Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
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

14th February 2010, Sunday

It’s not the hours of TV viewing, it’s the number of junk food commercials that cause obesity

The association between television viewing and childhood obesity is directly related to children’s exposure to commercials that advertise unhealthy foods, according to a new UCLA School of Public Health study published in the American Journal of Public Health.

The study, conducted by Frederick J. Zimmerman and Janice F. Bell, gathered data from primary caregivers of 3,563 children, ranging from infants to 12–year–olds, in 1997.

Among all children, commercial viewing was significantly associated with higher BMI, although the effect was stronger for children younger than 7 than for those older
than 7.

Non–commercial viewing, including watching DVDs or educational television programming, had no significant association with obesity. The findings strongly suggest that steering children away from commercial television may be effective in reducing childhood obesity, given that food is the most commonly advertised product on children’s television and the fact that almost 90 percent of children begin watching television regularly before the age of 2.
Commercial television pushes children to eat a large quantity of those foods they should consume least: sugary cereals, snacks, fast food and soda pop.)

 Dr KK Aggarwal
Chief Editor

News and Views (Dr G M Singh)

  1. ecton Dickinson & Co has voluntarily recalled millions of its intravenous infusion therapy devices distributed worldwide because the products could cause a potentially dangerous air embolism or fluid leakage. It recalled certain lots of its BD Q–Syte Luer Access Devices and BD Nexiva Closed IV Catheter Systems after determining their use could cause an air embolism or leakage of blood or IV therapy that could result in serious injury or death. The company is investigating reports of one death and one serious injury that may be linked to the problem, though so far the investigation is not conclusive, said Becton spokeswoman Colleen White. "We’re investigating two reports that may be associated with this problem," White told Reuters.
    The recall was initiated on Oct. 28, 2009 after the company received complaints of problems due to air entry through a part of the device. Becton said it notified its customers of the recall by letter and is working with the U.S. Food and Drug Administration and worldwide health agencies to coordinate recall activities.

  2. The American Lung Association offers these suggestions to help keep the air clean at home:

    Don’t allow smoking in the home.
    Have your home tested for radon gas.
    Make sure your home’s humidity level is below 50%. Install a dehumidifier if humidity levels are too high.
    To prevent attracting mold, make sure no plumbing is dripping or leaking.
    Keep trash covered and food securely stored to ward off pests.
    Avoid using candles or sprays to hide odors.
    Avoid using household products that contain toxic chemicals.

  3. Third–hand smoke: New term

    Tobacco smoke contamination lingering on furniture, clothes, and other surfaces, is dubbed third–hand smoke. It may react with indoor air chemicals to form potential cancer–causing substances, according to a study in the Proceedings of the National Academy of Sciences: After exposing a piece of paper to smoke, researchers at the Lawrence Berkeley National Laboratory found the sheet had levels of newly formed carcinogens that were 10 times higher after three hours in the presence of an indoor air chemical called nitrous acid (HONO) commonly emitted by household appliances or cigarette smoke. Nicotine reacted with the indoor air pollutant to form carcinogenic compounds called tobacco–specific nitrosamines (TSNAs). They found substantial levels of TSNAs on surfaces inside the smoker’s truck that was used in the study. More than half of the cancer–causing compounds remained more than two hours after the cigarette smoke had cleared.

  4. Proteinuria predicts mortality in kidney patients

    Proteinuria is a useful predictor of outcomes in patients with chronic kidney disease, a new study found. A Canadian cohort study included more than 900,000 adults who had at least one outpatient serum creatinine measurement and did not require dialysis at baseline. Data were gathered in a 2002–2007 registry that included estimated glomerular filtration rates (eGFRs) and proteinuria measurements. The study was published in the Feb. 3 issue of JAMA, the journal of the American Medical Association. The study showed that patients with heavy proteinuria and normal eGFR have worse outcomes than those with moderately reduced eGFR and no proteinuria. Although current guidelines call for staging chronic kidney disease (CKD) based on eGFR, they should perhaps be revised, given that use of that measurement alone may miss clinically relevant gradients in risk.

  5. Antidepressant may help cognitive recovery after stroke

    Treatment with the antidepressant escitalopram may enhance cognitive recovery after stroke. Researchers at the University of Iowa conducted a single–center study to determine if therapy with escitalopram would affect cognitive outcomes after stroke. Within three months of an index stroke, patients were assigned to a double–blind, placebo–controlled arm that compared escitalopram with placebo or a nonblinded arm involving problem–solving therapy, a psychological treatment that teaches patients how to deal with their problems. The main outcome measures were changes in several neuropsychological tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), performed at baseline and at the end of the intervention period. The study was funded by the National Institute of Mental Health and was published in the February Archives of General Psychiatry.

Conference Calendar
WAC 2010 (Winter Anesthesiology Conference 2010)
February 15–17, 2010
Ramada Resorts, Kochi, Kerala.

Public Forum

Press Release

All heart patients do not need angiography

All heart patients with heart blockages do not need angiography, said Dr. K K Aggarwal President, Heart Care Foundation of India and Editor eMedinewS.

Dr. Aggarwal said that failure of adequate medical treatment to provide desired quality of life is the main indication for angiography.

Quoting a formula, Dr. Aggarwal said that any person who can walk two kilometers, climb two flights of stairs or can have sex with his or her partner without any shortness of breath or uneasiness in the chest has no significant blockages inside the heart and may not need angiography.

He said that if a patient does not want angioplasty or bypass surgery, no angiography is needed. Also, patients with angina, or unstable angina where bypass surgery or angioplasty is not feasible, should not subjected to angiography.

Angiography is also not indicated for asymptomatic patients with coronary artery disease as a screening test. As well as after successful PTCA or bypass or in patients with acute heart attack, in absence of symptoms.

However, he said management of acute heart attack in the first three hours requires either clot dissolving therapy or opening up of the vessels with urgent angiography and angioplasty.

All young patients with heart blockages, survivors of cardiac arrest, heart disease with low functioning of the heart and symptomatic patients with heart blockages need angiography evaluation at the earliest and possible surgery and angioplasty.

Punjab & Sind Bank
Central Bank of India

Question of the day

What is treatment of acute renal failure in malaria?

The treatment of ARF includes guidelines initiation of appropriate antimalarials, at the earliest, and maintenance of fluid and electrolytes: Recording of intake and output chart, prevention of fluid overload, and secondary infection including pneumonia. Appropriate treatment of acquired infection with antibiotics. To prevent fluid overload a central venous pressure (CVP) line can be established.

Fluid challenge: 1. If any patient is dehydrated, he should be given a fluid challenge of upto 20 ml/kg of 0.9% saline infused over 60 minutes. In order to prevent fluid overload, auscultation of lungs and jugular venous pressure (JVP) measurements (and if possible, CVP measurements) should be performed after every 200 ml of fluid. The CVP should always be kept between 0 and +5. If there is no urine output after fluid replacement, an intravenous diuretic challenge may be given.

2. Diuretic challenge: The loop diuretic (furosemide or bumetanide) 40 mg is given initially and then in incremental dose of 100, 200 and 400 mg at half–hourly intervals. If there is still no urine flow, dopamine 2.5–5 mg/kg/min may be tried. Antimalarials
1. Quinine, chloroquine and artemisinin are the mainstay of therapy. Even in the presence of pregnancy and acute renal failure (ARF), quinine should not be withheld for fear of toxicity. Quinine should be given in a dose of 10 mg/kg 8 hourly during the first 48 hours of treatment. However, when it needs to be given beyond this period, the dose should be reduced to two–thirds or one-half. The dose should not be reduced in the initial 48 hours.

2. Cardiotoxicity of quinine must be of concern in malaria patients with ARF after 3 days of quinine therapy, and ECG monitoring during quinine infusion is recommended in all severe malaria patients with persistent ARF. If there is any arrhythmia, the infusion should be discontinued.

Dialysis: Dialysis has improved the survival of the cases when instituted early in the course. Clearance of urea and other molecular waste products is much faster with hemodialysis as compared to peritoneal dialysis. However, peritoneal dialysis has certain advantages such as: Peritoneal dialysis does not need a special set up, it can be started immediately, it may prove to be life saving. Thus, in the absence of facilities for hemodialysis whenever indicated, peritoneal dialysis should be started as early as possible.
Other associated conditions requiring attention:

  • Hypervolemia
  • Hyperkalemia
  • Metabolic acidosis
  • Anemia
  • Infection.

(Suggested reading: WHO. Severe falciparum malaria. Trans. R. Soc. Trop. Med. Hyg. 2000;94(Suppl.):1–90).

eMedinewS Try this it Works

Lessening the pain of venipuncture
Ask the patient which arm they prefer you to use. By giving this choice, you are helping them regain some control over their healthcare.

Dr Good Dr Bad

Situation: An elderly male had an A1C of 6.5%
Dr Bad: Its very good control.
Dr Good: Reduce the dose of drugs.
Lesson: A1C goal should also be set somewhat higher for older patients and those with a limited life expectancy. The American Geriatrics Society suggests an A1C target of 8 percent for frail older adults and individuals with life expectancy of less than five years.(Source: Ann Intern Med 2008;149:11.)

Make Sure

Situation: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the anti-platelet agent started?
Make Sure before starting intergrilin the BP is checked. Severe hypertension (systolic blood pressure≥ 200 mmHg or diastolic blood pressure >110 mmHg not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.

Laughter the best medicine

Hypochondriac – a person wants to have her ache and treat it too

Formulae in Imaging

Ultrasound can be used to characterize polypoid lesions of the gallbladder.(Source: Ahrendt SA. Pitt HA. Chapter 52: Biliary tract. pages 1597–1641 (page 1622). In: Townsend CM, Beauchamp RD, et al. (eds). Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice, 17th Edn. Elsevier Saunders. 2004; Sugiyama M, et al. Differential diagnosis of small polypoid lesions of the gallbladder. The value of endoscopic ultrasonography. Annals Surgery 1999; 229: 498–504.)

ENT Facts

There is no evidence to support any particular antibiotic regimen versus another for treatment of acute otitis media.

SMS Anemia

In leukocytosis with anemia, rule out presence of infection, inflammation, or a hematologic malignancy.

Milestones in Neurology

Macdonald Critchley (1900–1997) was a British neurologist. He was former president of the World Federation of Neurology, and the author of over 200 published articles on neurology and 20 books, including The Parietal Lobes (1953), Aphasiology, and biographies of James Parkinson and Sir William Gowers. His works on aphasia and parietal lobes are best known. He was one of the founders of the ‘British Migraine trust’.

Mistakes in Critical Care

Never write a period after mg or mL. ‘Period’ or ‘.’ Can be misread as ‘1’. Always write plain mg or mL

LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009

Drug Name Indication Approval Date
Nicotine (as Polacrilex) Lozenges 2mg & 4mg
To reduce the withdrawal symptoms, including nicotine craving, associated with quitting smoking and quitting chewed tobacco and guthka containing tobacco.


(Advertorial section)

Green Tea (Camellia sinensis) when used along with Unique Health Supplements like Sodium Metasilicate, Sodium,
Phosphate and Ammonium Chloride may help boost Body Metabolism to aid weight loss, block allergic response, slow down the growth of tumours, protect bones, fight bad breath, improve Skin, protect against Alzheimer's and Parkinson's disease and even delay the onset of Diabetes. The Combination is known to reduce the VLDL and LDL Levels and thus reduce the incidence of Stroke and Heart disease.

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–PadmaCon 2010 

Will be organized at MAMC on July 4, 2010, Sunday to commemorate Doctors′ Day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

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 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.

Readers Responses

  1. High caloric intake linked to diabetic retinopathy (Dr G M Singh) African–Americans with type 1 diabetes are at higher risk of developing diabetic retinopathy if they have a high caloric intake, according to a study in the January issue of the Archives of Ophthalmology. In a related study in the same issue, signs of retinopathy are present in Asians without diabetes, with the higher risk associated with traditional cardiovascular risk factors.

  2. Dear KK & Family: Please accept our heartiest congratulations to you and your family on the occasion of your being awarded the most prestigious national PADMA SHRI Award which you so richly deserve. It is a matter of great pride for us.
    Fame is not an end in itself. It has come to you as a by product of an exemplary and dutiful life.
    You are someone who is graceful, charming, unique and rare
    Who spreads happiness, liveliness and smiles everywhere
    As the blossom sends forth its fragrance, similarly your love for all becomes all embracing and inspiring.
    Like the blazing sun, your intellect throws luster on all you come in contact with
    You are an exceptionally generous person and that tends to rub off on all those who come in your contact.
    You are a catalyst of honesty, professionalism and mutual respect for all
    Absence of egoism has raised your glory and stature to the sky
    May the Creator of this splendorous world
    Graciously bless you and your family with good fortune.
    We are wishing for years and years of your affection to us.
    Wishing you many more awards and successes and honours.
    Dr. Urmil & K.B. Sharma ( B–7, Swasthya Vihar, Delhi–110092)