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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

11th April, 2010 Sunday

What are the examples of radiation exposures?

The average annual dose to persons residing in the United States is approximately 3.6 mSv (360 mrem). The majority of this dose (55 percent) is due to exposure to radon daughter products from the earth and construction materials, with man-made sources of radiation (eg, medical imaging studies), cosmic radiation, and natural radiation from endogenous sources (eg, the naturally occurring radioactive isotope of potassium, potassium-40) contributing the majority of the rest.

Examples of the ranges of exposures which might be seen following medical imaging procedures

1. A standard chest x-ray delivers a dose of 2 to 11 mrem (0.02 to 0.11 mSv, 0.02 to 0.11 mGy).

2. Interventional cardiologists working in a high-volume catheterization laboratory may have collar badge exposures exceeding 600 mrem (6 mSV) per YEAR.

3. A barium enema with 10 spot images delivers a dose of approximately 0.7 rem (700 mrem, 7 mSv, 7 mGy). Similar doses (7 to 8 mSv) are delivered from a CT scan of the chest or a PET scan.

4. Myocardial perfusion imaging, CT angiography of the chest, and percutaneous coronary interventions deliver doses in the range of 15 mSv.

5. A combined PET/CT scan of the chest is estimated to deliver a dose of 25 mSv.

The lowest radiation dose resulting in an observable effect in man on bone marrow depression, with a resultant decrease in blood cell counts, is in the range of 10 to 50 rem (100 to 500 mSv, 0.1 to 0.5 Gy).

The lowest total body dose at which the first deaths may be seen following exposure to ionizing radiation is in the range of 1.0 to 2.0 Gy. Depending upon the type of support given, 50 percent of people exposed to a dose of 3 to 4 Gy will be expected to die of radiation-induced injury.

There is virtually no chance of survival following a total body exposure in excess of 10 to 12 Gy.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo feature

Tableau in the Perfect Health Parade 2010 (organized by Heart Care Foundation of India and The Loomba Trust in association with Health Dept Delhi Govt, MCD, NDMC, IMA NDB, Janak Puri Branches, WFR, DTC, Dept of prohibition DG) deputing efforts for 'UN recognition of International Widows Day' to help 245 million widows and their children around the world.

Dr k k Aggarwal

News and views

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

1. Wrongful shock from ICD could be harbinger of death

Inappropriate shocks from an implantable cardioverter defibrillator (ICD) device may be linked to higher mortality, although causality remains questionable. Each ICD discharge not delivered for ventricular tachycardia or ventricular fibrillation independently raised the risk of dying from any cause by 40%. (Dr Johannes B. van Rees, Leiden University Medical Center)

2. Endovascular mitral valve repair challenges surgery

In patients with significant mitral value regurgitation, transcatheter repair using an investigational valve clip device appears to be safer than surgery and almost as durable. At 30 days, the major adverse clinical event rate (MACE) was 9.6% among patients treated with the catheter device, MitraClip, compared with 57% among the surgery group. (Dr Ted Feldman, NorthShore University Health System, Evanston, Ill.)

3. RF ablation helps in complex atrial fibrillation

Catheter ablation appears better than drug therapy for more complex, symptomatic atrial fibrillation, according to initial results of the CABANA pilot trial. Patients undergoing radiofrequency ablation had a 58% reduced risk of symptomatic recurrence compared with patients taking rate and rhythm control medication (65% versus 41% at 12 months. (Dr Douglas L. Packer, Mayo Clinic, Rochester, Minn)

4. Anticoagulant seems safe and effective

An investigational, selective factor Xa inhibitor called betrixaban demonstrated apparent safety and efficacy in a phase II trial, making it yet another contender in the race to develop an alternative to warfarin.

Mnemonic of the Day (Dr Prachi Garg)

Rheumatic fever:

Major criteria : CASES


Arthritis (migratory)

Subcutaneous nodules

Erythema marginatum,

Syndenham’s chorea

Celiac Disease (Dr Ishi Khosla)

Why is there no awareness so far about celiac disease? Awareness is limited as:

  • Perception of disease is uncommon

  • Disease has changed its presentation – it is described in medical textbooks as a -rare diarrheal condition of childhood.

  • Symptoms can be confusing especially in silent and atypical types

  • You have to look for Celiac disease to diagnose it

What’s New

Surgical decompression for carpal tunnel syndrome had a small benefit of modest clinical significance, compared to nonsurgical treatment (multimodal intervention) in a randomized trial. (Jarvik JG, Comstock BA, Kliot M, et al. Surgery versus non–surgical therapy for carpal tunnel syndrome: a randomised parallel–group trial. Lancet 2009;374:1074.)

eMedinewS fact about rheumatoid arthritis

Anti–CCP antibodies predict erosive disease more effectively among patients with RA than do assays for Rheumatoid Factor.

eMedinewS calculator

Calculator: DVT Probability: Wells Score System Clinical Findings

Paralysis, paresis or recent orthopedic casting of lower extremity (1 point)

Recently bedridden (more than 3 days) or major surgery within past 4 weeks (1 point)

Localized tenderness in deep vein system (1 point)

Swelling of entire leg (1 point)

Calf swelling 3 cm greater than other leg (measured 10 cm below the tibial tuberosity) (1 point)

Pitting edema greater in the symptomatic leg (1 point)

Collateral non varicose superficial veins (1 point)

Active cancer or cancer treated within 6 months (1 point)

Alternative diagnosis more likely than DVT (Baker's cyst, cellulitis, muscle damage, superficial venous thrombosis, post phlebitic syndrome, inguinal lymphadenopathy, external venous compression) (-2 points)

Total Criteria Point Count:

DVT Risk Score Interpretation

3-8 Points: High probability of DVT

1-2 Points: Moderate probability

2-0 Points: Low probability

(Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997;350(9094):1795-8.)

Quote of the day

‘The first requisite of success is the ability to apply your physical and mental energies to one problem without growing weary.’ (Thomas Edison)

Diabetes Fact

Normal urea, normal creatinine, high K, not on drugs, Diagnosis: Renal tubular acidosis type 4 (low K type 2, low K with stones type 1)

Public Forum
(Press Release)

Will bees be approved by FDA for treatments?

Honey: A Topical Treatment for Wounds: In recent years, there has been a resurgent interest in the use of honey in wound care said Padma Shri and Dr B C Roy Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Honey, a plant nectar that is modified by the honey bee Apis mellifera, has been used as a treatment for wounds since antiquity, with records of its use dating back to the early Egyptians, Assyrians, Chinese, Greeks, and Romans.

There are several mechanisms through which honey is thought to act on and heal wounds.

  1. When it is applied directly on a wound surface or via a dressing, it can act as a sealant, keeping the wound moist and free from contamination.

  2. In addition, honey is comprised of glucose (35%), fructose (40%), sucrose (5%), and water (20%). This high sugar content plus vitamins, minerals, and amino acids) provides topical nutrition that is thought to promote healing and tissue growth.

  3. Honey is also a hyperosmotic agent that draws fluid from the wound bed and underlying circulation, which kills bacteria that cannot thrive in such an environment.

  4. It is bactericidal in other ways as well. During the process of honey production, worker bees add the enzyme glucose oxidase to the nectar. When honey is applied to the wound, this enzyme comes into contact with oxygen in the air, which leads to the production of the bactericide hydrogen peroxide.

  5. Macroscopically, honey has also shown debriding action.

  6. Manuka (Medihoney) is a medicinal honey with enhanced antibacterial properties derived from floral sources in Australia and New Zealand. In June and July 2007, Health Canada and the US FDA, respectively, cleared it as the first medicinal honey product for use in wounds and burns.

  7. Peter Molan, a New Zealand biochemist at the University of Waikato, has reported that it can stop bacterial growth even when diluted up to 56 times. He has conducted studies on this honey in rats and piglets that have suggested that it has anti–inflammatory properties and can stimulate epithelial growth, advancing closure of skin in these animals.

  8. Research at the University of Sydney tested various strains of honeys against bacterial strains obtained from hospitals and found that even the strains most resistant to antibiotics failed to grow in the presence of honey.

  9. About 17 randomized controlled trials involving a total of 1965 participants have been published; 5 other types of clinical trials involving 97 participants treated with honey have also been reported in the literature. Furthermore there are about 16 trials of honey on a total of 533 wounds in animal models (which rule out a placebo effect). There are over 270 cases, of mostly chronic wounds cited in the literature that were treated with honey. Honey gave good results in all but 14 of these cases.

Question of the day

What are the indications for using Botox in cosmetology?

The use of botulinum toxin type A to improve the appearance of hyperfunctional facial lines is one of the most common cosmetic procedures performed today1. In India, the use of Botox has been recently approved for hyperkinetic facial lines, glabellar lines and hyperhidrosis. This is given by DCGI. Apart from this, Botox has approvals on cosmetic indications in more than 50 countries worldwide. As per the US FDA, the only approved indication for using Botox for cosmetic indications is for the Frown lines or Glabellar complex. It is now termed Botox Cosmetic and is fast becoming one of the most popular cosmetic procedures all over the world. With respect to the Indian scenario, since it has received the approval for hyperkinetic facial lines, it means it can be used in most of the basic and advanced indications of Botox. It is however advisable that when using Botox in cosmetic indications, it is better to use it for the basic indications until one gains a certain amount of confidence and experience before trying the advanced indications.

Basic Indications:

Glabellar Frown Lines

Crow’s Feet

Forehead Lines

Advanced Indications:

Chemical brow lift

Suborbital hypertrophic orbicularis

Infraorbital crow’s feet

Nasal scrunch ("sbunny lines")

Nasal flare

Nasolabial folds

Perioral lip lines

Marionette lines

Mental crease

Popply chin

Platysmal bands

Horizontal neck lines

Hypertrophic mandibular angles

Facial asymmetry

eMedinewS Try this it Works

Getting the best of the barb

Using wire cutters to remove a fish hook could present dangers. The barb could fly up and hit someone, potentially spreading inoculum, or the barb could lie on the floor and stick onto an unsuspecting person. To avoid such hazards, place a saline–soaked 4 × 4 gauze patch over the barb directly above where you are cutting. This will embed the barb in the gauze and protect you and others.

Dr Good Dr Bad

Situation: A patient with diabetic foot came for imaging test.

Dr Bad: Get CT done.

Dr Good: Get MRI done.

Lesson: MRI is the most accurate imaging test for diagnosis of osteomyelitis underlying diabetic foot ulcers. An accurate diagnosis of osteomyelitis is crucial to optimize outcomes. In a meta–analysis, the diagnostic odds ratios for clinical examination, radiography, MRI, bone scan, and leukocyte scan were 49.45, 2.84, 24.36, 2.10, and 10.07, respectively. Plain radiography had a sensitivity of 0.54 and a specificity of 0.68. MRI had a sensitivity of 0.90 and a specificity of 0.79. Bone scan was found to have a sensitivity of 0.81 and a specificity of 0.28. Leukocyte scan was found to have a sensitivity of 0.74 and a specificity of 0.68. (Clin Infect Dis 2008;47(4):519–27.)

Make Sure

Situation: A 50–year–old patient, highly stressed at work and a hypertensive as well complains of acid eructations and indigestion.

Reaction: Oh my God! He has hyperacidity. Put him on magaldrate

Lasson: Make sure, patients who are suffering from stress, diabetes and/or hypertension and who have hyperacidity/GERD/peptic ulcers, are put on magaldrate which is safe and effective as an antacid.


Laughter the best medicine

One day, after a man had his annual physical, the doctor came out and said, "You had a great checkup. Is there anything that you’d like to talk about or ask me?" "Well," he said, "I was thinking about getting a vasectomy."
"That's a pretty big decision. Have you talked it over with your family?"
"Yeah, and they’re in favor 15 to 2."

Formulae in Critical Care

Systemic vascular resistance (SVR)

Formula: SVR = (MAP – Mean CVP/CO) × 80

Comment: Represents the force that the left ventricle must
overcome to pump the blood to periphery.

Normal value: 900–1,400 dyne–sec/cm5.

Milestones in Medicine

1970s A.D.The World Health Organization announced worldwide eradication of smallpox.

Lab Test (Dr Naveen Dang)

Haptaglobin levels help to detect and evalutehemolytic anemia.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Dexketoprofen 12.5 mg/25 mg + Paracetamol 500 mg film coated tablets

For the treatment of acute musculoskeletal pain


(Advertorial section)



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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 are 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

Readers Responses

  1. Congratulations on receiving Padma Shri: Gaurakh Khandelwal

  2. Many congratulations doctor sahib on receiving the prestigious Padma award. Wish you good healthy life and many such achievements in future: Manoj Gautam

  3. My heartiest congratulations to Dr. Aggarwal: R N Zamindar, Charak pharma

  4. Congrats Sir for this great achievement: Sarfaraz Saifi, Azad News