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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague,

30th January, Saturday 2010

 Practice Changing Updates: PCI after thrombolysis after ST elevation myocardial infarction

For stable high risk ST elevation myocardial infarction (STEMI) patients who have received clot dissolving fibrinolysis with streptokinase one should go for routine angiography and possible percutaneous coronary intervention (PCI) within six hours. For lower risk patients, it is reasonable to use this approach if it can be carried out within 24 hours.
The recently published NORDISTEMI and TRANSFER AMI trials randomly assigned STEMI patients across a spectrum of risk and who were treated with fibrinolysis to a strategy of either immediate transfer for possible PCI or ischemia guided treatment in local hospitals.
Both trials found better outcomes with a routine invasive strategy.

1.Bohmer, E, Hoffmann, P, Abdelnoor, M, et al. Efficacy and Safety of Immediate Angioplasty Versus Ischemia-Guided Management After Thrombolysis in Acute Myocardial Infarction in Areas With Very Long Transfer Distances Results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2009.
2.Cantor, WJ, Fitchett, D, Borgundvaag, B, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med 2009; 360:2705.


Dr KK Aggarwal
Chief Editor


There are approximately 18,000 injury-related deaths at home each year. Some of the leading causes of home injury deaths are falls, fire/ burns, poisonings, choking or suffocations and drownings. Many more home injuries are treated at emergency departments, in doctors’ offices, or with self-care at home. Children and older adults are especially at risk for home injuries, and environmental factors can contribute to population disparities in home injuries. The causes and circumstances of home injuries are complex and multifaceted. Reducing the risk of injuries at home is challenging, but fortunately there many ways that practitioners can help promote safer behaviors and help change home environments for patients and their families. (Am Lifestyle Med 2010;4(1):75-81)

FDA approves Medtronic heart valve
FDA approved the device for adults and children with a heart defect that disrupts blood flow between the heart's right chambers and lungs. The new device can be implanted without open heart surgery.

Benefits of multivitamins called into question
A study published in the Archives of Internal Medicine tracked more than 161,000 post-menopausal women over eight years and found that multivitamins had no effect whatsoever in 10 health-related categories, from the rate of the most common cancers, heart attack and stroke to overall mortality. (Myrtle McCulloch, Georgetown University, Washington DC)

Colon cancer drug may delay progression
A mid stage trial of patients with advanced colon cancer showed that an experimental cancer drug, perifosine, helped delay disease progression and improve overall survival. When given in combination with capecitabine, the drug also increased the percentage of participants with stable disease for two weeks or longer.

Picoplatin may increase likelihood of rare blood disorders
The AP (1/26) reports that Poniard Pharmaceuticals Inc. on Sunday 'reported results from a midstage clinical study that compared picoplatin and other drugs to a standard chemotherapy regimen,' and found ‘the patients who received picoplatin had significantly less nerve damage from treatment than the patients who were given standard drugs.' However, 'patients on the picoplatin regimen were more likely to develop two rare blood disorders, thrombocytopenia and neutropenia, and their symptoms were both more frequent and more severe than patients who took the other drugs’. Poniard also said that patients treated with oxaliplatin did slightly better in terms of disease control, progression-free survival, and overall survival, compared with the picoplatin group.

Liraglutide approved by FDA to treat type 2 diabetes
The FDA approved once-daily injection for treating type 2 diabetes, liraglutide, but said more safety studies are needed before it can be cleared as a first-line treatment for the disease. The FDA said it approved the drug to help lower blood sugar levels when coupled with diet, exercise and other diabetes medicines.

Food restrictions in maternity wards are often unnecessary
A systematic review of previous studies has determined that there is no evidence that the restrictions maternity wards place on women in labor (not being allowed to eat or drink) have any benefit for most healthy women and their babies. The restrictions, which were originally put in place to reduce the risk of Mendelson's syndrome, are said to have become increasingly irrelevant as the use of general anesthesia during labor has decreased.

Study links exercise to increased cognitive function in older women
A new study from researchers in British Columbia has determined that older women who did an hour or two of strength training exercises each week had improved cognitive function a year later.

NIH study to look at hypertension-dementia link
A flurry of new research suggests that controlling blood pressure just might be the best protection yet known against dementia. In fact, the evidence is strong enough that the National Institutes of Health will soon begin enrolling thousands of hypertension sufferers in a major study to see if aggressive treatment better protects not just their hearts but their brains.

Signs that a baby is hungry (Dr G M Singh)
Some new parents have a tough time figuring out when their crying baby is truly hungry. The following are signs that a baby wants to eat:
1. Turning the head from side to side.
2. Opening the mouth and sticking out the tongue.
3. Putting hands, fingers or a fist in or near the mouth.
4. Puckering the lips.
5. Turning to the mother's breast.
6. Moving the mouth in the direction of something that's touching the cheek (the 'rooting' reflex).

Magnesium-rich foods (Dr G M Singh)
1.Whole grain foods, such as brown rice.
2.Vegetables and fruits, such as avocados, bananas and dried apricots.
3.Nuts, including cashews and almonds.
4.Seeds, beans and peas. Soy-based foods, such as tofu and soy flour.

 Readers Responses

1. Dear sir: Ref malaria question. I think the source of information is WHO and no Indian scientist having hand on experience in malaria. I may tell that these conditions donot occur with P. vivax. Hence, the foremost thing to find out is MALARIAL PARASITE SPECIES It may all exist with P. falciparum or some conditions with P. malariae. Dr. A. K. Bagga

2. Dear Dr Aggarwal: heartiest congratulations on getting the prestigeous Padma Shri award. Hope this will inspire you further to continue with your commendabe efforts  to  promote  medical education and updating all of us regularly with latest happenings in the field of medicine. Best wishes. Dr SL BROOR

3. Dear Dr. KK Aggarwal,Heartiest congratulations!  You really deserved the award of Padma Shri. Dr. Sangeeta Sharma, Professor & Head, Dept of Neuropsychopharmaoclogy, Institute of Human Behaviour & Allied Sciences

4. heartiest congratulations ob being conferred Padamashree for the excelent work you have been carrying out. may you get many more. Dr Rajesh Makashir

5. Dear Dr.K.K.Aggarwal, Namaskar, Greetings from Agartala-capital of Tripura, NE region of Mother India. Sir, my hearty congratulation to you for receiving Padam Shree award for all the good work you are doing for years together. Dr. C. M. CHHAJER, MD.

6. Dear Sir, Congratulation for the achievement of this great award. I also believe that you will always leave a footprints to be followrd by others due to your great efforts. Also your initiative of e-medinews is a great work for all of us. Hope you will keep on giving us new leanings. shiv, ( saffola)

7. Respected Sir, Please accept my heartfelt congratulations for the Padma Shri and best wishes for many more to come your way. Yours sincerely. Dr Prashant

8. Heartiest congratulation sir. Dr B P Tyagi

9. Dear Sir,This is in response to a report on clinical diagnosis of malaria ( as per WHO) in your emedinew dated 25-01-2010 Here, iI may mention that I am a research scientist with ICMR for last over 25 years. I have published on clinical spects of malariia in prime journals as a scientist in Malaria Research Center of ICMR. My findings sugest and we have recommended to National Malaria Program people too; that Headache may be a very common symptom especially in the endemic areas. We have found headache with or without fever to be a major symptomatology in malaria epidemiology. This is for information and for the readers to know. With regards, Dr. A. K. Bagga

10. In a bid to maintain a record of all the clinical establishments in the country and subsequently hold them accountable for their actions, the Cabinet gave its nod to the Clinical Establishments (Registration and Regulation) Bill 2010. The term clinical establishment would cover hospitals, maternity home, nursing home and any similar facility with beds. The definition would also include a laboratory that carries out pathological, bacteriological and other diagnostic services.

Every clinical establishment will need to register in the states where the law is made mandatory. However, the law would be initially applicable only in Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all the Union Territories. Since health as a subject figures in the concurrent list, other states are expected to adopt the legislation but cannot be forced to implement in the normal course of events. Although many states have enacted laws for regulating healthcare providers, the current regulatory process for hospitals, nursing homes, path labs is far from adequate and there are no uniform guidelines to hold these establishments accountable in case of negligence cases.
fe Bureaus (DR.G.M.SINGH) 

Punjab & Sind Bank
Central Bank of India

Question of the Day
Why are artemisinin derivatives superior to other drug therapies used in malaria?

The artemisinin derivatives are one of the most promising antimalarial medicines, offering the following pharmacological properties:
1. Rapid and sustained reduction of the parasite biomass
2. Effective against resistant parasites
3. Rapid resolution of clinical symptoms
4. Reduction of gametocyte carriage
5. Broad stage specificity
6. 7-day treatment in monotherapy

Resistance to artemisinin derivatives has been induced experimentally in rodent malaria; resistance to artemisinin and artemether has been obtained in P. yoelii and P. berghei, with reversal after drug pressure removal. Stable genetic resistance to artemisinin and artesunate has been induced in P. chabaudi growing the parasites in presence of increasing drug concentrations. Since artemisinin produces early remission of clinical symptoms of malaria, adherence to the full 7-day treatment regimen is generally poor. While increased drug pressure is probably the main determinant for spreading drug resistance to antimalarial drugs, high exposure of the parasite to incomplete treatment courses and to medicines of substandard quality may also play a significant role. If the high consumption of oral monotherapies is not reversed in favor of quality ACTs as recommended by WHO, the development and spread of resistance to artemisinin derivatives is very likely to occur, as has been the case with other antimalarial monotherapies.

Dr Good Dr Bad
Situation: A patient with type 2 diabetes was not being controlled on oral anti diabetics.
Dr Good: Add insulin.
Dr Bad: Change to insulin.
Lesson: A once-daily basal insulin regimen added to oral medication is an ideal starting point. (Source: Diabetes Obes Metab 2009 Jan 19)

Make Sure
Situation: A patient with antibiotic-associated relapsed diarrhea was not responding. Reaction: Oh my God! Why were probiotics not added in the regimen?
Make sure that a course of oral metronidazole is given for treatment of a non-severe initial relapse of Clostridium difficile-associated diarrhea (CDAD) and intermittent and tapering vancomycin therapy with probiotics for treatment of non-severe second relapse of CDAD.

Formulae in Imaging
A lateral width of 1 cm corresponds to about 10 percent pneumothorax.

Mistakes in Critical Care
Never write MSO4 or MgSO4. Instead, write morphine sulfate or magnesium sulfate.

Emedinews Try this It Works
Heeding a clue to possible dementia
Formal mental status testing is time-consuming and often unnecessary for general medical evaluation. If a patient with reasonable hearing acuity looks at his or her companion more than twice before answering, when directly questioned during history taking, there is a strong likelihood of incipient dementia.

Milestones in Neurology
Sigmund Freud was an Austrian neurologist and the founder of the psychoanalytic school of psychology. Freud is best known for his theories of the unconscious mind, especially involving the mechanism of repression; his redefinition of sexual desire. He is commonly referred to as the 'Father of Psychoanalysis'.

Laughter the Best Medicine
This old man visits his doctor and after a thorough examination, the doctor tells him, "I have good news and bad news, what would you like to hear first?" Patient: Well, give me the bad news first.

Doctor: You have ovarian cancer, I estimate that you have about two years left. Patient: OH NO! That's awful! In two years, my life will be over! What kind of good news could you probably tell me, after this???

Doctor: You also have Alzheimer's. In about three months you are going to forget everything I told you.

SMS Anemia
Pancytopenia is seen in aplastic anemia, folate or cobalamin deficiency, or hematologic malignancy like acute myeloid leukemia.                

Prayer is the language of a man burdened with a sense of need. (EM Bounds)

List of newly introduced drugs in India

Bromocriptine Mesylate Tablet IP 0.8mg, (additional Indication)

Indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.


Levosulpride ER Tablet 100/150/200mg

For the treatment of depression and schizophrenia in adults


Ambroxol 30 mg+ Terbutaline 2.5 mg + Guaiphenesin 100mg + Menthol 2.5 mg per 5 ml syrup

Additional strength


Propofol 10 mg+ Lignocaine 2.5 mg per ml injection

Additional strength


Mecobalamin 750 mg + Pyridoxine Hydrochloride 1.5 mg + Nicotinamide 45 mg tablets

For the treatment of diabetic neuropathy


Olmesartan (20/40mg ) +  Atorvastatin 5/10/20mg film-coated tablets

For the treatment of co-existing essential hypertension and hyperlipidemia in adult patients


 Public Forum : Press Release
Obesity raises the risk of Type 2 diabetes 
Obesity, more than lack of physical activity, raises the risk of type 2 diabetes in women, said Dr. K K Aggarwal, President, Heart Care Foundation of India and E MedinewS.

Quoting a study published in the journal Diabetes Care, by Dr. Frank Hu of the Harvard School of Public Health, Boston, Dr. Aggarwal said that the risk of diabetes increased with increasing weight and waist circumference, and decreased with physical activity levels.

Although both variables were significant predictors of type 2 diabetes, the researchers found that the association for waist circumference was substantially stronger than that for physical inactivity. Tall men and prostate

Economy-class syndrome
Primary care doctors should diagnose and treat Venous Thromboembolism (VTE), which includes deep-vein thrombosis and pulmonary embolism. VTE is a potentially fatal condition that occurs when a blood clot that is formed at one point of the circulatory system detaches and travels to block blood circulation at another point.

A pulmonary embolism occurs when this kind of clot, which usually forms in the veins of the leg, obstructs the pulmonary artery or one of its branches. This can cause acute heart failure or sudden death. The problem of deep-vein thrombosis gained notoriety when some passengers on long-haul flights came down with the condition, which some have dubbed "economy-class syndrome." Treating the condition at an early stage can help save lives and prevent complications such as pulmonary embolism or recurrent deep vein thrombosis.

Tall men seem to have a heightened risk of developing an enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH), added Dr Aggarwal. Advancing age and high fasting blood sugar levels also raise the odds of BPH, whereas a greater systolic blood pressure -- the first number in the blood pressure reading - may indicate a lower risk. One of the most common ailments in elderly men, BPH leads to bothersome lower urinary symptoms and is associated with complications such as urinary retention, blood in urine, stones, and urinary tract infections. Surgery may be required to relieve BPH. Dr. Claus G. Roehrborn from University of Texas Southwestern Medical Center, Dallas and colleagues found increased height to be an independent predictor of BPH.  

(Advertorial section)

Health supplements are just.... the supplements !!!

Our body is under constant threat to various invading pathogens,for which we need an adequate treatment.  Dietary supplements play a supportive role to the medical treatment and can provide antioxidants or enhance body immunity to combat infections,and do not claim to diagnosis, cure or treat a disease. Health supplements are not a drug or a medicine and do not play any role in modifying the course of illness.

Advertising in emedinews
emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com  

eMedinewS-revisiting 2010

The second eMedinewS-revisiting 2010 conference will be held at MAMC on 2nd January 2011. The event will have a day long CME, doctor of the year awards, cultural hangama and live webcast.  Suggestions are invited.

Also if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Some SMS congratulations greetings and blessings received for Dr KK Aggarwal

1. Dr. S.P. Singh, Congrats
2. Dr. Anita Sehgal, Heartiest congratulations, Sir.
3. Dr. Sodhi, Heartiest congratulations.
4. Dr. Prashant, Respected Sir, Kindly accept my heartfelt congratulations for the Padmashri and good wishes for many more to come.
5. Lion Girish Chaudhry, Congrats for the great achievement which you truly deserved. Keep your philanthropic spirits and always remember you are a national asset now. Cheers.
6. Sanjay Kumar Aggarwal, Addl. Dist. & Session Judge, My heartiest congratulations to you and family on getting prestigious Padmashri award. May God bless you,
7. Dr.G M Malik, President, JK IMA Edit. Congrats for award Padmashri,
8. Franklin, Lok Sabha TV, Dear Sir, congratulations for Padma award.
9. Dr. Praveen Jain, Jhansi, Great. Heartiest congratulations for bringing laurels to cardiology fraternity.
10. Dr Rajiv Malik: Congrats. You did it again. It is well deserved.
11. Dr. Vineet Sambhal, Ex. Editor, UP IMA: Hearty congratulations on getting prestigious Padmashri.
12. Madhu Phul: Heartiest congratulations. I feel proud being known you.
13. Anil Singhi: Respected Doctor bhiya, congratulations on getting Padmashri award.
14. Vijay Nagpal, Congrats. Your hard work and missionary zeal are truly impressive. We are proud of you. Vijay Srivastava, DGM P&S Bank
15. Heartiest congratulations on being awarded Padmashri. H.S. Virk
16. Congrats for Padmashri award. Madhu Jaju
17. Congratulations Sir. Great news. Vijay Suman Maroo
18. Arun Rai, Congratulations on being honoured with Padmashri. Shall meet upon return.
19. R C Periwal, Congrats
20. Ajit Jaju, Please accept our heartiest congrats for this richly deserved award. Indu Jain
22. Respected Sir, heartiest congrats on getting Padmashri, Vinita
23. Respected Dr. Aggarwal, congratulations for Padmashri award. With best compliments. Dhasmana family
24.  Prof. Rita Ganguly: Badhai ho.
25. Dr Bagotia, Dear Padmashri Dr. K K congratulations.
26. Congratulations on receiving Padmashri award. We are feeling proud of you, Sir. Dr. D Sahoo
27. Congratulations. Dr. Sethia
28. Congratulations for award, Vani, Mickoo and Vijay
29. Dr. Vivek Arora, IIHP DSB, Our heartiet congratulations for the award Sir. May you always prosper and your name shine bright.
30. Congrats. WE are proud of you. Sandeep
31. Congratulations Sir for another well deserved feather in your illustrious cap. Regards. Archana DD
32. Congrats on receiving the Padmashri awards. Regards. Dr. K Kumar
33. 36. Fatima, Gaurav and Azan, Congratulations K K Uncle. Lots of love.
34. Dr. Sanjay Chugh, Bahut Bahut badhayee K K Babu
35.  Dr. YashNigam, Congratulations Sir
36. Ashim, Congratulations Sir for getting Padma award
37. Ritu & Akhil, Congratulations baba. Love
38. Dr Anurag Dental, Sir, heartiest congratulations on your award
39. Dr L K Uppal, J.P. Hearty congratulations.
40. Dr. Vinay Kinra, Dear Dr Aggarwal, heartiest congrats. Feel proud of you. Keep it up.
41. Dr. Poonam & Ravi Tuli, Heartiest felicitations for the most prestigious award as another feather in your glittering cap.
42. Dr. R.P. Parasher: Congrats for getting Padma award.
43. Dr. Pradeep Poswal, Sir, heartiest congratulations. We are proud of you.
44. Dr. M.P. Gandhi, Congratulations.
45. Dr Pushpa Sodani, Congratulations on your receiving Padmashri.
46. Amrita, Congratulations on your receiving Padmashri
47. Dr H Jauhari, Heartiest congratulations. Well deserved and long overdue.
48. Congratulations. God bless you. Dr. Gupta
49. Gaurav Karan, Dear K K Uncle, congratulations on the Padmashri award. We are thrilled to know. Love from all of us in Boston
50. Dr Rukmani, Homeopathy: Congratulations
51. Congratulations, Dr. Punse
52. Congratulations, A K Kahar, Addl. Session Judge
53. Congratulations. Wish you achieve much more on this path of service of society with your sincere efforts and dedication. Manohar Total TV
54. Congratulations to get Padmashri, Dinesh Negi NB
55. Heartiest congrats, R K Goel
56. Congratulations for prestigious award, Ln. Anupma Kanti Dewan
57. Dr. Vivek Govind Rao, Sir, congrats to you and your family on this great achievement.
58.  Sanjiv Shelly Batra: Great achievements are like Tajmahal. Everybody will wonder how beautiful it is. But nobody can understand how difficult it was to build.
59. Arvind Chowdhry: Congrats on your awards.
60. Atul and family: Heartiest congratulations for this great honour. Even we feel honoured being your younger brother.
61. Kaushik Dutta, MAMC: Congratulations for the award. Your honour makes us proud.