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Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: , Website:


Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



7th December Monday 

Dear Colleague,

 emedinews top health stories of 2009

1. New diseases
No panic about this pandemic: After initial reactions most of the news about the 2009 H1N1 swine flu pandemic has been reassuring. The credit goes to the nature of the H1N1 virus itself, which spreads easily and makes people sick, but so far rarely in a life threatening way. And the word pandemic is misunderstood: a disease is considered pandemic if it has spread globally and affects a larger than-usual proportion of the population. The disease need not be severe. Another reason for the calm was the public health response. Being the first Internet age pandemic the public was well informed. The Health officials through media gave simple, concrete things to do to protect ourselves and others.  This was not the flu pandemic that the India experts were expecting. People were afraid of H5N1 bird flu virus circulating to see if it would mutate and become transmissible among humans.

2. Resurgence of diseases:
a. The 2009 dengue epidemic was different than the 2006 epidemic. The virus was 1 and 3 with a difference. More hepatopathy ( SGOT > SGPT  range 200-700), more GI symptoms, more severe thrombocytopenia (often < 10,000). The city was in panic with platelet hysteria and mania. 

b. Diphtheria cases on the rise: emedinews reported a marginal but significant rise in diphtheria cases all over the country included Delhi. Are we heading for a problem?

3. New guidelines
a. In its revised guidelines, the American College of Obstetricians and Gynecologists now recommends delaying the start of cervical cancer screening until age 21 and then screening most patients every other year instead of annually. Women between ages 21 and 29 years should undergo screening every 2 years. Women aged 30 or older who have had three consecutive normal results can be screened every 3 years if they have no history of cervical intraepithelial neoplasm 2 or 3, HIV, immunocompromise, or in utero exposure to diethylstilbestrol. According to experts, these recommendations are also applicable to women vaccinated against human papilloma virus. Conventional and liquid   based cytology are both accepted by the ACOG for the screening. Still in  India cervical cancer is number one cancer of the country.

b. WHO updates its guidelines on HIV drugs: In an update to its guidelines on HIV drugs, the WHO now recommends early start of antiretroviral therapy (ART) for adults and adolescents, delivery of more patient   friendly antiretroviral drugs and prolonged use of ARVs to decrease risk of transmission of the virus from mother   to   child. Following are few major recommendations. 1. ART should be started at a higher at CD4 threshold of 350 cells/mm3 for all HIV   positive patients, including pregnant women, irrespective of whether they have symptoms or not. 2. Phasing out of the drug Stavudine, or d4T, due to its long   term, irreversible side   effects in favor of Zidovudine or Tenofovir. 3.  Early use of ART in pregnancy, starting at 14 weeks and continuing for the entire period of the breastfeeding. Breastfeeding should continue until the infant is one year of age, provided the HIV   positive mother or baby is taking ARVs during that period. This will reduce the risk of transmission of the virus from the mother to the child and with better survival chance for the baby.

c. New mammography recommendations update: The US senators approved an amendment that would require health insurers to cover mammograms for women ages 40 to 49. In a 61 to 39 vote, the Senate dealt a significant blow to the power and credibility of the U.S. Preventive Services Task Force, by essentially deciding to disregard the task force's recent recommendation that women under 50 should not undergo routine mammograms.

d. Screens cancers may not be the answer: A provocative analysis in JAMA showed that screening with mammography and prostate-specific antigen can lead to detection and treatment of many cancers that pose minimal risk while achieving only modest reductions in the number of more advanced cases. Test finds slow-growing, indolent cancers that could have gone untreated without causing harm but wind up getting treated anyway, so people needlessly suffer through the complications of treatment. The authors suggests development of better tests that would differentiate between low  and high risk tumors; more conservative treatment of low risk tumors; targeting screening and prevention efforts at people in high risk groups. They also suggested not calling low risk tumors cancer, but referring to them as indolent lesions of epithelial origin, or IDLEs, instead.

4.Visceral fat and brown fat the new concepts
The visceral fat, churns out inflammatory factors and hormones. On the other hand subcutaneous fat, is metabolically sedate. Framingham Heart Study researchers reported that visceral, not subcutaneous, fat was associated with calcium deposits, a marker for atherosclerosis, in the body's main artery, the aorta.

White fat cells store fat. Most of the fat in the body visceral and subcutaneous, is white fat. But there are also brown fat cells that actually burn fat. We have brown fat as newborns to help with the regulation of body heat, but it's long been believed that it soon disappears. A surprising trio of articles published in The New England Journal of Medicine used PET scans to show that we actually retain appreciable amounts of brown fat as adults in an area between the shoulder blades, and that the more brown fat an adult has, the more likely he or she is to be lean with healthy metabolic indicators.

5.New drugs
a. Dabigartan is a new drug likely to enter market in 2010. Like Warfarin it is blood thinner but does not interact with other drugs, herbs, and foods and frequent blood tests are not necessary for monitoring. It in smaller dose (110 mg) is as effective at preventing strokes and causes  fewer major bleeds and at larger dose (150 mg) is more effective than warfarin at stroke prevention and causes similar number of bleeds.

b. Pitavastatin once introduced by Zydus a few years back now has been approved by US FDA and likely to be reintroduced in the Indian market. It is more effective than rosuvastatin.

6.New drug warnings
The FDA has issued a public health advisory warning patients and physicians that concomitant use of clopidogrel and omeprazole blunts the anti platelet effect of clopidogrel, so the combination should be avoided. The agency said the combination reduces the activity of clopidogrel by about half. Such a reduction could theoretically increase the risk of myocardial infarction and stroke, although there are no clinical data to support that hypothesis.

7.Blood sugar levels: Seeking the sweet spot
High blood sugar level is bad for diabetics but is also associated with worse outcomes for heart attack and stroke patients and, in fact, for hospital patients of all kinds. Several years ago, Belgian researchers showed that ICU patients fared far better if their blood sugar levels were very tightly controlled. But now results from a large randomized trial (NICE-SUGAR trial) showed that the death rate for tightly controlled patients was higher than it was for patients controlled to more conventional levels. In non ICU patients also study results featured suggested people with diabetes might be harmed, not helped, by overly ambitious goals for blood sugar control (an HbA1c goal of below 6%).Hypoglycemia episodes can trigger a cascade of events with mortal consequences and insulin may have negative effects. Blood sugar control doesn't make the sugar disappear; it goes into cells. That surge of sugar may disrupt normal cell functions that wind up affecting the heart and other vital organs.

Cardiovascular disease is fundamentally an inflammatory process.
JUPITER trial showed that people with LDL cholesterol less than 130 mg/dL but high CRP levels (2 mg/L or higher) could cut their risk of having a heart attack or stroke in half by taking a high dose (20 mg) of a powerful statin drug, rosuvastatin. C reactive protein is an indicator of inflammation. Statins lower LDL levels and calm inflammation.Subanalyses of the JUPITER published in Lancet showed that people in the trial who reached a very low LDL level (less than 70 mg/dL) cut their risk of having a heart attack, stroke by 55%. But those who achieved a sub 70 LDL and a CRP of less than 2 mg/L lowered their risk by 65%. And reaching a CRP of less than 1 mg/L lowered it by 79%.

9. Do your friends make you fat?
A new wave of research is showing that the causation of weight gain has a social dimension, spreading through social networks as if they were contagious. Dr. Nicholas Christakis, a Harvard Medical School professor based on information supplied by participants in the famous Framingham Heart Study has shown that your friend's obese friend may increase your chances of becoming obese, even if your friend is not heavy.

10.  New bills
a. The Govt. mooted the idea of a regulatory body above the medical council of India, Dental council of India and nursing council of India.

b. A bill, namely West Bengal Rural Health Regulatory Authority Bill2009 is being brought in the winter session of the W.B. Assembly. If passed, a parallel authority to the state medical council and MCI will be created in the state, to prepare a three years medical course for giving education to prepare a new cadre of medical professionals, namely, Rural Health Practitioner ( RHP ). The said AUTHORITY Will be empowered to give registration to these so called Bare Foot Doctors and regulate there medical practice. These RHPs will be allowed to only treat Rural People. They will not be allowed to treat Urban people which comes under any municipal corporation or board area. They will be authorised to issue illness and Death Certificates. They will be given a standard guideline for Treatment and Medicine list. The authority, will act as Medical Council for the RHPs. IMA Bengal State office is supporting the Government but IMA Calcutta branch is opposing this bill.

c. Andhra Pradesh Ordinance Against the Violence on Doctors and Medical Establishments saw many more states passing the same including Delhi.

(Source Harvard medical newsletter and Indian news)

Dr KK Aggarwal


Yoga Boosts Heart Health (Dr Prachi Garg)
Heart rate variability, a sign of a healthy heart, has been shown to be higher in yoga practitioners than in non practitioners. The ongoing variation of heart rate is known as heart rate variability (HRV), which refers to the beat to beat changes in heart rate. In healthy individuals HRV is high whereas cardiac abnormalities lead to a low HRV. Ramesh Kumar Sunkaria, Vinod Kumar, and Suresh Chandra Saxena of the Electrical Engineering Department, at the Indian Institute of Technology in Roorkee, in Uttrakhand, India, evaluated two small groups of men and concluded that there is strengthening of parasympathetic control in subjects who regularly practice yoga, through breathing exercises, stretching, postures, relaxation, and meditation, which is indicative of better autonomic control over heart rate and so a healthier heart.

Molecule Discovered That Makes Obese People Develop Diabetes
Many people who are overweight or obese develop insulin resistance and type 2 diabetes at some stage in their lives. A European research team has now discovered that obese people have large amounts of the chemokine molecule CXCL5, produced by certain cells in fatty tissue which causes insulin resistance and type 2 diabetes. Chronic inflammation of the adipose tissue, which is characteristic of obese people, is a crucial in the development of insulin resistence and type 2 diabetes, Lluis Fajas, lead author of the study and a researcher at the Institute of Health and Medical Research (Inserm) in France, said.

Ultrasound Enhances Noninvasive Down Syndrome Tests
A genetic sonogram maximizes the accuracy of non invasive testing for Down syndrome, said Dr. Kjersti Aagaard, assistant professor of  obstetrics and gynecology at  Baylor College of Medicine. A genetic sonogram is simply a sophisticated ultrasound that details the fetal anatomy in the second trimester, looking for the presence of major fetal anomalies or specific anatomic features (so called soft markers) that might be found in a child with Down syndrome.

Flaxseed Oil May Reduce Osteoporosis Risk
Animal studies suggest that adding flaxseed oil to the diet could reduce the risk of osteoporosis in post menopausal women and women with diabetes, according to a report to be published in the International Journal of Food Safety, Nutrition and Public Health.

Link Between Influenza Virus and Fever: Scientists Solve Riddle of New Mechanism in Immune System
Viruses are microscopic organisms. They plant their genes in the cells of their victim in order to reprogram them. The infected cells then no longer produce what they need to live, making lots of new viruses instead. Luckily, in most cases this hostile takeover does not go unnoticed. This is ensured by the cells' own sensors that recognise alien genetic material. One of them is RIG I. When RIG I encounters virus genes, it ensures that the body releases interferon which in turn puts killer cells on combat standby, which then destroy the infected cells. In a study Dr. Hendrik Poeck explains that RIG I also cranks up the production of a central cytokine in the case of a virus infection. As a result, many virus infections are accompanied by a high temperature. That is also what happens with influenza. Dr. Hendrik Poeck and Dr. Michael Bscheider and Dr. Olaf Groß are the primary authors of the study.
Fat Around the Middle Increases the Risk of Dementia
Women carrying a lot of fat around the middle are at greater risk of dying prematurely due to a heart attack or stroke, says Deborah Gustafson, senior lecturer at the
Sahlgrenska Academy.  If they nevertheless manage to live beyond 70, they run a greater risk of dementia. The study was carried out at the Neuropsychiatric Epidemiology Research Unit as part of the Sahlgrenska Academy major research project EpiLife.



Eye care snippets by Dr. Narendra Kumar: OPTICAL PROPERTIES

Nature of refraction. Light travels in a straight line. Opaque objects absorb the light. Mirror surfaces reflect the light back. Transparent surfaces such as glass allow the light to pass through. Light maintains a constant speed in space, but encounters resistance while passing through a transparent body. The phenomenon of the bending of light while passing from one transparent medium to the other of a different density is known as refraction.

Refractive index. The universal medium through which light travels is the air, the optical density of which is taken as a standard, and densities of different substances are compared with it. Refractive index of a substance is its refractive power in comparison with that of air, the higher the refractive index, the more efficient the light bending). High index lenses are useful in reducing lens thickness.

Refraction by prisms. The prism is made up of two sides meeting at an apex and joined by a base. The angle between the two inclining sides is called the angle of refraction. The incident ray of light entering a dense medium (glass) from a rare medium (air) bends towards the base as it enters the prism, and the emergent ray further bends towards the base as it leaves the prism. The total amount of deviation (towards the base) between the incident ray and the emergent ray is called the angle of deviation. If a person looks through a prism, an object appears displaced towards the apex of the prism.

Refraction by lenses. Light passing through a prism is never brought to a focus and no image is formed, but the prism refracts rays of light towards the base. A convex lens is formed with two prisms arranged with their bases together, and it converges the incident light to a point. A concave lens is formed with two prisms arranged with their apices together, and it diverges the incident light. In a spherical lens all meridians have the same curvature and a definite image can be formed at a point. In a cylindrical lens, where one meridian is curved and the other at right angle has no curvature, no image is formed at a point but in a straight line.

Specific gravity/density. The specific gravity or density of a lens material is the weight in grams of one cubic centimeter (cc) of that material. Polycarbonate is the lightest lens material, followed by CR-39, crown, and 1.6, 1.7, 1.8 and 1.9 hi-index glasses. Higher index materials, though, can be used to make thinner lenses.

Magnification. Changing curves and thicknesses change the apparent magnification that the wearer sees through a lens. Magnification depends on the front and back curves, the thickness and the vertex distance of the lens from the eye, and index in general is the controlling factor in the shape of the lens and its effect on magnification.

Abbe number. Dispersion / v-value or Abbe number is a relative measure of the dispersion (color distortion) of the lens. Regardless of the material, there is no colour distortion through the optical centre of a lens. As the eye turns and looks through the peripheral portion of a powered lens, the induced prism causes dispersion, and higher the v-value the less dispersion.

Notation of lenses. A lens with a focal distance of 1 meter has a refractive power of 1 dioptre (1 D); a stronger lens of a refractive power of 2 D will have a focal distance of 0.5 meter. Symbols + and – are used to indicate converging (convex) and diverging (concave) lenses respectively. In case of cylinders, a similar notation is used for each eye. The examiner faces the patient, the zero is at the examiner's left, and the scale is used below the horizontal with 900 at the bottom and 1800 at the right side.

medinews: revisiting 2009

IJCP Group is organizing emedinews: Revisiting 2009, a day long conference on 10th Jan  2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts will deliver lectures. CME will be followed by lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail We have crossed 700 registrations.

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Humor (

Santa in airplane going 2 Bombay .. While its landing he shouted: " Bombay ... Bombay "
Air hostess said: "B silent."
Santa: "Ok.. Ombay. Ombay"
Teacher: "What is common between JESUS, KRISHNA , RAM, GANDHI and BUDHA?"
Santa: "All are born on government holidays...!!!

Letters to the editor

1. Dr Aggarwal, u are doing great job by starting this emedinews. it gives lot of information within small interval of time. it is very useful for GP-S. Dr V K Sharma
2.  Dear Dr Aggarwal, First of all thank for your regular, recent information as emedinews. I am always feel more informative to read your emedinews. I am sure it will be improving the clinical skill of all specialist.. Dr Rajendra Kumar Maskara General Surgeon


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