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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; 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

25th August, 2010, Wednesday

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

The secret to joint pain relief — exercise

The culprits behind joint pain are osteoarthritis, old injuries, repetitive or overly forceful movements during sports or work, posture problems, aging and inactivity.

Ignoring the pain is not the answer nor is avoiding all motions that trigger discomfort. In fact, limiting the movements can weaken muscles, compounding joint trouble, and affect the posture. Pain relievers and cold or hot packs may offer quick relief but are temporary.

The right exercises are the long–lasting way to tame ankle, knee, hip, or shoulder pain. Practiced regularly they can even postpone or even avoid surgery. Becoming more active is also good for your heart, sharpens the mind, nudges blood pressure down and morale up, eases stress, shaves off unwanted pounds and lessens the risk of dying prematurely.

Being overweight is risky to the joints. Simply walking across level ground puts up to one–and–a–half times the body weight on the knees. Each knee bears two to three times the body weight when you go up and down stairs, and four to five times the body weight when you squat to tie a shoelace or pick up an item you dropped.

Strengthening the quadriceps (the muscles on the fronts of the thighs) and losing weight changes this equation. Each pound lost reduces knee pressure in every step taken. The risk of developing osteoarthritis drops by 50% with each 11–pound weight loss among younger obese women. In older men losing weight to shift from an obese classification to overweight, knee osteoarthritis would decrease by a fifth. For older women, that shift would cut knee osteoarthritis by a third.
(Source Health Beat)

Breaking News: Hepatitis E vaccine appears effective in China trial

A large trial in China published in Lancet has found that an experimental vaccine is shown to be safe and effective in protecting people against hepatitis E infection. In a phase 3 trial involving 97,356 healthy participants in China's coastal province of Jiangsu, half of them were given the China-made vaccine and the other half placebo. The vaccine -- made by Xiamen Innovax Biotech -- was given in three doses; the second being a month after the first, and the third six months after the first. Within a year after the third dose, 15 of the participants who were given placebo were found infected with hepatitis E. No one in the vaccine group was infected. The vaccine is well tolerated and efficacious for a general adult population. More studies are needed to assess the safety for pregnant women and for people younger than 15 years or older than 65 years. During a hepatitis E outbreak, or for travelers to an endemic area, protection can be quickly obtained by two vaccine doses given within one month.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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Photo Feature (from HCFI files)

Playing cards have been used as a medium of health awareness. Health Cards containing various health messages were released by the then health minister Mr Yoganand Shastri, and demonstrated by Dr K K Aggarwal during a press interaction at the Perfect Health Mela venue. 


K K Aggarwal


Rituals and Festival
From Rakshabandhan to Janmashtami - A Spiritual Yagna

India is a land of diverse faith and myriad cultures. The festival of Rakhi, though rooted in mythology and ancient Indian history, has not really been understood for what it actually represents. We recognize Rakhi as a celebration of the bond of love between a brother and a sister. But how many of us have actually thought about what this tie entails?

First and foremost, Rakhi is synonymous with purity of the relationship and purity of the self and consequently of the soul. It is not merely a thread tied on the brother's wrist by the sister whereby the brother pledges to protect her from any worldly harm. In a broader spectrum, it is a chance to free oneself from one's internal enemies - the vices. A man is pulled down by his negative energies and Rakhi gives him a chance to retrospect and pull out of that dark side.

This multicoloured thread with multiple decorations and motifs is tied not necessarily by only one's sister, but can be tied by any woman who shares a platonic relationship with a man. There is a complete absence of a physical relationship and has no age or space barriers between the two connected by this sacred thread. Simultaneously, it is absurd to think that a mere child or one who stays miles away would be able to offer protection to his 'rakhi' sister. The matter which is of prime importance here is the bond of spiritual love established between two individuals of the opposite sex.

Eight days after Rakhi we celebrate Janamashtami. The sacred thread tied during Raksha bandhan connects us to Janamashtami, when we celebrate the birth of Lord Krishna. In these period of eight days between 'purnima' and 'ashtami' we get a chance of cleansing and purifying our soul and subsequently getting reborn again.

This seven-day period, symbolic of the entire time taken for creation of the world by God can be likened to a recreation of the self by us. This period is to be seen as a time for penance when all negativism is purged to achieve the level of pure spirit. Needless to say, all forms of 'spiritual downers' should be abstained from, so that a hindrance free communion with the soul is made possible. In fact an ideal gift to one's sister can be the shedding of a strong vice in that person.

The message of Rakshabandhan is that of love and purity. We can see it as a thread tied on behalf of God to set us on Godly ways. The initial representation of rakhi as a pledge to protect the sister and her right to be protected by the brother has gained wide propagation due to the fact that in Indian history and mythology there have been instances when this facet of tying a thread on a man’s wrist has been highlighted. Rani Padmavati sent a rakhi to a Muslim king to ask for help when she was beseiged by enemies. In the realm of the Gods, we have Indrani tying a rakhi on Lord Indra. There is also the tradition of tying rakhi by a Brahmin to a Yajman.

The connection between Rakshabandhan and Janamashtami is highlighted keeping in view the spiritual aspect of man's life, which is the ladder that helps him to achieve oneness with God.


International Medical Science Academy (IMSA) Update
Clinical and prognostic subforms of new daily-persistent headache

New daily persistent headache (NDPH) is a type of daily headache that is unremitting from onset or very soon after onset. A new study that used modified criteria for the diagnosis found that 56 percent of patients with NDPH had prominent migraine features.

Robbins MS, Grosberg BM, Napchan U, et al. Clinical and prognostic subforms of new daily-persistent headache. Neurology 2010;74:1358-64.


News and Views

National ( MCD Health Chairman Responds)

Dr Vinod Kumar Monga: "I have read your comment on dengue today. MCD is following GOI, NICD and NVBDCP guidelines in notifying the disease. This may result in some under-notification but you will realize that it has been a gold standard till the advent of NS1 recently. Cost of a testing kit is also a factor in a public health programme. I am calling a meeting of all experts on dengue to discuss it further and recommend changes if found feasible. At the same time we must appreciate that it is like any other viral infection with mortality of 1 in 500 odd cases till now. Moreover general public also has to be vigilant and responsible in preventing this disease as only an aware neighborhood can be the key to its prevention."


Medication rapidly relieves bipolar depression symptoms

People with treatment–resistant bipolar disorder were relieved from symptoms of depression in as little as 40 minutes after an intravenous dose of the anesthetic medication ketamine. The potential for side effects makes ketamine impractical for standard use, but similar compounds may have potential as rapid and effective medications for depression, including bipolar depression.

Sugary drinks associated with diabetes, metabolic syndrome

Consumption of sugar–sweetened drinks, at least one drink per day, is significantly associated with the development of metabolic syndrome and type 2 diabetes mellitus. A meta–analysis published online Aug. 6 in the journal Diabetes Care, found that the high content of rapidly absorbable carbohydrates in sugar–sweetened drinks and the large volumes consumed may increase risk of metabolic syndrome and type 2 diabetes mellitus not only through obesity, but also by increasing dietary glycemic load, leading to insulin resistance, beta-cell dysfunction, and inflammation.

FDA may withdraw hypotension drug

The FDA said that it plans to withdraw marketing approval of the orthostatic hypotension drug midodrine hydrochloride because makers of the compound failed to provide post marketing evidence of efficacy.

Choose poultry over red meat to reduce risk of heart disease

Switching away from red meat could help women reduce their risk of heart disease, according to a large observational study. A serving of chicken or turkey to replace one of beef, pork, or lamb would lower coronary heart disease risk 19% (95% confidence interval 3% to 33%), stated Adam M. Bernstein, MD, ScD, of Harvard School of Public Health, and colleagues.

Be more pleasant to reduce your stroke risk

People who have disagreeable personalities have vascular abnormalities that may make them more prone to strokes and perhaps other cardiovascular events. In a study, carotid artery intima–media thickness, which is linked to stroke risk, was significantly greater in individuals who rated low on a scale of agreeableness, reported Angelina Sutin, PhD, of the National Institute on Aging in Bethesda, Md., and coauthors.

Regular beer doubles risk of developing psoriasis

Women who drink five or more regular beers a week may double their risk of developing psoriasis, a prospective cohort study found. However, data gathered from more than 80,000 nurses followed for almost 15 years found no increased psoriasis risk for other types of alcohol, including light beer suggesting that something unique to regular beer may be responsible, according to Abrar A. Qureshi, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues.


Legal Update

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

What are Rubber Bullets?

Rubber bullets were introduced in the US to quell anti–war and civil rights demonstrators in the 1960s. They were reintroduced in the late 1980s. Rubber bullets describe about 75 types of "less than lethal devices" that are designed to deliver a stinging blow that incapacitates but do not kill or penetrate flesh as regular metal bullets.

  • The first less–than–lethal bullets appeared in the 1880s when Singapore police shot sawed–off broom handles at rioters. By the 1960s, riot control police in Singapore, Malaysia, and Hong Kong were using wooden bullets. The Wooden bullets still in use today are called "knee–knockers.
  • British colonists replaced the wood, which could shatter and possibly penetrate, with rubber. By the 1980s, they switched to more accurate plastic bullets, solid polyvinyl chloride cylinders about 4 inches long and 1.5 1/2 inches wide.

They are most often used by individual police officers to subdue armed, mentally ill people. The bullets are supposed to be shot at the lower half of the body; but have also accidently killed people. Numerous groups from the European Parliament to Human Rights Watch have called for a ban on plastic bullets


Hepatology Update: Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

Q. What is the role of EUS in diagnosis of chronic pancreatitis?

A. Endoscopic ultrasonography (EUS) is likely to play an important role in diagnosis and management of patients with chronic pancreatitis. High resolution (<1mm) images of pancreatic parenchyma and duct structure can be generated without the use of ionizing radiation. Presently EUS is very popular in adult population. But, pediatric EUS is available only in limited centres and will gradually gain popularity; with the development of smaller probes and experience in children.

Infertility Update: Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital and Director; Precious Baby Foundation

Q. What are the precautions one should take after an IVF procedure?

A. The procedure demands no special precautions, but strenuous activity should be avoided. We advise the patients to be mentally and physically relaxed as much as possible. You can return to work if you wish, but first prefer to have a few days rest.

Eye update: Prof. Dr Samar Banerjee, Howrah

What are the risk factors for progression of diabetic retinopathy? 

  • Duration of diabetes: Longer the duration, more is the chance.
  • Age: Risk increases with age after puberty. Inadequate blood sugar control: DCCT showed that intensive blood sugar control lowers the incidence by 35.74%.
  • Hypertension: Systolic and diastolic hypertension, primary, secondary in nature worsens proliferative and non–proliferative diabetic retinopathy.
  • Genetic factors: Few genetic factors are predisposing for diabetic retinopathy. They are HLA DR, 4/0, 3/0, X/X, TNF–α polymorphism and polymorphism of heavy chain immunoglobin gene.
  • Nephropathy: Eighty–six percent diabetic patients with nephropathy have retinopathy and 24% of cases with retinopathy have nephropathic changes. Resultant hypertension, endothelial dysfunction might be the determining factors.
  • Systemic diseases: Severe carotid stenosis and anemia.
  • Pregnancy: Incidence of proliferative diabetic retinopathy is 3 times higher in pregnancy. Progression of retinopathy occurs in any degree retinopathy at conception in 77.5% of women. Progression of proliferative retinopathy occurs in 72.5% of cases. Twenty–six percent cases develop fresh retinopathy during pregnancy.
  • Addictions: Daily drinking alcohol in moderate to heavy amount worsens diabetic retinopathy. Role of smoking is controversial in different trials. By altering the glycemic control and retinal blood flow, it may worsen retinopathy
  • Dyslipidemia: Total serum cholesterol has been shown to be higher in diabetics with retinopathy group than those with normal retina. The level is more higher in proliferative group than background retinopathy group.

Medi Finance Update

Q. What can a doctor do if he thinks that a decision made by the assessing officer is not justified?

Ans. Appeal can be made against the orders of the assessing officer.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Calcium acetate 435mg + Magnesium carbonate 235mg tablets

For the management of hyperphosphatemia in adults patients with renal failure being treated with dialysis (hemodialysis or peritoneal dialysis



Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

Plasma Free Metanephrine: To help diagnose or rule out a pheochromocytoma.

Related tests: Catecholamines (plasma and urine); urine Metanephrines; vanillylmandelic acid (VMA)


Conference Calendar

HIV Science 2010

3rd Annual Symposium "HIV Science 2010"

Date: August 30 – 31, 2010
Venue: Vigyan Auditorium, (CSIR) Campus, Taramani, Chennai, Tamil Nadu.


IJCP Special

Dr Good Dr Bad

Situation: An obese patient failed to achieve weight loss goal through diet and exercise.
Dr Bad: Go for surgery.
Dr Good: Start drug therapy.
Lesson: Patients who fail to achieve weight loss goals through diet and exercise alone need a trial of drug therapy.

Make Sure

Situation: A patient developed rifampicin toxicity.
Reaction: Oh my God! Why was a history of ayurvedic drugs not taken?
Lesson: Make sure to enquire if a patient is also on ayurvedic drugs. Trikatu can enhance the action of anti TB drugs

Quote of the Day

Lao Tzu …"Do the difficult things while they are easy and do the great things while they are small. A journey of a thousand miles must begin with a single step."

Asthma Alert

Indications for hospitalization

  1. A peak expiratory flow rate < 40% of predicted or of the patient’s personal best value.
  2. Peak expiratory flow 40–70% of predicted with new–onset asthma, multiple prior hospitalizations or emergency department visits for asthma, use of oral steroids at the time of presentation with the acute deterioration, and complicating psychosocial difficulties.
  3. Most patients with a peak expiratory flow > 70% of normal or their personal best can safely continue their care at home.

Public Forum (Press Release for use by the newspapers)

Second attack of dengue is more dangerous

If you have suffered from dengue last year, you need to be more careful as the second attack of dengue may be more dangerous than the first attack. This was stated by Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

Giving the details, Dr. Aggarwal said that there are four different types of dengue and one can, therefore, suffer with dengue four times in his or her lifetime. Subsequent dengue infections are always more serious and are more likely to end up with deadly combinations.

Dr. Aggarwal said that a person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to dangerous level leading to complications.

Dr. Aggarwal said that in a dengue season nobody should take aspirin for fever as it can precipitate bleeding.

In dengue, most complications occur within two days of the fever subsiding and most people are careless during this period. Any type of abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to shift of blood volume and patient requires rapid infusion of oral or intravenous fluids in large quantity.

Dr. Aggarwal said that there is no need for giving platelets even if the count is as low as 10000 unless there is an associated bleeding.


An Inspirational Story

How we affect others
My second year attending college....
I moved 300 miles away from my home of six years and entered a private Christian college. I was thrilled that I was going to attend my first pick school. My favorite class was English I with Professor Wilcox. He encouraged creativity and open thought which was right up my alley.
Throughout high school I has been pretty much told what to write and what to think. I enjoyed the challenge of his vague writing assignments; it made me have to really think about what I put down on paper.
As the school year progressed I became very ill and missed several of my classes. I apologized over and over to my professors for missing their classes, and I did the assignments out of hospital rooms or between trips to specialists and weekly doctors visits. At the end of the term my medical condition had improved some and I was able to start doing some of the extra credit to make up for my daily grades. I worked double time to bring my grades up.
The day of my English final, Professor Wilcox approached me and handed me a single sheet of rose pink paper. He told me to read on my way home to Texas. I decided that I couldn't wait and the second I stepped into my dorm room I opened the paper and read aloud. He had wanted to thank me for encouraging him throughout the school year.
In his letter he described the plight of a young woman, the youngest in her class, struggling with sickness and a full class schedule that somehow managed to pull herself up by her bootstraps and muttle through the year.
The last line of his letter read as follows: "I have watched you thoroughly enjoy yourself in my class, and I have read of your struggle against all odds to stay in school. You truly personify my favorite verse in the book of Psalms. Thank you for showing the world how to be brave and how to rely completely on God." He then went on to quote the following verse: "I have set the Lord always before me; because He is at my right hand; I will NOT be shaken." –Psalm 16:8

I hadn’t realized it at the time but everything we do and say affects other people.
My being sick had helped a professor I barely knew to get through a very trying time in his life. I just want everyone to know that even though things may seem rough, there will always be better days ahead.


Mind Teaser (Vivek Kumar)

Read this………………

UP 8

The answer for yesterday’s Mind Teasure :1st row 29th column

Correct answers received from: Dr  NP SINGH (Nanu), Dr Virender Prakash Gautam, Dr. R. Dhillon, vivek kumar varanasi, Dr Manoj Aron, Dr G M Singh, Dr Ajmer Singh, Dr Vivek Kumar, Dr Manoj Aron, Dr GM Singh, Dr Harimohan Goel, Dr. CH. Srilatha, Dr.C.P.Gupta, Dr. Vineet Banga, Dr Anurag Jain, Dr.S.K.Bansal, Dr Kahkasha,. Dr.Satyoban Ghosh, Dr. Dinesh Kumar S, Dr.Satish Gunawant, Dr.Satyooban Ghosh, Dr. Ashok Gupta,   Dr. Susheela Gupta, Dr. Khurshid Alam, Dr. Ajay Gandhi, Dr Rashmi Chhibber, Dr Mukesh Bhandari., Dr. A K Bala, Dr Dheeraj Kapoor, Dr. Vinod K Gujral, Dr. Vishal Bansal, Dr. R. K. Goel, Dr  Neelam, Seth, Dr. Rohini Vaswani, Dr Fazl Ur Rahman, Dr R S Bajaj, Dr V K Sharma. 

Correct answers received for 23rd August Puzzle from: Dr Wahid Khan, Dr Vijay Kansal,  Dr. Gitanjali Arora, Dr U. Gaur, Dr. G. P. Pande, Dr Anurag Jain, Dr. Niren Garg, Dr Suresh Mittal, Dr Raju Kuppusamy, Dr S. K. Verma, Dr Mohd Jaseem Hassan, Dr. Ashok Kumar, Dr Reeta Rasaily,  Dr. B. N. Ganagdhar,   Dr. Kaushal  Kumar, Dr AnithaVijay, Dr Raghuveer Rao, Dr Ashok Gupta, Dr. A. Tumbanatham, Dr Rashmi Chhibber, Dr Jayashree B Keshav, In Charge - Scientific Publications,The Himalaya Drug Company, Dr. Sukanta Sen, Dr Saurabh Yadav, Prof. C V Raghuveer, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai,  Dr. K. L. Jindal, Dr. Shashi Saini, Dr. Maninder Ahuja, Dr Ashok Wasan. 

Send your answer to ijcp12@gmail.com


Humor Section

Doctor, there is an invisible man in your waiting room.
Doctor: Tell him I can’t see him now. Next.

Funny One Liner
A place where Papa pays and Son plays.


Readers Responses

  1. Dr Aggarwal: Thanks a lot for publishing my views about Baba Ram Dev's message about tall and unscientific claims of incurable diseases. If Baba Ram Dev's claims are true then all hospitals should be closed because no medicines or surgery will be required  for most disorders. As medical fraternity should we DOCTORS SWALLOW ALL THIS? We should approach DGHS who should give at least HUNDRED patients of chronic diseases (DOCUMENTED) and Baba Ram Dev should be requested to CURE. As he claims that he cures the diseases while we Allopathic Doctors treat Symptoms only.  Dr Gaurav Garg

  2. Thanks to emedinews which has become great source of information and revision. I want to lay my opinion on MCI and other happenings. The MCI has been off late maligned hugely (by media).  WE all know that in last 10 years thousands of engineering and medical colleges have been allowed by the central govt  with no control of quality or discipline and only on public consensus. I suspect the corruption in MCI will grow larger, will be legitimatized and will surely go undercover after the cues are left with central ministry.  This is conspiracy by the govt to take control of everything and mint money ultimately while keeping the real rot which is elsewhere. Naturally, docs in govt services will find it hard to revolt and those in pvt unbothered but rationally we all are concerned.  Dr Shailesh Gupta,  Asst Prof, Department of Physiology, Clinical neurophysiology & Sleep studies, Lifestyle Clinic, Sports medicine, Institute of Medical Sciences, Banaras Hindu University

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi 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.

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