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
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


Dear Colleague

16th March 2010, Tuesday

Excerpts of a seminar for physicians organized by Delhi Nephrology Society and Maulana Azad Medical College, New Delhi . Dr NP Singh – Moderator, Panelists Dr SC Tiwari, Dr KK Aggarwal, Dr Dinesh Khullar, Dr Sanjay Gupta and Dr Sanjiv Gulati

  1. CKD now can be predicted even while in the womb. An IUGR baby will be born with less number of nephrons and hence susceptible for chronic kidney disease in future.

  2. The term ‘Chronic Renal Failure’ has now been replaced with ‘Chronic Kidney Disease’.

  3. The term ‘Acute Renal Failure’ has now been replaced with ‘Acute Kidney Injury’.

  4. The term ‘Renal Osteodystrophy’ is now termed as "mineral bone disease".

  5. All laboratories should calculate estimated GFR and give this value along with serum creatinine.

  6. eGFR is = (140 – age) x Current Weight divided by 72 x Serum Creatinine.

  7. Diabetes and blood pressure account for 80% of patients with CKD.

  8. The family history of CKD is a risk factor for CKD.

  9. Acute Kidney Injury is a risk factor for future CKD.

  10. At a GFR of 60, one may see postprandial increase in phosphate level. Anemia also starts at this level.

  11. Nocturia may be the only manifestation of underlying CKD.

  12. In a patient with CKD, one should never prick the left hand as we must preserve the veins for future fistula.

  13. In CKD, ACE–inhibitors can be given at any level of serum creatinine under supervision.

  14. In every patient with CKD, rule out underlying iron deficiency anemia.

  15. In CKD, oral iron may not be absorbed properly and hence the patient may require intravenous iron.

  16. EPO is only required when GFR is less than 30 and serum iron is normal.

  17. ACE–inhibitors have anti–proteuric effects.

Dr KK Aggarwal
Chief Editor

Photo feature


SPARSH a project of Jabalpur Obstertics. and Gynecology. Society launched by Dr Sanjay Gupte, FOGSI President 2010 .

Dr k k Aggarwal

Kidney news and views (Dr Brahm Vasudeva)

Kidney donation may not impact long–term survival

People who donate a kidney to a sick friend or relative live at least as long as others in the general population, according to a study published in the Journal of the American Medical Association. Within the first 90 days after surgery to donate a kidney, their death rate was slightly higher at three per 10,000, compared with less than one per 10,000 in healthy non–donors,But, over 15 years, there was no difference in deaths of donors compared with others matched by age, health status, gender, and race.

Insulin Glargine may be effective treatment for obese, non–obese type 2 diabetics

According to a study published online March 4 in the journal Diabetes Obesity and Metabolism, treatment with insulin glargine is effective for lowering glycated hemoglobin (HbA1c), without substantial weight gain, in obese and nonobese individuals with type 2 diabetes.

Diabetes patients with more interactive relationship style may have lower risk

According to a study published in the journal Diabetes Care, patients with diabetes who have a more interactive relationship style and who are more inclined to seek social support when needed have lower five–year mortality than those who do not.

FDA News (Dr Monica Vasudeva)

FDA panel recommends pirfenidone for approval
FDA’s panel of lung experts on Tuesday voted in favor of an experimental drug from InterMune Inc., despite mixed evidence of whether it provides significant benefits for patients with idiopathic pulmonary fibrosis.

FDA approves Botox to treat elbow, wrist, and finger spasms

The FDA has on approved Allergan’s Botox [Botulinum toxin Type A] to treat spasms of the elbow, wrist and fingers. However, it has emphasized that Botox is not approved to treat spasms in larger muscles of the arms or legs. In 2009, the agency added warnings to Botox about its potential to migrate from limbs to other parts of the body, causing breathing problems.

Frequent napping linked to increased risk of type 2 diabetes in older adults

A study in the March 1 issue of the journal Sleep shows that frequent napping is associated with an elevated prevalence of type 2 diabetes and impaired fasting glucose in an older Chinese population.

Full house raises risk of hospital deaths

Admission to a hospital when most beds are occupied can be deadly for patients. A University of Michigan study showed that high occupancy increases the risk of dying in the hospital by 5.6 percent (published in the March issue of Medical Care). Researchers evaluated a set of critical factors that can affect hospital deaths: hospital occupancy, nurse staffing levels, weekend admission and seasonal influenza.

Hepatitis C and Insulin Resistance

Hepatitis C increases chances of type 2 diabetes by 3–4 folds. In studying the insulin resistance of 29 people with Hepatitis C, Australian researchers have confirmed that they have high insulin resistance, a precursor to diabetes. However, almost all insulin resistance occurs in muscle, with little or none in the liver, a very surprising finding given that Hepatitis C is a liver disease. [Source: journal Gastroenterology]

Sex at 60

At age 55, men can expect another 15 years of sexual activity, but women that age should expect less than 11 years, according to a study by University of Chicago researchers [online March 10 British Medical Journal]. Men in good or excellent health at 55 can add 5 to 7 years to that number.

Conference Calendar

Heart Saver First Aid (HSFA) Provider Course American Heart Association (AHA) Accredited (Target Audience – General Public)
Date: March 18, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.
Website: www.tact-india.com

What’s New

Orthopedics and spinal disease

Spinal fusion surgery may be more effective than unstructured nonsurgical care, but equally effective compared to intense multidisciplinary rehabilitation in patients with disabling nonradicular back pain.(Chou R, Baisden J, Carragee EJ, et al. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 2009; 34:1094.)

Cancer Alert

Colonic adenoma

A study of patients with colonic adenomas found that patients with a history of an advanced adenoma or multiple adenomas were at increased risk for recurrent adenomas during surveillance colonoscopies, even if the first follow–up study was negative. (Robertson DJ, Burke CA, Welch HG, et al. Using the results of a baseline and a surveillance colonoscopy to predict recurrent adenomas with high–risk characteristics. Ann Intern Med 2009; 151:103)

Quote of the Day

Underneath prayer disappears adversity.
(Pepper Giardino)

Diabetes Fact

The usual dose of sitagliptin is 100 mg once daily, with reduction to 50 mg for moderate to severe renal insufficiency (GFR <30 to 50 ml/min) and 25 mg for severe renal insufficiency (<30ml/min).

Public Forum (Press Release)

Chocolate, not tea, good for the heart

Regular consumption of polyphenol–rich cocoa products like dark chocolate may be considered a part of dietary approaches to lower BP, provided there is no total gain in calorie intake, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Drug treatment is the basis of blood pressure control, and it should always be accompanied by lifestyle measures such as exercise and proper diet.

The recommendation is an occasional cup of cocoa but not chocolate milk, because it is high in sugar and fat.

According to a survey of medical literature by German researcher, Dr. Dirk Taubert from the University Hospital of Cologne, Cocoa–rich products help lower high blood pressure and not tea. They covered 10 studies on cocoa that included 173 participants and five tea studies with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mm HG in systolic pressure and 2 to 3 mm in diastolic pressure –– enough to reduce the risk of stroke by 20 percent and of coronary heart disease by 10 percent. No such reduction in blood pressure was noted in any of the tea trials, which lasted an average of four weeks. Tea and cocoa contain different kinds of polyphenols –– flavan–3–ols in tea, procyanids in cocoa.

Question of the day

What is intrahepatic cholestasis in pregnancy?

Cholestasis in pregnancy can be related to pregnancy (intrahepatic cholestasis) or unrelated (choledocholithiasis, viral hepatitis, primary biliary cirrhosis).
Intrahepatic cholestasis is one of the most common causes of cholestasis during pregnancy. It usually occurs in second or third trimester and resolves spontaneously after delivery. The incidence varies in different countries. A particularly high incidence has been noted in Chile. For unknown reasons ICP has been found to be more common in multiparous pregnancies and twin pregnancies.

Clinical picture: Pruritus is the hallmark of this syndrome. It can be severe, intolerable, affecting whole body, predominantly in palms and soles and prominent during nights. Onset of pruritus is usually in the second or third trimester of pregnancy but cases have been reported in the first trimester. Examination usually shows signs of pruritus.
Jaundice is rare, seen in 10–20% of cases, usually conjugated hyperbilirubinemia. Steatorrhea is a common manifestation but is more often subclinical.
Urinary tract infection is common in intrahepatic cholestasis of pregnancy (ICP), and may play a role in precipitating the onset of this syndrome. Fever is not seen with ICP, unless there is an associated infection.

Laboratory findings: Increase in serum alanine aminotransferase activity is a sensitive test for diagnosis of ICP. However with values >1,000, one must suspect acute viral hepatitis, which can be ruled out with relevant tests (anti–HAV IgM, anti–HEV IgM). The alkaline phosphatase is usually elevated in the pregnancy and hence is not a reliable indicator of ICP.

eMedinewS Try this it Works

Glue for torn fingernail

Glu can be used to mend a torn fingernail by applying a small amount over the tear and allowing it to dry

Dr Good Dr Bad

Situation: A BPH patient came with severe symptoms.
Dr Bad: Get an ultrasound done.
Dr Good: Get ultrasound and blood sugar done.
Lesson: In patients with BPH, diabetes is associated with more severe lower urinary tract symptoms compared with non diabetic men (J Urol 2000;163:1725–9.)

Make Sure

Situation: A known patient of NIDDM taking oral hypoglycemics presents with hyperglycemic crisis.

Reaction: Oh, my God! I did not manage the patient aggressively

Make sure that patients with impaired glucose tolerance or NIDDM are fully evaluated for complications at the first visit. Present approach to therapy of NIDDM is characterized by approach to therapy of NIDDM is characterized by proactive shifts to agents that may be combined or prescribed in maximal doses to achieve normal or near normal glycemia from the time of diagnoses of NIDDM or impaired glucose tolerance, in order to prevent complications.

Medi Finance : (BUDGET 2010–2011)

Small Scale Industries

• Would be permitted to take full credit of Central Excise duty paid on capital goods in a single installment in the year of their receipt.
• Secondly, they would be permitted to pay Central Excise duty on a quarterly, rather than monthly, basis.

Punjab & Sind Bank
Central Bank of India
¤JCP Group

Laughter the best medicine

Histopathology report

Some areas of the necrotic material seem to show the ghastly outlines of chorionic villi.

Formulae in Critical Care

Corrected CSF white blood count
Formula: Subtract 1 WBC for every 1,000 RBCs

Mistakes in Clinical Practice

All drug names, dosage units, and directions for use should be written clearly to avoid confusion

Dr Sanjiv Chopra, Dean Faculty Harvard will be delivering a lecture on “Ten Tenants of Leadership” on 20th Saturday 2P.M. at MAMC (Maulana Azad Medical College), Dilll Gate.

Title of Talk:  Leadership for the 21st Century:  The Ten Tenets of Leadership

Learning Objectives:
1. Discuss the qualities of great leaders.
2. Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
3. Emphasize that we can all lead and can do so at many different levels.
4. Explore what made or makes many leaders – historical and contemporary – so effective.

Leadership Talk Description

In this talk Dr. Sanjiv Chopra  will discuss historic figures such as Mahatma Gandhi, Florence Nightingale, and Winston Churchill, as well as contemporary leaders, and examine what makes them effective.  What are some of the qualities and attributes of the great leaders?  What is leadership, and can it be taught or is it something you’re born with?  He will assert that great leaders listen will, they have empathy, they dream big, they’re resilient, they have a sense of purpose.  The possess humility and humor, they also have integrity and great people skills. Dr. Sanjiv Chopra will examine whether Adolf Hitler, who was certainly a charismatic figure and fiery orator, was a great leader. He  will discuss 10 Tenets of Leadership. Anyone who follows these tenets will be on the path to becoming a better leader. Leaders occur in all walks of life, and one can lead at many different levels.

Organisers: emedinews, Ficci Ladies Organisation, DMA, MAMC, HCFI, WFR

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

TRUS (Transrectal USG) is superior to trans abdominal USG to assess the morphology and diseases of prostate and to help in TRUS–guided prostate biopsy

Lab test (Dr Navin Dang)

Blood test recommended for screening for celiac disease: Tissue transglutaminase (IgA) estimation. Raised in celiacs. Must be confirmed by a biopsy.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Rifaximin 400mg (additional Indication)

For the treatment of hepatic encephalopathy


(Advertorial section)


Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

Advertising in eMedinewS

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

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April). Over 300 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

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. Congratulations Dr. Aggarwal, We want to tell you how proud we are of you for your outstanding achievement in obtaining Padma Shri award. Please accept our compliments and wishes for your happiness and success. I commend you for your dedication and hard work. You deserve to be proud of your achievement. May your future efforts be equally successful and rewarding. We compliment you on your success and send our best wishes for the future, You are a example of how commitment and hard work pay off: Sanjeev Kr. Gupta. Asst. General Manager Techpark India Pvt. Ltd.

2. Hello Dr Aggarwal, My reply is the response to the recent MCI guidelines regarding the doctor–pharmas relation. Ours is a noble profession. We also earn our living out of it.
I don’t think any doctor would prescribe sub standard medicines for personal benefits because that way he also will lose patients. The pharma industry is now a well–developed and one of the fastest growing business full of competition, and sponsorship is here to stay for medical education and research, even if MCI bans one type of practice the means of giving benefits would change given the tough competition between pharmas, and guidelines such as these only further promote unethical means. The losers would only be genuine doctors who cannot afford to attend medical conferences on their own, given the avg. consultation fee in India of a doctor in pvt. sector which is only Rs.100–500 i.e $2–10 approximately. In this US, it is $100 and recently our national pediatric conf.had a spot reg. of Rs.11,000/– . MCI should also have a regulation on these issues. By merely torturing poor doctors who are delegates in these conferences, nothing can be achieved, our doctors will rather lose out on the recent innovaions in medicine: Dr Puneet Wadhwa.Faridabad