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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

  Editorial ...

25th September, 2010, Saturday

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

Alternate therapy for adults with poorly controlled asthma

Tiotropium bromide effective when added to low–dose inhaled corticosteroids

A drug commonly used for the treatment of chronic obstructive pulmonary disease (COPD) successfully treats adults whose asthma is not well–controlled on low doses of inhaled corticosteroids, reported researchers supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. "This study’s results show that tiotropium bromide might provide an alternative to other asthma treatments, expanding options available to patients for controlling their asthma. The goal in managing asthma is to prevent symptoms so patients can pursue activities to the fullest," said NHLBI Acting Director Susan B. Shurin, M.D.

According to the study, adding tiotropium bromide to low doses of inhaled corticosteroids is more effective at controlling asthma than doubling inhaled corticosteroids alone, and as effective as adding the long–acting beta agonist salmeterol. The results were published online in the New England Journal of Medicine and presented at the Annual Congress of the European Respiratory Society in Barcelona, Spain.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
  Photo Feature (from the HCFI Photo Gallery)

IJCP adds another feather to its cap

The Journal of Reproductive Medicine from IJCP and Institute of Reproductive Medicine and Women’s Health, Chennai was officially launched at the 10th International Conference, Updating in Sub fertility Obstetrics and Gynecology. 6–8th August 2010
In the photo : (from left to right): Dr.T.R.Varma, Dr. Peter Sjoblom, UK, Dr. Abha Majumdar, New Delhi, Dr. Nalini Mahajan, New Delhi, Dr. Radha Pandiyan, Chennai, Dr. Korula George, Vellore

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Prostate cancer

Analyses from randomized trials of PSA screening have shown that PSA velocity adds little or no independent prognostic information to PSA alone.


  1. Vickers AJ, et al. Prostate–specific antigen velocity for early detection of prostate cancer: result from a large, representative, population–based cohort. Eur Urol 2009;56:753.
  2. Thompson IM, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2006;98:529.
  National News

2nd BSNL Dil Ka Darbar 2010

The 2nd BSNL Dil Ka Darbar 2010 is being organized by the Heart Care Foundation of India on 26th September, Sunday at Maulana Azad Medical College, New Delhi from 8 AM – 5 PM. The event celebrates the World Heart Day falling on the same day. Organized along the lines of the Mugal Darbar, this one-day non stop Public Forum is a unique opportunity for the public or Fariyadis to directly address their questions to top medical experts free of charge.
The Focus of the event is Preventing Sudden Cardiac Death.
The Event will be blessed by Sh Gopal Das, CMD, BSNL.
Mr Rakesh Mehta, IAS, Chief Secretary, Delhi Govt. will be the Chief Guest. Sh.Rajendra Kumar IAS Principal Secretary Health & F.W. Delhi Govt will preside over the event.
Mr SS Ghonkrokta, Drug Controller, Delhi State; Dr S Bhattacharjee, Director, Health Services, Delhi Govt.; Dr PK Sharma, MOH, NDMC; Dr N K Yadav, MHO, MCD; Dr A.K.Aggarwal Dean Maulana Azad Medical College; Sh. Mohan Lal Director ISM & H Delhi Govt.; Dr Praveen Chandra, Chairman Interventional Cardiology, Medanta – The Medicity; Ms. Sushma Bhattar President, Maheshwari Club; Sh. D D Agrawal, President Marwari Yuva Manch, New Delhi; Lion C.P. Aggarwal President Lions Club of Alaknanda; Sh K D Baheti President All India Vaishya Federation (Delhi Pradesh); Lion Sunita Bansal, Chief Patron, Lions Club of New Delhi Shakti,; Ms Nalini and Kamalini are the Guests of Honour.

2000 general public has already registered for participating in the public forum.

3 Years Course in Emergency Medicine

Moolchand Medcity has started three year post graduate course in Emergency Medicine by George Washington University. The course is post graduate equivalent and a good opportunity for young doctors who want to make successful career in Emergency Medicine.  The Course has limited seats (10). Every year new batch starts from October.  Dr Gayatri Mahindroo,
gayatri.mahindroo@moolchandhealthcare.com, 9810718109

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association. Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Delhi grapples with dengue, cases cross 2,500 mark

As Delhi rolls up its sleeves to host the 19th Commonwealth Games, civic authorities continue to grapple with what experts are calling a "cycle of dengue". According to the Municipal Corporation of Delhi (MCD), the infectious disease has claimed five lives so far. The total number of patients reached 2,536 Wednesday. The number this year is expected to cross the 2006 figure of 3,366 cases. Nearly 70 new dengue cases are turning up in the city every day despite the regular fogging operations and checks against breeding of dengue causing mosquitoes in houses. (Source: The Times of India)

  International News

(Contributed by Dr GM Singh)

Aaron’s sign: Acute appendicitis

Continuous firm pressure of the finger over Mc Burney’s point (about 2 inches above the anterosuperior iliac spine on the line drawn between the spine and the umbilicus) elicits a referred pain or feeling of distress in the epigastrium or precordial region.

Protein shows promise in heart failure

According to a study presented at the Heart Failure Society of America meeting, patients with moderately severe heart failure had structural and functional improvements after two months of treatment with subcutaneous B–type natriuretic peptide (BNP, Nesiritide). Left ventricular (LV) volumes and mass improved a lot with active therapy than placebo. Measures of diastolic function and quality of life also improved in patients treated with BNP compared with placebo.

Resistance fears alleviated for once–daily drug

The protease inhibitor darunavir can be administered once–daily to treatment–experienced HIV patients without an increased risk of resistance. In a phase III randomized open–label study, darunavir, boosted with ritonavir and given once–daily showed comparable efficacy to the approved twice–daily dosing, according to Erkki Lathouwers, MSc, of Tibotec BVBA in Beerse, Belgium.

Depression + heart disease = lethal combo

Depression and heart disease can be deadly on their own but together raise the risk of death even more. The risk of all–cause mortality was raised 67% for patients with coronary heart disease and 2.10 times for those with depressive symptoms in the long–running Whitehall II study of British civil servants. But patients who had both conditions had almost five-fold risk vs those who had neither (Hermann Nabi, PhD, of the University of Versailles, France in Heart)

  Pediatrics Update

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

Fasting blood sugar

Even mild elevations in fasting blood sugar values during childhood predict a risk for developing type 2 diabetes mellitus. In the Bogalusa heart study, children with fasting blood sugar values in the upper half of the normal range (between 86 and 99 mg/dL (4.8 to 5.5 mmol/L) have 2.1 times the risk for developing diabetes during adulthood, and 3.4 times the risk for developing pre–diabetes, independent of the child’s weight status (Arch Pediatr Adolesc Med 2010;164:124.).

  Infertility Update

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

When is the insemination done?

Usually the insemination is done around the time of ovulation. The timing is assessed by serial ultrasound and time is fixed after the injection for follicular rupture.

Do we need anesthesia for IUI?

IUI or intrauterine insemination is an OPD procedure done without anesthesia. Sometimes, abdominal cramps are noted after the procedure. These are due to the uterine contraction and usually subside in a short period of time.

  Diabetes Update: Question of the Day

What are the indications for insulin therapy in type 2 diabetes mellitus? Indications for insulin therapy are: (Dr KM Prasanna Kumar)

Indications for insulin therapy are:

  • Type 1 diabetes
  • Secondary diabetes due to pancreatic disorders
  • Gestational diabetes not controlled with diet modification
  • Latent autoimmune diabetes of adults
  • Oral hypoglycemic agents failure – Primary or Secondary in type 2 diabetes
  • During hospitalization, surgery or any other acute illness in type 2 diabetic individuals
  • Type 2 diabetics with significant renal and hepatic failure
  • Newly diagnosed type 2 diabetes with significant hyperglycemia (fasting blood glucose >250 mg%). These individuals often need insulin for few weeks and then can be managed with oral agents.
  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What are the futile treatments in medical care delivery?

In the late 1980s and early 1990s, some argued that clinicians could terminate futile treatments. Unfortunately, the term futility has been used inconsistently. Physiologic futility means that an intervention will have no physiologic effect.

  • Qualitative futility refers to an intervention that fails to end a patient’s total dependence on intensive medical care.
  • Quantitative futility occurs when physicians conclude (either through personal experience, experiences shared with colleagues, or consideration of reported empiric data) that in the last 100 cases, a medical treatment has been useless.
Generally, it is now agreed that there is no objective standard of futility; the term merely conceals subjective value judgments about when a treatment is "not beneficial." Some hospitals have enacted "unilateral DNR" policies to allow clinicians to provide a do–not–resuscitate order in cases where consensus cannot be reached with families and there is medical opinion that resuscitation would be futile if attempted.

Texas, Virginia, Maryland, and California have enacted so–called medical futility laws. These laws protect clinicians from liability if they terminate life–sustaining treatments against family wishes. In Texas, if the medical team and family continue to disagree about terminating interventions despite an ethics consultation, then the hospital is supposed to try to facilitate transfer of the patient to another institution willing to provide treatment. If this fails after 10 days, then the hospital and clinician may unilaterally withdraw treatments determined to be futile. The family may appeal to a state court. Early data suggest the law increases futility consultations for the ethics committee and most families concur with withdrawal decision.
  Medi Finance Update

Q. In what case can a doctor get deduction of more than the amount spent?

Ans. A doctor can get deduction of 125% on the sum paid to approved bodies and is to be used for scientific social science, statistical program, national laboratory, university, IIT or other approved bodies.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Diclofenac and its formulations for animal use

July 4, 2008

GSR 499(E) dt.4.07.08

  Lab Update

Tumor marker tests

Tumor markers are chemicals made by tumor cells that can be detected in blood. But, they are also produced by some normal cells in the body and levels may be significantly raised in noncancerous conditions, which limit its diagnostic use. Examples of tumor markers: Prostate–specific antigen (PSA) for prostate cancer; cancer antigen 125 (CA 125) for ovarian cancer; calcitonin for medullary thyroid cancer; alpha-fetoprotein (AFP) for liver cancer and human chorionic gonadotropin (HCG) for germ cell tumors, such as testicular cancer and ovarian cancer.
(Contributed by Dr Arpan Gandhi and Dr Navin Dang)

  IJCP Special

Dr Good Dr Bad

Situation: An alcoholic developed amebiasis.
Dr Bad: Take metronidazole.
Dr Good: Take metronidazole and stop alcohol.
Lesson: Metronidazole may interact with alcohol and can cause disulfiram–like reaction.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

Quote of the Day

“Literature, music and the arts, all are necessary for the development and flowering of student to form an integrated total personality.” Rabindranath Tagore.
(Contributed by Dr GM Singh)

Hypertension Alert

Individuals who drink should limit their consumption to no more than 2 drinks (1 oz or 30 mL ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons. It alone can reduce blood pressure by 2–4 mmHg.


Read this…………………

Which of the following patients should receive statin therapy for hyperlipidemia?

  • 34 year old male smoker with systolic pressure of 150 mmHg on an  ACE inhibitor. His total cholesterol is 220mg/dl and HDL is 40mg/dl.
  • 60 year old female, non-smoker with systolic blood pressure of 160mm Hg on hydrochlorothiazide. Her total cholesterol is 250mg/dl and HDL is 40 mg/dl.
  • 74 year old male, non-smoker with systolic pressure of 180mmHg on amlodipine. Total Cholesterol is 150mg/dl and HDL is 50mg/dl.
  • 50 year old male, non-smoker whose systolic is 140mmHg and who is not on medication for hypertension. His total cholesterol is 300mg/dl and HDL cholesterol is 55mg/dl.
  • 45 year old female with diabetes mellitus who is a non-smoker and her systolic pressure is 110mmHg. Total cholesterol is 130 and HDL is 70mg/dl.

A. All of the above
B. None of the above
C. 3, 4 & 5
D. 1 & 5
E. 3 & 5
(Contributed by Ashish Verma MD)

Answer for yesterday’s Mind Teaser: “hitting below the belt”.

Correct answers received from: Dr Nilesh Kale, Dr.G.Padmanabhan, Dr. Shashi Saini, Dr. Suman Kumar Sinha, Dr Chandresh Jardosh, Dr Kalpana Mohan, Dr.R.K.Goel, Dr Muthumperumal Thirumalpillai, Dr Sudha Nayyar, Dr S. Upadhyaya, Dr S. Upadhyaya, Dr.Susheela Gupta,Dr.K.P.Rajalakshmi, Ms. Deepti Katyal Uppal, Dr Virender Prakash Gautam, Dr Santvana Pandey, Dr Meera Rekhari, Dr. Aditya Rattan, Dr.Asim Kumar Sen, Dr Nagendar Gupta, Dr. Manjesha, Dr Lokesh, Dr. Naorem Sharat, Dr.K.Raju, DR.PARVESH K. SABLOK, Dr.Prabha Sanghi. Dr kamlesh Kanodia, Dr Rajiv Khosla, Dr Shashi Chhabra, DR JAYASHREE SEN, Dr. Prashant Bharadwaj, Dr Ajmer Singh, Dr Vijay Kansal, Dr Kala Sarma

Answer for 23rd Sept Mind Teaser is: "Breaking a custom".
Correct answers received from: Dr Anurag Jain, Dr Virender Prakash Gautam

Send your answer to ijcp12@gmail.com

  Humor Section

Bill, Jim, and Scott were at a convention together and were sharing a large suite on the top of a 75 story sky scraper. After a long day of meetings they were shocked to hear that the elevators in their hotel were broken and they would have to climb 75 flights of stairs to get to their room. Bill said to Jim and Scott, "Let’s break the monotony of this unpleasant task by concentrating on something interesting. I’ll tell jokes for 25 flights, and Jim can sing songs for 25 flights, and Scott can tell sad stories the rest of the way.
At the 26th floor Bill stopped…… telling jokes and Jim began to sing. At the 51st floor Jim stopped singing and Scott began to tell sad stories. "I will tell my saddest story first," he said. "I left the room key in the car!"
(Contributed Dr Chandresh Jardosh)

Important laws which the great Newton forgot to state

Law of Encounters

The probability of meeting someone you know increases when you are with someone you don’t want to be seen with.
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

The Trouble Tree

The carpenter I hired to help me restore an old farmhouse had just finished a rough first day on the job. A flat tire made him lose an hour of work, his electric saw quit, and now his ancient pickup truck refused to start. While I drove him home, he sat in stony silence. On arriving, he invited me in to meet his family. As we walked toward the front door, he paused briefly at a small tree, touching tips of the branches with both hands.
When opening the door, he underwent an amazing transformation. His tanned face was wreathed in smiles and he hugged his two small children and gave his wife a kiss. Afterward he walked me to the car. We passed the tree and my curiosity got the better of me. I asked him about what I had seen him do earlier. Oh, that’s my trouble tree," he replied. "I know I can’t help having troubles on the job, but one thing’s for sure, troubles don’t belong in the house with my wife and the children. So I just hang them up on the tree every night when I come home. Then in the morning I pick them up again." "Funny thing is," he smiled, "when I come out in the morning to pick ‘em up, there ain't nearly as many as I remember hanging up the night before."

  Readers Responses
  1. Dear doc. eating dark chocolates is cardio friendly, if one does not like chocolates, then beverages rich in cocoa powder would be as effective? Because of calories rich chocolates may not be good for diabetics, and lead to weight gain for known cardiac patients/normal people with no heart disease. Please reply, is cocoa powder as effective as dark chocolates. Thanks. Neelamnath.  

  2. Dear Dr Agarwal, I fully agree with Dr Franklin regarding the double standards adopted by MCI.
    There are one set of standards for rural and poor patients and another for urban and well-to-do patients. In India, VIP culture exists and will remain. The strategy by those in the policy making body is discourage the doctors who practise ethically and are always concerned with the economy of the patient before prescribing.  Health is a state subject also. So I appeal to MCI please discuss the exit test with all the stake holders before rushing to Ministry with your expert advise. DO NOT BURDEN the doctors and I wish all of you first clear this exit test when you introduce it. Sincerely: Dr R.S.Bajaj.

  3. The milk of knowledge overflows in torrents to the loving GP's hearts, to the trusting and yearning souls. The child-like innocence, pure and sincere love attracts this milk of knowledge most. The CME organisers, by nature feel the urgency of the GP's no sooner than the GP's wants it. As the milk of knowledge flows spontaneously out of love of the GP's; so does the milk of wisdom and love of DR.K.K.AGGARWAL flows uninterrupted in the yearning and pure devotion of G P's of the medical profession. The G P's do not have to demand for the knowledge, a mere impulse is sufficient to elicit a spontaneous response of the CME.
    Similarly, DR.K.K.AGGARWAL a true medical person spiritually feeds and nourishes the innocent GPs like devotees totally dependent on CME grace. Hearty thanks to the organizers of CME  (Dil ka Darbar) DR.G.M.SINGH

  Public Forum

(Press Release for use by the newspapers)

A to G of heart care: World Heart Day

On the eve of World Heart Day and the forthcoming BSNL Dil Ka Darbar on Sunday being organized to commemorate the World Heart Day at Maulana Azad Medical College Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal; President Heart Care Foundation of India said that wild animals do not get heart attacks because they live in accordance with the laws of nature and we have never heard of wild animals getting angioplasty or bypass done.

Dr. Aggarwal said that heart disease is preventable and the easiest way to learn this is to remember the A to G of cardiovascular prevention. ABC represents safe parameters and DEFG represent what to do to achieve these parameters.

  • A stands for Abdominal Girth which should be kept lower than 85 cm in men and less than 80 cm in women.
  • B stands for Blood Pressure which should be kept lower than 120/80.
  • C stands for bad non–HDC Cholesterol which should be kept less than 130 mg%.

    The prevention strategies include
  • D stands for Diet which should be in moderation and include variety.
  • E stands for Exercise which should be taking 10000-steps walk or 80 minutes of walk or 40 minutes of brisk walk or 20 minutes of brisker than brisk walk.
  • F stands for Fun or taking life differently. For example, half glass full vs half glass empty
  • G stands for God which is a parasympathetic state of mind achieved by Pranayama, yoga and relaxation techniques.
  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday–BSNL Dil ka Darbar A daylong 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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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