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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

9th May, 2010, Sunday

10 tips for exercising safely

Dear Colleague

One should a start an exercise program under doctors supervision if one is above 40 and starting for the first time; before taking on a more strenuous regimen or if you have any injuries or a chronic or unstable health condition like heart disease or several risk factors for heart disease, asthma, high blood pressure, joint or bone disease (including osteoporosis), a neurological illness, diabetes or if you have been experiencing chest pain, shortness of breath, or dizziness.

Here are 10 tips for avoiding injuries as reported by Health Beat from Harvard

  1. Take five to 10 minutes to warm up and cool down properly.

  2. Plan to start slowly and boost your activity level gradually unless you are already exercising frequently and vigorously.

  3. Be aware that training too hard or too often can cause overuse injuries like stress fractures, stiff or sore joints and muscles, and inflamed tendons and ligaments. Sports prompting repetitive wear and tear on certain parts of your body — such as swimming (shoulders), jogging (knees, ankles, and feet), tennis (elbows) — are often overuse–culprits, too. A mix of different kinds of activities and sufficient rest is safer.

  4. Listen to the body. Hold off on exercise when you’re sick or feeling very fatigued. Cut back if you cannot finish an exercise session, feel faint after exercise or fatigued during the day, or suffer persistent aches and pains in joints after exercising.

  5. If you stop exercising for a while, drop back to a lower level of exercise initially. If you're doing strength training, for example, lift lighter weights or do fewer reps or sets.

  6. For most people, simply drinking plenty of water is sufficient. But if you’re working out especially hard or doing a marathon or triathlon, choose drinks that replace fluids plus essential electrolytes.

  7. Choose clothes and shoes designed for the type of exercise. Replace shoes every six months as cushioning wears out.

  8. For strength training, good form is essential. Initially use no weight, or very light weights, when learning the exercises. Never sacrifice good form by hurrying to finish reps or sets, or struggling to lift heavier weights.

  9. Exercising vigorously in hot, humid conditions can lead to serious overheating and dehydration. Slow your pace when the temperature rises above 70°F (21°C). On days when the thermometer is expected to reach 80°F (27°C), exercise during cooler morning or evening hours or at an air–conditioned gym. Watch for signs of overheating, such as headache, dizziness, nausea, faintness, cramps, or palpitations.

  10. Dress properly for cold–weather workouts to avoid hypothermia. Depending on the temperature, wear layers you can peel off as you warm up. Don’t forget gloves.

Delayed muscle soreness that starts 12 to 24 hours after a workout and gradually abates is a normal response to taxing your muscles. By contrast, persistent or intense muscle pain that starts during a workout or right afterward, or muscle soreness that persists more than one to two weeks, needs a doctors consult. 

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From file)

Involve Celebrities in Health Awarenss

Celebrity dressed in red to advocate healthy heart. Heart Care Foundation of India is well aware of the charm an idolism people of our country have towards celebrities especially film stars, they are role models and people follow their foot steps. They can be invited for inauguration, message release or a casual visit. It is a certainty that the presence of a celebrity in an event or campaign will not only raise the impact of the message by many folds but will ensure its acceptability and adaptability. Ashish Vidyarthi, film star playing a ludo health game on the occasion of GLOW RED campaighn, to create awareness about rising heart diseases in women.

Dr k k Aggarwal

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

Losartan for NASH

Angiotensin II is involved in the pathogenesis of hepatic fibrosis and enhances iron deposition and insulin resistance. A pilot study of losartan in seven patients with NASH suggested a benefit on blood markers of hepatic fibrosis and serum aminotransferase levels. (Hepatology 2004;40:1222)

News and Views (Dr Brahm and Monica Vasudeva)

Indulging in four unhealthy behaviors may age individuals by 12 years

Being inactive ( < 2 hours of activity per week), eating poorly (fruits and vegetables < 3 times per day), smoking, and too much drinking ( > 3 pegs /day for men and 2 for women) are bad. Now, a newly published paper assesses and quantifies those behaviors. In short, combine all of the above and you’ll end up seeming 12 years older than people your age who do none of the above. They are 3.49 times more likely to die over the course of the study than their countrymen (and women) who practiced clean living. That included a 3.14 times greater risk of death from cardiovascular disease; a 3.35 times greater risk of death from cancer; and a 4.29 times greater risk of death form any other cause. 96% of those with healthy behaviors were alive at the end of the study, compared with 85% of those with the worst health habits. Two poor and two healthy behaviors, doubles the risk of dying compared to having only healthy behaviors. (April 26 issue, Archives of Internal Medicine).

Additional 10 to 15 pounds may not exacerbate mortality–disease risk

New information is indicating that carrying an extra 10 to 15 pounds really isn’t that bad. Studies have shown that it will not increase one’s risk of dying from cardiovascular disease or cancer. In fact, the additional weight may help people retain a youthful appearance and prevent osteoporosis. However, there is a vast difference between subcutaneous fat and visceral fat, which appears to exacerbate the risk for heart disease and diabetes.

Researchers explore chocolate–depression connection

According to a study published April 26 in the Archives of Internal Medicine, people who consume larger amounts of chocolate may be more depressed than those who eat lesser amounts of it. 

Here are some ideas to prevent female infanticide and female feticide (Dr GM Singh)

  1. Free education for women up to college and even post graduate education in government run institutions (Similar plans are being implemented in many states in India)

  2. Males should stand up to their own moms and dads when they start chirping about unwanted female children.

  3. Create a feminine movement so that women feel a sisterhood towards each other and stand up for a woman in a neighboring house rather than turn a blind eye.

  4. Refuse marriage of women into households or be very careful of families that have only male children or a very high percentage of males. Chances are high that they did you know what. Again, a few innocents will be in needless trouble, but sometimes poisonous and normal snakes look alike and it is better to get out a stick and protect your own daughters and sisters.

  5. Do not provide any government incentives to families that have only males. Again the bad snake good snake logic applies. But that is OK. Consider it payback for all the dead female children.

  6. Provide extra incentives for families that have more than one girl child. This will help correct the gender balance in a few years.

  7. If you have a female child, educate her and provide her the same opportunities as a male child. This is the one thing that makes female killing folks look foolish and dumb.

  8. Encourage marriage of males to educated women. Conversely, an educated female class will be more aware of their rights.

Mnemonic of the Day ( Dr Maj Prachi Garg)

 Causes of Neonatal jaundice between 24 hrs to 2 wks (Remember the sentence) Babies – Hate Paediatricians Because Pain is Inevitable

Breast milk jaundice

Quote of the Day

'You can have brilliant ideas, but if you can’t get them across, your ideas won’t get you anywhere'. Lee Iacocca

DMA Update: Today is Mother’s Day

Overweight women need to lose only 5% to 10% of their weight to achieve a 50% decrease in urinary leakage, according to a recent New England Journal of Medicine article.

Question of the Day

What is the management of methyl alcohol poisoning?                                Dr Milind Y Nadkar, Rayomand Bengali, Mumbai

Methyl alcohol (methanol) is used as a denaturant and is a component of varnishes, paint removers, windshield washers, copy–machine fluid, anti–freeze solutions and as solvent.

Acute poisoning

The toxic dose is small; 30 ml of a 40% solution can be fatal. Ingestion of methylalcohol usually occurs with ingestion of cheap illicit liquor (hooch). People of lower socioeconomic strata most often suffer from hooch tragedies. Following ingestion, methylalcohol is found in the liver, GI tract, eyes and kidneys. In the liver, it is metabolized to formaldehyde and formic acid by alcohol dehydrogenase. Both these metabolites are toxic, the latter causing the more serious delayed effects.

Clinical features

Methanol is absorbed rapidly from GI tract and levels peak within 1–2 hours. The time of onset is variable. Early manifestations are primarily due to methanol itself and include nausea, vomiting, headache, vertigo and gastritis. At high serum levels (> 40 mg/dl), methanol can cause obtundation, convulsions and coma. Late manifestations may occur after 30 hours and include visual disturbances, severe metabolic acidosis, seizures, coma and death. The latent period is longer when ethanol is ingested concurrently. Ocular toxicity is associated with diminished vision, flashing spots, dilated pupils, optic disc hyperemia, retinal edema and blindness. Severe poisoning leads to myocardial depression, bradycardia and shock.

Laboratory investigations

Apart from arterial blood gases, serum osmolality and anion gap are helpful in diagnosis. Renal and liver function tests should be undertaken and blood methanol levels should be measured if possible. CT scan of the brain may show bilateral putamen necrosis. A diagnosis of methanol poisoning is sometimes made in retrospect on the basis of this finding. Though diagnosis is clinical, calculation of the osmolal and anion gap can help assess severity where serum methanol levels cannot be estimated.


Unabsorbed methanol should be removed by gastric lavage. Supportive measures involve the correction of acidosis, control of seizures and maintenance of nutrition. Alkalinization of urine enhances excretion of formic acid. Specific measures involve administration of ethanol to saturate alcohol dehydrogenase in the liver so as to prevent the formation of the toxic metabolite, formaldehyde. A 5% solution of ethanol is prepared and 15 ml/kg is given as loading dose and then 2–3 ml/kg/hour as maintenance dose orally. It can also be given intravenously. Hemodialysis enhances elimination of methanol and formic acid and is indicated when methanol levels exceed 50 mg/dl. In the absence of serum methanol level measurements, the osmolar gap is useful to assess the indication for and duration of hemodialysis in methanol–poisoned patients. Folic acid has been used to enhance conversion of formate to carbon dioxide and water. The dose is 50 mg IV 4 hourly for 24 hours. 4–methylpyrazole, an inhibitor of alcohol dehydrogenase, has been successfully used as an alternative to ethanol and dialysis.

Suggested reading

  1. Clancy C, Litovitz TL. Poisoning. In: Textbook of Critical Care, 3rd edition, Ayres SM, Grenvik A, Holbrook PR, Shoemaker WC, (Eds.), WB Saunders Company, Philadelphia 1995:1186–210.

  2. Parikh CK. Inebriant poisons. In: Parikh’s Textbook of Medical Jurisprudence and Toxicology, 5th edition, CBS Publications. 1990:847–76.

Stupid Question: (drsooneita@gmail.com)

At the dentist when he’s sticking pointed objects in your mouth...
Stupid Question: Tell me if it hurts?
Answer: No it won’t. It will just bleed.


If you see a piece of paper stuck to the back window of your car
Lock your doors and just drive away. Remove the paper later. Some robbers may be waiting for you to get out of the car and they come and take control of your car.

eMedinewS Try this it Works: When measuring diastolic blood pressure is difficult

Have the patient lift up his or her arm and clench the fist about 10 times. This drains the blood from the forearm. Then, as the patient keeps the arm raised, inflate the occlusion cuff until the pressure rises above the systolic point. Have the patient lower the arm, and take the pressure. This makes the fifth Korotkoff sound much more distinct.

International Vaccines recommendations

Hepatitis A Vaccine 2 weeks before travel

Dr Good Dr Bad

Situation: A patient with sepsis developed thrombocytpenia.
Dr Bad: It is due to drugs.
Dr Good: It is due to sepsis.
Lesson: More than 50 % of patients with sepsis show thrombocytopenia in their peripheral smear.

Make Sure

Situation: A 14–day–old neonate presented with pneumonia. On history, it was found that mother had complains of dysuria, mucopurulent cervical discharge, episodes of sometimes cervical bleeding and lower abdominal.
Reaction: Oh my God! You should have treated the mother with azithromycin.
Lesson: Make sure to remember that pneumonia in neonates can be prevented by treating mother, having Chlamydia trachomaits infection, with azithromycin.

IMADNB Joke of the Day (Dr. Tarun Gupta)


The recruit complained to the sergeant that he’d got a splinter in his finger. "You should have more sense," was the harsh comment, "than to scratch your head."

Formulae in Rural Practice:

ESR in men Formula: ESR = Age in years/2

Milestones in gastroenterology

1577–1644: Van Helmont conducted the first scientific studies on the digestive system and stimulated interest into the nature of gastric juice. Van Helmont believed that food was initially digested in the stomach by acid and fermented. Further fermentation with bile occurred in the duodenum.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)


To help diagnose and monitor C-cell hyperplasia and medullary thyroid cancer; to screen those at risk for multiple endocrine neoplasia type 2
(MEN 2).

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Hydroxy ethyl starch 10% Solution for infusion

For the treatment of imminent or manifest hypovolemia and shock.


MCI Updates

Dr Ketan Desai resigns from BJ Medical College

President of the Medical Council of India (MCI) and professor of Urology at the BJ Medical College (BJMC), Dr Ketan Desai, has sent his resignation letter (dt April, 28, 2010) to college by registered post. Sources in the BJ Medical College confirmed receiving and forwarding Desai's resignation letter to the state government.

Who is the President of Medical Council of India?

Asd per the MCI constitution, being an autonomous institute, unless removed by the council itself Dr. Ketan Desai is and will remain the President of MCI. The day he gets a bail, he is legally and officially allowed to sit on the President’s chair unless he volunteers to resign and quit the post.



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Contact: drkk@ijcp.com emedinews@gmail.com


eMedinewS–Padma Con 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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Public Forum (Press Release for use by the newspapers)

Life style counseling can reduce heart disease

An intensive, effort to change lifestyle in people at high risk of heart disease can help them reduce such risk factors as high blood pressure, cholesterol and smoking. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India at a camp, where he was the Chief Guest, and organised by Varishta Nagrik Club for senior citizens at Yamuna Vihar.

A trial, called the Euroaction study, published in Lancet compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 at high risk. Half got the counseling from a team of nurses, dietitians, physiotherapists and the treating doctors. The counseling was given to families as well as individuals.

The trial included two groups of patients. One, those who already had developed coronary heart disease; another, those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years.

  1. Fifty five percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent of those not getting the advice.

  2. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart-friendly oily fish, compared to 35 percent and 8 percent in the other group.

  3. Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking.

    Mother's day message

    On the occasion of Mother's Day, Dr Aggarwal said thatit was very necessary that women get their regular tests done as while looking after the health and need of their families they tend to neglect their own health. The health of a woman reflects on the health of her family

Readers Responses

  1. Dear Dr. Aggarwal: In the section of etiology of sinus bradycardia (Mnemonic), Inj. atropine is mentioned which appears wrong.There is no mention of beta-blockers or certain calcium channel blockers which do cause bradycardia: Dr. S K Parashar

Emedinews response: high dose atropine in many books has been mentioned as a cause.