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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

  Editorial ...

28th October 2010, Thursday

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

Alternative drug option for cholera treatment

In a randomized double-blind trial, single dose azithromycin treatment of cholera resulted in better clinical and bacteriological results than six doses of ciprofloxacin. The study results were presented by Wasif Khan, MBBS, of the International Centre for Diarrhoeal Diseases Research in Dhaka, Bangladesh at the annual meeting of the Infectious Diseases Society of America (IDSA). He said that single-dose azithromycin is now the standard of care at the center, which treats around 30,000 cholera cases annually. The objective of the study was to find an alternative for ciprofloxacin, which in recent years had shown declining efficacy, though frank resistance was rare. A single dose of ciprofloxacin had clinical and bacteriological success rates of 93% and 97%, respectively in 1993-1994. The respective rates were 27% and 10% in 2003-2004. The center compensated by administering multiple doses of the drug, which brought the rates back up to 67% and 60%. The study included 246 men with cholera, who were randomly assigned to receive either a single dose of azithromycin 1 gm or six doses of ciprofloxacin twice-daily for three days. The first two doses were one gram each and the last four were 500 mg each. The salient observations of the study were as follows:

  • Clinical success (no watery stool within 48 hours of starting the drug): Azithromycin 63% vs ciprofloxacin 44%; the difference was significant at p=0.005.
  • Bacteriological success (no cholera bacteria in the stool after 48 hours of starting the drug): Azithromycin 68% vs ciprofloxacin 45%; the difference was significant at p<0.001.
  • Patients on azithromycin had significantly fewer stools and lower stool volume, at P=0.004 and P<0.001, respectively.

The minimum inhibitory concentration (MIC) needed to block 90% of the bacteria was 0.404 micrograms per milliliter for ciprofloxacin, some 135 times greater than the amount needed when the drug was first tested against cholera.

Dr KK Aggarwal
Editor in Chief
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  Chikungunya Update

(RP Vashist, Consultant and Head Public Health, Govt. of Delhi)

Management of Chikungunya

Supportive Treatment

  • Rest and mild movements of joints
  • Cold compresses for inflamed joints
  • Liberal fluid intake or IV fluids

Drug Treatment

  • Chloroquine is gaining ground as a possible treatment for the symptoms associated with Chikungunya and as an antiviral agent to combat the Chikungunya virus.
  • According to the University of Malaya, in unresolved arthritis refractory to aspirin and nonsteroidal anti-inflammatory drugs, chloroquine phosphate (250 mg/day) has given promising results.
  • Research by Italian scientist, Andrea Savarino, and his colleagues, and a French government press release in March 2006 have added more credence to the claim that chloroquine may be effective in treating Chikungunya.
  • Researches on treatment of the infection advise against usage of aspirin.
  • Ibuprofen, naproxen and other NSAIDs are recommended for arthritic pain and fever.


  • Antibiotics.
  • Long-acting steroids.
  • Short-term steroids during the acute phase of illness.
  Photo Feature (from the HCFI Photo Gallery)

 17th Perfect Health Mela 2010 - Eco fest

More than 2000 children from different schools of Delhi participated in “Eco-fest”, international Eco Clubs Festival.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Artemisinin resistance and P. falciparum

Results of malaria blood smears performed three days after treatment initiation may be used as a screening tool for artemisinin resistance. Artemisinin resistance is highly unlikely if the proportion of patients with parasite density <100,000 parasites/microL following a three-day course of therapy with an artemisinin combination regimen is <3 %.

(Ref: Stepniewska K, et al. In vivo parasitological measures of artemisinin susceptibility. J Infect Dis 2010;201:570).

  National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email:emedinews@gmail.com

Chikungunya count low as most cases go undetected

After dengue, chikungunya is creating a scare among Delhiites and health agencies. MCD has reported 33 cases so far but its officials admit that cases are under-reported due to lack of availability of specialised kits to confirm the disease. Both private and government hospitals are getting a large number of patients with acute to chronic joint pain. Patients are reporting to hospitals after high-grade fever. "It (chikungunya) is a poor cousin of dengue. It mimics dengue symptoms like fever, rashes, drop in platelets, etc, but the distinguishing symptom is acute joint pain," said Dr Sanjeev Bagai, CEO, Batra Hospital. (Source: The Times of India)

National AIDS meet to focus on motivating doctors

Around 50 city doctors will attend the third national conference of the AIDS Society of India (ASI) in Hyderabad from Friday. The three-day event, which will see participation from doctors and researchers across India, will focus on newer approaches in HIV and discuss comprehensive ways of managing HIV. The focus of this year’s conference is also providing motivation and increasing the tally of doctors who have been working full-time towards treating AIDS patients. ccording to ASI data, India has around 22.7 lakh people who have either AIDS or HIV and only around 100 doctors engaged full-time in their treatment. “It has been 25 years since the awareness on AIDS began in India. By organising a conference in Andhra Pradesh, one of the worst HIV affected states in India, we are looking at providing more information to the people to increase HIV care,” said Dr IS Gilada, secretary general, ASI. The conference will also look at cheaper medicines that are now available in India for HIV patients, he added. (Source: The Hindustan Times)

DNB degree-holders can now teach medicine

Doctors with a Diplomate of the National Board of Medical Examinations (DNB) degree can now teach in medical colleges. In a major decision, the Union health ministry has approved the Medical Council of India's (MCI) proposal to allow doctors, who have a DNB degree, to teach just like those with a MD/MS degree. The move will help the nation to 3,000 new medical teachers who obtain a DNB degree in 54 subjects. Till date, DNB was never recognized on a par with other PG medical degrees like MD/MS. The latest rule will allow those DNB degree-holders, who have been teaching for several years to be automatically recognized as faculty members. Those doctors who pass out with a DNB degree from a medical college will get the same status. However, DNB degree-holders who have passed out from private or non- MCI recognized medical colleges will have to have experience of an additional year of senior residency in a teaching medical institution to be on a par with a qualified MD/MS candidate. (Source: The Times of India)

  International News

(Dr Monica and Brahm Vasudev)

Scientific statement urges close monitoring and management in patients on QT-prolonging drugs

Hospitalized patients taking QT-prolonging drugs may be at risk for drug-induced long-QT syndrome (LQTS) and should be closely monitored by electrocardiogram (ECG) for the incidence of the serious arrhythmia known as torsade de pointes (TdP), according to a scientific statement from the American Heart Association and the American College of Cardiology Foundation published online Feb. 8 in Circulation.

Fatty acid to enhance anticancer drug

Scientists of the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) have discovered that bioavailability and efficacy of the blood cancer drug azacytidine increase when the substance is coupled to a fatty acid.

Spouses who care for partners with dementia at 6-fold higher risk of same fate

Husbands or wives who care for spouses with dementia are six times more likely to develop the memory-impairing condition than those whose spouses don't have it, according to results of a 12-year study led by Johns Hopkins, Utah State University, and Duke University. The increased risk that the researchers saw among caregivers was on par with the power of a gene variant known to increase susceptibility to Alzheimer's disease. The study is reported in the Journal of the American Geriatrics Society.

Non-cardiac surgery too soon after stenting raises risk of heart problems

Scottish researchers report in the journal Circulation: Cardiovascular Interventions that patients who can postpone non-cardiac surgery for at least six weeks after receiving a coronary stent are less likely to suffer reduced blood flow to the heart, heart attack and death than those who have surgery sooner.

  Gastro Update

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

What is the clinical presentation of ulcerative colitis?

Bloody, mucous diarrhea is the hallmark of UC. It can be initially intermittent, resolving spontaneously.

  •  Mild disease: < 4 stools/day with passage of blood less than daily and no systemic symptoms.
  • Moderate to severe colitis: > 5 loose stools with blood / day often with nocturnal stools and urgency. Tenesmus is extremely common. Pain of colitis is predefecation, cramp like, suprapubic that is relieved by defecation.
  • Severe colitis: > 12 bloody stools/ day, with abdominal distention and tenderness with tachycardia and fever. It causes toxic megacolon.
  Infertility Update

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

What are the symptoms and complications of pelvic inflammatory disease (PID)?  

Symptoms of PID

The infection may be subclinical (occurring without any symptoms), or there may be fever, chills, or pelvic pain indicating inflammation of the entire pelvic area.

Complications of PID

  • Severe or frequent attacks of PID can eventually cause scarring, abscess formation, and tubal damage that result in infertility. About 20% of women who develop symptomatic PID become infertile. The severity of the infection, not the number of the infections, appears to pose the greater risk for infertility.
  • PID also significantly increases the risk of ectopic pregnancy (fertilization in the fallopian tubes). A small US study suggests, however, that even mild Chlamydia infection that occurs in the upper genital tract may cause a higher proportion of ectopic pregnancies than previously thought.
  Neuro Update : Question of the Day

What are the indications for Lumbar Puncture, EEG and Neuroimaging in the child presenting with a first simple febrile seizure?

The American Academy of Pediatrics (AAP) practice parameters for the neurodiagnostic evaluation of the child with a first simple febrile seizure states

Lumbar puncture

• Strongly recommended in infants <12 months as clinical signs and symptoms of meningitis may be absent or minimal at this age.
• Strongly recommended in infants and children with febrile seizures who have had prior antibiotic treatment since it can mask signs and symptoms of meningitis.
• Should be considered between 12 months and 18 months because clinical signs and symptoms of meningitis may be subtle.
• An early L.P. is recommended in presence of meningeal signs and symptoms or suspected intracranial infection
• Beyond 18 months: Not routinely recommended.
•  Not recommended for treatment of recurrent attacks of febrile seizures

There is no need to perform neuroimaging prior to LP.
EEG and Neuroimaging: Not routinely indicated in evaluation of first simple febrile seizure.

  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

For what duration should a medicolegal record be kept by the doctor/hospital?

Whenever a medicolegal case is hospitalized or discharged, the same should be intimated to the police and necessary entries should be made in the medicolegal report/record or register. The records should be kept under lock and key, in the custody of the doctor concerned or may be kept in any designated Record Room, in hospitals where such facility is available. Most hospitals have a policy of maintaining all medicolegal records for variable periods of time. However, as per law, there is no specified time limit after which the MLRs can be destroyed. They should be preserved for any further required legal references/Court of Law. Hence, all the medicolegal record should be preserved for a period of at least 15 years and should be destroyed only after scrutiny by an appropriate committee. Now a days, films/microfilms and computers are also used for safe record keeping with computerized signature and authentication.

  Medi Finance Update

Indirect Tax


  • Additional banking licenses to private sector players may be granted
  • Non Banking Financial Companies could also be considered, if they meet the RBI-seligibility criteria.
  Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Fixed dose combination of Histamine H-2 receptor antagonists with antacids except for those combinations approved by Drugs Controller, India

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

MRSA Screening

Methicillin-resistant Staphylococcus aureus screening.
Sample required: nose swab; occasionally swab of wound infection site or skin lesion.

emedinews 3D echocardography
  IJCP Special

Dr Good Dr Bad

Situation: A patient came with right heart failure.
Dr Bad: Continue with your normal fluid intake.
Dr Good: Restrict your fluid intake
Lesson: In right heart failure, fluids should be restricted.

Make Sure

Situation: A patient missed her last dose of hepatitis B vaccine as she was out of station at 6th month
Reaction: Oh my God! Why was the vaccine not given between 4-6 months?
Lesson: Make sure that all patients are given the complete vaccine regimen. The correct regimen is 0, 1-2 months and 4- months.

Quote of the Day (Dr Chandresh Jardosh)
'It is most true, stylus virum arguit, - our style betrays us.' Robert Burton

Mind Teaser

Read this…………………

dinner dinner

Answer for yesterday’s Mind Teaser: "Correct answer is A. "
The patient's true sodium is likely to be even higher than 150. She is hypernatremic due to increased insensible losses of water from fever and increased work of breathing (thus increasing the relative concentration of sodium and causing hypernatremia). As she has multiple myeloma, she has increased plasma paraprotein. This can lead to pseudohyponatremia as explained here. Sodium is dissolved only in the water portion of the serum. In the setting of hyperparaproteinemia, protein occupies more space in a given volume of serum, resulting in a decrease in the percentage of water (with its sodium content). Thus, an artificially low serum sodium concentration is obtained, even though the concentration of sodium present in the water phase may be unaltered. If we measure this patient's serum osmolality, she will have an increased osmolar gap.

Correct answers received from: Dr Anupam, Dr Prachi

Answer for 26th October Mind Teaser is: "Keep in shape"
Correct answers received from: Dr. G. Padmanabhan, Dr. Gitanjali Arora, Dr.K.Raju

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

Having a Bad Day?

Well, then, consider this..............

In a hospital's Intensive Care Unit, patients always died in the same bed, on Sunday morning, at about 11:00 a.m., regardless of their medical condition. This puzzled the doctors and some even thought it had something to do with the supernatural. No one could solve the mystery as to why the deaths occurred around 11:00 a.m. on Sunday, so a worldwide team of experts was assembled to investigate the cause of the incidents. The next Sunday morning, a few minutes before 11:00 a.m., all of the doctors and nurses nervously waited outside the ward to see for themselves what the terrible phenomenon was all about. Some were holding wooden crossses, prayer books, and other holy objects to ward off the evil spirits. Just when the clock struck 11:00, P Johnson, the part-time Sunday sweeper, entered the ward and unplugged the life support system so he could use the vacuum cleaner

  An Inspirational Story

(Contributed by Dolly Aggarwal)

10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren't caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free yourself from the many problems each one will be causing you.

Avoid stereotyping or labeling people or situations

The words you use can trip you up. Negative and critical language produces the same flavor of thinking. Forcing things into pre-set categories hides their real meaning and limits your thinking to no purpose. See what's there. Don't label.

  Readers Responses
  1. Dear Sir, Thanks a lot for providing updates on Chikungunya. Regards Dr Prachi
  Public Forum

(Press Release for use by the newspapers)

Over 2700 children participated in Eco Fest at MTNL Perfect Health Mela

The attraction of the 5th day of MTNL Perfect Health Mela being held at NDMC Grounds, Laxmi Bai Nagar, New Delhi, was participation by over 2700 children from 48 schools. The Eco Club students participated in competitions like paper bag making, cartoon drawing, yoga, aerobics and making the best use of e-waste.

A seminar was organized on Sudden Cardiac Death. Padma Shri and Dr bc Roy National Awardee Dr. KK Aggarwal, Dr. S.P. Manchanda, Dr. H.K. Chopra, Dr. S.K. Aggarwal and Ms Nalini and Ms Kamalini, the Kathak danseuses participated in the discussion.  The panelists said that to revive the patient after death, mouth to mouth resuscitation is not necessary only chest compressions are necessary.

Another seminar was organized on Science behind Rituals and Festivals which was attended by Dr. KK Aggarwal, Dr. Anupama Sethi Malhotra, Dr. Tripathi and Dr. Yadav. The panelists said that every ritual in mythology is based on how to keep mind, physical body and soul healthy.

Inter Dance School odissi competition was also held in which over 22 schools participated.

Punjabi Academy presented a Cultural Show along with Bhangra Dance during the ongoin MTNL Perfect Health Mela.

Over 3000 school children got their checkups done

NDMC, School Health Scheme of DHS and Heart Care Foundation of India jointly examined over 3000 children. Obesity was found to be a serious concern in the urban school population.

Over 5000 health checkups done

Over 5000 people participated in health checkups. 50% of them were found to have high blood pressure which they were not aware of Over 300 patients were found to have high blood sugar without their earlier knowledge.

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
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
17th MTNL Perfect Health Mela 2010 day programme
Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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