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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; 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

  Editorial ...

3rd September, 2010, Friday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Dengue: new classification

The World Health Organization (WHO) previously classified symptomatic dengue virus infections into 3 categories for reporting purposes: undifferentiated fever, classic dengue fever, and dengue hemorrhagic fever (DHF).

These categories have recently been controversial for various reasons:

  • The term DHF suggests that hemorrhage is the chief manifestation, whereas plasma leakage leading to shock is the most specific feature of severe dengue and is most important for clinical management.
  • Classification is difficult when patients meet some but not all 4 diagnostic criteria, especially if pivotal clinical laboratory data are unavailable.
  • The diagnostic criteria for DHF have been inconsistently applied in epidemiologic and scientific reports.
  • Reporting that is limited to DHF, according to the WHO classification scheme, underestimates the disease burden of dengue illness.

Recently published guidelines from the WHO have adopted a revised classification.

  • Severe dengue: Patients who show severe plasma leakage (i.e., leading to shock or fluid accumulation with respiratory distress), severe hemorrhage, or severe organ impairment (defined as AST or ALT =1000, impaired consciousness, or severe involvement of the heart or other organs).1
  • Dengue: Non–severe dengue is further divided into dengue with or without "warning signs" (abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy or restlessness, liver enlargement >2 cm, or increase in hematocrit concurrent with rapid decrease in platelet count).


  1. Dengue: guidelines for diagnosis, treatment, prevention and control– new edition. World Health Organization, Geneva 2009, p. 1.

Dengue Formula of 20

  1. Platelet count < 20,000: observe
  2. Fall in SBP > 20 mm Hg
  3. Rise in pulse by > 20 per minute
  4. Rise in hematocrit by 20%
  5. Fall in hematocrit by 20% from baseline after IV fluids
  6. Tourniquet test > 20 petechie per square inch
  7. Treatment of leakage: 20 ml /kg/hour of fluids
  8. DHF: Less than 20 platelets per 7 high power fields (equivalent to < 100,000 platelet count)
  9. Pulse pressure < 20 mm Hg
  10. Make sure that the patient passes minimum 20 ml urine per hour

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Padma Awardees

Padma Awards are announced every year on 26th January and are the second, third and fourth highest civilian awards. The first group of Padma Awardees received their award from Hon’ble President of India on 31st March this year.


Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Goal blood pressure in patients with cardiovascular disease

Prior recommendations of a goal blood pressure of less than 130/80 mmHg in patients with cardiovascular disease have been revised to a more lenient target. The current recommendation is to have antihypertensive therapy to lower the blood pressure to less than 140/90 mmHg; and a goal of <135/85 mmHg for those patients who can tolerate either the addition of one more antihypertensive drug or an increase in the dose of current therapy. A goal blood pressure of less than 140/90 mmHg is reasonable for patients who do not want to increase the intensity of antihypertensive therapy. (ACCORD BP trial and NAVIGATOR trial N Engl J Med 2010; 362:1575; N Engl J Med 2010; 362:1477.)

  National News

Terrorist Strike during Commonwealth Games?

The US Government has warned its citizens traveling to India during the Commonwealth Games of a possible threat of terrorist action and violence. However, the US Government clarified that they have no information of specific threat of attack  that any individual or group is planning to coincide with the games.
This warning was expected from the western countries and our own country is also aware of the threat. We, as medical doctors, are also prepared for any such eventualities even though theoretical. Blast and other terrorist injuries are now being taught to most of the general practitioners through CMEs.

  International News

(Contributed by Dr Brahma and Dr Monica Vasudev)

Docs’ religion may influence end–of–life care

The religious beliefs of doctors who treat patients at the end of life appear to influence clinical decision-making according to a survey. Doctors in the UK, who reported being very or extremely religious, were less likely to endorse certain end–of–life decisions. The study is reported online in BMJ.

Mixed risks for PPIs + clopidogrel

Proton pump inhibitor (PPI) and clopidogrel, when used together, significantly increased the risk of myocardial infarction but not death as per findings of a meta–analysis. The study involved almost 160,000 patients and noted a 31% increase in the relative risk of MI among patients who took the two drugs together vs those who did not. Conversely, the analysis also observed that combined use of the two drugs did not significantly increase the risk of dying. Treatment with a PPI reduced the risk of gastrointestinal (GI) bleeding by 50% in patients receiving clopidogrel alone or with a placebo.

Low–dose aspirin may benefit pregnant women at risk of developing chronic hypertension

UK’s National Institute for Health and Clinical Excellence (NICE) recommends daily low–dose aspirin for women at risk of developing chronic high blood pressure during pregnancy. It also says that all general practitioners should advise women at risk of pre–eclampsia to take 75mg of aspirin daily from 12 weeks until birth.

Atrazine causes prostate inflammation in male rats and delays puberty

In a new research, prenatal exposure of male rats to low doses of atrazine may lead to prostate inflammation. They were also found to go through puberty later than non–exposed animals. Atrazine is a widely used herbicide and used to control weeds and grasses in crops such as corn and sugar cane. Atrazine and its byproducts are known to be relatively persistent in the environment, and may possibly contaminate water supplies.

  Dengue Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta Medicity

What are the criteria for admission in a patient with suspected dengue?

Findings through further investigations

  • Rising hematocrit
  • Pleural effusion, ascites or asymptomatic gall–bladder thickening
  • Co–existing conditions such as pregnancy
  • Co–morbid conditions, such as diabetes mellitus, hypertension, peptic ulcer, hemolytic anemia etc.
  • Overweight or obese (rapid venous access difficult in emergency)
  • Infancy or old age
  • Social circumstances: Living alone, living far from health facility, without reliable means of transport
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Q: What are the precautions one should take after the IVF procedure?

A. There are no special precautions that need to be taken, but strenuous activity should be avoided. Try to be mentally and physically relaxed as much as possible. You can return to work if you wish, but you may prefer to have a few days rest. There is no evidence of any extra measures that could positively influence the outcome of your treatment.

  Vaccine Update: Question of the day

Is it necessary to add pertussis vaccine for children over 7 years? (Dr Harish Pemde, New Delhi)

Although pertussis is uncommon after 7 years of age, it is far less common in children who have received pertussis vaccine. However, the adolescents previously immunized with DPT or DaPT have also been found to develop pertussis disease in later life. So, both types (DPT or DaPT) of the vaccine can be used in reduced quantities along with TT or dT at 10 and 16 years of age in healthy adolescents. Acellular pertussis is preferred as the whole cell vaccine produces more side effects in comparison to a pertussis. However, the efficacy is similar with both the vaccines.

Suggested readings

  1. BMC Infect Dis 2005;5:116.
  2. Lancet 2005;366:991–998.
  3. Eur J Obstet Gynecol Reprod Biol 2005;121(1):104.
  4. Gyenecol Oncol 2002;86(2):157.
  5. Int J Cancer 1995;61(4):450.
  6. http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html
  7. www.who.int/vaccines
  8. www.cdc.gov/mmrw
  9. www.vaccine.org
  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is the right to refuse medical interventions? Theresa Marie "Terri" Schiavo case of United States

In 1990, 27–year–old Theresa Marie "Terri" Schiavo suffered cardiopulmonary arrest in her home leading to a persistent vegetative state requiring artificial nutrition and hydration by feeding tube. After eight years without neurologic recovery, her husband and guardian requested that her feeding tube be removed, but her parents objected and the case went to court. The judge determined that there was "clear and convincing evidence" that she would not have wanted to be kept alive in this state. Despite several attempts on the part of Schiavo’s parents’ to prevent removal of her feeding tube, including claims that she could recover, the Florida state Supreme Court affirmed that her husband could exercise her right and discontinue treatments. The US Supreme Court stood by the lower court’s decision and refused to hear the case.

  Medi Finance Update

What are Index Funds?

Index funds include stock or bond funds that closely match the performance of a market index, such as the NSE.

  Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Propranolol 40mg (SR Pellets) + Flunarizine 5mg/10mg capsules

For the prophylaxis of migraine


  Lab Update

Transferrin saturation or index

Anemia of chronic disease

A low Serum Iron is less specific. It also occurs in the anemia of chronic disease or anemia of chronic inflammation (ACD/ACI). In this setting, however, there is usually a parallel reduction in the TIBC, resulting in a near normal percent saturation. However, about 20% of patients with ACD/ACI have transferrin saturations in the iron deficiency range because of an inability to access their normal or even increased marrow iron stores.

  IJCP Special

Dr Good Dr Bad

Situation: A with non fasting patient came for cholesterol test.
Dr. Bad: Get complete Lipid Profile done.
Dr. Good: Get total cholesterol and HDL cholesterol done.

Lesson: For total and HDL cholesterol fasting is not a pre–requisite.

Make Sure

Situation: A patient with human bite developed infection in the wound.
Rection: Oh my God, why were antibiotics not started in time?
Lesson: Make sure all patients with human bite are put on early augmenting group of antibiotics.

Quote of the Day

Martin Luther King Jr …"Faith is taking the first step, even when you don’t see the whole staircase."

(Contributed by Dr Prachi Garg)

Hypertension Alert

A person with pre-hypertension, is more than 3 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.

  Mind Teaser

Read this………………


(Contributed by Dr GM Singh)

The answer for yesterday’s eQuiz: D. Increase dietary calcium intake.

  • A third of the patients with kidney stones have a family history of stone formation, and most of these stones are caused by hypercalciuria. This patient is therefore at increased risk for stone formation. A high–calcium diet (defined as 1 to 4 g/d of calcium) has been shown to reduce the risk of calcium oxalate stone formation by binding calcium to oxalate in the gut and preventing oxalate absorption and its filtration into the urine. Calcium supplementation either in addition to or in place of increased dietary calcium has not been shown to decrease the risk of stone formation. Also, calcium carbonate supplementation with meals may be associated with increased stone formation.
  • Increased dietary intake of sucrose appears to increase urine calcium excretion independent of calcium intake and has been shown to increase the risk of incident kidney stones in women.
  • Animal protein intake contributes to increased purine metabolism and uric acid production and has been associated with uric acid stone formation. Animal protein ingestion also leads to decreases in urine citrate and increase in urine calcium.

The Correct answers received from: Dr. Muthumperumal Thirumalpillai, Dr Shashi Saini

The Answer of 1st September Puzzle is: I Understand Correct answers received for 1st September Puzzle from: Dr Uma gaur, DR. GITANJALI ARORA, Dr.D.Marwah, Dr G V PremKumar, Dr. Dinesh Kumar S, Dr. S M Govil, Dr. S. Margekar, Dr.Satyoban Ghosh.

The Correct answers received for 31st August Puzle: Dr Shahsi Chabra

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr Maj Prachi Garg)

Q. When do you stop at green and go at red?

A. When you’re eating a watermelon!

Funny One Liner (Dr G M Singh)

Compromise: The art of dividing a cake in such a way that everybody believes he got the biggest piece.

  An Inspirational Story

A Candidate for a News Broadcaster’s post was rejected because of his voice. He was also told that with his obnoxiously long name, he would never be famous.

We all know him as Amitabh Bachchan.

  Readers Responses
  1. Respected sir, Thanks for such a valuable information, it really helped me in my practise. i want to request you if possible please try to add one column on homoeopathy also. thank u regards Dr.Gurjit Kaur
  2. Thank you for your kind information on KRISHNA. I was thinking " MAKAN" means BUTTER. The word RABB for ALLAH or WAHEGURU means the same thing Progenitor, Organizer and Destroyer   -------------- this concept in Islam is TAUHEED E RABUBIAT ---------- the GOD is one and only one who is the Khalique, Malik, Razique and Mudabbir. When we go into the deep all religion is ONE and their God is one and ONLY, and we should bow to HIM and only to HIM. Thank you for enlightening me on the concept. With best regards. FAZL UR RAHMAN.
  3. Thank you for the excellent coverage. Please keep it up. May Lord Krishna give Krishna Kumar Aggarwal, good health, happiness & peace of mind. Dr Raghuveer Rao.
  4. If you have a slow heart rate (bradycardia), is it safe to drink wine? If so, how much per day? Does alcohol affect the heart rate? Dr G M Singh
    A. Small amounts of alcohol can speed up the heart rate. Although that doesn’t make it a tonic for bradycardia, moderate drinking is safe for most people with bradycardia. Moderate means one or two drinks a day for men, no more than one drink a day for women. Larger amounts of alcohol all at once (binge drinking) or over time can be toxic to the heart muscle, leading to heart failure or the common rhythm disorder known as atrial fibrillation.
  5. Reading on Krishna Janam - the perspective was a great mental treat. Dr Aashish Sabharwal
  Public Forum

(Press Release for use by the newspapers)

Dengue Helpline

In view of the dengue epidemic in the city, Heart Care Foundation of India has started a dengue helpline (No. 9958771177) which will answer queries of the public from 8 am to 4 pm.
Giving details, Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee, President Heart Care Foundation of India and senior heart specialist Moolchand Hospital, said that this year, the dengue cases are not only more but are also behaving in a different manner from earlier cases.
1.    They have GI involvement.
2.    Liver enzymes are raised
3.    Pancreas and the gall bladder are involved
4.    Platelet count is often falling to less than 10000
6.    Platelet dysfunction is seen even in marginally low platelet counts, presence of rash
7.    Overall dengue mortality is low
8.    All four varieties of dengue are same
The dengue helpline will be attended by doctors who will answer the queries of the public so that the public is aware when and when not to go to the doctor. Mild dengue requires no treatment

  Conference Calendar

8th Annual National Conference - Indian Society of Pediatric Radiology

Date: September 4 to 5, 2010
Venue: Pune, Maharashtra, India

Website: http://ispr2010pune.com

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday– BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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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