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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


Dear Colleague

8th April, 2010 Thursday

New C. difficile guidelines

Two professional societies (Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America) have issued updated Clostridium difficile guidelines to address epidemiologic and treatment changes since guidelines were first released in 1995.The update was published in the May Infection Control and Hospital Epidemiology

  1. In the last 15 years, new more virulent strain of C. difficile has been identified.

  2. New dates shows decreased effectiveness of metronidazole in severe disease.

  3. While stool culture is the most sensitive test, it is not clinically practical due to slow turnaround time.

  4. Toxin testing is most important clinically, but lacks sensitivity.

  5. A potential strategy is to employ a two–step method that uses enzyme immunoassay testing of glutamate dehydrogenase (GDH) as initial screening, and then uses the cell cytotoxicity assay or toxigenic culture as the confirmatory test for GDH–positive stool specimens. Results seem to differ based on the GDH kit used, so this is an interim recommendation.

  6. Polymerase chain reaction (PCR) testing seems to be rapid, sensitive and specific, but more data are needed before it can be recommended for routine testing.

  7. Repeat testing during the same episode of diarrhea is discouraged, as it has limited value.

  8. Use metronidazole for an initial episode of mild–to–moderate C. difficile infection (CDI). The dosage is 500 mg orally three times per day for 10 to 14 days.

  9. For an initial episode of severe CDI, use vancomycin. The dosage is 125 mg orally four times per day for 10 to 14 days.

  10. For the first recurrence of CDI, usually use the same regimen as the initial episode, though stratify by disease severity.

  11. For the second or later recurrence, use vancomycin with a tapered and/or pulse regimen.

  12. Do not use metronidazole after the first recurrence or for long–term chronic therapy, due to the potential for cumulative neurotoxicity.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

Press Conference on WHO Day Perfect Health Parade, Dr. S Rajpal, Ms Anjolie Ela Menon Painter Artist, Padmashri Awardee Dr KK Aggarwal, Mr. RS Bhatnagar and Mr SL Bhambri the country Head The Loomba Trust (Organized by Heart Care Foundation Of India and The Loomba Trust).

Dr k k Aggarwal

News and views

Medpage Meeting Notes: American College of Cardiology
Atlanta, GA • March 14 – 16, 2010

1. Pushing blood pressure too low may be harmful

Lower is not necessarily better for blood pressure control in patients with diabetes and coronary artery disease.
There was no difference in a composite endpoint of death, myocardial infarction, or stroke between patients with an average systolic pressure 130–140 mm Hg and those with a lower average pressure, according to Rhonda Cooper–DeHoff, of the University of Florida in Gainesville. Patients who had uncontrolled systolic blood pressure (140 mm Hg and higher) had significantly increased cardiovascular risk. Patients who were most tightly controlled, however, had an increased risk of all–cause mortality compared with those in the middle range, during both the trial and an extended follow–up of about five years.

2. BP variability linked to adverse CV outcomes

Hypertensive patients with the most variability in blood pressure between healthcare visits have a greater risk of stroke and coronary heart disease than patients with more stable pressure. In an analysis of the Anglo–Scandinavian Cardiac Outcomes Trial –– Blood Pressure Lowering Arm (ASCOT–BPLA), mean blood pressure during the study weakly predicted stroke risk and was not associated with risk of adverse cardiovascular outcomes.Visit–to–visit variability in blood pressure, however, acted as a strong predictor of both, such that patients with the most variability had a fourfold increased risk of stroke and a threefold increased risk of coronary heart disease events. One is better off with a higher pressure and less variability than a lower pressure and more variability.

3. Dual action antihypertensive outperforms ARB alone

A novel agent that counteracts vasoconstriction as both an angiotensin receptor blocker (ARB) and neprilysin inhibitor appears to fight hypertension better than an ARB alone. LCZ696 reduced diastolic pressure by a mean of 2.17 mm Hg (P<0.0001) more than comparable doses of the ARB valsartan (Diovan) upon which it is based. (Dr Luis M. Ruilope, of the Hospital 12 de Octubre in Madrid).

4. Close lipid and BP control fail in diabetes

Intensive blood pressure and lipid management does little against elevated cardiovascular risk in diabetes, according to results from the ACCORD study. Using a blood pressure target of 120 mm Hg rather than the general population standard of 140 did not reduce the primary outcome of nonfatal MI, nonfatal stroke, and death from cardiovascular causes. (Dr William C. Cushman, VA Medical Center Memphis, Tenn). Likewise, adding fenofibrate to standard statin therapy did not reduce the major adverse cardiovascular events (Dr Henry C. Ginsberg, Columbia University New York City). (NEJM)

What’s New: Oral bicarbonate for CKD

In a randomized trial, treatment with oral bicarbonate slowed progression of chronic kidney disease and improved nutritional status of patients with creatinine clearances between 15 and 30 mL/min per 1.73 m2. (de Brito–Ashurst, I, Varagunam M, Raftery,MJ, Yaqoob, MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 2009;20:2075.)

Mnemonic of the Day (Dr Prachi Garg)

4th Heart Sound SHIT

S tenosis (aortic/pulmonary)

H ypertension/Heart Block

I ischemic heart disease

T amponade


What can celiac disease lead to?

If undiagnosed, celiac disease can lead to autoimmune diseases – thyroid, multiple sclerosis (MS), lupus, liver disease, alopecia, fibromyalgia, rheumatoid arthritis, type 1 diabetes.

Other problems - Osteoporosis, joint pains, epilepsy, migraines, infertility, schizoiphrenia, depression, malignancies like adinocarcinoma, oesophageal cancer, Hodgkin's lymphoma, melanomas, thyroid cancer, eczema.

Diabetes Fact

Best way to monitor Diabetic Ketoacidosis is pH and not serum potassium.

Public Forum
(Press Release)

10th Perfect Health Parade in the Capital

Flagging off the 10th Perfect Health Parade from Jantar Mantar outside Commonwealth Games Office, Shri Suresh Kalmadi, Chairman, Commonwealth Games 2010 said that New Delhi is prepared to host the Commonwealth Games. He also released special tableaus – one talking about the problems faced by the widows and their children and the second on "Green Delhi" focusing on Delhi Transport Corporation’s preparations for the forthcoming Commonwealth Games. He said that widows and their children should be given a priority in the community.

The parade was organized by Heart Care Foundation of India and the Loomba Trust to create health awareness in general and the health of the widows and their children in particular. The associated partners of the event were Department of Health, Delhi Government, MCD, NDMC, Deptt. of WCD (Prohibition) Govt. of Delhi, New Delhi and Janak Puri Branches of IMA, World Fellowship of Religions and M/s Bhatnagar & Sons.

The parade in the form of tableaus made on the style of the Republic day parade, created awareness about the health issues faced by the widows and DTC’s preparedness for the forthcoming Commonwealth Games.

Present on the occasion, Mr. Raj Loomba founder trustee and Chairman of The Loomba Trust said that like in the West, India should also celebrate 23rd June as International Widows Day. He also read out a message by Ms Preiti Zinta, the Brand ambassador of The Loomba Trust, who in her message said that free education should be provided to the children of widows.

Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India, said that widows are at a higher risk of heart attack, diabetes and paralysis.The problems faced by the widows are psychological depression, social disorganization, insecurity, health deterioration, dependence on others, deviance and delinquency.

Acharya Dr Sadhvi Sadhna Ji Maharaj, Shri Naresh Kumar, IAS, CMD DTC, Ms Nalini Kamalini, famous Kathak Dancers, Dr NK. Yadav, MHO, MCD, Dr PK Sharma, MOH, NDMC, Dr KS Bhaghotia, CMO, DHS, Dr AK Kansal, President IMA Janak Puri Branch, Dr Sanjay Sood, President IMA New Delhi Branch etc. were also present at the flagging–off ceremony.

Question of the day

What is the basic principle of radiosurgery?

Radiosurgery has been around for nearly a century. Only the terminology is new. It was in 1891 that Jacques Arsene d–Arsonval made a fundamental observation that electrical current above 10,000Hz did not produce muscular stimulation but can ablate and cut tissue. Hence all the modern electrosurgery units work above 10,000Hz.

The commonly used Hyfrecator has a frequency of 500KHz or 500,000Hz or 0.5MHz. The modern radiosurgery units are all clones of the 1970’s radiosurgery unit manufactured by Dr. Erving Ellman, which works with a frequency of 3.8 Mhz. The question of why 3.8MHz was answered in 1978 by Maness who showed that at this frequency there is least lateral heat conduction on cutting the skin. Since MHz frequency is used for FM radio transmission these newer electrosurgery units, which also work in this frequency, are called Radiosurgery units.

Radiosurgery equipment: The radiosurgery equipment consists of electric and electronic circuits to take in 220Volts of current at 60Hz frequency and give out 380,00,000 Hz or other high frequency output. These frequencies are modulated by rectifiers and filters to give electrons which vibrate at 380,00,000 times per second and have various unique attributes.

As end users we either want electrons to either cut the skin or coagulate the skin.

These electrons generated are delivered to the skin by either a single electrodemonopolar or two electrode–bipolar. This is the active electrode. The electrons transmitted by the active electrode are collected by the antenna plate, which could be called passive electrode. Whether the passive electrode has to be in contact with the patient skin or not has to be ascertained according to the manufacturers recommendation.

eMedinewS Try this it Works

The challenge of compliance

Maintain a "compliance book." This contains details, such as the patient’s phone number or that of a friend or relative, and information about medications and appointments. These patients are called daily by a staff member to inquire about their progress, to remind them to do certain tests (eg, blood glucose), or to help them remember scheduled visits.

Dr Good Dr Bad

Situation: A diabetic patient with allergy had high eosinophil count.

Dr Bad: The two are unrelated.

Dr Good: Get urine Microalbumin and triglyceride tests done.

Lesson: Allergic disorders may be associated with microalbuminuria in men with type 2 diabetes. Eosinophil count was positively associated with systolic BP, serum triglyceride concentration and albumin excretion rate in men. (Clin J Am Soc Nephrol 2009 Oct 1).

Make Sure

Situation: A lady took her daughter to the physician for not gaining weight.

Reaction: Doctor, inspite of munching something or the other all day long, my daughter is not gaining weight

Make sure that besides "munching" large quantities she also eats some quality food containing balanced amount of macro as well as micronutrients.


Laughter the best medicine

Things you don't want to hear during surgery:


Has anyone seen my watch?

Formulae in Critical Care

Arterial alveolar O2 tension ratio

Formula: PaO2/PAO2

Comments: Calculate when FiO2 is more than 60%.
This formula is an index of oxygenation.

Normal value: 0.75–0.9.
0.5 to 0.3 is moderate hypoxia.
<0.3 is severe hypoxia.

Milestones in Medicine

1865 A.D. Joseph Lister introduces antiseptic methods to surgery during a time when close to half of all surgical patients died of postoperative infection.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Chlorthalidone Tablet 6.25mg

For the treatment of mild to moderate hypetension.


(Advertorial section)


Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

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 or 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 400 registrations already done.

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, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). 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 BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

DMC Interaction on 'Medical Ethics & Doctor–Pharma Relationship – New MCI Amendments' postponed till further information

Readers Responses

  1. Dear Dr Agarwal, heartiest Congragulations for your award. Thank you for eMedinews as it is very informative and it is more useful than attending CMEs: Dr Law

  2. Dear Dr Aggarwal, Congratulations once again for this recognition of your achievements. Wish you many more: Dr SK Joshi

  3. Even Blood Bank Technical and Medical Staff should be protected against Hepatitis B. Regards: Dr NK Bhatia

  4. Respected Sir, Many Many congratulations on getting award recently. Regards. Dr Neeraj Gupta

  5. God grace u. Long live: Dr K Palsingh.