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emedinews is now available online on www.emedinews.in or www.emedinews.org
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

29th March, 2010 Monday

Breaking News: No Link to Femur Fractures Found with Bisphosphonates

Results of a meta–analysis by Dr Dennis Black, of the University of California San Francisco reported online in the New England Journal of Medicine that atypical femoral fractures in patients with osteoporosis are extremely rare and not significantly more common with bisphosphonates. Among more than 14,000 patients involved in three large randomized trials, only 12 fractures of the subtrochanteric or diaphyseal femur were recorded. Data from the Fracture Intervention Trial (FIT) and its five–year extension, which compared alendronate to placebo, were analyzed including the HORIZON Pivotal Fracture Trial, which tested zoledronic acid. However Dr Elizabeth Shane, of Columbia University in New York City, said that drug holidays with careful observation should be considered for  patients with osteoporosis and fracture risk factors who are receiving long–term therapy and are found to have reduced markers of bone turnover.

Dr KK Aggarwal
Chief Editor

News and Views

New form of inhaled insulin may be less risky than Exubera

According to research presented at a chemical society meeting, Afrezza (insulin human {rDNA origin}), a new form of inhaled insulin, appears to help people with diabetes who must use insulin, with fewer potential risks than Exubera (insulin inhaled), an earlier form of inhaled insulin that is no longer on the market.

Afrezza, which is awaiting approval from the US FDA, works faster, keeps blood sugar levels at a closer to normal level, and has less risk of causing hypoglycemia than currently available injectable insulins. It also appears to have less risk of causing lung problems than Exubera.

Meeting Update: Multidisciplinary Head and Neck Cancer Symposium Chandler, AZ • February 25 – 27, 2010

1. PET predicts cancer aggression

Pretreatment PET imaging help predict survival in patients with head and neck squamous cell carcinoma treated with intensity–modulated radiation therapy. Uptake of fluorodeoxy glucose (FDG) tracer in the primary tumor had a significant association with disease–specific survival and a strong trend with overall survival. Nodal uptake of FDG had a significant association with distant disease–free survival. (Dr Min Yao)

2. Elderly can go for aggressive therapy

Older patients benefit as much as younger ones from aggressive chemoradiation for head and neck cancer. Patients ages 70 and older had more toxicity and required more supportive care, but their disease–specific survival, recurrence rate, and patterns of failure did not differ from those of younger patients. (Dr Stephanie A. Michal, Cleveland Clinic)

3. Preserving larynx preserves voice

Larynx preservation led to little difficulty speaking in a majority of five–year survivors of laryngeal and hypopharyngeal cancer with no laryngo–esophageal dysfunction. Among patients treated with induction chemotherapy followed by radiation therapy, 57% had low voice disability and 15% had severe disability. The degree of disability correlated directly with the extent of vocal cord mobility after induction chemotherapy. (Dr Gilles Calais, Hôpital Bretonneau, Tours, France)

4. Lymphedema common in head and neck cancer

Treatment of head and neck cancer causes potentially severe lymphedema, which responds to complete decongestive therapy in most cases. The most severe lymphedema occurred in patients treated with surgery and radiation therapy, followed by definitive surgery alone. Complete decongestive therapy led to clinical improvement in a majority of the patients, including 83% of those treated with surgery alone. (Dr Jan S. Lewin, M.D. Anderson Cancer Center, Houston)

5. Ipsilateral radiation controls tonsil cancer

Patients with newly diagnosed tonsillar cancer can have long–term disease control and minimal risk of contralateral recurrence with ipsilateral radiation therapy. Only two of 102 patients had contralateral failure during a treatment experience dating back to 1970. Ipsilateral radiation therapy resulted in 100% locoregional control at the primary site and ipsilateral neck. (Dr Gregory Chronowski, M.D. Anderson Cancer Center, in Houston)

What’s New

PTU and children: Not to be prescribed as the first line drug in most children or adults. PTU is still preferred to methimazole during the first trimester of pregnancy and in patients with life–threatening thyrotoxicosis or thyroid storm. (Bahn RS, Burch HS, Cooper DS, et al. The role of propylthiouracil in the management of Graves’ disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid 2009;19:673.

Diabetes Fact

Low dose ACE inhibitors are used to check the progression of nephropathy even in presence of normal BP.

Public Forum
(Press Release)

Trans fat not more than 2 grams per day

Trans fats are bad for the heart said Dr K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS. Though small amounts of Trans fat occurs naturally, most trans fat is artificially produced when vegetable oil is partially hydrogenated. Partial hydrogenation results in fats that are easier to cook with and spoil less easily than naturally occurring oils. They make the food tastier and increase its shelf life.

Trans fat promotes heart disease by elevating LDL, or the "bad" cholesterol, in blood. They go further by lowering one’s HDL—the good cholesterol that actually helps prevent heart disease.

Consumption of saturated fats raises the LDL cholesterol concentration, but does not lower HDL. Thus, while saturated fats adversely affect the lipid profile, they may not be as harmful as trans fatty acids. Trans fatty acids may also interfere with the desaturation and elongation of n–3 (omega–3) fatty acids. These are important for the prevention of heart disease and complications of pregnancy. In an analysis from the Nurses’ Health Study, for each increase of 2 percent of energy from trans fat, the relative risk for incident coronary heart disease was 1.93.

There are no known physiologic benefits related to the consumption of trans fatty acids; thus, reduction in their intake makes sense. Trans fatty acids are a major component of many commercial baked goods, such as cookies and cakes, and most deep–fried foods.

As per American Heart Association one should consume no more than 2 grams of trans fat per day, which is about as much as someone would get from naturally occurring trans fat. The US regulation allows trans fat levels of less than 0.5 grams per serving to be labeled as 0 grams per serving. The best diet is characterized by low amounts of both saturated and trans fatty acids.

Question of the day

What is the basic principle of radiosurgery?

Radiosurgery has been around for nearly a century. Only the terminology is new. It was in 1891 that Jacques Arsene d–Arsonval made a fundamental observation that electrical current above 10,000Hz did not produce muscular stimulation but could ablate and cut tissue. Hence all the modern electrosurgery units work above 10,000Hz.

The commonly used Hyfrecator has a frequency of 500KHz or 500,000Hz or 0.5MHz. The modern radiosurgery units are all clones of the radiosurgery unit manufactured by Dr. Erving Ellman in the 1970s, which works with a frequency of 3.8Mhz.

The question of why 3.8MHz was answered in 1978 by Maness who showed that at this frequency there is least lateral heat conduction on cutting the skin. Since MHz frequency is used for FM radio transmission these newer electrosurgery units, which also work in this frequency, are called Radiosurgery units.

Quote of the Day (Dr Mayur Jain)

Whenever you want to know how rich you are?

Never count your currency, just try to drop a Tear & count how many hands reach out to WIPE it. That’s true richness.

SMS of the Day (Dr Ingole, MD)

It is better to light candle rather than to curse darkness.

Fall update (Dr G M Singh)

What is the evidence that reducing falls actually reduces fractures?

Although most fragility fractures result from falls, the clinical trials of falls prevention interventions tend to have been much smaller than pharma–funded trials of anti-osteoporosis drugs. And only 1–5% of falls result in a fracture. However because  highest risk of second fracture is in the first few months – before drug treatments for bone fragility could work so falls prevention is likely to be crucial despite the lack of direct evidence.


eMedinewS Try this it Works

Otitis externa solution

If otitis externa is taking a long time to heal and a whitish, mildew–like substance is seen, local application of 1% clotrimazole solution can help. Apply the solution with a cotton swab twice daily for about 2 weeks.

Dr Good Dr Bad

Situation: A patient with diabetic nephropathy came for diet advice.
Dr Bad: Do not take proteins.
Dr Good: You can take soya proteins.
Lesson: Soy–protein consumption reduces proteinuria in type 2 diabetes with nephropathy. Consumption of soy protein reduced urinary urea nitrogen (–0.9 ± 0.8 vs. 0.2 +/– 0.6 mg/dL, respectively), proteinuria (–78 ± 37 vs. 42 +/– 39 mg/day, respectively), blood sodium (–2 ± 0.04 vs 2.0 ± 0.06 mg/dL, respectively) and serum phosphorus (–0.03 ± 0.2 vs 0.2 ± 0.3 mg/dL, respectively) compared with animal protein. (Ren Nutr 2009 Sep 14). 

Make Sure

Situation: A patient of pulmonary Koch’s talking ATT complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.

Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Patient: Doctor, should I file my nails?

Doctor: No, throw them away like everybody else.

Formulae in Critical Care

Vital capacity (VC)

Formula: VC = TV + IRV + ERV

TV = Tidal volume, IRV = Inspiratory reserve volume, ERV = Expiratory reserve volume.

Milestones in Medicine

1928 A.D.Sir Alexander Fleming discovered the germ–killing power of a mold called penicillium, later isolated as penicillin, the first antibiotic.

Mistakes in Clinical Practice

An error, which is more common than it seems to be. There is no need of IV diazepam after an episode of seizures is over. It only prolongs the post ictal drowsiness if given after seizures. Once the seizure is over the emergency is over unless the patient goes into relapse or is a state of status epilepticus. Hence, after an episode of seizures the patient should be started on anti seizure medicines.

Lab Test (Dr Naveen Dang)

CD4 and CD8 test are done to measure the strength of the immune system usually in patients diagnosed with HIV infection.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Magnesium Valproate Prolonged release tablet 600mg

1) For the treatment of generalized or partial seizures as monotherapy or adjunctive therapy.

2) For prophylaxis of migraine headache in adults.

3) For the treatment of manic episodes associated with bipolar disorders


(Advertorial section)


Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

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

Readers Responses

  1. Dear Dr Aggarwal, First of all I thank you and congratulate you for updating medical knowledge through eMedinews. You have started a wonderful programme and it is becoming popular with high appreciation among the readers. Despite the unanimous decision taken by the Central Council of IMA against BRMS course the MCI has cleared the course. In my opinion if this new proposal materializes, then, in another 5 years, BRHC holders will numerically outnumber the MBBS degree holder by 3:1. Ultimately they will fight for a short course to achieve MBBS degree and even Postgraduate degrees. Dr.Alex Franklin.

  2. Notice: If you know anyone who has met with a fire accident or people who are born with problems / disabilities such as jointed ear, nose and mouth, they can avail free plastic surgery at Pasam Hospital, Kodaikanal from March 23rd to 4th April 2010 by German Doctors, free of cost. Contact Nos. 04542 – 240668, 245732