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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

28th April, 2010 Wednesday

Padma Awards cannot be titled

As an organizer, whenever you invite any Padma Awardee as a Guest of Honour or Chief Guest for a function, certain constitutional requirements must be kept in mind. The guests cannot be named as ‘Padma Shri XYZ’ or ‘XYZ Padma Shri’. For example, one cannot write on the card ‘Dr Ashok Seth Padmashri’ or 'Padmashri Dr Ashok Seth’.

The Constitutional validity of Padma Awards was challenged in two public writ petitions on the ground that the awards are not titled within the meaning of Article 18(1) of the Constitution of India and they are unconstitutional.

While upholding the Constitutional validity of the awards, the Supreme Court of India in its judgment dt. December 15, 1995 in transferred case (civil) no. 9 of 1994 with transferred case (civil) no. 1 of 1995 directed that the awards should not be used as suffix or prefix to an individual’s name.

The Supreme Court of India observed – "The national awards do not amount to titles ‘within the meaning of Article 18(1) of the Constitution’ and they should not be used as suffix or prefix.........".

However, Ministry of Home Affairs has clarified further and has allowed the award winner to use the following formulations for letterheads etc.: (with examples)

‘Padma Bhushan Awardee Dr Naresh Trehan’ or ‘Dr Naresh Trehan Padma Bhushan Awardee’ or ‘Dr Naresh Trehan Awarded Padma Bhushan by the President’.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo Feature

Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal being felicitated at the IMANDB Annual Day Meet at Moolchand Medcity, New Delhi on April 25, 2010 by past presidents of IMANDB Dr K B Sharma and Dr Urmil Sharma. Also in the picture: Dr Sanjay Sood (President IMANDB).  

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

FDA approves kidney cancer drug for transplant use

The FDA has approved everolimus to help prevent organ rejection in adult kidney transplant patients. The transplant drug works as part of a combination therapy with cyclosporine, basiliximab, and corticosteroids.

News and Views (Dr Brahma and Dr Monica Vasudeva)

Higher–flow bloodlines may lower dialysate dosage and overall arterial pressure

According to research presented at a clinical meeting of the National Kidney Foundation, dialysis bloodlines designed to deliver higher blood flow result in a lower dialysate dose than standard tubing.

Liraglutide better than sitagliptin for glucose control

According to a study published April 24 in The Lancet, liraglutide (Victoza) is better than sitagliptin (Januvia) for glucose control. Liraglutide, a glucagon–like peptide–1 (GLP–1) agonist, reduced glycosylated hemoglobin by an absolute 0.60% more at the 1.8 mg dose and 0.34% more at 1.2 mg than the dipeptidyl peptidase–4 (DPP–4) inhibitor sitagliptin (both p<0.0001) in a study of 665 adult patients with type 2 diabetes inadequately controlled on metformin who were randomized to once daily injections of liraglutide at 1.2 mg or 1.8 mg or oral sitagliptin once daily (100 mg).

XMRV’s threat potential to nation’s blood supply

A virus that may be transmitted in the same way as HIV, and has been linked to prostate cancer and chronic fatigue syndrome. It’s not yet clear how dangerous XMRV, or xenotropic murine leukemia virus–related virus, is, but a NIH–funded group, which includes scientists from the FDA and CDC, is working to find out just how prevalent it is and hopes to develop effective tests.

HIV patients to start antiviral medicines right after diagnosis

In a major shift of HIV treatment policy, San Francisco public health doctors have begun to advise patients to start taking antiviral medicines as soon as they are found to be infected, rather than waiting...for signs that their immune systems have started to fail. Patients who start early are more likely to live longer, and less likely to suffer a variety of ailments –– including heart disease, kidney failure, and cancer –– that plague long–term survivors.

Mnemonic of the Day (Dr Prachi Garg)

Gynecomastia (drugs) DISCO MTV









What’s New

Hib vaccine

The Centers for Disease Control and Prevention (CDC) has recommended Hib immunization (with any available Hib vaccine) at the earliest opportunity for children aged 12 months through 4 years whose Hib booster was deferred because of vaccine shortage. Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommendations for use of Hib vaccine. (MMWR Morb Mortal Wkly Rep 2009;58:1008.)

Quote of the Day

"A non–doer is very often a critic–that is, someone who sits back and watches doers, and then waxes philosophically about how the doers are doing. It’s easy to be a critic, but being a doer requires effort, risk, and change." Dr. Wayne W. Dyer

Diabetes Fact

Malignant term without cancer are Malignant HT, Malignant hyperthermia, Malignant rheumatoid with skin involvement.

DMA Update: 9th May is Mother's Day

Urinary incontinence in women is a neglected problem, but doctors can play a crucial role in treatment

Question of the Day

What is the ideal treatment for otitis media?

  • The management consists of a course of antibiotics (coamoxyclav as first–line or cefaclor/cefixime as second–line of treatment) for 5 to 10 days in acute otitis media.

  • In case of recurrent attacks, the addition of antihitaminics and nasal decongestants is mandatory to open up refractory eustachian tube.

  • In serous otitis media or glue ear, a course of oral steroids and/or intranasal corticosteroids is given for a period of 3 weeks. Failure of treatment would require a grommet insertion.

  • Tympanostomy tubes or grommets are ventilation tubes which not only drain the middle ear fluid but also ventilate the middle ear mastoids and open up the Eustachian tube.These tubes are self extrudable, as they are gradually pushed to the periphery (around 6–9 months) and thrown out with wax; thus not causing a perforation later.

Role of Healthcare Professionals: Tobacco (Dr G M Singh)

At national level

Do's and Don’ts

  1. Do educate media and policy makers on health and environment hazards.

  2. Do carry out translation research on tobacco use, particularly chewing tobacco which is under researched and our major problem.

  3. Do collect data on morbidities.

  4. Do create a "tobacco control cell" in your national professional organization.

  5. Don’t invest in tobacco stock, divest your portfolio if done earlier.

  6. Don’t let your association or other professional associations invest in tobacco stocks.

  7. Don’t accept sponsorship for research, conference, or travel from tobacco companies.

Public Forum (Press Release for use by the newspapers)

MP3 Noise pollution: Safety guidelines for "leisure–time" noise exposure

Too much noise not only pollutes the environment, it can permanently damage your hearing, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Rule of thumb: MP3 users should set the volume no higher than 60 percent of its full capacity when using "ear buds" style headphones, like those that come with iPods. With over–the–ear headphones, one can use 70 percent as the maximum as per a report in the Journal of Pediatrics.

Playing an MP3 player at full blast could harm the hearing. Parents should look for signs of a problem, like when a child complains of ringing in the ears or sounds being muffled.

Prolonged exposure to sounds louder than 85 decibels (dB) can cause gradual hearing loss. A normal conversation is about 60 dB. Many personal stereo systems at maximum level are over 100 dB. Rock concerts and firecrackers can be 140 dB and higher. Noise levels need to reach 120 dB to 140 dB to become uncomfortable or painful.

Manufacturers, should equip MP3 players with an indicator that displays the volume level in terms of decibels, along with a signal –– such as a flashing light –– that goes off when decibel levels reach the danger zone.

Noise–induced hearing loss usually happens slowly, with no pain. Right after exposure to noise, you may notice some "ringing" in your ears. You might have trouble hearing people talk. After several hours or even a few days, these symptoms may go away. However, when you are exposed to loud noise repeatedly, you could have hearing loss that lasts forever.

The louder the sound, the shorter the time period before noise induced hearing loss can occur. Sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss. A good rule of thumb is to avoid noises that are "too loud" and "too close? or that last "too long."

For average factory noise, 85 dB, it takes only 8 hours for noise–induced hearing loss (NIHL). Other excess levels include: passing motorcycle, 90 dB–8 hours exposure for NIHL, subway train or diesel truck, 100 dB–2 hours exposure , helicopter and power mower 105 dB 1 hour, and, ranking with auto horn, propeller aircraft, and air raid siren, live rock music 90–130 dB 20 minutes.

Listening to music/muzak at 110 to 120 decibels damages hearing in less than an hour and a half.

iPOD guidelines

  1. A typical person can safely listen to an iPod for 4.6 hours per day at 70 percent volume using stock earphones.

  2. Listening to music at full volume through an iPod for more than five minutes a day using stock earphones can increase the risk of hearing loss in a typical person.

  3. Individuals can safely listen to iPods for 90 minutes a day with the supplied earphones if the volume is at 80 percent of maximum levels without greatly increasing the risk of hearing loss.

  4. The safest limit is 2 hours a day at 50% of the volume.


eMedinewS Try this it Works

Swabs can affect endocervical sampling

When obtaining an endocervical sample for gonorrhea culture, the specimen should be obtained by use of a swab that has a wire shaft and either a calcium alginate or synthetic fiber tip. Swabs with wooden shafts or cotton tips may be toxic to
N. gonorrhoeae.

Dr Good Dr Bad

Situation: A patient with microalbuminuria came to a cardiologist.

Dr Bad: You have no heart problem.

Dr Good: Get your stress test done.

Lesson: Reduced eGFR and microalbuminuria double the prevalence of cardio vascular disease, independently of traditional cardiac risk factors and glycemic control in patients with type 2 diabetes. (Diabet Med 2008;25(12):1426–32.)

Make Sure

Situation: In a hospital setting, gentamycin resistance was becoming a problem.

Reaction: Oh my God, you should have done an antibiotic switch.

Make sure: Antibiotic switch policy is adapted in such settings where selected antibiotics are withdrawn for six months and switched to similar but antibiotics with different mechanisms of resistance. (Pharmacotherapy 2004;24:224S)


Laughter the best medicine

IMANDB Joke of the Day

The man goes home and sees his wife preparing dinner. He stands fifteen feet behind her and says, "What’s for dinner, honey?" He gets no response, so he moves to ten feet behind her and asks again. Still no response, so he moves to five feet. still no answer. Finally he stands directly behind her and says, "Honey, are you deaf. what’s for dinner?" She replies, "For the fourth time, I SAID CHICKEN!"

Formulae in Critical Care

Calcium and Phosphate

Formula: Keep Ca × P product <60.

Milestones in Diabetes

Bernardo Alberto Houssay (1887–1971) was an Argentine physiologist. Along with Carl and Gerty Cori he was awarded Nobel Prize for Physiology or Medicine in 1947 for his discovery of the role played by pituitary hormones in regulating the amount of blood sugar (glucose) in animals.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Calcium: when to order the test

As part of a routine metabolic, electrolyte panel, in persons with kidney, bone, or nerve disease, or when symptoms of significantly increased or decreased calcium concentrations are present.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Artesunate (25/50/100mg) + Amodiaquine (67.5 mg/135/270mg) bilayered Tablets

For the treatment of uncomplicated malaria due to Plasmodium falciparum strain in various age groups


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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.

IMSA Delhi – Workshop on Mind Body Medicine

A workshop on Mind Body Medicine is being organized to mark the birthday of Late Acharya Sushil Ji Maharaj

Date: June 13, 2010

Venue: Acharya Sushil Muni Ashram, C – 599 Defence Colony, New Delhi

Organizer: IMSA Delhi in Association with World Fellowship of Religions, IMA NDB and Heart Care Foundation of India

All Doctors and Nurses can attend. There is no fee.

Speakers: Dr K K Aggarwal

Blessings: Acharya Dr Sadhna Ji Maharaj

Timings: 8–12 noon

Workshop contents: Practical mind body prescriptions for doctors

Register: SMS 9811090206 or email emedinews@gmail.com

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Readers Responses

  1. WORLD LAUGHTER DAY 2010: 2nd May, Sunday: LAUGH DELHI LAUGH: On this auspicious day, I appeal to every one to laugh wherever you are, on your own or in a group, between 7–9 am, even for couple of minutes. We can link the world with laughter: Dr Santosh Sahi, Laughter Yoga Leader & Teacher.

  2. Dear Dr. Aggarwal: Our day at Om Shanti Retreat Centre was extremely rejuvenating. Your organizational capabilities are par excellence. If you can just mail the one word prescription for each day. We listened with rapt attention but did not make the notes. The best Honor to you shall be that I shall share the 7-day prescription in the industry, during my lectures, with Quote and Unquote Dr. KKA: B B Gupta

  3. Dear Dr Aggarwal, eMedinews has emerged as an important communication forum under your dynamic leadership. I foresee many important functions that can gradually be considered for riding piggyback on this initiative. Support groups for patients and caregivers with various disorders are few and ill–equipped. Families struggle in isolation and patients veer towards depression. Perhaps the virtual space for eSupport Groups can be provided by this newsletter. Regards and good wishes: Anuj Sinha, Director, Vigyan Prasar, NOIDA