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

11th March 2010, Thursday

A1c predicts cardiovascular disease and death in nondiabetics

Compared to fasting glucose tests, A1c levels also predict diabetes development and cardiovascular disease and death. A new study of nondiabetic adults used blood samples from more than 11,000 black or white adults participating in the Atherosclerosis Risk in Communities study. The study found

  1. Baseline reference risk of 5.0% to 5.5%

  2. A1c of 5.5% – 6%: 86% increased risk of being diagnosed with diabetes

  3. A1cs between 6% and 6.5% had 4 times the risk

  4. A1C over 6.5% had 4–16 times the risk.


The same trends were true for coronary heart disease and stroke. Study participants with A1cs under 5% had a reduced risk for all three outcomes. The results indicated that even patients with A1cs in the normal range may be at an increased risk for coronary heart disease, stroke and death.

Dr KK Aggarwal
Chief Editor

News and Views (Dr G M Singh)

Belatacept Benefits Seen After Kidney Transplant

In adult kidney transplant patients, belatacept –– a selective costimulation blocker –– is associated with better renal function and similar patient/graft survival at one year compared to cyclosporine, with these benefits also seen in recipients of extended criteria donor kidneys, according to two studies published online Feb. 16 in the American Journal of Transplantation.

Sex during pregnancy: What do women really do?

Here’s what they learned from the women, who ranged in age from 17 to 40 (average age 29):

  • Nearly a quarter of the women had feared that vaginal intercourse would harm their baby, but only three of the women ended up postponing intercourse until their babies were born.

  • Two of these three women engaged in other forms of sexual activity.

  • About 80% of women reported some kind of sexual activity during their third trimester; 39% reported sexual intercourse during their birth week.

  • Frequency of sexual activity did not drop off for most women until their third trimester, although about 10% said they had sex more often during their third trimester than during their first or second.

  • Nearly all of the women who were sexually active during pregnancy reported vaginal intercourse; 38% reported oral sex (either fellatio or cunnilingus), 20% reported masturbation, and 7% reported anal intercourse.

  • About 39% of women said they desired sex during pregnancy as much as they did before they were pregnant. About a third of women said they had less sexual desire while pregnant.

  • About half of the women said sex during pregnancy was just as satisfying as it was before. About 28% said it was less satisfying.

  • 41.5% of the women said they felt less attractive or sensual while pregnant. Yet, 75% said their partners did not find them any less desirable.

  • Three–fourths of the women reported no sexual problems, but others did. Problems included low desire, painful sex, inability to orgasm, and difficulty in lubrication. Despite these issues, only 11% of women said they felt the need to speak with their doctors about sex during pregnancy.

(Source: The Journal of Sexual Medicine, February 2010;7:136–142.)

Chronic fatigue syndrome may have the following symptoms

  • Extreme tiredness for longer than 24 hours, especially after exercise

  • Forgetfulness, or difficulty maintaining focus

  • Tiredness that persists after sleep

  • Muscular aches and pains

  • Joint pain that isn’t accompanied by redness or swelling

  • Headaches that vary in severity, pattern or type

  • Soreness of the lymph nodes beneath the arm or in the neck

The U.S. National Library of Medicine offers this list of possible reasons for earache:

  • Arthritis in the jaw

  • An infection in the middle or outer ear

  • Changes in pressure that damage the ear

  • An object lodged in the ear, or a significant buildup of ear wax

  • A ruptured or perforated eardrum

  • A sinus infection, infected tooth or sore throat

  • Temporomandibular joint syndrome (TMJ)

Did You Know? (Sent by Dr Uday Kakroo)

12 percent of all American scientists are of Indian origin; 38 percent of doctors in America are Indian; 36 percent of NASA scientists are Indians; 34 percent of Microsoft employees are Indians; and 28 percent of IBM employees are Indians. For the record: Sabeer Bhatia created and founded Hotmail... Sun Microsystems was founded by Vinod Khosla. The Intel Pentium processor, that runs 90 percent of all computers, was fathered by Vinod Dham. Rajiv Gupta co–invented Hewlett Packard’s E–speak project. Four out of all Silicon Valley start–ups are run by Indians. Bollywood produces 800 movies per year and six Indian ladies have won Miss Universe/Miss World titles over the past 10 years.

Conference Calendar

ISA 2010 – (V National Congress of Indian Stroke Association & the International Stroke Conference)
Date: March 12–15, 2010
Venue: JLN Auditorium Complex, AIIMS, New Delhi


Quote of the Day

Prayer is not merely an occasional impulse to which we respond when we are in trouble: prayer is a life attitude. (Walter A. Mueller)


Question of the day

What is the clinical significance of probiotic + prebiotic therapy in IBD?

The stomach normally contains a relatively small number of bacteria that are predominantly Gram-positive and aerobic. In the proximal small intestine, bacterial concentration and pattern are quite similar to those of the stomach. However, along the length of the small intestine, there is a transition to higher concentrations of bacteria and an increasing predominance of Gram-negative species in the distal ileum. A dramatic increase in bacterial concentration is present across the ileal-cecal valve with the total number of microorganisms increasing by approximately a million-fold (from 108 to 1010-1011) and anaerobes outnumbering aerobes by a ratio of 1,000:1. While inflammatory processes per se have been extensively studied, relatively little attention has been directed to the important role of luminal bacteria in IBD pathogenesis. For example, it has long been recognized that the anatomic sites of highest bacterial concentration (distal ileum and colon) are the sites most frequently affected by inflammation in patients with IBD.

The clinical importance of these bacteria is supported by many observations. Entire bacteria or their products have been detected within inflamed mucosa of patients with Crohn’s disease. Clinical experience has suggested that activity in patients with Crohn’s disease can be reduced through the use of antibiotics or diversion of the fecal stream, supporting the general notion of the importance of bacteria in sustaining inflammation in IBD. Purified bacterial products can initiate and perpetuate experimental colitis. Finally, it has been noted that the spontaneous colitis that consistently develops in many transgenic and knockout mutant murine models of colitis may not occur when these lines are maintained in germ-free conditions.

Most probiotics belong to a large group of bacteria empirically designated as lactic acid bacteria (lactobacilli, streptococci, bifidobacteria) that are important components of the human GI microflora where they exist as harmless commensals.

Lactic acid is the principal end product of metabolism for all these species. New probiotics also include other microbes such as yeast (e.g. Saccharomyces boulardii) and entirely unrelated bacteria (Clostridium, Bacillus subtilis). Probiotic strains must be of human origin because some health-promoting effects may be species-specific. They also must be both acid-and bile-resistant and have the ability to sustain metabolic activity within the luminal flora, where ideally they should survive, if not persist, for the long-term. These strains are presumed to be antagonistic against pathogenic bacteria through the production of antimicrobial substances and promoting a reduced luminal colonic pH. It is axiomatic that they must be safe for human use and should maintain their viability and other beneficial products through processing, culture and storage. Nondigestible carbohydrates are considered the best candidate prebiotics. Lactulose was shown to increase concentration of Bifidobacterium bifidus in bottle-fed infants and to stimulate growth of lactobacilli in the colon to reduce ammonium absorption in hepatic encephalopathy.

A pilot study using probiotic preparation as maintenance treatment in patients allergic or intolerant to sulfasalazine or mesalamine was carried out. Twenty patients received 6/g of probiotic preparation daily for 12 months and were periodically assessed; stool culture and determination of fecal pH were also performed at various intervals. Microbiological determination showed a significant increase in concentrations of lactobacilli, bifidobacteria and S. salivarius subsp. thermophilus, which was evident after 10 days and persisted through the treatment period. No significant modification was seen in the concentrations of the other bacterial species. Fecal pH was significantly reduced by the treatment and most patients (75%) remained in remission.

Subsequently, efficacy of this oral probiotic preparation was compared with placebo in the maintenance treatment of chronic relapsing pouchitis. Fecal concentrations of lactobacilli, bifidobacteria and S. salivarius subsp. thermophilus were significantly increased within one month of initializing probiotic preparation treatment and remained stable throughout the study.

Hence, the use of probiotics and prebiotics is an effective approach for patients with IBD.


eMedinewS Try this it Works

Treating Cramps

To minimize or eliminate heat cramps grasp the upper thigh between the thumb and index finger and squeeze hard until the cramp goes away.

Diabetes Fact

Glucose homeostasis is dependent on a complex interplay of multiple hormones: insulin and amylin, produced by pancreatic beta cells; glucagon, produced by pancreatic alpha cells; and gastrointestinal peptides including glucagon–like peptide–1 (GLP–1) and glucose–dependent insulinotropic polypeptide (GIP; gastric inhibitory polypeptide).

Dr Good Dr Bad

Situation: A 80 year old male patient with acute heart attack was posted for reperfusion therapy
Dr Good: Chew 300 mg aspirin and 75 mg clopidogrel
Dr Bad: Chew 300 mg aspirin
Lesson: Start clopidogrel 75 mg as opposed to prasugrel for patients older than 75 years of age who are treated with fibrinolytic therapy.

Make Sure

Situation: Sir, he collapsed after sublingual nifedipine was given Reaction: Oh, my God! I forgot to check for LVOT obstruction
Make sure that before giving sublingual nifedipine that the patient does not have LVOT obstruction. (left ventricular outflow tract)

Medi Finance
(BUDGET 2010–2011)


  • The expenditures shall be allowed for deduction, in case tax deducted thereon is deposited before due date of filing the return.

  • Interest charged on tax deducted but not deposited by the specified date to be increased from 12 per cent to 18 per cent per annum (this amendment is proposed to take effect from 01/07/2010).
Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Actual medical record:
Healthy appearing decrepit 69 year–old male, mentally alert but forgetful.

Formulae in Critical Care

Predicted endotracheal tube size for age
Formula: = 4 + (age/4) for pediatric age group.

Milestones in Neurology

H. Houston Merritt (1902 – 1979) was one of the pre–eminent academic neurologists of his day. As the chair of the Neurological Institute of New York from 1948 to 1967, he oversaw the training of hundreds of neurologists; 35 of his former students have become chairs of academic neurology departments across the United States. He was also the dean of the Columbia University College of Physicians and Surgeons from 1958 to 1969. Merritt was also known in his day as an expert on neurosyphilis; his 1946 monograph on the topic provided an overview of this condition, which almost disappeared from the medical eye shortly thereafter owing to the advent of penicillin.

Mistakes in Clinical Practice

A trailing zero should never be used after a decimal e.g, 1 mg not 1.0 mg.

Today is World Kidney Day (Dr N P Singh)

Glomerular Filtration Rate (GFR): Your GFR tells how much total kidney function you have. It may be estimated from your blood level of creatinine. Normal is about 100 ml/min, so lower values indicate the percentage of normal kidney function which you have. If your GFR falls below 60 ml/min you will usually need to see a kidney disease specialist (called a nephrologist), If the treatment you receive from the nephrologist does not prevent a further reduction in GFR, your kidney doctor will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you may need to start one of these treatments soon.

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

Cause of BPH: Imbalance between testosterone and estrogen due to aging, stromal epithelial interaction, growth factors and neurotransmitters either singly or in combination have been suggested as etiological factors.

Lab test (Dr Navin Dang)

The patient should be instructed to be fasting for 10 to 12 hours and the dinner one evening before should be a non fatty, non greasy, non alcoholic dinner for lipid profile estimation.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Oxcarbazepine 150/300/600mg Tablet (Addl. Indication

Treatment of generalized tonic–clonic seizures in adults and children


(Advertorial section)



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 done already.

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 (2pm onwards) and Sunday 18th April (7am–4pm). 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 or BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs (This Saturday and Sunday)

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.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. Dear Sir, emedinews is a very noble process that you have started. I would like to put a request. Is there any way that through it, doctors can also know about upcoming CMEs? I find it very difficult. By the time the DMA magazine arrives, if any CME is mentioned there in, those dates are already gone. I would highly appreciate your guidance & help in this field as now technology is changing and we doctors need to keep abreast with the latest to be able to serve the patients better. Have a good weekend. Regards: Dr. Alka Kaul

  2. Heartiest congratulations. May God bless you with more success and achievements: Dr. Rai

  3. Congratulations on receiving Padma Shri award. Wishing you luck and success in all that you do: Manjuli Bhargava, Manjuli Prakashan


Chronic Kidney Disease: A Family Affair (TODAY IS WORLD KIDNEY DAY)

Chronic kidney disease (CKD) is the permanent loss of kidney function. CKD may be the result of physical injury or a disease that damages the kidneys, such as diabetes or high blood pressure.
CKD is a silent condition. In the early stages, you will not notice any symptoms. CKD often develops so slowly that many people don't realize they're sick until the disease is advanced and they are rushed to the hospital for life-saving dialysis.

Who is at risk?
Risk factors are conditions that make you more likely to develop a disease.

The leading risk factors for CKD are
1. Diabetes
2. High blood pressure
3. Family history of kidney failure


Diabetes is the leading cause of kidney failure.
High blood pressure is the second leading cause.
CKD runs in families, so you may have an increased risk if your mother, father, sister, or brother has kidney failure.


Some racial groups are also at increased risk for CKD.
1. African Americans are nearly four times as likely to develop kidney failure as white Americans.
2. American Indians have nearly three times the risk compared to whites.
3. Hispanic Americans have nearly twice the risk of non-Hispanic whites.


Screening for kidney disease includes simple blood and urine tests.
If you have diabetes or high blood pressure, or a close family member with kidney failure, you should get checked for kidney disease, especially if you're a member of one of the racial or ethnic groups at higher risk for CKD.


How can I find out if I have CKD?
Since early CKD has no symptoms, the only way to find out if you have it is through simple medical tests.
1. Blood pressure: High blood pressure can lead to kidney damage, and it can also be a sign that kidney damage has already occurred. If your blood pressure is high, you'll want to get it under control to make sure your kidneys remain healthy.
2. Blood: The glomerular filtration rate (GFR) measures how efficiently the kidneys are filtering waste from the blood. The new method of calculating GFR requires only a measurement of the creatinine (kree-AT-ih-nin) in a blood sample. Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. When kidneys are not working well, creatinine builds up in the blood.
3. Urine: Measuring the amount of a protein called albumin in the urine can show a kidney problem. A large amount of protein in the urine is known as proteinuria and is a sign of kidney damage. Your doctor may test for protein using a dipstick in a sample of your urine taken in the doctor's office. The color of the dipstick indicates the level of protein.


A test that can show smaller amounts of protein or albumin in the urine is called a microalbumin test and also uses a dipstick in the urine.


Your doctor may also do a calculation of the protein-to-creatinine or albumin-to-creatinine ratio. A ratio greater than 30 milligrams of albumin per 1 gram of creatinine indicates that the kidneys are leaking helpful substances from the blood and failing to filter out harmful substances. This test should be used in people at high risk, especially those with diabetes.


If your first laboratory test shows high levels of protein, another test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, you have persistent protein in the urine (proteinuria) and should have additional tests to test your kidney function.


A 24-hour urine collection is no longer necessary. Small samples of urine and blood, which can easily be taken in the doctor's office, are all the new methods require.


What can I do to slow down or avoid kidney failure?
Learning about reduced kidney function allows you to take steps to keep your kidneys healthy as long as possible.


You can control many of the things that can make CKD worse and may lead to kidney failure.
1. If you have diabetes, control your blood glucose, also called blood sugar. Studies show that keeping tight control of blood glucose can delay or prevent kidney failure.
2. If you have high blood pressure, keep your blood pressure below 140/90 mm Hg.
3. If you have high blood pressure with CKD, keep your blood pressure below 130/80 mm Hg. Blood pressure medicines called ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) protect the kidneys better than other medicines. You may need a combination of two or more drugs to keep your blood pressure below 130/80. In many cases, a medicine that lowers blood pressure by increasing urination, called a diuretic, should also be part of the plan.
4. If you have CKD, don't eat too much protein. Protein breaks down into the waste products the kidneys must excrete. Reducing those waste products by eating less protein means the kidneys don't have to work so hard. But eating too little protein can lead to poor nutrition. Work with a dietitian to make sure you get the right amounts of protein and other nutrients.


What can I do to avoid the complications of CKD?
CKD can lead to many other health problems well before kidney failure occurs.
1. Anemia. Anemia develops when the kidneys fail to produce enough erythropoietin, or EPO, the hormone that directs the bones to make red blood cells. Anemia can cause heart problems.
2. Bone problems. Healthy kidneys help keep your bones strong by balancing the levels of calcium and phosphorus in the blood. CKD can lead to bone problems by throwing those minerals out of balance.
3. Acidosis. The kidneys also maintain the acid/base balance in the blood. Kidney problems may lead to acidosis, a condition in which the blood is too acidic. Acidosis can disrupt body functions.
4. Cardiovascular disease (CVD). Patients with CKD are more likely to die from a heart attack or stroke than from kidney failure. Even a small loss of kidney function can double a person's risk of developing CVD.
If you have CKD, you will need to have regular checkups to monitor blood levels of creatinine, urea nitrogen, potassium, phosphorus, parathyroid hormone, hemoglobin, and cholesterol.

You have the power to prevent kidney failure.
Work with your doctor to manage the health problems that CKD can cause. Taking charge of your health can make your kidneys last longer. You have the power to prevent kidney failure.

(Source: http://kidney.niddk.nih.gov, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health)

With regards,
Dr. Sukanta Sen
Index Medical College, Indore


Celebrate WORLD KIDNEY DAY With Department of Medicine MAMC AND Sanjivni
(In collaboration with Delhi Nephrology Society ) 11th March 2010 9 am onwards

Program highlights:


1.   High blood Sugar detection camp (in line with the theme of WKD10: keep your sugar under control!!!)


2.  Public lectures by Eminent physicians


3.  Release of the book ‘KNOW YOUR KIDNEYS’ for general public by honourable Principal Secretary (Health) Sh J P SINGH ji, Govt of NCT of Delhi at 10 am


4. Annual kidney awareness Padyatra from Jain Bal Ashram, Darya Ganj to Rajpath to be flagged off by Dr. Kanwar Sain, Honourable Mayor of Delhi, Govt of NCT of Delhi at 12.30pm.


5. Panel Discussion on “Preventing Kidney Disease –Role of Physicians”(Venue Auditorium, MAMC), at 7.30 pm followed by Dinner. Dr Amit Benerjee , Medical Supt , Lok Nayak Hospitals will be chief guest Panellists are (Dr SC TEWARI, DR KKAGARWAL, DR MANJU AGGARWAL, DR DINESH KHULLAR &DR SANJAY GUPTA)


Dr N P SINGH    All are welcome!!!   DR R DEWAN