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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


30th April, 2010 Friday

Should one take preventive vitamins?


  1. Simple multivitamins (containing 0.5 to 1.5 RDA of all vitamins) are probably not beneficial for most adults who eat a balanced diet and get regular sun exposure or drink vitamin D–fortified dairy products. Because multivitamins may be harmful in some people, vitamin recommendations should be tailored to individual patients.

  2. A diet with five to nine servings of vegetables and fruits per day supplants multivitamin use in most patients. This diet promotes health not only by providing known vitamins, but also because it contains fiber and other less well–defined nutrients and replaces meat and animal fat.

  3. Women of childbearing potential should take a vitamin supplement containing at least 400 micrograms of folic acid per day. In addition to a varied diet, women who are trying to conceive should take a daily supplement of 400 to 800 micrograms folic acid or a prescription prenatal vitamin.

  4. People who take vitamin A–rich diet, pregnant women, and those who are at increased risk for fractures or osteopenia should avoid supplements that contain vitamin A, including multivitamin supplements.

  5. In osteoporosis, or previous fracture, add supplement of 800 IU of vitamin D with calcium, particularly if dietary intake is inadequate and sun exposure on the skin is poor. For all adults over age 70, the RDA is 600 IU per day. The value of vitamin D supplementation is marginal in younger adults but is better established in the elderly.

  6. High dose vitamin E (≥400 IU/day) increases all–cause mortality. No one without special indications take supplements containing high doses of vitamin E for preventive health care.

  7. Patients on anticoagulants should not be given high doses of vitamin E, which might cause bleeding complications.

  8. Patients at risk for vitamin deficiency, such as those with alcoholism, malabsorption, vegan diet, a history of gastric bypass surgery, or some inborn errors of metabolism, as well as those being treated with hemodialysis or parenteral nutrition, should receive multivitamins.

  9. Blood tests for vitamin deficiency are useful in some patients. Marginal blood levels should not be overinterpreted as abnormal. Patients with clear–cut deficiencies should be treated with additional vitamins.

  10. Patients should not use large doses of individual vitamins.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo Feature (Earth Day)

Dr HT Sangliana, Vice Chairman, Minority Commission, GOI, being felicitated wih a memento by R Mehta, Advisor Min. of Env. & Forests, GOI; Also in the picture (left to right): MI Hussain, Principal DPS Mathura Road, Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal and Sh Pramod Grover, Vice Chairman DPS Society. (For health awarenes, involve the people who counts)

Dr k k Aggarwal

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

Pentoxifylline for severe alcoholic hepatitis

Updated guidelines suggest pentoxifylline as an alternative to steroids in selected patients with severe alcoholic hepatitis. Tumor necrosis factor (TNF) levels are increased in patients with alcoholic hepatitis provided a rationale for use of pentoxifylline (an inhibitor of TNF synthesis) in alcoholic hepatitis.

A guideline (2010) issued by the American Association for the Study of Liver Diseases and the American College of Gastroenterology suggests pentoxifylline (400 mg orally three times daily for four weeks) as an alternative to steroids in patients with severe alcoholic hepatitis (Maddrey score ≥32), especially if there are contraindications to steroids. (Hepatology 2010;51:307)

News and Views (Dr Brahma and Dr Monica Vasudeva)

Prostate cancer vaccine

A decision is due from the FDA on Dendreon’s application to bring the country’s first cancer–treatment vaccine to market. The company’s prostate–cancer treatment, called Provenge (sipuleucel–T), leaps beyond the blunt instruments of surgery, radiation and chemotherapy to mobilize patients’ own immune systems against their tumors. Some analysts estimate a course of Provenge will cost between $50,000 and $ 75,000.

Bariatric surgery mask diabetes

Bariatric surgery may appear to cure diabetes based on measurements such as fasting plasma glucose and hemoglobin A1c, but postprandial glucose may still be high. [Dr Anna Marina, and Dr Dace Trence, of the University of Washington in Seattle at the American Association of Clinical Endocrinologists meeting].

Vegetable Compound Sensitizes Prostate Cancer

A substance found in cruciferous vegetables can make resistant prostate cancer cells sensitive to taxane therapy with docetaxel. Dong Xiao, PhD, assistant professor of pharmacology at the University of Pittsburgh Cancer Institute, said that phenethyl isothiocyanate, a constituent of edible cruciferous vegetables such as watercress, broccoli, bok choy, and cauliflower, suppresses the growth of cancer cells both in culture and in experimental animals. They demonstrated that combining phenethyl isothiocyanate with docetaxel increased apoptosis in androgen–independent human prostate cancer cell lines PC–3 and DU145.

Diabetics at higher risk of atrial fibrillation

In the Journal of General Internal Medicine, Dr. Sascha Dublin of Group Health Research Institute has linked diabetes to a 40 percent greater risk of developing atrial fibrillation; and she found this risk rises even higher, the longer people have diabetes and the less controlled their blood sugar is.

Prostate cancer: risk increases with the number of affected family members

Prostate cancer "runs in the family." Men with family members who have been diagnosed with the disease have an elevated risk of developing cancer of the prostate. Researchers of the department headed by Kari Hemminki at DKFZ, a German Cancer Research Center, analyzed 26,651 prostate cancer patients, 5,623 of whom came from families in which the disease had been diagnosed before. The more of a man’s direct relatives, i.e. brothers and fathers, are affected, the higher is his personal risk to develop prostate cancer himself. Men up to an age of 65 years with three affected brothers have a risk that is 23 times higher than that of the control group (men without affected family members). Men aged between 65 and 74 years, whose father was or is the only one affected, have a risk that is increased by 1.8 times and, thus, the lowest risk elevation in the familial cancer group. The personal risk is higher, younger the affected relatives were at the time of diagnosis.

Mnemonic of the Day (Dr Prachi Garg)

Swollen DIP (distal interphalangeal) joints – SPROG


What’s New : The use of a pacifier is associated with a reduced risk of sudden infant death syndrome

Concerns that pacifier use might interfere with exclusive breastfeeding were not corroborated by a randomized trial that found that pacifier use did not effect the rate of exclusive breastfeeding at three months of age. (Jenik AG, Vain NE, Gorestein AN, etal. Does the recommendation to use a pacifier influence the prevalence of breastfeeding?. J Pediatr 2009;155:350.)

Quote of the Day

"High achievement always takes place in a framework of high expectation." Jack Kinder

Diabetes Fact

Emphysematous cholecystitis is another diabetes complication. More males, high mortality.

DMA Update: 9th May is Mother’s Day Message

Age itself does not cause incontinence. Urinary tract changes that accompany age, such as increased involuntary contractions and decreased bladder sensation and contractility, make incontinence more likely.

Question of the Day

Which is the most critical period of life for development ?

The most important period of life of all stages for development is between ages 2 to 5 years. Attitudes, habits, patterns of behavior established during the early years determine to a large extent how successfully individuals will adjust to life as they grow older.

SMS of the Day (Dinesh Singh)

Santa galti se samunder me gir gaya. Doobte doobte uske hath me machlii mili. Use pakad kar bahar pheka aur bola 'JA TU TOH APNI JAAN BACHA LE.'

Public Forum
(Press Release for use by the newspapers)

ECG can be normal in acute heart attack

Chest pain which can be pinpointed by a finger or lasts less than 30 seconds is not a heart pain said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

ECG might not be a diagnostic test for acute heart attack. It can be normal in the first six hours of heart attack. If a heart attack is suspected one should do serial ECGs or serial blood tests for the next 12 hours to rule out a heart attack.

The presentation of a heart attack can be atypical. A person may present with toothache, neck pain, acidity or abdominal pain. In diabetics, the heart attack may be silent with no chest pain.

If chewable aspirin is given to a victim of heart attack at the onset of chest pain, the chances of sudden death may reduce by 22%.

Most heart attack deaths occur in the early hours of the day usually within 3 hours of getting up. Therefore early morning chest pain should not be ignored.

ECG may be unreliable in women and in patients with abnormal electrical activity of the heart. In these situations, 3-dimensional echocardiography is of help. It detects heart attack much before an ECG can diagnose it.

Any irregular heart rate whether low or high coming for the first time in life after the age of 40 should raise the alarm of an underlying impending heart attack. A pulse rate of less than 60 or more than 100 is abnormal.

eMedinewS Try this it Works: Don’t forfeit the fetor

When you see a patient with suspected alcohol or other substance abuse, there is no substitute for simply smelling the patient’s breath. Try examining the optic fundi with the ophthalmoscope, regardless of whether such an examination is indicated or not. This allows you to get as close as possible to the patient.

Dr Good Dr Bad

Situation: A diabetic patient came with deranged liver functions.

Dr Bad: We need to rule out viral hepatitis.

Dr Good: We need to rule out hemochromatosis.

Lesson: All diabetics with abnormal liver enzymes should be screened for hemochromatosis. It is present in 1–2% of all diabetics. Often diabetes is the first  manifestation of the condition. Deranged Liver function is the most frequent finding leading to a diagnosis. (Clinical Diabetes 2004;22:101–2)

Make Sure

Situation: A 70–year–old male with antibiotic–associated diarrhea and TLC of 24000 died.

Reaction: Oh my God! Why was surgery not considered in this case?

Make sure that urgent surgical evaluation is done in patients with acute ab associated gastroenteritis who are ≥65 years and have a white blood cell count ≥20,000 cells/microL and/or a plasma lactate between 2.2 and 4.9 mEq/L.

MTNL Perfect Health Mela

Laughter the best medicine

IMANDB Joke of the Day

A little girl attending the school clinic started crying as the doctor approached her. "I’m only going to take your pulse," the doctor explained. "But don’t I need it?" sobbed the little girl.

Formulae in Critical Care

Packed cell volume (PCV) : Formula: PCV = Hb in g% × 3

Milestones in Diabetes

Rosalyn Yallow (born 1921) is an American medical physicist. She was co–awarded the Nobel Prize in Physiology or Medicine in 1977 for her development of radioimmunoassay (RIA) technique. This procedure can be used o measure insulin with much greater precision than techniques used earlier.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

MRSA (Methicillin-resistant Staphylococcus aureus) screening: Sample required is swab of nose; occasionally swab of wound infection site or skin lesion.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date


For use as sweetner in drug formulations


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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.

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Readers Responses

  1. Thank u sir the effort is worth lauding: Deepak Bhardwaj

  2. Dear Dr Agarwal, at the outset kindly accepts my heartfelt congratulations for the Padma Shri and good wishes for many more to come. I am a regular reader of RECENT Medical Journals for the last 40 years but I have not found them more useful than your emedinews published every day: Dr O.P. Agarwal, M.D

  3. 24th April was World Veterinary day. It has long been recognized that humans and animal share more than 60% of known infectious diseases (whether domestic or wild); 75% of recent emerging human diseases came from animals and 80% of the pathogens that could potentially be used in bioterrorism are zoonotic. It is also known that human populations need a regular diet of protein particularly from milk, eggs or meat, and that a deficiency can also be a public health problem: Dr U Kakroo