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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

5th May, 2010, Wednesday

Can statins be given on alternate days?

Dear Colleague

Alternative day dosing has been suggested. Small studies have compared daily statins with alternate day dosing.1–6 Every other day regimens, and even once weekly regimens, have also been evaluated as strategies for improving tolerability.7, 8

Trials with atorvastatin, fluvastatin, and rosuvastatin suggest that to yield similar LDL–C lowering, the 'every other day' dose needs to be on average nearly twice that of the daily dose.1,2,4,8 Most studies in alternate day regimens have used dose less than 40 mg.

Major trials have used daily statin therapy. In the absence of large randomized trials demonstrating equivalent effects on clinical outcomes with alternative dosing regimens, one should prescribe daily dosing.


  1. Rindone JP, Hiller D, Arriola G. A comparison of fluvastatin 40 mg every other day versus 20 mg every day in patients with hypercholesterolemia. Pharmacotherapy 1998;18:836.
  2. Matalka MS, Ravnan MC, Deedwania PC. Is alternate daily dose of atorvastatin effective in treating patients with hyperlipidemia? The Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS). Am Heart J 2002;144:674.
  3. Jafari M, Ebrahimi R, Ahmadi-Kashani M, et al. Efficacy of alternate-day dosing versus daily dosing of atorvastatin. J Cardiovasc Pharmacol Ther 2003;8:123.
  4. Ferrer-Garcia JC, Perez–Silvestre J, Martinez–Mir I, etal. Alternate–day dosing of atorvastatin: effects in treating type 2 diabetic patients with dyslipidaemia. Acta Diabetol 2006;43:75.
  5. Wongwiwatthananukit S, Sansanayudh N, Dhummauppakorn R, etal. Efficacy and safety of rosuvastatin every other day compared with once daily in patients with hypercholesterolemia. Ann Pharmacother 2006;40:1917.
  6. Backes JM, Venero CV, Gibson CA, et al. Effectiveness and tolerability of every–other–day rosuvastatin dosing in patients with prior statin intolerance. Ann Pharmacother 2008;42:341.
  7. Kayikcioglu M, Ozerkan F, Soydan I. Effectiveness and safety of alternate–day simvastatin and fenofibrate on mixed hyperlipidemia. Am J Cardiol 1999;83:1135.
  8. Ruisinger JF, Backes JM, Gibson CA, etal. Once–a–week rosuvastatin (2.5 to 20 mg) in patients with a previous statin intolerance. Am J Cardiol 2009;103:393.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature

Award presentation ceremony: Dignitaries at the 'SMS campaign on female feticide', organized by MMAFF (Medical Moment Against Female Feticide). On the dais are: Dr Ashwini Dalmia, Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal, Dr Narendar Saini, Dr Ramesh Dutta, Dr Vinod Khetrapal and Dr Naresh Chawla. Function held at Delhi Medical Association Hall on Saturday.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Revised TNM staging criteria

A new edition of the AJCC/UICC cancer staging manual has been released that revises TNM categories and stage groupings for a variety of cancer sites. The 7th edition revision of the combined AJCC (American Joint Committee on Cancer) and UICC (International Union Against Cancer) TNM (tumor, node, metastasis) cancer staging manual took effect in January 2010.

The criteria by which individual TNM categories are defined, as well as the stage groupings (combinations of T, N, and M that comprise stage I to IV disease) have changed for multiple cancer sites.

The most prominent changes are in lung, esophageal, gastric, biliary, colorectal, and prostate cancer. In addition, new TNM staging systems have been developed for gastrointestinal stromal tumors (GIST), intrahepatic cholangiocarcinoma, and carcinoid tumors.

(Edge SB, Byrd DR, Compton CC, et al. (Eds). AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th ed, Springer, New York, 2010.)

DMC Update

Can a resident of Haryana file a complaint in Delhi Medical Council?

No. He has to file in Haryana Medical Council. As per DMC/DC/F.14/Comp. 680/2/2010 order dated 20th April, 2010, the DMC referred such a complaint to Haryana State Dental & Medical Councils. "A complaint of Smt. Sarita r/o. 41/18, Laxmi Garden, Gurgaon, Haryana, alleging medical negligence on the part of Dr. Anjali Bagga, Kalyani Hospital Pvt. Ltd., Mehrauli Road, Gurgaon and Columbia Asia 21st Century Healthcare, Palam Vihar, Gurgaon, was examined by Delhi Medical Council. On perusal of the complaint, the Council observes that since as per records available in Delhi Medical Council, Dr. Anjali Bagga with the particulars mentioned in the complaint, is not registered with Delhi Medical Council and the Columbia Hospital is in Gurgaon, hence, the complaint is being referred to your office for necessary action".

News and views

FDA issues warning about Cardiac Science defibrillators

According to the FDA, defibrillators made by the Cardiac Science Corporation and sold under the label ‘Power Heart’ could fail because of their faulty software.

Sigmoidoscopy may reduce deaths from colorectal cancer.

A single sigmoidoscopy between ages 55 and 64 can reduce deaths from colorectal cancer, according to a study published online in the Lancet. It is a more effective tool than mammography for breast cancer or PSA tests for prostate cancer.

CT scans may help apparently healthy people better gauge their heart risk

CT heart scans may help millions of seemingly healthy people get a better fix on their heart risk, according to a study published in the Journal of the American Medical Association.

Long–term use of anabolic steroids appears to weaken heart more than previously thought.

Long–term use of anabolic steroids damages the heart more than researchers previously believed and could be setting up many users for heart disease and death, according to a new study in Circulation.  

Mnemonic of the Day (Dr. Prachi): Sinus bradycardia–aetiology–SINUS BRADICARDIA

Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Deficient blood sugar (hypoglycemia)
Bmbalance of electrolytes
Cushing’s reflex (raised ICP)
Rx (drugs, such as high–dose atropine)
Deep anaesthesia
Ischemic heart disease

What’s New

In children, the most commonly used anticholinergic agent for overactive bladder (OAB) is oxybutynin. In a study based on data from the US FDA Adverse Event Reporting System, central nervous system side effects associated with oxybutynin occurred more frequently in children than adults and included hallucination, agitation, sedation, confusion, amnesia, and nightmares. (Gish P, Mosholder AD, Truffa M, eatl. Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases. J Pediatr 2009;155:432.)

Quote of the Day: Prakash Rajpal

If someone points out your mistake – Be Happy that actually someone is interested in what you have done.

DMA Update: 9th May is Mother’s Day

Established urinary incontinence is caused by either storage problems, such as overactive detrusor and stress incontinence, or emptying problems, such as underactive detrusor and urethral obstruction.

Question of the Day: (Dr. Shiv Aggarwal. Florida)

What is the treatment of choice for treatment failure in acute rhinosinusitis?

Treatment failure is defined as progression of symptoms at any time during treatment or failure to improve after seven days of therapy. Patients who fail first–line therapy require alternative antibiotic selection. Levofloxacin or high–dose amoxicillin–clavulanate (4g/250mg/day) have been recommended.

Suggested reading
Anon JB, Jacobs MR, Poole MD, et al. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2004;130:1.

Stupid Question: (drsooneita@gmail.com)

At a family get-together: When some distant aunt meets you after years
Stupid Question Munna, you’ve become so big.
Answer: Well you haven’t particularly shrunk yourself.

SMS of the Day (Dr G M Singh)

It’s practically impossible for a woman to have a husband and a lover together in her life for long. You have to make a choice sooner or later.

eMedinewS Try this it Works: Less traumatic reduction of dislocated shoulders

To reduce dislocated shoulders, gently lay the patient prone with the ipsilateral arm dangling over the edge of the table. This in itself invariably reduces pain. Reassuring the patient and encouraging him or her to relax are also helpful. After achieving patient comfort, wait for a few minutes and you will find a shoulder that, if not fully self–reduced, needs only a subtle maneuver.

Do You know?

We live in a nation where car loan is available at 8% but education loan at 12%

Dr Good Dr Bad

Situation: A Brain Scan is required in a patient on pacemaker.



Lesson: The magnetic field of MRI process can disturb the pacemaker’s electrical circuit and hence C.T. Scan is the preferred procedure in such cases.

Make Sure

Situation: A 10–day–old neonate developed purulent conjunctival discharge. On history, it was found that mother had repeated episodes of PID.

Reaction: Oh my God! You should have treated the mother for Chlamydia trachomatis infection with azithromycin.

Lesson: Make sure to remember that C. trachomatis infection is effectively treated with single dose of azithromycin 1 g.

IMADNB Joke of the Day (Dr. Chopra Faridabad)

Banta–Santa ne milkar petrol pump khola par ek bhi customer nahin aya – bolo kyun?
Petrol–pump first floor par tha.
Chalo ek aur....

Phir dono ne first floor per restaurant khola, ek bhi customer nahin aya – bolo Kyun?
Petrol pump ka board nahin hataya tha.
Chalo ek aur....

Phir dono ne ek taxi li, ek bhi sawari nahin ayi – bolo kyun?
Woh taxi mein age peche baithkar sawari dhundh rahe the...
Chalo ek aur....

Dono ne ek bachche ko kidnap kiya or bachche ko yeh kah kar bhej diya – 5 crore rupe lekar ayo verna tujhe mar denge or bachcha ghar gaya aur uske baap ne 5 crore rupe deker bachche ko bhej diya – bolo kyun?
Bachche ka baap bhi Banta senior tha.

Formulae in Critical Care: Blood oxygen concentration

Formula: (Hemoglobin × oxygen saturation) × 1.34

Milestones in Gabapentin

1954: Gabapentin was originally discovered over 40 years ago by the Japanese, who initially, were looking for an antispasmodic or muscle relaxant.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang) : HLA-B27 antigen

To determine whether you have human leukocyte antigen B27 (HLA–B27) on the surface of your cells; to help assess the likelihood that you have an autoimmune disorder associated with the presence of HLA–B27The most common of these disorders is ankylosing spondylitis (AS) – 90% of patients with AS are positive for HLA–B27. Other disorders that have an association with the presence of HLA–B27 include: Juvenile rheumatoid arthritis (JRA),. Reiter’s syndrome, Isolated acute anterior uveitis, and in patients with inflammatory bowel disease etc .

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Abacavir Sulfate Tablet 60mg

For the treatment of HIV–1 infection in combination with other antiretroviral agents




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Contact: drkk@ijcp.com emedinews@gmail.com


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)

Excess Fat around the Waist May Increase Death Risk for Women

There is increasing evidence that excess abdominal fat is a risk factor for long–term conditions like diabetes and heart disease. However, a recent study from Harvard and the National Institutes of Health published in the journal Circulation links abdominal obesity and women's risk of premature death, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. As per the study, women who carry excess fat around their waists are at greater risk of dying early from cancer or heart disease than women with smaller waistlines, even if they were of normal weight.

In the study researchers followed more than 44,000 nurses over the course of 16 years to track their medical history and lifestyle. At the beginning of the study the women were asked to measure their waists and hips. Every two years, the women completed questionnaires about their health, providing information about their age, activity level, smoking status, diet, blood pressure and cholesterol levels.

They examined the cause of death for all women who died over the course of the study. In total, 3,507 deaths occurred, of these, 1,748 were due to cancer and 751 were due to heart disease. They discovered that women with greater waist circumferences were more likely to die prematurely, particularly from heart disease, when compared to women with smaller waists. For example, women with waist size equal to or greater than 35 inches were approximately twice as likely to die of heart disease as were women with a waist size less than 28 inches, regardless of their body mass index. Similarly, women with a waist size equal to or greater than 35 inches also were twice as likely to die of cancer as were women with a waist size less than 28 inches. Women who had a greater waist circumference and were also obese were at the greatest risk of premature death. Greater waist circumference is a sign of collecting excess fat around one’s midsection, called abdominal obesity. A healthy waist limit for women is 80 cm and for men is 85 cm. Waist circumference is determined by measuring around the waist at the navel line.

MCI Update

The bail application of the MCI President probably will be heard in the High Court today (Wednesday). Whether or not he gets the bail will depend upon how seriously CBI contests the case. In the meantime, CBI has already put it on their website www.cbi.gov inviting complaints against MCI functioning.

MCI Autonomy

Medical Council of India is an autonomous body and has three basic functions. Firstly - medical education, secondly - maintenance of medical register and, thirdly – to maintain discipline and ethics amongst the medical practitioners. MCI body consists of around  150 members out of which eight are nominated by the Central Government; one each is elected by the State Medical Councils; one each is elected from each State Medical University and one each is nominated by every State. These 150 members of MCI represent MCI and not one single person. Each and every representative to MCI thus invariably a renowned person of his area.

In the present MCI crisis, the 150 member body of MCI should come together and bring MCI out of crisis and if the same is not done, it is very likely that autonomy of the MCI will be lost. The medical profession should not be surprised if the council is divided and medical education taken out of medical council by the govt.

Unfortunately, Indian Medical Association, at a time of crisis, is delinking itself officially from MCI as we have seen many statements from the office bearers saying that IMA has nothing to do with MCI. It is the duty of the IMA to save the autonomous structure of MCI and find an alternative to the present crisis till the court decides either way.

If there is corruption in the system, it has to be fought to its root level. The alleged corruption is that the medical colleges are given clearances after taking money. Corruption can only start if the concern medical college does not have the specified infrastructure. Every medical college will invariably also be a part of corrupt system, if this is the case. If the medical colleges feel that the MCI requirements for inspection are unrealistic, they should fight and ask for amendments otherwise they should obey what the MCI guidelines are. If everybody starts fulfilling MCI requirements, there will be no space for corruption.

Readers Responses

  1. Dear Dr Aggarwal: Emedinews daily has been covering one or two main articles daily. What is the way to get the previous articles? Is there a index of all main topics covered mentioning the date on which the article was published and the way to download them? Any search option on the website where the topic of interest could be mentioned and the list of all articles on the subject with dates is displayed, Please inform. Regards Dr Sushrut Almast
    A: see www.emedinews.in, you can search on the website for any tagging.