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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

13th August 2010, Friday

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

Human clinical trial of NIH–developed dengue vaccine begins (NIH report)

After more than a decade of development at the National Institutes of Health (NIH), human clinical testing for a vaccine to prevent infection by the mosquito–borne dengue virus has begun. The vaccine was developed by scientists at the National Institute of Allergy and Infectious Diseases and is undergoing clinical study at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

About 2.5 billion people in more than 100 countries worldwide live in areas where they are at risk of dengue infection. Dengue fever is caused by any of four related viruses: DENV–1, DENV–2, DENV–3 and DENV–4, which are transmitted to humans by Aedes mosquitoes. Dengue virus is prevalent in the tropical and subtropical regions of the world and each year infects about 50 million to 100 million people. It accounts for 25,000 deaths annually; most of them in children.

Most people infected with dengue virus experience no symptoms at all or only a mild fever. Others develop flu–like symptoms, headache, and joint and muscle pain. A smaller portion of those infected experience the more severe dengue hemorrhagic fever/shock syndrome (DHF/DSS), which can cause high fever, pain, bleeding, a drop in blood pressure, and, in some cases, coma or death.

There is no vaccine to prevent dengue infection or drug treatment for those who become infected. Current treatment recommendations include bed rest, drinking fluids, and taking medicine to reduce fever. The only way to prevent infection is to avoid being bitten by Aedes mosquitoes. These mosquitoes are most active during the day and thrive in urban environments, two factors that make them difficult to avoid. Controlling the mosquito vector can work, but it is very expensive and difficult to sustain. In the long run, vaccination would be a more efficient and cost–effective approach.

The new vaccine is tetravalent, meaning that it is designed to protect against all four dengue viruses, also called serotypes. This is especially important because of the way the immune system responds. A person who develops antibodies against one serotype of dengue virus is protected against only that specific serotype. To be fully protected against the four forms of dengue, a person must have antibodies against all four serotypes of the virus. However, having some antibodies to dengue may be worse than having none: Someone who has antibodies against only one or a few of the virus serotypes is actually at higher risk of developing the severe form of the disease upon infection by another serotype. But a person who is immune to all four serotypes cannot be reinfected, and, therefore, is less likely to develop DHF/DSS.

The candidate vaccines are live-attenuated, or created by making the live virus harmless or less virulent.

Dr KK Aggarwal
Editor in Chief
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Photo Feature

A poster Competition was organized by MMAFF (Medico Movement against Female Foeticide) on 7th August, 2010 at DMA Hall. Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal was the guest of honour on the occasion.

In the Photo: Dr Ashwini Dalmia, Chairman MMAFF; Dr Narender Saini, President DMA; Dr UC Bansal and Dr Sudesh Ratan


k k Aggarwal


News and Views


Backache, neck ache - symptoms of 'laptop-itis' (TOI)

Because of the way the computers are designed, using a laptop almost inevitably leads to poor posture, said Kevin Carneiro from the University of North Carolina at Chapel Hill School of Medicine. Typing can also cause carpal tunnel syndrome, an injury to the nerve that passes through the wrist.

Intrnational ( Dr Monica and Dr Brahm Vasudev)

Patients in poorer communities less likely to receive optimal care before starting dialysis

The wealth or poverty of kidney disease patients’ communities impacts the quality of care patients receive before starting dialysis, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology. On examing data, from 28,135 patients treated at 1,127 dialysis centers in 16 states between June 1, 2005 and May 31, 2006, investigators found that patients in poorer communities were less likely to undergo a recommended procedure i.e, the creation of an arteriovenous fistula, before starting dialysis.

Hypertension, poor glycemic control may be common in patients with diabetic retinopathy

According to a study published online July 12 in the Archives of Ophthalmology, patients with diabetes who have poor glycemic control and high blood pressure) are more likely to have diabetic retinopathy than their better controlled peers.

What is percentile? (Dr GM Singh)

A person's BMI percentile is a way of showing how his or her measurement compares to people of same age. For example, if a person has BMI in the 60th percentile, 59% of those of the same gender and age have a lower BMI

FDA approves vaccines for the 2010–2011 Influenza season

The U.S. Food and Drug Administration has announced that it has approved vaccines for the 2010–2011 influenza season in the United States. Seasonal influenza vaccine protects against three strains of influenza, including the 2009 H1N1 influenza virus, which caused the 2009 pandemic. Last year because the 2009 H1N1 virus emerged after production began on the seasonal vaccine, two separate vaccines were needed to protect against seasonal flu and the 2009 H1N1 pandemic flu virus, but this year, only one vaccine is necessary.

Male asthmatics may face increased prostate cancer risk (Padmashri Awardee Dr N P Gupta)

Findings of an Australian study show that men with a history of asthma, and those who have used asthma medications, particularly systemic glucocorticoids, are at increased risk for developing prostate cancer. In the study, a history of asthma was associated with a small but significant 1.25–fold increased risk for prostate cancer, and the risk for men who used medications was statistically similar to those who did not use medications, at a respective 1.29 versus 1.12 increased risk.


Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Hunger strikers–what is the role of doctor?

In India, different doctors resolve this ethical dilemma in medical practice in different ways and are decided by the medical examination/its findings and influenced by various factors as the age/mental and physical condition, sanity and over all compose mentis/ personality in the interest of person health, limb and life. The 43rd World Medical Assembly Malta, November 1991 and the 44th World Medical Assembly Marbella, Spain, September 1992 enumerated that hunger strikes occur in various contexts but they mainly give rise to dilemmas in settings where people are detained in prisons, jails and immigration detention centers. They are often a form of protest by people who lack other ways of making their demands known and the same is treated as democratic right. In refusing nutrition for a significant period, they usually hope to obtain certain goals by inflicting negative publicity on the authorities. Short–term or feigned food refusals rarely raise ethical/medical problems. Genuine and prolonged fasting risks death or permanent health damage for hunger strikers and can create a conflict of medical/ethical values for doctors/ physicians across the globe


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Chronic pancreatitis

Acute pancreatitis is an event, whereas chronic pancreatitis is a process.


In children, chronic pancreatitis is usually associated with genetic conditions such as typical or atypical cystic fibrosis or hereditary pancreatitis or is idiopathic. In adults, chronic pancreatitis is usually associated with alcoholism (70%) or is idiopathic.

Current thinking regarding chronic pancreatitis is that it begins as acute pancreatitis and progresses to end stage fibrosis. Both genetic and environmental factors influence the rate of progression. Genetic susceptibility factors include PRSSI, SPINKI and CFRT mutations. Hereditary pancreatitis carriers a high risk of malignancy in future. The anatomic variants predisposing to chronic pancreatitis are thought be post traumatic pancreatic duct scars, pre ampullary duodenal wall cysts, sphincter of oddi disorders (controversial), pancreatic divisum (controversial) and autoimmune pancreatitis. Chronic pancreatitis either in isolation or associated with other syndromes such as Sjogren’s, inflammation bowel disease has also been described. The etiological factors described for acute pancreatitis such as toxins, drugs and metabolic disorders such a hyper calcemia hyperparathryroidism etc., hyyperlipidimia, could also lead to chronic pancreatitis.

Evidence-Based Medicine

DR NP SINGH(Nanu), Professor of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital

Bisphosphonates not associated with risk for esophageal, gastric cancers

Despite reports suggesting a potential link between oral bisphosphonates and esophageal cancer, the drugs do not appear to pose increased risk, according to a case–control study in JAMA.

Using a national database, U.K. researchers identified some 46,000 adults (mostly older women) who filled a prescription for a bisphosphonate over an 11–year period, and matched them for age and sex to 46,000 controls. During about 4.5 years’ follow–up, 0.3% of all subjects developed gastric or esophageal cancer. Cancer incidence did not differ between the groups. Findings were similar in subanalyses that examined specific types of bisphosphonates, as well as analyses limited to patients with gastroesophageal reflux disease or Barrett esophagus. The authors conclude: "These drugs should not be withheld, on the basis of possible esophageal cancer risk, from patients with a genuine clinical indication for their use."

Question of the day

Does a positive ANA suggest lupus? (Dr Sujata Sawhney)

A positive ANA certainly does not equal systemic lupus erythematosus (SLE). In low titers, it is positive in up to 5% of the normal population. It is also positive in many other autoimmune conditions such as, scleroderma, mixed connective tissue disease, Sjogren’s syndrome and also in juvenile dermatomyositis. A negative ANA on a Hep 2 cell line virtually excludes lupus. ANA thus has a good negative predictive value but a positive test is seen in normal individual and many autoimmune conditions. Other than rheumatological disorders it is positive in autoimmune hepatitis, Hashimoto's thyroiditis, and in some patients with primary pulmonary hypertension.


1. Sawhney S, Garg PM. Laboratory tests in rheumatology. In: Bhave’s Textbook of adolescent.


Public Forum (Press Release for use by the newspapers)

Even nuts can cause severe allergy

Most allergic reactions in children occur at home, most are triggered by peanuts or cashews, and treatment is often delayed said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil ka Darbar & MTNL Perfect Health Mela.

Anaphylaxis is a severe life threatening allergic reaction and develops within seconds or minutes of exposure. The immune system releases histamine that cause tightening of the airways and shock. Common causes of anaphylaxis are foods, drugs or insect bites.

In the journal Allergy, Dr. Mimi L. K. Tang from Royal Children's Hospital, Melbourne and colleagues report 123 anaphylactic reactions in 117 children over a 5-year period. The median age of the children was 2.4 years. There was 1 death, in a 7-year old girl with a known peanut allergy who ate a peanut satay sauce. Most events, 48%, took place at home, and almost all initially involved breathing and skin symptoms. Gastrointestinal and cardiovascular effects were also common.

The median time from exposure to the offending agent to allergic reaction was 10 minutes, and the median time until treatment was 40 minutes. Food was the most common trigger (85 percent), with peanuts (18 percent) and cashew nuts (13 percent) being the most common causes. Six percent of allergic reactions were caused by drugs and 3 percent by insect stings.


Conference Calendar

Emergency Care Training for non ICU Nurses – Target Audience – Nurses only

Date: August 13, 2010
Venue: 142, Bharathiyar Road, Papanayakanpalayam, Coimbatore, Tamil Nadu.


An Inspirational Story


A personal goal or personal goals are yours - they are what you want not what others want for you. Believe in yourself - you can do anything. See what Jacquie has to say.

The key to being happy is to respect your desire to make your life better by your own choices-even if and, especially when others ridicule them. Do not let the ignorance or the short-sightedness of others redirect your life's goal.

Everyone has their own path to follow-their own map for the future. The key is to understand everyone is different and to respect their goals as well as your own. Do not accept behavior that goes against your beliefs or wishes, and do not accept behavior from friends, family, or a spouse that you wouldn't accept from a stranger.

Be true to yourself. Stand firm. And, do not postpone your dreams or wishes to please someone else's idea of what it should be...

I know that I am not done learning to be successful. As I grow, my definition of success will grow with me and it is within my power to DEFINE success. SUCCESS is in my knowledge that I DONT HAVE TO FOLLOW ANYONE ELSE'S PATH. Life is my lesson and I am it's humble student.


IJCP Special

Dr Good Dr Bad

Situation: A patient on intergrilin therapy had high grade fever.
Dr Bad: Give injection paracetamol.
Dr Good: Give Tablet paracetamol.
Lesson: Minimize procedures including arterial and venous punctures, IM injections, nasogastric tubes, etc. while the patient is on intergrilin therapy.

Make Sure

Situation: A diabetic hypertensive was denied a beta–blocker because of the traditional teachings.
Reaction: Oh my God! You should have used nebivolol.
Lasson: Make Sure that diabetics are not denied beta-blockers when indicated. Nebivolol has no side effect on glucose metabolism unlike atenolol.

Quote of the Day

3 faster means of communication

i) Tele–phone
ii) Tele–Vision
iii) Tell–a–woman
iv) Need Still faster, ask her not to tell anyone.

(Contributed by Dr. Prachi Garg)

Are you fit to fly?

Deep Vein Thrombosis

  • Maintain normal schedule using the time of the patient’s home country (best for short trips; may help to keep a watch on home time).

  • Gradually adjust schedule by an hour or two daily, until medication is taken according to local time.

  • Abruptly change schedule so medication is immediately taken according to local time (may lead to extended delays between doses; not to be used with insulin).

International Medical Science Academy Update (IMSA)

Meconium aspiration syndrome

A prospective study of 394 term infants with meconium stained amniotic fluid (MSAF) demonstrated that newborns without any sign of respiratory distress immediately after birth did not develop meconium aspiration syndrome (MAS). All 19 patients who developed MAS had signs of respiratory distress within 15 minutes of birth including 18 infants with Apgar scores < 8.


  1. Wuhl E, Trivelli A, Picca S, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med 2009;361:1639.

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Ketorolac Tromethamine Ophthalmic Solution 0.45%.

Indicated for the treatment of pain and inflammation following cataract surgery



Medi Finance

Q. If an amount is received from an employee of nursing home as contribution towards provident fund, and paid the said amount after due date, then what is the tax implication?

Ans. As per Finance Act 2003, provident fund is allowed as deduction, if it is paid before the due date of filing the return. If it is not paid within due date then allowed as deduction in the year in which it is paid.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)


As part of a routine metabolic, electrolyte panel, in persons with kidney, bone, or nerve disease, or when symptoms of significantly increased or decreased calcium concentrations are present.


Lateral thinking

Read this………………


The answer for yesterday’s puzzle "forgive and forget"

Correct answers received from: Dr Ashok Wasan, Dr Mohit Joshi, Dr.Mamta Sharma, Dr Simran Singh, Dr Saurabh Yadav, Dr Chandresh Jardosh, Dr Hena Vasdeva, Dr Susheela Gupta, Dr Kala Sarma, Dr. Prashant Bharadwaj, Dr Rajiv Bhatt and Dr Niti Bhatt, Dr. Joginder pal Manocha, Dr.Satyoban Ghsoh, Dr. Dinesh Kumar S, Dr.Satyoban Ghosh, Dr. Akshay Bharadwaj, Dr.A. K. Saxena, Dr. Alok Deb, Dr Anjani Kumar, Dr R.S.Bajaj, Dr Shashi Saini, Dr Puneet Kathuria, Dr. Shubha Laxmi Margekar, Dr Aanchal Jain, Dr Suparna Khera, Dr Kamlesh Kanodia, Dr.K.Raju, Dr.Akshat Bhargava,  Dr Shashi Chhabra, Muthumperumal Thirumalpillai, Dr.B.N.Ganagdhar, Dr GIRISH CALLY, Dr Anurag Jain, rajukuppusamy.dr, Dr R.S.Bajaj, Dr anupam sethi malhotra,

Correct answer received for 11th August Puzzle: Dr Anurag Jain.

Send your answer to ijcp12@gmail.com


Humor Section


Poems written by Wife and Husband

I wrote your name on sand it got washed,
I wrote your name in air, it was blown away,
Then I wrote your name on my heart,
And I got Heart Attack.

God saw me hungry, he created pizza,
He saw me thirsty, he created Pepsi,
He saw me in dark, he created light,
He saw me without problems, he created YOU.

Funny One Liner

A history teacher and his wife were sitting at a table. The wife asked. ‘Anything new at work?’ He replied, ‘No, I’m teaching History.’

(Contributed by Dr. Jagjit Singh)



Readers Responses
  1. Sir, I congratulate you from the core of my heart for the Herculean task you have taken in the "eMedi news": Dr Jayashree Sen

  2. Dear Dr Aggarwal, thanks for message that we should celebrate commonwealth game festival as our own festival and should do everything so that every respected foreigner visitor, appreciates our country. We should extend all kind of warm gestures and assistance to them. But contrary to it, what is coming in media, being daily discussed in parliament has badly defamed our reputation in our country and whole world, foreigners are shocked that they do not know and even Indian citizen is feeling that whether they will be executed in good spirit or not and under whose guidance. It appears that in our country corruption is a part of our blood and nobody can live without it or can get rid of it. Your idea is good but it is time to punish the culprit just now so that in future no body will dares to do such irregularities and mistakes and of course we shall celebrate commonwealth game celebrations but not under guidance of culprits and miscreants: drnakipuria@gmail.com

  3. Dear Sir: Drugs prescribed are changed with generic for profits, Junior Doctors quality and competence is a concern as there is no role for the senior doctors while employing them. Manoj

  4. DO NOT MISS OUT ON THIS VITAMIN LEVEL: A number of patients that present to myself with blood dyscrasias , whether it is anemia, leucopenia, thrombocytopenia or pancytopenia upon investigation are found to have vitamin B12 deficiency. Interestingly, their blood abnormality corrects completely by replacement of the deficient vitamin. It is well documented that pancytopenia simulating aplastic anemia may be a result of vitamin B12 deficiency, with features on bone marrow biopsy suggestive of complete marrow failure and NOT the classical MEGALOBLASTIC features. I would strongly suggest all GPs and physicians to keep a watch out and perform this test as and when required a little more generously. The Indian population is very prone to becoming vitamin B12 deficient. The main reason being our being predominant vegetarians, and the lack of adequate amounts of this vitamin in fruits and vegetables. Also, a lot of us are deficient in intrinsic factor which is required to absorb this from the diet and / or suffer from antral gastritis which kills the production of this essential factor. So, remember next time you see a patient with a blood-related cytopenia, check this vitamin level ! Dr. Anupama Jaggia, Chairperson and Hony. Active Visiting Consultant, Sir Ganga Ram Hospital, New Delhi.

  5. Dear Editor, Dr. Kishore Shah’s short story is indeed hilarious; I sympathise with him, though, for having lost a worthy patient like that! Dr. Narendra Kumar

  6. Thanks Dr Aggarwal, for providing space for DR ANIL VARSHNEY regarding Medical ethics.

  7. Dr KKA please revive this thing, start this from yourself, I , DR KP SINGH, declare that i will not charge from any MBBS doctor my fee for Ultrasound, Whole Body, Echocardiography, Color Doppler, Carotid Doppler and Peripheral Doppler study and my clinical services. Please contact me 09818110832. Dr K P Singh

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi Gate.

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

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
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

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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