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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

27th March, 2010, Saturday

High resolution ultrasound for giant cell arteritis

The American College of Rheumatology 1990 criteria for the diagnosis of giant cell arteritis require the presence of three of the following: age 50 years or older; new onset of localized headache; temporal artery tenderness on palpation or decreased pulsation; erythrocyte sedimentation rate of 50 mm/hour or higher and abnormal temporal artery biopsy.

Rapid diagnosis and initiation of treatment are mandatory because of the potential for irreversible vision loss, the most feared complication associated with this most common of adult vasculitidies.

A meta analysis by Dr Aikaterini Arida, and colleagues from Athens University Medical School in Greece showed that a halo sign detected on ultrasound, indicating edema of the temporal artery, is both sensitive and specific for giant cell arteritis. The presence of a unilateral halo sign has an overall sensitivity of 68% and specificity of 91%. With a bilateral halo sign, the sensitivity and specificity are 43% and 100%, respectively.

Dr KK Aggarwal
Chief Editor

News and Views

Meeting Update: American Society of Clinical Oncology (ASCO) Genitourinary Cancer Symposium, San Francisco, CA • March 5 – 7, 2010

Robotic surgery changes some prostate CA treatment

Robot – assisted surgery for prostate cancer require alteration in radiation. The pelvic anatomy after robotic radical prostatectomy is considerably different than the same location after open surgery. The study was presented by Dr Ariel Hirsch, of Boston University. Distance to the rectum and the separation of the pelvic floor musculature is much greater with the minimally invasive approach, which may require an adjustment to the posterior and lateral radiation field design.

Higher–priced prostate therapy taking over

Robotic and laparoscopic procedures jumped from 1.5% to 28.7% of radical prostatectomies in the Medicare population between 2002 and 2005 (P<0.0001), as per a study by Dr Paul L. Nguyen, of the Dana – Farber Cancer Institute and Brigham and Women’s Hospital in Boston.

Extensive Node Dissection Key for High–Risk Penile Cancer

A study presented by Dr Viraj A. Master, of Emory University in Atlanta. Thorough lymph node dissection improves survival in high–risk penile cancer but is vastly underused. For high–grade tumors, excision of at least eight lymph nodes was associated with 86.4% higher multivariate–adjusted odds of survival at five years than less complete dissection.

Novel urine test IDs prostate cancer

An experimental urine test may pick up prostate cancers before biopsy in high–risk men. The Prostate Cancer Gene 3 (PCA3) test score at the time of a negative first biopsy predicted a positive rebiopsy two years later with 79.1% specificity and 36.4% sensitivity, according to retrospective analysis of a clinical trial reported at the Genitourinary Cancers Symposium.

Urine screening not worth the money in bladder CA

Adding urine tests to standard cytoscopy for surveillance after non–muscle invasive bladder cancer may increase cost without boosting detection, according to a prospective cost– effectiveness study presented by Dr Jose A. Karam, of the University of Texas M.D. Anderson Cancer Center in Houston.

Prostate CA prevention affirmed for BPH drug

For men with benign prostatic hyperplasia, dutasteride both prevents prostate cancer and boosts the predictive power of prostate specific antigen. Presenting the findings, Dr G. Gomella, of the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia. said that the drug was associated with 40% lower incidence of prostate cancer diagnosis than the BPH drug tamsulosin in at–risk men.

Conference Calendar

ENDOSURG 2010 – The Department of Surgical Disciplines is organizing the ‘Fourth AIIMS Surgical Week’, International Conference, CME cum Live Workshop
Date: March 26 – 28, 2010
Venue: All India Institute of Medical Sciences, New Delhi

What’s New: First degree heart block risky

A large prospective cohort study of individuals from the Framingham Heart Study found that, compared with a normal PR interval, individuals with first degree AV block were more likely to develop atrial fibrillation, had a greater risk of receiving a permanent pacemaker, and a higher all–cause mortality. (Cheng S, Keyes MJ, Larson MG, et al. Long–term outcomes in individuals with prolonged PR interval or first– degree atrioventricular block. JAMA 2009;301:2571.)

Diabetes Fact

Hypoglycemia response: first to increase is glucagon (not Epinephrine), than GH, Ephinephrine, thyroxine, cortisol)

Public Forum (Press Release)

Manage stress to reduce chances of heart attack

Keeping stress levels under control can significantly reduce the risk of a heart attack or death in patients with coronary artery disease, said Dr K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

If we can lower heart patients anxiety level, we may be able to reduce their risk of heart attack and prolong their life.

Yinong Young–Xu of Brookline, Mass. examined 516 patients with coronary artery disease. Those who reduced or kept their anxiety level steady were as much as 60 percent less likely to have a heart attack or die compared to those who had an increase in anxiety level.

This ratio remained steady after adjusting for other potential cardiovascular risk factors including age, sex, education, marital status, smoking, hypertension, diabetes mellitus, previous heart attack, body mass index, total cholesterol, blood pressure, heart rate, ejection fraction and exercise treadmill test duration.

Lifetime prevalence of anxiety disorder is around 30 percent among people with heart disease.

Question of the day

What dose of ACE inhibitor should we aim for in heart failure patients and what should we do if creatinine rises?

ACE inhibitor

Starting dose

Target dose

Captopril 6.25 mg tds 50 mg tds (can go up to 100 mg)
Enalapril 2.5 mg bd 10 mg bd (can go up to 20 mg)
Ramipril 1.25 mg bd 5 mg bd
Lisinopril 2.5 mg od 30 mg od (can go up to 40mg)
Trandolapril 0.5 mg od 4 mg od

Titration steps are usually starting with a minimum dose and doubling every two weeks to maximum tolerated dose – just before the patient gets dizzy. Remember: a small dose is better than no dose at all. You should check the renal function one week after every up–titration and keep the blood pressure above 90mmHg systolic. A serum creatinine increase of 50% over baseline or up to 266µmol/l is acceptable – whichever is least. If exceeded, go back to the previous dose. (Dr G.M. Singh)

Quote of the Day

Anyone can give up, it’lss the easiest thing in the world to do. But to hold it together when everyone else would understand if you fell apart, that's true strength. (Steve Job)

eMedinewS Try this it Works

New–onset insomnia and BPH

Whenever an elderly man comes in complaining of new-onset insomnia, inquire about nocturia. Men with benign prostatic hypertrophy (BPH) often present first with insomnia. The latter resolves when BPH is treated.

Dr Good Dr Bad

Situation: A patient was found to have an average weight gain of 2 kg per year.
Dr Bad: Its ok.
Dr Good: You are at risk for diabetes.
Lesson: Among untreated primary care patients with type 2 diabetes and A1C <7%, younger patients and those with weight gain were more likely to have diabetes progression and should be the focus of aggressive diabetes management. Each decade of increasing age reduced the risk of progression by 15%. Each 1– lb increase in weight was associated with a 2% increased odds of progression. (Diabetes Care 2008;31(3):386– 90.)

Make Sure

Situation: A terminally ill patient who develops bed sores, is given systemic antibiotics only.
Reaction: Please change the position of the patient frequently and keep the skin clean and dry.
Make sure good nursing care and maintenance of skin hygiene should be advised first to patients with bed sores, along with topical antibiotics.

Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Prisoner: Look here, doctor! You’ve already removed my spleen, tonsils, adenoids, and one of my kidneys. I only came to see if you could get me out of this place!

Intensivist: I am, bit by bit.

Formulae in Critical Care

Venous oxygen concentration (CvO2)

CvO2 is venous oxygen content as blood returns to heart.

Formula: CvO2 = (1.34 × Hgb × SvO2) + (PvO2 + 0.0031) Formulae in Clinical Practice 17 Critical Care Manual

Normal value: 15.5 volume %. or 15.2 ml O2/dL.

Milestones in Orthopedics

Martin Benno Schmidt (1863 – 1949) was a German pathologist.
He specialized in pathological investigations of bone disorders such as rickets, osteogenesis imperfecta and osteomalacia. He is remembered for his description of autoimmune polyendocrine syndrome, type II, which is a disease characterized by autoimmune activity against more than one endocrine gland. This condition is sometimes referred to as ‘Schmidt’s syndrome’ or ‘polyglandular autoimmune syndrome, type II’.

Schmidt also performed important studies regarding the metastasis of tumors, and with pathologist Ludwig Aschoff (1866 – 1942), he published a treatise on pyelonephritis called Die Pyelonephritis in anatomischer und bakteriologischer Beziehung.

Mistakes in Clinical Practice

A very common error is calling the drugs in short forms or half pronunciation of their names. It’s due to rapid changing nursing and medical officer–on–duty staff in the emergency departments. The hospital guidelines should be clear to write full name and not abbreviations or half names.

Lab Test (Dr Naveen Dang)

hs–CRP is used as a marker for assessing the risk for heart disease.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Dexmedetomidine ( as HCl) 100mcg /ml Injection

For sedation of initially and mechanically ventilated patients during treatment in an intensive care setting.


(Advertorial section)


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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

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