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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

29th May, 2010, Saturday

PPIs may cause bone fractures when used for more than one year or at higher doses: FDA

Dear Colleague

High doses or long–term use of PPIs or proton pump inhibitors can lead to an increased risk of bone fractures. This holds especially true for those over the age of 50, and for people on the high dose. The latest warning is based on a FDA review of several studies of the treatment. These epidemiologic studies revealed an elevated fracture risk at the hip, wrist, and spine. But the studies do not, definitively prove that PPIs are the cause of the fractures.

FDA has instructed the manufacturers of the drugs to change the labels for both the prescription and the over–the–counter versions of the proton pump inhibitors. The FDA said they should only be taken for 14 days to help ease frequent heartburn, and under no circumstances should over–the–counter PPIs be taken for more than three 14–day periods in a year.

Most researchers believe that more fractures are due to decreased calcium absorption from the diet because of the reduced stomach acid. But, it’s also possible that these drugs interfere with bone maintenance. Notably, PPIs have previously been linked to an increased risk of contracting pneumonia and the troublesome bacterium Clostridium difficile, as well as to an increased risk of dementia.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file): Health Modules

Involving Politicians to Promote Holistic Health

"Hit the iron when it is hot" and "involve the people who counts" are two basic health awareness modules. Politicians are public figure and have their own followings. Heart Care Foundation of India has been on a regular basis inviting politicians to the press conferences to address health issues. In one such press conference Dr A K Walia Finance Minister was invited. In the picture the technique oif Saline Nasal Wash is being demonstrated. 

Dr k k Aggarwal
Dr. A. K Walia, Finance Minister observing Dr. K. K. Aggarwal demonstrating Jal neti

International Medical Science Academy Update (IMSA): New FDA Drug Update


US FDA has approved liraglutide, a GLP–1 (glucagon–like peptide–1) incretin analog that can be administered subcutaneously once daily. It is not considered a first–line therapy for type 2 diabetes. (http:// www.fda. gov /Drugs / DrugSafety / Post market Drug Safety Information for Patient sand Providers/ ucm198543.htm Accessed February 10, 2010.)


Mnemonic of the Day (Dr Prachi Garg)

Narcolepsy: Symptoms and epidemiology – CHAP

  • Cataplexy
  • Hallucinations
  • Attacks of sleep
  • Paralysis on waking

    (The usual presentation is a young male, hence "chap")

News and Views

FDA Update : Sprix (ketorolac tromethamine) has been granted FDA approval for the short–term (up to 5 days) management of acute moderate to moderately severe pain that requires analgesia at the opioid level. It provides ambulatory patients with a convenient, potent, and fast–acting option for pain relief.

Biggest deal: 6 acres for Rs 4000 crores

A six–acre government plot in an upcoming southern Mumbai neighborhood fetched the highest bid of Rs 4,053 crore from the Lodha Group on Tuesday, setting an all–India record. The Mumbai Metropolitan Region Development Authority (MMRDA), which controls the land, allowed multiple towers instead of a single ‘iconic’ tower. It also permitted 100% residential construction instead of the earlier stipulation of just commercial. In 2008, Delhi–based developer BPTP had bagged a 95–acre plot in Noida for Rs 5,000 crore, but the deal was later called off. Till now, DLFs bid of Rs 1,750 crore for 350.7 acres in Gurgaon last year was considered the country’s highest. But on Tuesday afternoon, Lodha Group beat this record by several times after it outbid three developers for the Wadala plot by quoting double the reserve price. MMRDA had set a minimum rate of Rs 40,000 per sqm (Rs 1,980 crore) and Lodha put in its bid for a hefty Rs 81,818 per sqm.

Imagine what will happen to the cost of healthcare if this someone was to build a health care facility at this site.

Quote of the day (Paramjeet Chadha)

Life is just like a sea, we are moving without an end. Nothing stays with us, what remains is just the memories of some people who touched us as Waves.

Question of the Day

What is the relationship between type 2 diabetes mellitus and the metabolic syndrome?
Dr Anoop Misra, Dr M Madhavan, Dr NK Vikram, Dr RM Pandey, Dr V Dhingra & Dr K Luthra, New Delhi

Metabolic syndrome is an intermediate condition that portends an increased future risk of development of type 2 diabetes mellitus and coronary artery disease (CAD). Insulin resistance is the common key denominator of the metabolic syndrome, and abdominal obesity, a major risk factor, is associated with insulin resistance.1 In the initial stages, endocrine pancreas is able to overcome insulin resistance by secreting excess insulin, thus keeping blood glucose under control. Hyperinsulinemia therefore is a surrogate marker of insulin resistance. When insulin resistance is persistent or increases, pancreatic –cells get ‘exhausted’, thus, causing decrease in insulin levels and leading to hyperglycemia. Asian Indians have high percent body fat and higher truncal and abdominal adiposity at a lower lean body mass, a phenotype conducive to insulin resistance and type 2 diabetes mellitus.2

Studies have shown that aggregation of features of the metabolic syndrome is associated with increased risk of type 2 diabetes mellitus and increased prevalence of chronic complications.3 People who predominantly have low insulin secretion show about a 3–fold risk, while those who have predominantly insulin–resistance have about a 5–fold risk, and the presence of both leads to a 20–fold higher increased risk for type 2 diabetes mellitus.4


  1. Misra A, Vikram NK. Clinical and pathophysiological consequences of abdominal adiposity and abdominal adipose tissue depots. Nutrition 2003;19(5):457–66.

  2. Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: Evidence and implications. Nutrition 2004;20(5):482–91.

  3. Costa LA, et al. Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in type 2 diabetes. Diabet Med 2004;21(3):252–55.

  4. Haffner SM, et al. Carotid artery atherosclerosis in type–2 diabetic and nondiabetic subjects with and without symptomatic coronary artery disease (The Insulin Resistance Atherosclerosis Study). Am J Cardiol 2000;85(12):1395–1400.

Liver Fact

In alcoholic liver disease, SGOT will be never more than 8 times normal and SGPT will never be more than 5 times normal.

Women Safety Tips

The elbow is the strongest point on your body. If you are close enough to use it, do!

World No Tobacco Day 31st May

Sikhism: Sikhism talks about four prohibitions which include cutting of hair, adultery, consumption of meat, fish or egg and use of tobacco and any other non-medicinal intoxicant or drug.

eMedinewS Try this it Works : Acting against gastric aspiration

Patients receiving mechanical ventilation can be at risk for gastric aspiration if kept in a supine position for too long. Maintaining such patients in a semi recumbent position to reduce gastric aspiration has been shown to be of benefit.

Dr Good Dr Bad

Situation: An elderly patient had A1C of 7.2%.
Dr Bad: You need to bring it to 6.5%.
Dr Good: It is adequate.
Lesson: There is an emerging perception that tight glycemic control may be beneficial in primary prevention of cardiovascular disease (CVD) in younger patients with diabetes, but may become deleterious in older patients with established or subclinical CVD. Because the pathogenesis of atherosclerosis spans decades, beneficial effects of tight glycemic control on CV outcomes are mainly in younger patients without established macrovascular disease.

Make Sure

Situation: A 40–year–old man presents with carbuncles on the back. Reaction: Oh my God! Evaluate this patient for diabetes mellitus.
Lesson: Make Sure to evaluate for diabetes on in such patients. Carbuncles are clusters of boils that result in extensive sloughing of skin and scar formation. They are due to Staphylococcus aureus infections and occur more frequently in diabetes.

IMANDB Joke of the Day

A anatomy professor taking  alecture " Yesterday we went through the uterus and today we will go through the vagina".

Formulae in Clinical Practice

Oxygen Delivery (DO2)
Formula: Do2 = CaO2 × CO. × 10
= 1.39 SaO2 × CO. × 10
CO. – Cardiac output in l/min, 10–for dI/l.
Normal value: 800–1,600 ml/min.

Milestones in Cardiology

1543: Vesalius observed the absence of connection between the two ventricles; blood therefore could not pass from one to the other.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

What is a reference range?

Some tests provide a simple yes or no answer. Was the culture positive for strep throat? Did the test find antibodies to a virus that indicates an infection? For many more tests, the meaning of the results depends on their context. A typical lab report will provide your results followed by a reference range. For example, your results for a thyroid–stimulating hormone (TSH) test might look something like: 2.0 mIU/L, ref range 0.5 – 5.0 mIU/L. The test results indicate that it falls within the "normal" range.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date


For use as sweetener in drug formulations



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eMedinewS– Padma Con 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 .


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Public Forum (Press Release for use by the newspapers)

Passive smoking and dementia link

Breathing in secondhand smoke has now been shown for the first time to raise the risk for Alzheimer’s disease and other forms of dementia, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

There have been studies that have shown that exposure to secondhand smoke is related to subclinical cardiovascular disease and clinical cardiovascular disease. There also have been studies showing that atherosclerosis, hardening of the arteries, is related to an increased risk of dementia.

A new study completes the loop by showing that inhaling someone else’s smoke increases the incidence of dementia. There is an alternative pathway other than cardiovascular disease with potential neurotoxic effects. Secondhand smoke could affect the neurodegenerative process behind dementia and may lower the threshold for dementia–like symptoms.

A six–year evaluation revealed that elderly people with high lifetime exposure to secondhand smoke for 30 years or more were about 30 percent more likely to develop dementia than those without such exposure. Analysis of the data showed that the combination of long–term exposure to secondhand smoke and the presence of cardiovascular disease nearly doubled the risk of dementia. Long–term exposure to secondhand smoke alone increased the risk of dementia by about a third.

The study also found a greater incidence of dementia in people who were not diagnosed with cardiovascular disease but who had detectable abnormalities of their carotid arteries, the main arteries to the brain, on ultrasound images. People exposed to secondhand smoke who had those abnormalities (such as narrowed carotid arteries) were 2.5 times more likely to develop dementia as those with no carotid abnormalities and no secondhand smoke exposure.

Readers Responses

  1. A new OC with a new estrogen, a new progestin, and a new indication
    This new formulation is expected to be the first estradiol–containing pill that provides reliable contraceptive efficacy and cycle control. It is also possible that Qlaira will be the first birth control pill with an FDA–approved indication for treatment of heavy or prolonged menstrual bleeding. The appeal of the natural estrogen (estradiol) combined with an important noncontraceptive benefit will, hopefully, make users more successful contraceptors. Dr. GM Singh

  2. To, Padma Shri Dr. K K Aggrawal: Dear Sir, Appreciate an article on Quackery. The quacks are all over in India. The Ruling of Supreme court is very transparent. The Poonam Verma Vs Ashwin Patel case says "A person who does not have any knowledge of a particular system of Medicine but Practices in that system is a quack and a mere pretender to medical knowledge or skill, or to put differently, a charlatan".                                                                                           
    While Mukhtyarchand Vs State of Union verdict is "A harmonious reading of section 1 of 1956 Act and Section 17 of 1970 act leads to the conclusion that there is no scope for a person enrolled on the State Registrar of the Indian Medicine or Central Registrar of Indian Medicine to Practice Modern Scientific Medicine in any of its branches unless that person is also enrolled on a State Medical Registrar within the meaning of 1956 Act."
    "The right to practice Modern Scientific Medicine or Indian Medicine cannot be based on the provisions of the Drugs Rules and the Declaration made there under by state Governments." A B.A.M.S. Or HOMEOPATHY person is not Registered in state medical register in India. so, all these peoples cannot practice allopathy. Goverment is unaware about Quackery and plays with the life of Indian patients. Unity of Doctors definitely eradicate the Quackery and compel Government to Punish Quacks: Dr. Ghanshyam A. Umre, Ganeshpur Road, WANI, yavatmal 44530


          MCI Update: The court cases of MCI now come on hearing on 31st May, 3rd June and 8th June.