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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


Dear Colleague

25th march 2010, Thursday

TB Update 

1. The scientists have demonstrated the utility of nucleic acid amplification (NAA) testing for diagnosis of tuberculosis in a large public health setting. The recent recommendations from the CDC also supports that NAA testing be performed on at least one respiratory specimen from patients with suspected pulmonary TB.1

In a trial of 328 patients with active pulmonary TB randomized to receive moxifloxacin or isoniazid (in addition to rifampin, ethambutol and pyrazinamide), comparable rates of sputum culture negativity after eight weeks were observed (55 and 60 percent). Moxifloxacin is a suitable alternative for patients who are intolerant of INH or infected with INH–resistant Mycobacterium tuberculosis. Fluoroquinolones should be used only in persons with intolerance of or resistance to first–line agents.2


  1. Laraque, F, Griggs, A, Slopen, M, Munsiff, SS. Performance of nucleic acid amplification tests for diagnosis of tuberculosis in a large urban setting. Clin Infect Dis 2009;49:46.

  2. Dorman, SE, Johnson, JL, Goldberg, S, et al. Substitution of moxifloxacin for isoniazid during intensive phase treatment of pulmonary tuberculosis. Am J Respir Crit Care Med 2009;180:273.

Dr KK Aggarwal
Chief Editor

News and Views (Dr Monica and Dr Brahm Vasudeva)

Medical–Legal Landscape

Georgia Supreme Court upholds higher standard of proof in medical malpractice cases

A sharply divided Georgia Supreme Court on Monday upheld a key part of a sweeping 2005 law that made it more difficult for patients to win medical malpractice cases involving emergency healthcare providers. The ruling, a blow to plaintiff’s attorneys and other critics of the legislation, requires a higher standard of proof by patients injured by emergency room workers to win malpractice claims. The legislation required the plaintiffs to prove that emergency room doctors acted with ‘gross negligence’ when they failed to order a test that would have detected a brain aneurysm. The plaintiffs argued that the requirement was unconstitutional, saying it’s a nearly insurmountable hurdle.

Bathing trauma patients with antiseptic wipe may reduce bloodstream infection risk

Doctors at Harborview Medical Center in Seattle found that trauma patients given a daily antiseptic wipe down were much less likely to develop a catheter–related bloodstream infection than patients who received a daily, non–antiseptic wipe down. According to the study in the Archives of Surgery, they were also much less likely to develop either a MRSA or Acinetobacter infection.

Smokers who quit may experience improved arterial health within one year

Quitting can improve artery function and actually make blood vessels healthier. The benefit was the equivalent of a 14% reduction in the risk of cardiovascular disease, the Milwaukee Journal Sentinel noted. Investigators reached that conclusion by using a test known as flow–mediated dilation, which uses ultrasound to look at the ability of the brachial artery to relax. Participants who quit smoking had an improvement in flow–mediated dilation from 6.2% to 7.2%.

Impotence may increase heart attack risk in some patients

After following some 1,500 men in 13 countries who were previously diagnosed with cardiovascular disease, researchers in Germany noted that participants who also had ED were 1.9 times as likely to die from heart disease; twice as likely to have a heart attack; 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. For the first time, researchers have shown that ED is a strong predictor of the likelihood that men will die of heart disease. Treatments for cardiovascular disease had no effect on ED, so the German researchers concluded that ED is an independent risk factor for cardiovascular disease.

Increasing vitamin D levels may cut heart disease risk

Raising the amount of vitamin D in the blood appears to help some people –– at least those deficient in the vitamin –– reduce their risk of heart disease by about 30%, according to research presented at the Annual Meeting of the American College of Cardiology. Researchers also found that patients who raised their vitamin D levels were 33% less likely to have a heart attack, 20% less likely to develop heart failure, and 30% less likely to die between visits to their physician.

Vitamin, mineral supplements may not prevent disease

According to the Journal Nutrition Business, recent studies undertaken to assess benefits of vitamin and mineral supplements have delivered a flurry of disappointing results. The supplements failed to prevent Alzheimer’s disease, cancer, heart attacks, strokes, type 2 diabetes, and premature death. Instead, all major health organizations for cancer, diabetes, and heart disease advise against supplements in favor of a healthful diet rich in fruits, vegetables, whole grains, and legumes.

Conference Calendar

Kovai Lumen 2010 (Collaborative Workshop on) Management of ST elevation Myocardial Infarction)
Date: March 27–28, 2010
Venue: Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu.

What’s New: CRT for CHF

Cardiac resynchronization therapy has known benefit in patients with more severe heart failure. A randomized trial found benefits in patients with milder HF as well, mainly in those patients with a QRS duration > 150 msec (Moss AJ, Hall WJ, Cannom DS, et al. Cardiac–resynchronization therapy for the prevention of heart–failure events. N Engl J Med 2009;361:1329.)

Diabetes Fact

In recent–onset type 1 diabetes with low fasting insulin and high antibodies one can  give anti CD3 monclonal antibodies to prevent progression of type 1 diabetes.

Public Forum (Press Release)

Up to 61% people have normal–weight obesity

More than half of normal–weight persons may have a high percentage of body fat making them susceptible to heart disease, diabetes and other metabolic disorders.

Men whose body fat is greater than 20 percent and women whose body fat is greater than 30 percent are suffering from ‘normal weight obesity’, even though their weight may be normal for their size, said Dr K K Aggarwal, President Heart Care Foundation of India and Editor eMedinewS.

The prevalence of people with a high amount of body fat despite a normal weight is relatively high. Many of these people have metabolic abnormalities.

Even normal–weight people should be advised to exercise and eat a healthy diet to reduce their level of fat, especially belly fat.

In study by Dr Lopez–Jimenez and presented at the American College of Cardiology’s Annual Meeting, in Chicago, out of 2,127 people who participated in the U.S. government’s Third National Health and Nutrition Examination Survey, 61 percent of the participants had levels of body fat that indicated ‘normal–weight obesity’.

It was associated with high cholesterol; high levels of leptin, a hormone found in fat and other tissues that’s involved in appetite regulation; and high rates of metabolic syndrome.

Even a small amount of extra fat increase the risk for diabetes and heart disease.

Excess body fat in the belly is a menace, whatever your weight.

Question of the day

How do you manage melasma with the various topical agents available?

It must be understood that epidermal type responds much better to depigmenting agents compared to the dermal type where the elimination of pigment is governed by transport via macrophages and is not accessible to depigmenting agents. The objective in melasma therapy should be:

  1. Retardation of proliferation of melanocytes

  2. Inhibition of melanosome formation

  3. Enhancement of melanosome degradation

General therapeutic guidelines:

  1. Avoidence of UVL (Ultra violet light) by use of physical or chemical sunscreens.

  2. Discontinue contraceptive pills.

  3. Using of bleaching agents like hydroquinone 2 to 5% cream/lotion.

  4. Hydroquinone is aften combined with local steroids (Dexamethasone, Hydrocortisone/Mometasone) and tretinoin 0.1% in ethanol and propylene glycol 1:1 or in hydrophilic ointment.

  5. Other agents that can be used are Kojic acid (2–4%), Azelaic acid (10–20%), Glycolic acid 6-10%, and N–Acetyle 145 cysteaminyl alcohol (a phenolic agent).

Quote of the Day

There are no failures – just experiences and your reactions to them. (Meimei)

eMedinewS Try this it Works

Central venous access

For easier central venous access, place a small pillow or towels between the patient’s shoulder blades. This technique allows better access to vessels for both the subclavian and the internal jugular approach.

Dr Good Dr Bad

Situation: A diabetic was found to have low HDL cholesterol.
Dr Bad: Its ok as your LDL is normal.
Dr Good: You are at high risk.
Lesson: Low levels of high–density lipoprotein cholesterol (HDL–C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL–C). Patients with low HDL–C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL–C. HDL–C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL–C oxidation, and antiplatelet and anti–inflammatory actions. (Rev Cardiovasc Med 2008;9(4):239–58.)

Make Sure

Situation: A 4 year old girl with rickets is unresponsive to high doses of vitamin D.
Reaction: Oh my God! Why didn’t you advise alfacalcidol
Make sure to advise alfacalcidol in patients unresponsive to calcium/vitamin D therapy. Alfacalcidol, in numerous studies, has been found to be effective in refractory cases of rickets.

Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Intensivist: "Did you take the patient’s temperature?"
Nurse: "No. Is it missing?"

Formulae in Critical Care

Venous oxygen content (CvO2)

Formula: CvO2 = (1.34 × SvO2 × Hb) + (0.0031 × PvO2)

SvO2 – percentage saturation of oxygen in venous blood.

Comment: Normal values are 14.5–15.5 ml/100 ml of blood.

Milestones in Orthopedics

Harold A sofield (1900–1987), pioneered the operative fixation of fractures of hip by performing the first nailing of a femoral neck fracture in chicago area.

Metal rods can be surgically inserted in the long bones to improve strength, in patients of osteogenesis imperfecta, a procedure developed by Harold A. Sofield, MD, at Shriners Hospitals for Children in Chicago. In 1959, with Edward A. Miller, MD, Sofield wrote a seminal article describing a solution that seemed radical at the time: the placement of stainless steel rods into the intramedullary canals of the long bones to stabilize and strengthen them. His treatment proved extremely useful in the rehabilitation and prevention of fractures; it was adopted throughout the world and still forms the basis of orthopedic treatment of osteogenesis imperfecta.

Mistakes in Clinical Practice

Abbreviations with a period following (mg. or mL.): Omit period and use (mg or mL).  The period is unnecessary and could be mistaken as the number 1 if poorly written.

Lab Test (Dr Naveen Dang)

Beta 2 microglobulin is used to help evaluate the severity and prognosiso of multiple myeloma, leukemia, or lymphoma, to distinguish between kidney disorders and to detest kidney damage.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Anidulafungin Injection (Lyophilized powder) 50mg/100mg per vial

For the treatment of invasive candidiasis including candidemia and esophageal candidiasis in adult 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

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

Readers Responses

Azad overrules IMA’s objections to rural MBBS course : By Prashant K. Nanda

New Delhi, March 18 (IANS) The Indian Medical Association (IMA) has three problems with the government’s plan to create a special cadre of rural doctors through a truncated MBBS course, but the health ministry has refused to yield to its pressure and will push ahead on the subject as planned.
According to a top health ministry official, a seven–member delegation of the IMA met Health Minister Ghulam Nabi Azad and apprised him of their reservations over plans for the rural doctors’ course.

"The IMA has three problems with the plan," a senior health ministry official told IANS. "They want to call the new medical institutions for rural doctors as ‘schools’ and not colleges, as planned by the ministry. They are also opposed to naming these four–year courses as degrees. The IMA wants these to be called diplomas and not degrees, as a normal MBBS course is of five–year duration," the official said.

"The doctors’ association also wants a separate registration for these rural doctors," the official added. However, the health minister has rejected their demands.

"The minister listened to their problems patiently but told them that there is no conflict of interest with the regular doctors. The changes as demanded by the IMA will not be incorporated," the official added.

Bachelor of Rural Health Care (BRHC), popularly called Rural MBBS, is a four–year course for rural students who will work in health sub–centres and primary health care centres.

Azad has often raised the issue of shortage of doctors in India. "A whopping 80 percent of the doctors are serving just 20 percent of the population. The doctor–patient ratio is not encouraging," Azad said in a function Wednesday and reiterated that there is a need for more doctors in villages.

According to the medical education regulator, the Medical Council of India, rural doctors are the need of the hour. "They cannot do surgeries but can treat 300 different types of ailments that rural Indians face regularly," MCI president Ketan Desai told IANS.

"I am in favour of rural doctors. Those sitting in cities like Delhi and Mumbai cannot understand the trauma of villagers and how they suffer without any medical attention," Desai added.