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eMedinewS is now available online on www.emedinews.in or www.emedinews.org
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

26th August, 2010, Thursday

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

Paracetamol may increase asthma risk in adolescents

Yet another new study has shown a link between asthma and Paracetamol. According to a study in the American Journal of Respiratory and Critical Care Medicine, 13– and 14–year–olds who take paracetamol are more than twice as likely to have asthma as teens the same age who never take paracetamol.

A team of scientists led by a researcher in New Zealand worked with 322,959 children, aged 13 to 14 years, at 113 centers throughout 50 countries.

The majority of the teens (73%) reported using acetaminophen at least once in the previous year (medium use), and 30% said they had used it at least once a month (high use).

Investigators eventually discovered that those using paracetamol at least monthly had 2.5 times the asthma risk of nonusers. Once–a–year users had a 43% increase in risk of asthma.

Frequent users of Paracetamol were also more than twice as likely to have rhinoconjunctivitis as kids who never took the drug, while medium users had a 38 percent greater risk.

For eczema, frequent users had a 99 percent increased risk, while medium users had a 31 percent increased risk. Frequent users of paracetamol were 2.75 times as likely to say their wheezing was so bad it disturbed their sleep and limited their ability to speak.

However, the study does not show that the drug causes the problems. It is equally likely that the children were taking the drug because they were already suffering from asthma.

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

In In the photo: Prof Kiran Walia, Health Minister Delhi, Professor S S Aggarwal, DIPSAR and Acharya Dr Sadhna Ji. Also in the photo: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI
The Perfect Health Parade is organized every year by Heart Care Foundation of India in collaboration with Delhi Govt Departments and NGOs (World Fellowship of Religions, Acharya Sushil Muni Ahimsa Trust, IMA, DMA etc). Last year it was flagged off from Raj Ghat on May 31, 2009.


K K Aggarwal


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

Clinical and laboratory features used to assess neurologic prognosis after cardiac arrest may not be reliable in early evaluations in the setting of induced hypothermia therapy. (Ann Neurol 2010; 67:301, Neurology 2010;74:965).


News and Views

National News

A live surgical workshop on cosmetic rhinoplasty was held on 13th and 14th august 2010 at Nilratan Sircar Medical college kolkata and was organised by Department of ENT The faculty included Prof P S Saharia, Dr Jasveer Singh (Delhi), Prof T K Hazra HOD ENT NRSMC and Dr Kamalendu Haldar (Kollata). Prof P S Saharia talked on "Septoplasty & Rhinoplasty". He eloborated various aspects of dealing cases of septorhinoplasty.Prof T K Hazra HOD delivered lecture on "My experince on septorhinoplasty"Result of long term followup. A few patients whom he had operated 10 years back were present at the time of speech. Dr Jasveer Singh also delivered a lecture discussing the significant of ant nasal spine in rhinoplasty.The programme was inaugarted by Director of Medical Education,Prof S N Banerjee.Sixteen live surgeries on cosmetic rhinoplasty were performed covering different types of deformities with different approaches (open and close) and different types of operations like saddlenosecorrection, tip plasty, augmentation rhinoplasty,hump reduction and croocked nosedeformity. Nearly 150 delegates not only from West Bengal but also from Bangladesh, Assam and Bihar attented the workshop.

International News ( Dr Brahm and Dr Monica Vasudev)

Kidneys from cardiac–death donors may be as good as those from brain–dead donors

Contrary to accepted wisdom, kidney donations from people whose hearts have stopped beating may, in fact, be just as good as donations from brain–dead organ donors, according to a paper published in The Lancet. Recipients of cardiac–death–donor kidneys have identical five–year survival to those patients who received a more traditional transplant organ — at least among first–time transplant recipients. They also have similar estimated glomerular filtration rates. The study included 8,289 kidneys donated after brain death and 845 donated after controlled cardiac death with adult recipients recorded in the UK transplant registry from 2000 through 2007. While delayed graft function occurred more often with cardiac–death donation (50% versus 25% brain–death donation, P<0.0001), it didn’t appear to impact transplant outcome, unlike for recipients of kidneys from brain–death donors, in which delayed graft function was predictive of inferior transplant survival.

Some insulin–producing beta cells may persist in long–term type 1 diabetes survivors

According to a study published online Aug. 10 in the journal Diabetes, the insulin–producing beta cells destroyed by type 1 diabetes may actually be in a constant state of turnover, even in people who’ve had diabetes for decades.

Arterial pulsatile compression of right anterolateral medulla may play etiologic role in type 2 diabetes

According to a study published online Aug. 16 in the journal Surgical Neurology International, Arterial pulsatile compression of the right anterolateral medulla may play an etiologic role in the development and progression of type 2 diabetes mellitus.

Pretreatment of deceased donor kidneys with steroids may not reduce incidence of acute renal failure

Pretreatment of deceased donor kidneys with steroids failed to reduce the incidence of acute renal failure or delayed graft function, according to a study published Aug. 17 in the Annals of Internal Medicine.


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

Can weight loss surgery be recommendation in adolescents with morbid obesity ?
Adjustable gastric banding (AGB) is one of two established surgical interventions to address severe obesity in adolescents. A randomized trial of 50 adolescents compared AGB with a supervised lifestyle intervention (1). During the two–year follow–up period, the patients in the AGB group lost an average of 34.6 kg, as compared with 3.0 kg in the lifestyle group. Of note, almost 30 percent of the patients undergoing AGB required revisional procedures.

O’Brien, PE, Sawyer, SM, Laurie, C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 2010; 303:519.

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

Q. If I conceive by IVF, will my baby be normal?
A. Studies have shown that there is no increased risk of abnormality in IVF conceived babies compared to those conceived naturally.

Paediatrics Question of the day: Dr Tanmay Amladi

What is the normal frequency of stool and urine in a newborn baby?
• Irregular for first 72 hours or till breast milk well established.
• Generally speaking at least one void every two hours.
• Very, very variable.
• From one stool every 7th day to 7–8 stools a day! Small frequent staining of the diapers may also be present.

Evidence Based Medicine: Dr NP SINGH (Nanu), Professor of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital 

Plasma Renin Activity Predicts Blood Pressure Responses to β–Blocker and Thiazide Diuretic as Monotherapy and Add–On Therapy for Hypertension.
Age and race categories or renin profiling have been recommended to predict blood pressure responses to monotherapy with a –blocker or thiazide diuretic. Whether these or other characteristics predict blood pressure responses when the drugs are administered as add–on therapy is uncertain. Methods: We evaluated predictors of blood pressure response in 363 men and women ≤65 years of age with primary hypertension (152 blacks, 211 whites), 86 of whom (24%) were untreated and 277 of whom (76%) were withdrawn from previous antihypertensive drugs before randomization to either atenolol followed by addition of hydrochlorothiazide (N = 180) or hydrochlorothiazide followed by addition of atenolol (N = 183). Responses were determined by home blood pressure averages before and after each drug administration. Race, age, plasma renin activity, and other characteristics including pretreatment blood pressure levels were incorporated into linear regression models to quantify their contributions to prediction of blood pressure responses. Results: Plasma renin activity and pretreatment blood pressure level consistently contributed to prediction of systolic and diastolic responses to each drug administered as mono– and as add–on therapy. Higher plasma renin activity was consistently associated with greater blood pressure responses to atenolol and lesser responses to hydrochlorothiazide. The predictive effects of plasma renin activity were statistically independent of race, age, and other characteristics. Conclusions: Plasma renin activity and pretreatment blood pressure level predict blood pressure responses to atenolol and hydrochlorothiazide administered as mono– and as add-on therapy in men and women ≤65 years of age.

Reference: Turner ST, Schwartz GL, Chapman AB, et al. Am J Hypertens 2010;23(9):1014–22.


Legal Update: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What does history state about withdrawal of medical care?

The first suggestion that clinicians should withhold medical interventions from terminally ill patients in some circumstances probably dates to Hippocrates’ injunction "to refuse to treat those (patients) who are overmastered by their disease, realizing that in such cases medicine is powerless".

Clinicians and religious leaders also have argued that withholding care from dying patients may be appropriate in some situations. In 1835, Jacob Bigelow urged fellow members of the Massachusetts Medical Society to withhold "therapies", such as cathartics and emetics, from hopelessly ill patients. In 1848, John Warren, the surgeon who performed the first operation with ether anesthesia, urged that ether should be used "in mitigating the agonies of death." In 1958, Pope Pius XII, in response to questions about resuscitating patients and maintaining comatose patients on respirators, stated that clinicians had no obligation to use such "extraordinary" means to forestall death.


  1. Hippocrates. The art. In: Hippocrates: The Loeb classical library, Jones, WHS (Ed), Harvard University Press, Cambridge, 1923.
  2. Bigelow, J. Self–limited disease: address to the Massachusetts Medical Society, May 27, 1835. In: Nature in disease, Ticknor and Fields, Boston, 1854.
  3. Warren, J. Etherization, with surgical remarks. Ticknor & Co, Boston, 1848.
  4. Pope Pius XII. The prolongation of life. In: Ethics in medicine. Reiser, SJ, Dyck, AJ, Curran, WJ (Eds), MIT Press, Cambridge 1997.

Medi Finance Update

Q. What all does total income include?

Ans. Total income includes income from various heads like:

• Salary
• Rental income
• Capital gains
• Business and profession
• Income from other sources e.g.interest, etc.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Sertaconazole 2% w/v+ Zinc Pyrithione 1% w/v Shampoo

For the treatment in adults patients with dandruff/seborrheic dermatitis of the scalp



Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

Copper (24–hour urine, total and free blood, and hepatic):

To measure the amount of copper in the blood, urine, or liver; to help diagnose and monitor Wilson’s disease; sometimes to identify copper deficiencies and excesses.


IJCP Special

Dr Good Dr Bad

Situation: An obese patient came with BMI of more than 40.
Dr Bad: Go for surgery.
Dr Good: First try diet, exercise and drug therapy.
Lesson: Obesity surgery is indicated in patient with BMI more than 40 who have failed diet and exercise with or without drugs.

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water – soluble aspirin is chewed to reduce chances of sudden death.

Quote of the Day

John Keats …"It is very easy to defeat someone, but it is very hard to win someone."

Asthma Alert

Near fatal asthma

Assessing patient risk for fatal asthma exacerbation is important because many, if not most, asthma–related deaths are preventable if risk factors are recognized and addressed early.

Major risk factors

  1. Recent history of poorly controlled asthma (increases in dyspnea and wheezing, frequency of nocturnal awakenings, use of beta–adrenergic agonist rescue medications, and increased diurnal variability in peak expiratory flow rate)
  2. Prior history of near–fatal asthma (requiring endotracheal intubation and mechanical ventilation or a history of a prior intensive care unit admission)

Mind Teaser (Vivek Kumar)

Read this………………

What is ’50 O 5 E’

The answer for yesterday’s Mind Teasure : up before 8

Correct answers received from: Dr Anurag Jain, Dr Ashok Wasan, Dr.Susheela Gupta, Dr. Dinesh Kumar S, Dr Yogesh Saxena

Correct answers received for 24th August Puzzle from: Dr. Anjani, Dr.VK SHARMA, Dr.R.S. Bajaj, Dr Golmei Jendum, Dr Rakesh Bhasin, Dr.P.S.Sarma, Dr Rajeev Sethi, Dr Vijay Kansal, Dr. Amritendu Saha, DR. Arvin Kamra, Dr Uma Gaur, Dr. Wahid Khan, Dr Shashi Chhabra

Correct answers received for 23rd August Puzzle from: Dr Kalpana Mohan

Correct answers received for 22nd August Puzzle from: Dr Govinda Narke,

Send your answer to ijcp12@gmail.com


Humor Section

Let us be generous like this: Four Ants are moving through a forest.
They see an ELEPHANT coming towards them. Ant 1 says: we should KILL him.
Ant 2 says: No, Let us break his Leg alone.
Ant 3 says: No, we will just throw him away from our path.
Ant 4 says: No, we will LEAVE him
because he is ALONE and we are FOUR.

Funny One Liner
A foolish man tells a woman to STOP talking, but a WISE man tells her that she looks extremely BEAUTIFUL when her LIPS are closed.
(Contributed by Dr Chandresh Jardosh)


An Inspirational Story

A woman named Vicki once knew a young person at church named Susan. Susan always seemed effervescent and happy, although Vicki knew she had faced struggles in her life. Her long–awaited marriage had quickly ended in divorce. She had struggled to get a grip on her single life. She hadn’t chosen it, but she decided she would live it with utmost enjoyment and satisfaction. Susan was active in Sunday school, in the choir, as a leader of the junior high girls' group, and in the church renewal movement. Vicki enjoyed knowing Susan. Susan's whole face seemed to smile.

One day Vicki asked Susan, "How is it that you are always so happy, you have so much energy, and you never seem to get down?" With her eyes smiling, Susan said, "I know the Secret!"

"What secret is that, what are you talking about?" Vicki asked. Susan replied, "I’ll tell you all about it, but you have to promise to share the Secret with others."

Vicki agreed, "Okay, now what is it?"

The Secret is this:

"I have learned there is little I can do in my life that will make me truly happy. I must depend on God to make me happy and meet my needs. When a need arises in my life, I have to trust God to supply according to HIS riches. I have learned most of the time I don't need half of what I think I do. HE has never let me down."

Since I learned that Secret I am happy.

Vicki’s first thought was, that’s too simple! But upon reflecting over her own life she recalled how she thought a bigger house would make her happy –but it didn’t! She thought a better–paying job would make her happy –but it hadn’t. When did she realize her greatest happiness? Sitting on the floor with her grandchildren, playing games, eating pizza or reading a story, a simple gift from God. Susan knew the secret, Vicki learned the secret, and now you know it too!

We can’t depend on people to make us happy. Only GOD in His wisdom can do that. Trust HIM!
And now the Secret passed on to you!


Readers Responses

  1. Very Rightly said. We need not be panicky rather accept it and learn to live with it. Public must be made aware of the Warning Signs which should bring them to the hospital, rather than overloding them with every patient of suspected Dengue. Narinderpal Singh

  2. My policy of Platelet Counts 1. More than a Lakh Do it Alternate day , 2.50,000 to 1lakh -Do it daily, less than 50,000 twice a day and hospitalize for observation, if less than 20,000 and bleeding from GITravt, hematuria, menorrahgia Give platelets, less than 10,000 give platelets. Narinderpal Singh
    Emedinews responds: I will even wait at 10,000 if there is no bleeding. Will admit only if required if the fever has subsidized and the patient can not tolerate LIMCA with salt.
    Dr Vinod Kumar Monga responds: "i agree...giving platelets is no more reqd in 99%of cases...infact plasma is d in thing now and luckily we are not getting very serious cases this year. "

  3. Honable Sir, this is in context to Dr. Good & Dr. Bad. About 2 years back there was a rave for bariatric surgery in obese & metabolic syndromes. However a close follow up of such patients has revealed that they can’t stick to balanced nutrient diet (the original sinner for their problem). They thus land up in follow up with various complications like malnutrition & anemia. These complications in middle & old age group are themselves a problem. However when it comes to medical therapy, it needs a very well planned approach. I have seen a few of my colleagues prescribing orlistat but pt response is not as desired, also the financial compliance too is poor due to cost of drug. I have not come across any propriety/ branded methyl cellulose in market.  Dr Dibendujoy Verma
    eMedinewS responds: One should try bariatric diet before subjecting one for bariatric surgery).

Public Forum (Press Release for use by the newspapers)

Heart patients must stay active

Any level of leisure time physical activity curbs the risk of death among men and women with coronary heart disease, said 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 quoting a study published in the American Journal of Cardiology.

Done by Dr. Anil Nigam of Montreal Heart Institute in Quebec, Canada, the study evaluated leisure time physical activity among 14,021 generally middle–aged men and women with heart disease who had artery–clearing procedures between 1974 and 1979.

The study found that heart patients often limit their physical activity due to shortness of breath, chronic fatigue, circulation problems in the legs, or other symptoms of the disease.

In the study following patients for an average of 14.7 years, it was found that decreasing leisure time physical activity levels correlated with increasing death rates.

The death rate was lowest (30 percent) among men and women involved in strenuous recreation such as endurance activities or competitive team sports. Men and women reporting moderate or mild activity levels had higher overall death rates of 35 and 40 percent, respectively. The death rate was highest (42 percent) among men and women reporting leisure activities that primarily involved sitting.

Sedentary folks, versus those more physically active, were 1.6 times more likely to die from cardiovascular disease or other causes over the long term.

People with coronary heart disease need to be physically active to improve their overall health and survival.


Conference Calendar

Dr. Sood Nasal Research Foundation announces Rhinology Update
November 11– 15, 2010 with 22nd National Endoscopic Sinus Surgery Course Dr. Shroff’ Eye & ENT Hospital, New Delhi.
International Faculty: Dr. Dinesh Mehta, Dr. Munish Shandilya, Dr. Vinod Anand, Dr. Parul Goyal, Dr. David Smyth
National Faculty: Dr. P. Thulasidas, Dr. K. R. Meghanadh, Dr. Vishnu Reddy, Dr. P. S. N. Murthy
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College, New Delhi.


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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