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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

27th August, 2010, Friday

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

Just a Little Belly Fat Can Damage Blood Vessels

People who put on even a little weight around their middle hinder the function of endothelial cells that line their blood vessels, increasing the risk for high blood pressure. Endothelial cells are vital as they control the ability of the vessel to contract and dilate, which in turn controls blood flow. Damage to the endothelium can lead to the vessel not functioning properly and eventually high blood pressure.

When people put on a modest amount of weight, in the belly, they tend to have a greater impairment of endothelial function as per Dr. Virend K. Somers, a professor of medicine at the Mayo Clinic School of Medicine. Endothelial function is a marker of health of the blood vessel.

The researchers randomly assigned 43 normal–weight adults to either gain about nine pounds or keep their current weight. They measured endothelial function in the brachial artery, in the arm and assessed the ability of the artery to dilate. Measurements were taken before the study started, after eight weeks of weight gain and again after 16 weeks of weight loss. People who gained weight showed a decrease in the ability of the artery to dilate. However, when they shed the weight again, the ability of the brachial artery to dilate properly snapped back to normal. It’s only 10 pounds weight gain which can have potentially harmful effects on blood vessels. The Study is published in the Aug. 17 issue of the Journal of the American College of Cardiology

Dr KK Aggarwal
Editor in Chief
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Photo Feature (from HCFI files)


The Perfect Health Mela is being organized for past 17 years by Heart Care Foundation of India in collaboration with Delhi Govt Departments and NGOs, PSUs etc.  In the year 2000 the perfect Health mela was organised from Oct 16 - Oct 25 at Jawahar Lal Nehru Stadium. In the photo: Mr Kirti Azad, Cricketer distributing awards


K K Aggarwal


International Medical Science Academy (IMSA) Update

Major medical complications associated with surgery for lumbar spinal stenosis in older adults

Over the 2002 to 2007 time period, the incidence of major complications and 30–day mortality associated with lumbar spine surgery in older adults increased in association with an increased frequency of complex fusion procedures.


  1. Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010;303:1259–65.

News and Views

National News

The Medical Training Initiative (MTI) Scheme
RCP has launched the MTI scheme to allow international medical graduates (IMGs) to be matched with paid training fellowships in NHS Trusts and Health Boards. Royal College of Physicians (RCP), in partnership with ALUMNI ASSOCIATION, MEDICAL COLLEGE TRIVANDRUM, is now accepting applications of interest to join the Medical Training Initiative (MTI) Scheme.
The MTI scheme offers the opportunity of 2 years clinical training and experience in UK National Health Service (NHS) hospital trusts for suitably qualified international medical graduates.  If appointed to a position after joining the scheme, doctors will be directly contracted to an NHS Trust and be remunerated at standard UK rates: Dr S Krishnakumar (kkumardr@yahoo.com).

Direct Taxes Code Bill
The version approved by the Cabinet exempts incomes up to Rs 2 lakh per annum (against the current Rs 1.6 lakh) from tax, proposes to tax incomes between Rs 2 lakh and Rs 5 lakh at 10%, between Rs 5 lakh and Rs 10 lakh at 20% and beyond Rs 10 lakh at 30%.  For women and senior citizens, the exemption limit would be Rs 2.5 lakh per annum. At present, women have to pay tax on incomes of Rs 1.9 lakh per annum or more and senior citizens on incomes of Rs 2.4 lakh or more.

One more dengue detah in Delhi

Dr V K Monga: " in our expert group meeting today, the experts opined that all 4 types and 12 genotypes have been seen this year. Incidentally another death from dengue has been confirmed in Delhi today making the figure of 2 deaths. Total sero confirmed cases are 609"

International News

Early–stage CKD associated with increased risk of atrial fibrillation

Early–stage chronic kidney disease is associated with increased risk (18%) of atrial fibrillation as findings of a study published in the American Heart Journal.

Blood pressure drug to go off the market

Shire PLC said it will pull its blood-pressure drug midodrine hydrochloride off the market by the end of September following warnings from federal regulators who said the drug has not been proven effective.

Clopidogrel tailoring beneficial in acute coronary syndrome

A recent study has found that tailoring clopidogrel loading dose by platelet reactivity monitoring may overcome high on–treatment platelet reactivity (HTPR) in cytochrome (CYP) 2C19* 2 carriers. This intervention may reduce risk of thrombosis after percutaneous coronary intervention (PCI). The study is published online Aug. 11 in the Journal of the American College of Cardiology.

SGLT2 inhibition: a new kidney–based strategy to reduce hyperglycemia

SGLT2 inhibition is a new and emerging type 2 diabetes therapeutic approach with novel mechanism of action that reduces hyperglycemia while preserving insulin secretion, preventing hypoglycemia and controlling body weight. It explores renal glucose reabsorption via selective inhibition of the sodium–glucose transporter–2. (Source: Center for HealthCare Education)


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

Can influenza vaccine be given in patients with egg allergy?

Influenza vaccination now is recommended for all individuals six months of age and older. In addition, the actual ovalbumin content of several brands and lots of the 2009–2010 seasonal and H1N1 influenza vaccines was one or two orders of magnitude lower than the manufacturers’ claimed maximum levels in two independent assessments.1,2 Furthermore, the rate of serious adverse reactions to the vaccine was the same whether or not vaccine skin testing was performed prior to a two-step administration protocol (5 versus 3%, respectively).3 In light of the recent data, the clinical recommendations have changed for the influenza vaccine administration protocols in patients with egg allergy:

  • For the patient who is six months of age or older and has known egg allergy of any severity, except severe anaphylaxis, we suggest administration under observation of a vaccine that contains ≤1 mcg ovalbumin per 0.5 mL as a single dose without prior vaccine skin testing.
  • If a vaccine that contains =1 mcg ovalbumin per 0.5 mL dose is not available, or if the history of anaphylaxis was severe, we suggest administration of the vaccine under observation by a two-step protocol without prior vaccine skin testing.


  • Waibel KH, Gomez R. Ovalbumin content in 2009 to 2010 seasonal and H1N1 monovalent influenza vaccines. J Allergy Clin Immunol 2010;125:749.
  • Li JT, Rank MA, Squillace DL, et al. Ovalbumin content of influenza vaccines. J Allergy Clin Immunol 2010;125:1412.
  • Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg–allergic patients. Pediatrics 2010;125:e1024.

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

Q. Is IVF the last option?

A. IVF is the option, which has highest success rate and is also the most expensive. But, it is not the "end of the road". Many women have conceived naturally or with intrauterine insemination, even after IVF. However, for those with blocked tubes and very poor sperm counts, it is the only option.

Diabetes Update: Prof. Dr Sidhartha Das, Cuttack

What will be the scenario in management of diabetes mellitus in near future?

There are many promising agents, insulin analogs and non–insulin antidiabetic agents in various stages of development which are likely to be available in the management of type 2 diabetic subjects in near future. The incretin analogs, amylin analogs, combined PPAR–Ýand–β agonists, islet neogenesis gene–associated protein (INGAP) and few of the ongoing research products may be available in the coming decades. Polypharmacy with judicious combination of antihyperglycemic agents (intestinal agents, insulin sensitizers, antilipolytic agents, antiobesity agents, fatty acid oxidation inhibitors, glucogenolysis inhibitors, etc.) along with hypoglycemic drugs like β–cell secretagogues and/or insulin will be the mainstay in the management of diabetes mellitus in the future. Management of diabetes mellitus has to give due importance to the postprandial hyperglycemia normal lipid profile and blood pressure.

Besides pharmacotherapy, the approach to management of diabetes mellitus has to be an individualized therapeutic alliance among the patient, his family, the physician and other members of the healthcare team. Diabetes self–management education has to be an integral component of diabetic care. Further, emphasis should be given to prevention and management of complications, where, besides blood pressure and lipid management, focus should be given to cessation of smoking, nephropathy screening, retinopathy screening and foot care. Similarly, special attention should be given to children and adolescents with diabetes, preconception care and diabetes in the geriatric population as the goals and targets are different in these situations.


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

What are the various types of firearms and their medicolegal significance?

A firearm is an assembly of a barrel and an action from which a projectile or projectiles are propelled by products of combustion. Most firearms consist of 3 parts: the chamber, the lead, and the bore. There are 2 types of fire arms: smooth bored and rifled.

  • In shotguns, the inner surface of the bore is smooth from end to end.
  • In the revolver, automatic pistol, and the rifle, the bore is cut longitudinally into a series of spiral grooves and these weapons are therefore termed rifled weapons.

A bullet fired through a rifle, passes through the bore and its surface comes into contact with the projecting spiral lands. In this way a spinning motion is imparted to the bullet, which keeps the projectile relatively stable in its flight. Both types of cartridge contain a charge of propellant powder. A shotgun cartridge is loaded with a smokeless powder consisting of cellulose nitrate either alone or in combination with nitroglycerine. Apart from their difference in chemical composition, smokeless powders also vary in physical characteristics such as the size and shape of the grains. All cartridges have a primer cap which is set into the flat base of the cartridge case which is also known as the head. The head of the cartridge case is frequently used to identify, not only the manufacturer but also the country of origin of a cartridge case and it plays a very important role in a medicolegal case as in the Jessica Lal murder case.

The medical appreciation of the nature of firearm wounds/its surgical intervention/management/certification depends upon knowledge of the structure of firearms and ammunition, and the understanding of the mechanism of the discharge of projectiles.


Medi Finance Update

Q. Are any deductions available for donations?

Ans. Yes, 50% of amount paid is allowed as deduction in general cases to eligible organizations and 100% in cases where it is specifically mentioned.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Faropenem sodium Extended Release Tablet 225/300/450 mg

For the treatment of respiratory tract infections, urinary tract infection, skin and skin structure infections and gynecological infections



Lab Update: Dr Arpan Gandhi and Dr Navin Dang

Iron deficiency anemia

In men and postmenopausal women, anemia is usually caused by gastrointestinal blood loss from certain types of cancer (esophagus, stomach, colon), long–term use of aspirin or nonsteroidal anti–inflammatory medications (NSAIDs), peptic ulcer disease.

Tests to diagnosse iron deficiency anemia diagnosis include:
Serum iron: This test measures the amount of iron in your blood.
Serum ferritin: It is a protein that helps store iron in your body.
Transferrin level
• Total iron–binding capacity (TIBC)
• Reticulocyte count
• Serum transferrin receptor


IJCP Special

Dr Good Dr Bad

Situation: An obese patient with metabolic syndrome wanted a prescription for liposuction.
Dr Bad: Go ahead.
Dr Good: It won’t be beneficial.
Lesson: Liposuction can reduce weight and fat but does not improve insulin sensitivity.

Make Sure

Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.

Quote of the Day

John Keats …"You can win life if you simply avoid two things - Comparing and Expectation."

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.

Minor risk factors

  1. Aeroallergen exposure, particularly pet ownership, is associated with episodes of near fatal asthma in sensitized individuals.
  2. Aspirin–induced asthma is one of the manifestations of aspirin exacerbated respiratory disease. These patients are at increased risk for fatal asthma.
  3. Exercise
  4. Cocaine and heroin usage is a frequent trigger for severe acute asthma exacerbations.
  5. An increased frequency of near fatal asthma episodes at the time of menstruation has been reported.

Mind Teaser (Vivek Kumar)


The answer for yesterday's Mind Teaser : L O V E

Correct answers received from: Dr Chandresh Jardosh, Dr. A. K.Saxena, Dr Muthumperumal Thirumalpillai, Dr. Dinesh Kumar S
Correct answers received for 25th August Puzzle from: Dr Uma
Correct answers received for 24th August Puzzle from: Dr. Ashok Kumar

Send your answer to ijcp12@gmail.com


Humor Section


One GOOD way to REDUCE Alcohol consumption

Before Marriage – Drink whenever you are SAD
After Marriage – Drink whenever you are HAPPY

Funny One Liner
Life Insurance:
A contract that keeps you poor all your life so that you can die Rich.


An Inspirational Story

A German once visited a temple under construction where he saw a sculptor making an idol of God. Suddenly he noticed a similar idol lying nearby. Surprised, he asked the sculptor, "Do you need two statues of the same idol?" "No," said the sculptor without looking up, "We need only one, but the first one got damaged at the last stage." The gentleman examined the idol and found no apparent damage. "Where is the damage?" he asked. "There is a scratch on the nose of the idol." said the sculptor, still busy with his work. "Where are you going to install the idol?"

The sculptor replied that it would be installed on a pillar twenty feet high. "If the idol is that far, who is going to know that there is a scratch on the nose?" the gentleman asked… The sculptor stopped his work, looked up at the gentleman, smiled and said, "I will know it."

The desire to excel is exclusive of the fact whether someone else appreciates it or not. "Excellence" is a drive from inside, not outside.

Excellence is not for someone else to notice but for your own satisfaction and efficiency.


Readers Responses

  1. Dr N P Singh: Molecular techniques based on genomic sequence detection by reverse transcription (RT)-PCR, nested PCR, nucleic acid sequence-based amplification (NASBA), and real-time PCR are assumed to be significant for the rapid diagnosis and identification of dengue virus serotypes and have gradually been accepted as new standards over virus isolation for detection of dengue virus in acute-phase serum samples Among these, the two-step nested RT-PCR approach is routinely practiced in almost all laboratories. But these are only meant for research and not for outbreak situation.

  2. Thanks Sir, for providing all latest updated news and views. Dr K P Singh

  3. Thanks Sir, you have explained the spiritual as well as historical meaning of the value of RAKHI in nutshell beautifully . Dr K P Singh.

Public Forum (Press Release for use by the newspapers)

Do not ignore Sore throat in children

In the ongoing dengue problem in Delhi, many respiratory viral infections are presenting with cough and nasal discharge. These patients do not require any antibiotic, 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.

However, school children with any sore throat should not be ignored and a local family doctor should rule out bacterial sore throat, which if goes undetected, can cause rheumatic involvement of the valves of the heart, a condition called as rheumatic fever.

Such children invariably will have pain in throat while swallowing, red angry–looking tonsils and painful enlargement of lymph nodes at the angle of the mouth. Immediate antibiotics are needed to prevent future involvement of the heart. No cogh and nasal discharge will be present.

Children also should not be given aspirin indiscriminately as it is known to be associated with fatal liver disease, in susceptible children.

The first attack of rheumatic fever is rare after the age of 35.


Conference Calendar

Chest Update 2010

Under the auspices of American College of Chest Physicians, South India Chapter

Date: August 28–29, 2010
Venue : G.R.T. Convention Centre, Chennai, Tamil Nadu.


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

26th 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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