HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



You can download previous issues at www.emedinews.in

21st December Monday

Dear Colleague,

 Obese women should gain little or no weight during pregnancy

One fifth of urban pregnant women are obese, and more and more doctors are advising them to watch their weight if they want an easy pregnancy and a smooth delivery.  Earlier this year, the IOM issued guidelines that lowered the minimum recommended weight gain for obese women to 11 pounds, from 15. Now, Cornell researchers recommend that obese pregnant women should not gain any weight at all and if they do gain weight, it should be limited to three percent of their baseline weight. 

Dr KK Aggarwal



 Newest FDA Approvals

On December 14, 2009, the US FDA gave its approval to long acting injectable Zyprexa Relprevv (olanzapine) for the treatment of schizophrenia in adults. Zyprexa Relprevv is administered by intramuscular injection and sustains the delivery of olanzapine for up to 4 weeks

The antipsychotic Zyprexa (olanzapine) was approved by the FDA on December 4, 2009 in tablet form as an option for the treatment of schizophrenia and manic or mixed episodes associated with bipolar I disorder in adolescents aged 13 to 17 years. The FDA recommends using Zyprexa as part of a total treatment program for pediatric patients with schizophrenia and bipolar I disorder, which may include psychologic, educational, and social interventions. The FDA also cautions clinicians to be aware about the risk of weight gain and hyperlipidemia in adolescents (compared with adults) and the potential for long term risks.

Safety Notices

On December 4, 2009, the FDA issued a notification to health care professionals about revisions to the Hepatic Effects section of the prescribing information for all products containing diclofenac sodium (including Voltaren gel). The updated labels for diclofenac products now  carry new warnings and precautions about the likelihood of elevations in liver function test results during treatment.

Increased alcohol intake increases breast cancer recurrence

According to a study, obese, postmenopausal women and those who were the heaviest drinkers faced the greatest risk of breast cancer recurrence. In the study, women who were moderate to heavy drinkers reportedly had a 1.3 fold increase in breast cancer recurrence vs those who drank only minimally or abstained. Greater the amount of alcohol consumed, higher were the chances of recurrence. Women who drank less than 6 grams of alcohol per day (about a half-glass) had no increased recurrence risk. Among breast cancer survivors, a 1.5-fold increased risk was noted among post-menopausal women, but not among pre-menopausal women; a 1.58 fold increase risk was observed among overweight and obese women, while there was no increase in the risk among normal-weight women.

Study recommends using Herceptin and chemotherapy together

Based on their findings, a US study has recommended using Herceptin (trastuzumab) together with chemotherapy. The N9831 trial, a Phase III, one-year multicenter, trial observed a 25% decrease in the risk of cancer recurrence or death when Herceptin and chemotherapy were administered at the same time as compared against women who had been given Herceptin after chemotherapy. Overall, the addition of one year of Herceptin to chemotherapy, whether sequentially or concurrently, was associated with a 33% reduction in the risk of cancer returning compared with chemotherapy alone.

Immune system may be the culprit in COPD

A study published in the December 15 issue of the American Journal of Respiratory and Critical Care Medicine has highlighted the role of the immune system in COPD or chronic obstructive pulmonary disease. Nearly all people diagnosed with COPD have emphysema or chronic bronchitis or most commonly, both conditions. Dendritic cells, a type of immune cell sets off immune responses were found to exhibit increased activity in the lung and interact with lymphocytes. These dendritic cells become more active as the disease progresses. Altering or checking the action of these cells could halt disease progression.

A cure for tinnitus...a possibility now

Scientists are hopeful of a cure for tinnitus soon after its onset. A study from the University of Western Australia has shown that spontaneous nerve activity in the brain is dependent on nerve signals generated in the inner ear. Reducing these signals from the inner ear could decrease the brain activity and thus cure tinnitus. The increased nerve activity in the brain is often caused by exposure to loud noise such as music or machinery. But, after six weeks, the increased nerve activity generated in the brain becomes independent of input from the ears. This suggests that if tinnitus can be treated by dampening down nerve signals from the ear, it must be done quickly early phase of tinnitus development before it becomes irreversible.

Study links risk of Alzheimer's disease to levels of appetite hormone

A 12-year study involving  198 elderly volunteers has reported that high levels of leptin in older volunteers, a hormone that regulates appetite, are associated with decreased risk of developing Alzheimer's disease; while, those with the lowest levels of leptin had more chances of developing the disease. Low leptin levels have been linked to the brain plaques found in patients with Alzheimer's. A quarter of those with the lowest levels of leptin went on to develop Alzheimer's disease, compared with 6% of those with the highest levels suggesting that leptin levels in older adults may serve as one of several possible biomarkers for healthy brain aging. The study is published in JAMA.

Acid reflux disease vs Heart attack

If you have a burning pain in your chest, you may be suffering from heartburn caused by gastroesophageal reflux disease, or GERD. But, it could also be a warning sign of a heart attack that may be life-threatening. Visit your doctor as soon as you can. . Answering few questions may be of help.

Type of pain: Heartburn due to GERD may be felt as a burning sensation just below the sternum (the breastbone) or ribs, it moves up into the throat with reflux of acid. Lying down or bending may aggravate the pain. In contrast, the chest pain due to a heart attack is a sudden and severe dull pain in the center of the chest. This pain may radiate to arms, into the jaw, ear or neck.

Other associated symptoms: In acid reflux, there is a sour taste in the mouth. Heart attack is associated with cold sweats, a symptom not common in heartburn, as well as lightheadedness, nausea, shortness of breath and heart palpitations.

Onset of pain: Pain due to acid reflux in GERD may occur after consuming fatty or greasy foods, acidic foods, spicy foods or caffeine or 30 to 45 minutes following a large meal. A heart attack may be preceded by physical exertion or may occur during high stress.

Duration of pain: Pain due to heartburn in GERD typically reduces after 5 to 10 minutes. The pain of a heart attack pain is longer-lasting, and may fade away and come back.

Relief from pain: Heartburn due to acid reflux responds to antacids. The pain of a heart attack will respond to nitroglycerin tablets.


A self-important young physician was haranguing an elderly family doctor about modern developments in medicine. "The days of the non-specialist are over," he claimed. "To keep abreast with modern medical science one must specialize intensively. Even the old so-called specialties were far too broadly based. Take ear, nose and throat work, for instance - nowadays that represents far too wide and complex a field of investigations for one man to cover scientifically. I intend to concentrate only on the nose…" "Really?" murmured the old doctor. "Which nostril?"

The Consultant was doing a hospital round. He stopped at the bedside of one gloomy looking patient and examined the chart and case notes, nodding wisely. You are progressing very well indeed, my man, he announced at last.

I see that your neck is still very swollen, but I'm not too worried about that. I dare say you're not! burst out the patient. "And if yours was swollen don't kid yourself that I'd be shedding any tears either.

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Letters to the editor
1. It was good to know about the ventilator settings for critically sick H1N1 patients. Is anybody having hands on experience with Lung Bypass (ECMO - Extra Corporeal Membrane Oxygenator) used for H1N1 patients, who are too sick to respond to ventilators? Kindly share which hospital is giving this facility etc etc. Dr Vivek Chhabra.

2. Dr Aggarwal, thank you for your newsletter. I am sure a lot of people like me read it regularly and appreciate the contents. Shelly Batra, MD

3. respected sir, i regularly go through ur e-medinews, great effort. make a small gynae section also. wish u a very best of luck. Poonam.

4. Dear Brother DR.KK Simply MAGNIFICIENT. It can only come from a person like you WHO PRACTICIZES.. God bless. Our Profession is both ENRICHED AND GLORIFIED to have a SAGE like YOU amongst us. It will take Generations for Medical Fraternity to REALIZE YOUR TRUTH. GOD BLESS. Loving regards always Dr. N. K. Bhatia

5. Dear Dr Aggarwal: Let me again Congratulate for Keeping Up the Momentum of Academic Exercise every Day In the Morning. It is very easy to start anything but its takes lots of effort to keep the Programme going and Your  single handed enthusiasm cannot me matched. I have to again request you to Kindly through your ejournal inform the members about the Medicine Update2009 being held at MAMC from 21st Dec.  http://mamc.ac.in/medicine-update2009. Prof K Srinath Reddy , President ,Public Health  Foundation of India will be the Chief Guest and will inaugurate the Update at 12.30 PM on Monday 21st Dec. I will also request you to Kindly cover the Update and Key messages can be disseminated to all those who due to some reasons cannot attend the same. Also the Update is accredited by DMC for 21hrs. With Warm Regards. DR  NP SINGH(Nanu),

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emedinews: revisiting 2009
IJCP Group is organizing emedinews: revisiting 2009, conference on 10th Jan 2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (whats new in cardiac surgery), Dr Ajay Kriplani (surgical cure for obesity and diabetes), Dr Praveen Chandra (left main stenting), Dr Harsh Mahajan (PET Scan), Dr Kaberi Banerjee (all about infertility), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephrology update), Dr. Ambrish Mithal from Medanta on Diabetes, Dr Vanita Arora (ECG arrhythmias), Dr Subramanium (Co Q 10 a new modality), Dr Neelam Mohan (Paed. Hepatology), and Dr. Sanjay Chaudhary on Eye Update etc) will deliver lectures.
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 Eye care snippets by Dr. Narendra Kumar (OptometryToday@gmail.com)


Vision is the result of the dioptric apparatus of the eye, the retina, the nerves, and the central nervous system. The first step in the optical examination of the patient is to determine his/her visual acuity.

In the testing of the acuity of vision, Snellen's test types are commonly used.  These consist of a series of letters of gradually smaller size. The first line of type is so constructed that  it should be read by a person with normal vision from a distance of 60 meters, the second line from 36 meters, the third from 24, the fourth from 18, the fifth from 12, the sixth from 9, and the seventh  from 6 meters. Thus if the  patient  sits at a standard distance of 6 meters, s/he should be able to read the seventh line of the test types easily with each eye separately. If s/he can not read this line, his/her distant vision is defective.

The acuity of vision is recorded as a fraction, the numerator denoting the distance at which the patient sits away from the test types (6 meters), and the denominator indicating the line that s/he sees at this distance.  If his/her vision is normal, s/he should read the seventh line from a distance of 6 meters, and his/her visual acuity would be 6/6. If from this distance, s/he can only see the first line which a person with normal vision should see from a distance of 60 meters, his/her V.A. is 6/60.

In the United States, the fraction is written in terms of feet; vision of 6/6 is, thus, 20/20 and of 6/60, 20/200.

The test types should be clear in print and with uniform illumination, the light being shaded from the patient's eyes.  If 6 metre distance between the test types and the patient is not available, reversed test types above the patient's head and a mirror on the opposite wall at a distance of 3 meters may be used.

One eye is covered at a time, and the patient asked to read the lowest possible line. The other eye is then covered and vision recorded. In a person with normal vision, the result will be recorded as follows: RE = 6/6, LE = 6/6.

Many patients cannot read even the top letter; the vision is less than 6/60 in these cases and it is better to bring the patient nearer to the test types at a distance from where s/he can recognize the top letter. Vision recorded will now be designated by the fraction 2/60, 3/60 or 4/60 as the case may be.

Where vision is lower even than this and no test letter at any distance can be recognized, the counting of fingers is resorted to, the practitioner holding up his/her hand in front of the patient and asking him/her the number of fingers s/he can see. The result is then recorded thus: V = C.F. at 1 meter, or whatever the case may be. In case the patient cannot count fingers at any  distance, the practitioner then moves his/her hand in front of  the patient's eye, and if the patient can notice the movement the result is recorded as: V = H.M.  When this is also unavailing the final test i.e., the ability to determine between light and dark is tried; patient is asked to tell whether the light in the practitioner's hand is switched on or off. Failure to recognize this is recorded as 'No PL' (no perception of light). When mere PL exists, the light is thrown into the eye from different directions, and the patient is asked to tell the direction  from which the light  appears to be coming;  this is known as projection, and a note is made (indicating '+' for 'perception', ' ' for 'no perception', and '+' for doubtful perception). In case of malingerers, illiterates, or young children, a 'C' (Landolt's broken ring test) or 'E' chart may be used instead of the ordinary 'English' or 'Hindi' test types.

After recording distant vision, the testing of near vision is also important. The patient remains seated with enough light coming from above the left shoulder. S/he is given the near vision test type (Jaeger' or Roman) and asked to read at the average reading distance (35 cm. or 14 in.) or at his/her nrmal working distance. Vision is recorded as the smallest type which can be read comfortably, as follows: N.V. = J1 or N5 at 35 cm.  (J1, J2, J3, J4, J5, J6; or N5, N6, N8, N10, N12, N14, N18, N24, N36, N48, as the case may be).

Legal blindness varies in definition from country to country. A person who cannot be corrected to more than 6/60 in the better eye is considered blind in India.




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