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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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


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  Editorial …

28th August 2011, Sunday

Metformin reduces A1C levels more than DPP–IV inhibitor monotherapy

Metformin as initial therapy is supported by a meta–analysis of 140 trials and 26 observational studies.

Older drugs (metformin and second generation sulfonylureas) had similar efficacy in reducing A1C values (1%) and other cardiovascular risk factors (blood pressure, lipids, body weight) compared with newer drugs (thiazolidinediones, meglitinides, and GLP–1 receptor agonists).

Ann Intern Med 2011; 154:602.

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Metformin reduces A1C levels more than
DPP–IV inhibitor monotherapy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

"18th Perfect Health Mela 2011"

Addressing a press conference Dr. K K Aggarwal, Padma Shri & Dr. B.C. Roy Awardee, President Heart Care Foundation of India and MTNL Perfect Health Mela. The conference was organised to announce the dates of "18th Perfect Health Mela 2011" from 14th to 23rd October 2011 at NDMC Grounds Laxmi Bai Nagar, New Delhi.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Contraceptives at doorstep in 19 districts

JAIPUR: The Accredited Social Health Activists (ASHA) will make contraceptives available to beneficiaries in 19 districts to boost population control at their doorsteps. Volunteers will make a list of all eligible couples in a village and their preferred type of contraception and will share the data with the sub–centre and the primary health centres. ASHA will collect the contractive consignment and make the stock for every month available from the block primary health centre, community health centre and primary health centre. A senior family welfare department official said the project would start by next month. A source said that ASHA would charge Re 1 for a pack of three condoms, Re 1 for a cycle of the oral contraceptive pill (OCP) and Rs 2 for one–tablet pack of the emergency contraceptive pill (ECP). "Efforts are being made to ensure the contraceptives are readily available in the rural areas," the official said. (Source: TOI, Aug 26, 2011)

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Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

Hospital acquired infections costly, preventable

A program to reduce hospital–acquired infections can save an average of $1.1 million a year, according to results of a new study. In 2002, one in every 20 hospitalized patients developed a healthcare–associated infection (HAI), making HAIs one of the leading causes of death and illness in the U.S., and costing up to $33 billion dollars, according to the Department of Health and Human Services (HHS). The 1.7 million reported HAIs resulted in an estimated 99,000 deaths in that year, wrote Hugh Waters, MS, PhD, of Johns Hopkins Bloomberg School of Public Health, and colleagues in the September/October issue of the American Journal of Medical Quality. (Source: Medpage Today) A program to reduce hospital–acquired infections can save an average of $1.1 million a year, according to results of a new study. In 2002, one in every 20 hospitalized patients developed a healthcare–associated infection (HAI), making HAIs one of the leading causes of death and illness in the U.S., and costing up to $33 billion dollars, according to the Department of Health and Human Services (HHS). The 1.7 million reported HAIs resulted in an estimated 99,000 deaths in that year, wrote Hugh Waters, MS, PhD, of Johns Hopkins Bloomberg School of Public Health, and colleagues in the September/October issue of the American Journal of Medical Quality. (Source: Medpage Today)

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Vessel calcium points to brain disease

Calcification in major blood vessels measured with CT scans is not only a risk factor for heart disease but also for white matter lesions and small infarcts within the brain, Dutch researchers said. In a study of nearly 900 participants in the population–based Rotterdam Study, calcification in coronary arteries, the aortic arch, and the carotid arteries both outside and inside the brain was significantly associated with increased white matter lesion volume and the risk of cerebral infarcts, reported Aad van der Lugt, MD, PhD, of Erasmus Medical Center in Rotterdam, Netherlands, and colleagues. "Compared with ultrasound plaque imaging, quantification of CT calcification provides additional information in regard to the pathophysiology of vascular brain disease," the researchers wrote online in Arteriosclerosis, Thrombosis and Vascular Biology. (Source: Medpage Today)

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All cesareans need VTE prevention, guideline says

All women having a cesarean delivery should get preventive therapy for venous thromboembolism, according to a new guideline from the American College of Obstetricians and Gynecologists. Since the procedure doubles the risk of venous thromboembolism, physicians should place compression devices on all women who aren’t already receiving some form of thromboprophylaxis, Andra James, MD, of Duke University, and colleagues wrote in the guideline, which was published in Obstetrics & Gynecology. (Source: Medpage Today)

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FDA approves icatibant for rare swelling condition

The FDA has approved the injectable drug icatibant (Firazyr) to treat acute hereditary angioedema (HAE) attacks, making it the first such medication available in the U.S. that patients with the rare genetic condition can administer themselves. Patients with HAE suffer periodic, painful attacks of severe swelling in various parts of the body including hands, feet, face, abdomen, and sometimes the throat, which can cause airway restriction. It is caused by a deficiency in the C1 esterase enzyme, which regulates inflammatory and coagulation responses. Defective C1–inhibitor can cause a biochemical imbalance that can produce unwanted peptides, which, in turn, induce the capillaries to release fluids into surrounding tissues, causing the swelling. (Source: Medpage Today)

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    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Nuptials and Breaks can cause weight fluctuation and body changes

Both men and women who divorced or married were more likely than never–married people to have a small weight gain according to a study, which looked at weight gain in the two years following a marriage or divorce among more than 10,000 people in the United States surveyed from 1986 to 2008.

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    Twitter of the Day

@DrKKAggarwal: #IJMD–Implant placement has been a constant challenge in the field of dentistry. Vol. 1, Issue 3, March–April 2011 Dr.K.K.Aggarwal

@DeepakChopra: #PeaceIsTheWay Empowerment of women is the fastest way to a more peaceful just sustainaible and healthy world–Berlin Congress

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Can a person with fracture fly?

  1. Patients with full–leg casts, for safety reasons, may be required to travel by stretcher, purchase an extra seat, or fly business or first class.
  2. Casts applied within 48 hours should be split lengthwise along each side (bivalved) to avoid injury from the expansion of air trapped between the skin and the cast if the limb swells.
  3. Pneumatic splints should be partially deflated to avoid rupture from expanding gas.

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    Spiritual Update

Why Krishna is shown wearing yellow clothes on a blue body?

None of us know the collar size, height, weight, age, waist size etc of Lord Krishna. When any one, irrespective of age, is presented to us with blue skin, yellow clothes and a flute in the hands we equate the person with Lord Krishna.

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    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

The World is a Puzzle

There was a man who had a little boy that he loved very much. Everyday after work the man would come home and play with the little boy. He would always spend all of his extra time playing with the little boy. One night, while the man was at work, he realized that he had extra work to do for the evening, and that he wouldn’t be able to play with his little boy. But, he wanted to be able to give the boy something to keep him busy. So, looking around his office, he saw a magazine with a large map of the world on the cover. He got an idea. He removed the map, and then patiently tore it up into small pieces. Then he put all the pieces in his coat pocket.

When he got home, the little boy came running to him and was ready to play. The man explained that he had extra work to do and couldn’t play just now, but he led the little boy into the dining room, and taking out all the pieces of the map, he spread them on the table. He explained that it was a map of the world, and that by the time he could put it back together, his extra work would be finished, and they could both play. Surely this would keep the child busy for hours, he thought. About half an hour later the boy came to the man and said, "Okay, it’s finished. Can we play now?" The man was surprised, saying, "That’s impossible. Let’s go see." And sure enough, there was the picture of the world, all put together, every piece in its place.

The man said, "That’s amazing! How did you do that?" The boy said, "It was simple. On the back of the page was a picture of a man. When I put the man together the whole world fell into place."

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    Gastro Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

Can celiac disease present with abnormal liver function tests?

Yes, celiac disease can present with abnormal liver enzymes; therefore, screening of celiac disease in patients with raised liver enzymes, especially if there is associated anemia, is a must.

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  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


This test is used to evaluate thromboembolic disorders, including ligneous conjunctivitis (a type of mucous membrane abnormality).

This test is normally prescribed when searching for the following diseases:

  • Disorder involving the fibrinolytic system
  • Ligneous conjunctivitis

High levels of plasminogen can be seen in:

  • Pregnancy (peak of 165% of normal in third trimester)
  • Increased triglyceride and/or cholesterol levels

Low levels of plasminogen can be seen in:

  • Liver disease
  • Consumptive coagulopathies
  • Fibrinolytic therapy
  • DIC
  • Advanced age

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    IJCP Special

Dr Good Dr Bad

Situation: A patient at risk for stroke came for diet consult.
Dr Bad: Take normal diet.
Dr Good: Take high potassium diet.
Lesson: Individuals who eat a diet rich in potassium appear to have a lower risk for stroke than people with minimal potassium intake. (Journal Stroke)

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Make Sure

Situation: A patient with fever and cough developed complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

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  Quote of the Day

(Dr GM Singh)

The cruelest lies are often told in silence. Adlai Stevenson


(Ms Ritu Sinha)

Ethnic Cleansing: Killing of a certain ethnic or religious group on a massive scale.

    G P Pearls

(Dr Pawan Gupta)

Moxicillin 5 days every 8 weeks reduced attacks of COPD.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Medical literature must exist in the public domain to serve as legitimate evidence in court

  • To constitute valid medical testimony, the witness must be identified
  • For a document to serve as legitimate evidence in a trial it must exist in the public domain and the degree to which a medical document/literature/book validates the point you are making depends upon the reliability of the document. The author of a document is a witness and you are calling upon to testify.
  • Conventions for citing sources are somewhat dynamic. However, at a minimum you should identify the individual, institution, or publication that authored the document and the publication date.
  • When it is not otherwise evident, you ought to make quick reference to the qualifications of the author to lend an air of credibility to the document. Although it is not necessary to read additional information into the records, you must be prepared to provide a complete bibliographic citation if called upon to do so by the court of law or cross lawyer.

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    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

Women lose knee cartilage faster than men do

MRIs show women lose three to four times more knee cartilage annually.

Women have higher risk for osteoarthritis than men do; moreover, women who have knee osteoarthritis sustain greater cartilage loss than do men with knee osteoarthritis. To determine whether differences in cartilage health distinguish men and women with no clinical evidence of knee osteoarthritis, researchers in Australia compared magnetic resonance imaging (MRI) results in 169 women and 102 men (all white).

All participants underwent MRI at baseline and at a mean of 2.3 years later to measure knee cartilage volume and to detect defects at tibiofemoral and patellar sites. Men were substantially older than women (mean age, 60 vs. 57). However, in analysis adjusted for age, height, weight, and baseline total bone area, women lost four times more tibial (1.6% vs. 0.4%; P=0.05) and three times more patellar cartilage (2.3% vs. 0.8%; P=0.02) annually than did men. Women also had substantially higher risk for progression of cartilage defects in the tibial area (odds ratio, 3.0) but not in the patellar area.

(Source: Published in Journal Watch Women’s Health September 3, 2009)

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    Mind Teaser

Read this…………………

The most sensitive imaging modality for diagnosing ureteric stones in a patient with acute colic is:

1. X–ray KUB region
2. Ultrasonogram
3. Non–contrasts CT scan of the abdomen.
4. Contrast–enhanced CT scan of the abdomen

Yesterday’s Mind Teaser: Which one of the following is the common cause of congenital Hydrocephalus is?

1. Craniosynostosis
2. Intra uterine meningitis
3. Aqueductal stenosis
4. Malformations of great vein of Galen

Answer for Yesterday’s Mind Teaser: 3. Aqueductal stenosis

Correct answers received from: Dr Sukanta Sen, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Pramod Deshpande Buldana, Dr Anil Bairaria, Dr Jainendra Upadhyay, Dr yJ Vasavada, Dr Lalit Tanwar, Dr Mohit Joshi, Dr Sukanta sen, Dr Pallipalayam Sivaramakrishanan Ragavan.

Answer for 26th August Mind Teaser: 4. CEA
Correct answers received from: Dr Anupama, Dr Shreya, Dr Pramajot, Dr Nishant, Dr Piyush, Dr K Raju.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. Prabha Sanghi)

Every time I hear the dirty word ‘exercise’, I wash my mouth out with chocolate.

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
S (+) Etodolac 300mg + Thiocolchicoside 8mg Tablet
For the treatment of patients with acute painful musculoskeletal conditions
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Do not ignore 2nd attack of dengue

If you have suffered from dengue in the past be more careful as the second attack of dengue may be more dangerous than the first attack, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

There are four different strains of dengue and one can, suffer with dengue four times during lifetime. Subsequent dengue infections are more likely to end up with deadly complications.

A person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to a dangerous level leading to complications.

In a dengue season nobody should take aspirin for fever as it can precipitate bleeding, he added.

In dengue most complications occur within two days of subsiding of fever and most people are careless during this period. Any abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to shift of blood volume and patient requires rapid infusion of oral or intravenous fluids in large quantity.

There is no need for giving platelets unless the counts have fallen lower than 2% of original platelet counts.

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    Readers Responses
  1. Dear Sir, Your editorial “Was Lord Ganesha born of a stem cell transplant?” was very informative. Regards: Dr Prachi
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta