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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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; Chairman Ethical Committee 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


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  Editorial …

29th August 2011, Monday

Linagliptin new DPP–IV inhibitor

It is used as an adjunct to diet and exercise in adults with type 2 diabetes mellitus. It can be used as monotherapy or in combination with other oral agents. It lowers A1C by o.5% (1–4). Adverse reactions were uncommon, but include nasopharyngitis, hyperlipidemia, cough, hypertriglyceridemia, and weight gain (5).

As it is eliminated via the enterohepatic system, no dose adjustment is necessary in patients with renal or hepatic impairment.


  1. Diabetes Obes Metab 2011;13:65.
  2. Diabetes Obes Metab 2011;13:258.
  3. Scott LJ. Linagliptin: in type 2 diabetes mellitus. Drugs 2011;71:611.
  4. Diabetes Obes Metab 2011.
  5. http://bidocs.boehringer–ingelheim.com/BIWebAccess/ViewServlet.ser?

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Linagliptin new DPP–IV inhibitor

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Dr Kaberi Banerjee, presented her views on MTP, PNDT Act in the recently concluded National Conference on Insight on Medico Legal Issue.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Doctors to spend more time with patients

The Medical Council of India may soon specify how much time doctors should spend with patients so that the regimen of medicines being prescribed to them is clear.

A recent World Medicines Situation 2011 report brought out by the WHO had said that doctors in developing countries, on average, spend less than 60 seconds in prescribing medicines and explaining the regimen to patients.

Consequently, only half of the patients receive advice on how to take medicines and about one third of them don’t know how to take drugs immediately on leaving the facility.

Source TOI 27th Aug

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Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

Stress coronary CT scan

Stress CT perfusion scan on a 128 slice CT scanner is comparable to stress cardiac MRI at identifying reversible ischemia, and to catheter angiography at identifying significant stenosis, while delivering very low radiation exposure (sensitivity of 96%, negative predictive value of 94%) according to Gudrun M. Feuchtner, MD, from Innsbruck Medical University in Innsbruck, Austria, and colleagues. The radiation exposure for the entire rest/stress CT protocol averaged 2.5 mSv (0.93 mSv for the stress exam, 1.59 mSv for the rest exam). (Source: Medpage Today)

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Autism not caused by vaccines

Some vaccines can cause some adverse effects, including seizures and brain inflammation but autism isn’t one of them, according to a new report from the Institute of Medicine. (Source: Medpage Today)

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Heart risk unclear for psoriasis drugs

Preliminary signals of excess cardiovascular risk with two monoclonal antibodies used for treating plaque psoriasis were not confirmed in a meta–analysis, but the analysis may not have been sufficiently powered to detect a significant increase, the reviewers said. (Source: Medpage Today)

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Non–small cell lung cancer drug gets FDA nod

The FDA has approved crizotinib (Xalkori), a novel targeted therapy for late–stage non–small cell lung cancer. The Pfizer drug, an inhibitor of anaplastic lymphoma kinase, is a twice–daily pill intended for a select group of patients who express the abnormal anaplastic lymphoma kinase (ALK) gene, which causes cancer development and growth. (Source: Medpage Today)

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    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Study finds that it’s possible to be fat and healthy

A study out of York University has some refreshing news: Being fat can actually be good for you. Published in the journal Applied Physiology, Nutrition and Metabolism, the study finds that obese people who are otherwise healthy live just as long as their slim counterparts, and are less likely to die of cardiovascular causes. "Our findings challenge the idea that all obese individuals need to lose weight," says lead author Jennifer Kuk, assistant professor in York’s School of Kinesiology & Health Science, Faculty of Health.

Kuk’s team looked at 6,000 obese Americans over a 16–year span, comparing their mortality risk with that of lean individuals. They found that obese individuals who had no (or only mild) physical, psychological or physiological impairments had a higher body weight in early adulthood, were happier with this higher body weight, and had attempted to lose weight less frequently during their lives. However, these individuals were also more likely to be physically active and consume a healthy diet. Researchers used a newly–developed grading tool, the Edmonton Obesity Staging System (EOSS), which has been found to be more accurate than body mass index (BMI) for identifying who should attempt to lose weight. Developed by University of Alberta researchers, it is modelled on staging systems that classify the extent and severity of other diseases such as cancer, mental illness and heart disease. It offers five stages of obesity based on both traditional physical measurements such as BMI and waist–to–hip ratio, plus clinical measurements that reflect medical conditions often caused or aggravated by obesity (such as diabetes, hypertension and heart disease).

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    Twitter of the Day

@DrKKAggarwal: #AJPP Addison’s disease presenting intially as bronchial asthma in a child T Satish Kumar et al AJPP Vol –14 no… fb.me/1eyEnF7Lq

@DeepakChopra: #PeaceIsTheWay Next session Is religion a hindrance or a help to peace? Your opinion please! Berlin Peace Festival

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

How to deal with re-feeding syndrome?

If the re-feeding syndrome occurs, doctors should immediately slow nutritional replenishment and correct low levels of phosphates, potassium and magnesium while monitoring the cardiovascular system. In patients at risk of re-feeding syndrome, nutritional support is initially delivered at a maximum of 10 kcal/kg/day and raised gradually to full needs within a week. In extreme cases this energy intake is limited to 5 kcal/kg/day.

Before and during the first 10 days of feeding, it is important to give 200-300 mg oral thiamine a day, 1-2 vitamin B complex tablets three times a day or intravenous vitamin B, and a balanced multivitamin and mineral supplement each day. One should monitor and supplement oral, enteral, or intravenous potassium, phosphate and magnesium in such patients. On average, patients should receive 2-4 mmol/kg/day potassium, 0.3-0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium.

Moderately to severely ill patients with marked edema or a serum phosphorous < 2 mg/dL should be hospitalized to intravenously correct electrolyte deficiencies.

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    Spiritual Update

Why is the first hour in any medical emergency is important

One should not ignore warning signals as "time is life" in medical science. The three cardinal warning signals are: any symptom which is unusual, any symptom which cannot be explained and any symptom appearing for the first time in life. ‘Time is life’ is an old saying. In acute heart attack,..

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    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

The Rock

An old farmer had plowed around a large rock in one of his fields for years. He had broken several plowshares and a cultivator on it and had grown rather morbid about the rock. After breaking another plowshare one day, and remembering all the trouble the rock had caused him through the years, he finally decided to do something about it.

When he put the crowbar under the rock, he was surprised to discover that it was only about six inches thick and that he could break it up easily with a sledgehammer. As he was carting the pieces away he had to smile, remembering all the trouble that the rock had caused him over the years and how easy it would have been to get rid of it sooner.

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    Gastro Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

Can celiac disease present with abnormal liver function tests?

Yes, celiac disease can present with abnormal liver enzymes; therefore, screening of celiac disease in patients with raised liver enzymes, especially if there is associated anemia, is a must.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • The ammonia test is primarily used to help investigate the cause of changes in behavior and consciousness.
  • It may be ordered, along with other tests such as glucose, electrolytes, and kidney and liver function tests, to help diagnose the cause of a coma of unknown origin or to help support the diagnosis of Reye's syndrome or hepatic encephalopathy caused by various liver diseases.
  • An ammonia level may also be ordered to help detect and evaluate the severity of a urea cycle defect.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with metabolic syndrome was found to have impaired kidney functions.
Dr Bad: They are not related.
Dr Good: They are related.
Lesson: People with metabolic syndrome are at 55% increased risk for kidney disease (reduced kidney functions), according to a study to appear in the Clinical Journal of the American Society of Nephrology. (Ref: Thomas G, et al. Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2011 Aug 18. Epub ahead of print)

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Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

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    Quote of the Day

(Dr GM Singh)

The size of your success is measured by the strength of your desire; the size of your dream; and how you handle disappointment along the way. ~ Robert Kiyosaki

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Polysaccharide vaccine gives immunity against typhoid for 3 years in 67–75% cases. However oral vaccine in 3 doses provides 90–95 % immunity in 3 years.

    Mind Teaser

Read this…………………

In a child, non–functioning kidney is best diagnosed by:

1. Ultrasonography
2. IVU
3. DTPA Renogram
4. Creatinine clearance

Yesterday’s Mind Teaser: The most sensitive imaging modality for diagnosing ureteric stones in a patient with acute colic is:

1. X–ray KUB region
2. Ultrasonogram
3. Non–contrasts CT scan of the abdomen.
4. Contrast–enhanced CT scan of the abdomen

Answer for Yesterday’s Mind Teaser: 3. Non–contrasts CT scan of the abdomen.

Correct answers received from: Dr Shirish Singhal, Dr BK Mittal, Dr Muthumperumal Thirumalpillai, Dr.Chandresh Jardosh, Dr Neelam Nath, Dr. G.P.Pande, Dr Anil Bairaria,

Answer for 27th August Mind Teaser: 3. Aqueductal stenosis
Correct answers received from: Dr Anupama, Dr Priti, Dr Sudha, Dr Piyush, Dr Shashi, Dr Ravindeer, Dr Jainendra Upadhyay, Dr Valluri Ramarao, Dr y. j. vasavada, Dr.K.V.Sarma

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr. Prabha Sanghi)

Funny definition

Conference Room: A place where everybody talks, nobody listens and everybody disagrees later on.

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Amlodipine Besilate IP Eq. to Amlodipine 5mg + Indapamide USP SR 1.5mg Tablet
For the treatment of mild to moderate hypertension
    Public Forum

(Press Release for use by the newspapers)

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Risk of heart attack triples with pre-hypertension

A person with pre–hypertension, upper systolic blood pressure between 120–140 mmHg and lower diastolic pressure between 80–90 mmHg, is more than three times likely to have a heart attack and 1.7 times more likely to have heart disease than a person whose blood pressure is lower than 120/80 mmHg, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Normal blood pressure is lower than 120/80 mmHg and hypertension is a blood pressure more than 140/90 mmHg or higher.

If pre–hypertension is aggressively treated, 47% of all heart attacks can be prevented. Lifestyle modifications such as weight control, regular physical activity and changes in diet are recommended for people with pre–hypertension. The importance of pre–hypertension has been listed as one of the top 10 recent advances in cardiology. Every effort should be made to lower the blood pressure below 120/80 mmHg.

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    Readers Responses
  1. Dear Sir Inspirational Story The World is a Puzzle is very nice. Regards: Dr Priya
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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