonylureas, glinides and TZDs), insulin, and also, several medications prescribed for common diabetes comorbidities (certain beta-blockers, antidepressants, antipsychotics and neurological agents).

Importantly, it has been shown that in patients with type 2 diabetes even a modest sustained reduction of the initial body weight (5–10%) can significantly mitigate diabetes–related complications by improving glycemic control, lipid profiles and blood pressure.

    Mind Teaser

Read this …………………
(Dr GM Singh)

Which of the following is not true regarding wandering spleen?

a. The spleen is attached to a long vascular pedicle without the usual mesenteric attachments.
b. Torsion and infarction of the spleen are common complications.
c. There is congenital atresia of the dorsal mesogastrium in children.
d. Splenectomy is required in all cases.

Yesterday’s Mind Teaser: Hi Way Pass

Answer for yesterday’s Mind Teaser:
Highway underpass

Correct answers received from: Dr K Raju, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Rashmi Chhibber, Dr Neelam Nath, Dr U Gaur,Dr Y J Vasavada,Dr Bharat Aggarwal

Answer for 22nd April Mind Teaser: b
Correct answers received from: Dr Gopal Shinde, Dr Muthumperumal Thirumalpillai, Dr S Upadhyaya

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Some universal laws

Law of Accidental Numbers: If you dial a wrong number, you never get a busy signal and someone always answers.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

    Medi Finance Update

(Dr GM Singh)

A nomination can be created, cancelled or changed any number of times by the investors who made the original investment. It does not imply additional cost to the investor.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Fluticasone Propionate 50mcg/125mcg/250mcg + Salmeterol xinafoate 25mcg/25mcg/25mcg Powder for inhalation

For the maintenance treatment of asthma and for the treatment of COPD associated with chronic bronchitis


    IMSA Update

International Medical Science Academy (IMSA) Update

Among measurements of C–peptide immunoreactivity (CPR), a marker of beta cell function, postprandial CPR index (postprandial serum CPR to plasma glucose ratio) is the best predictive marker for future insulin therapy in patients with type 2 diabetes.

(Ref: Saisho Y, Kou K, Tanaka K, et al. Postprandial serum C–peptide to plasma glucose ratio as a predictor of subsequent insulin treatment in patients with type 2 diabetes. Endocr J 2011 Mar 10. Epub ahead of print)

  Quote of the Day

(Dr GM Singh)

The only way to get the best of an argument is to avoid it. Dale Carnegie.

    Readers Responses
  1. Dear Sir, eMedinewS has become most popular media for interaction especially on medical subjects. You are doing a wonderful job. Physiotherapists claim themselves as doctors and want to add the prefix "Dr." in front of their names even though the lower courts and Supreme Court have barred them from doing so. Now they are moving politically and trying to delink themselves from the Paramedical Council. They have demanded that they learn more than a doctor and so a separate council for physiotherapist should be formed similar to the Dental Council forgetting that they are only technicians under a Doctor. These issues should be discussed and published in emedinews to create awareness among doctors. Thanking you, wish you all success: Dr. Alex Franklin.
  2. Dear Dr. Aggarwal, the write up on mediclaim was an eye–opener. I would like to add one more category – the patients admitted in daycare do not get reimbursed if admission was for less than 24 hours. This way it’s the mediclaim co. and not the doctor who decides the length of admission. Dr JS Ranya.
    Public Forum

(Press Release for use by the newspapers )

Soya for blood pressure

One half of a cup of soya nuts each day may work as well as anti–hypertension medication to lower blood pressure in postmenopausal women. This was stated by Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

Quoting a study published in Archives of Internal Medicine, May 28, 2007 Dr. Aggarwal said that hypertensive women in the soya nut–group had a drop in systolic blood pressure of 9.9 percent, and a drop in diastolic blood pressure of 6.8 percent.

Among those women with pre–hypertension (systolic blood pressures between 120 mmHg and 139 mmHg), the soya nuts decreased systolic blood pressure by 5.5 percent and diastolic blood pressure by 2.7 percent. The nuts also lowered systolic blood pressure by 4.5 percent and diastolic pressure by 3.0 percent in women with normal blood pressure. Women also showed an 11 percent reduction in their low–density lipoprotein (LDL) or "bad" cholesterol.

    eMedinewS Special

1. eMedinewS audio lectures (This may take a few minutes to open)

2. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

  Towards Well Being


    Forthcoming Events

May 7–8, 2011, National Seminar On Stress Prevention

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
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: Saturday 7th May (2 pm onwards) and Sunday 8th May (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: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com.


September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA from.
Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts

Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011
(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)

Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES and Dept of Health and Family Welfare Govt of NCT of Delhi.

Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).

Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Naveen Dang, Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta