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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

12th February 2010, Friday

Changing Practice Guidelines: A1C
The American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) have joined forces to recommend the use of the hemoglobin A1C assay for the diagnosis of diabetes.

A1C values vary less than FPG (fasting plasma glucose) values and the assay for A1C has technical advantages compared with the glucose assay. A1C gives a picture of the average blood glucose level over the preceding 2 to 3 months.

A1C has numerous advantages over plasma glucose measurement:

  1. It is a more stable chemical moiety
  2. The patient does not need to fast
  3. Measuring A1C is more convenient and easier for patients who will no longer be required to undergo a fasting or oral glucose tolerance test.
  4. It correlated tightly with the risk of developing retinopathy.

The committee has determined that an A1C value of 6.5% or greater should be used for the diagnosis of diabetes. This cut–point, is where risk of retinopathy really starts to go up.

Avoid using estimated average glucose, or EAG, as this is just a way to convert the A1C into glucose levels.
(Source: American Diabetes Association (ADA) 69th Scientific Sessions. Presented June 5, 2009. Diabetes Care. Published online June 5, 2009.)

 Dr KK Aggarwal
Chief Editor

News and Views

  1. Even normal glucose in kids may predict diabetes later on Increases in fasting plasma glucose during childhood, even though levels remain in the normal range, can predict adult prediabetes and type 2 diabetes later in life. In a study among individuals with a fasting plasma glucose of less than 100 mg/dL as children, increasing levels were associated with greater risks of prediabetes (P<0.001) and type 2 diabetes (P=0.03) in adulthood. As per Dr Gerald Berenson, of Tulane University Health Sciences Center in New Orleans, the threshold is 85 mg/dL, above which the risk of adult problems began to increase. (February 2010, Archives of Pediatrics and Adolescent Medicine).
  2. New treatment for Dupuytren’s contracture
    The US FDA has approved the first drug for the progressive hand disease known as Dupuytren’s contracture: the injectable collagenase clostridium histolyticum. The biologic drug, breaks down excess collagen that builds up in the hand, preventing relaxation and normal straightening of fingers. Until now the only effective treatment for the condition was surgery, which often entails a long recovery with physical therapy.
  3. Moms’ depression during pregnancy linked to antisocial behavior in teens
    Children from urban areas whose mothers suffer from depression during pregnancy are more likely than others to show antisocial behavior, including violent behavior, later in life. Furthermore, women who are aggressive and disruptive in their own teen years are more likely to become depressed in pregnancy, so that the moms’ history predicts their own children’s antisocial behavior. (January/February 2010, Child Development).
  4. Pseudomonas can kill maggots
    Scientists from the Copenhagen Wound Healing Centre, Statens Serum Institut and the University of Copenhagen in Denmark showed that maggots applied to simulated wounds heavily infected with the bacterium Pseudomonas aeruginosa, were unable to treat the wound and were left dead after 20 hours.
  5. Saffron curry may stop people going blind
    In a trial, volunteers given pills containing the spice, which gives curry its yellow color, for three months showed ‘significant improvements’ in their vision. The experts in Australia and Italy claim the aromatic herb "may hold the key to preventing the loss of sight in the elderly".
  6. HPV vaccine may reduce genital diseases
    High–coverage human papillomavirus (HPV) vaccination among adolescents and young women may result in a rapid reduction of genital warts, cervical cell abnormalities, and diagnostic and therapeutic procedures, researchers report in a new study published online February 5 in the Journal of the National Cancer Institute. Some of these genital abnormalities are precursors of cervical, vulvar, and vaginal cancers).

Conference Calendar
India Lab Expo 2010 (International Symposium on Oncopathology a Review and Update of Diagnostic Problems)
February 11–13, 2010
Venue: Pragati Maidan, New Delhi.

Public Forum
Press Release

Express your love on Valentine's Day by including health in the celebration!

February 14 Make the day a healthy Valentine’s Day said Dr. K K Aggarwal President, Heart Care Foundation of India and Editor eMedinewS.

What can you do with your loved ones:

  1. Go for a healthy meal
  2. Go for a long walk.
  3. Send an environmental friendly e card or greeting card.
  4. Stay away from smoking. Remember smoking and love are repellants to each other.
  5. Destress your partner by communicating "that you care for her or him."
  6. Gift a health check to your loved ones.
  7. Avoid drinking.
  8. Beware of misuse of date rape drugs.
  9. Beware of misuse of Viagra drugs.

A heart–healthy meal may include plenty of fruits and vegetables and foods low in saturated fats, trans fat and salt. Include a hearty salad or a dessert centered around fruit.

Plan an event that encourages physical activity, such as a love song dance–off, nature walk etc.

Give your loved ones a favorite healthy alternative to candy or chocolate, such as a fruit basket.

Send a health–e–card to show someone you care about them and their health.

Question of the day
What is the Management of pulmonary edema in malaria?

Pulmonary edema is a serious complication of severe malaria, with a high mortality (over 80%). It may appear several days after chemotherapy has beenstarted and at a time when the patient’s general condition is improving and the peripheral parasitemia is diminishing. In most cases there are features of adult respiratory distress syndrome (ARDS), implying increased pulmonary capillary permeability or may be iatrogenically from fluid overload. Pulmonary edema is often associated with other complications of malaria and may also occur in vivax malaria. The first indication of impending pulmonary edema is an increase in the respiratory rate, which precedes the development of other chest signs. The arterial pO2 is reduced. Hypoxia may cause convulsions and deterioration in the level of consciousness and the patient may die within a few hours.


  1. Keep the patient upright; raise the head of the bed or lower the foot of the bed.
  2. Give a high concentration of oxygen by any convenient method available, including mechanical ventilation.
  3. Give the patient a diuretic, such as frusemide, 40 mg, by intravenous injection. If there is no response, increase the dose progressively to a maximum of 200 mg.
  4. In intensive care units, mechanical ventilation with positive end–expiratory pressure (PEEP), a wide range of vasoactive drugs and hemodynamic monitoring should be done.
  5. If there is pulmonary edema due to overhydration in addition to the above: Stop all intravenous fluids
  6. Use hemofiltration immediately, if available
  7. If there is no improvement, withdraw 250 ml of blood by venesection into a blood transfusion donor bag so that it can be given back to the patient later.

(Suggested reading: A Practical Handbook 2nd Edition, WHO, Geneva 2000).

Clinton Receives Two Stents

Former President Bill Clinton was taken to New York's Columbia-Presbyterian Hospital this afternoon with complaints of chest pain and subsequently received two stents. In 2004, Clinton had quadruple bypass surgery at the hospital after angiography revealed significant blockages in four coronary arteries. Six months later, Clinton had surgery to remove fluid and scar tissue from his left chest cavity.

Punjab & Sind Bank
Central Bank of India

eMedinewS Try this it Works
Focus on the fundus
Have the patient put on his or her eyeglasses and repeat the exam through the eyeglass lenses. The glasses often help focus on the retina and make the examination much easier.

Dr Good Dr Bad
Situation: A 13–year–old diabetic child needed to increase his metformin dose.
Dr Bad: Metformin is not given in children.
Dr Good: You can increase up to 2 grams per day.
Lesson: In pediatric patients, metformin is started as an oral dose of 500 mg, administered once–daily. The dose can be increased by 500 mg increments, initially as 500 mg twice daily, to a maximum daily dose of 2000 mg given as 1000 mg twice daily. (Diabetes Care 2002; 25:89.)

Make Sure
Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

Laughter the best medicine  (Swapna C K)
After nearly forty years in practice as a gynecologist, John decided he had enough money to retire and take up his real love, auto mechanics. He left his practice, enrolled in auto mechanics school, and studied hard. The day of the final exam came and John worried if he would be able to complete the test with the same proficiency as his younger classmates. Most of the students completed their exam in two hours. John, on the other hand, took the entire four hours allotted. John tossed and turned in bed that night, dreading the next morning when the exam scores would be returned.

The following day, John was delighted and surprised to see a score of 150% for his exam.

John spoke to his professor after class. "I never dreamed I could do this well on the exam. But tell me, how did I earn a score of 150%?"

The professor replied, "I gave you 50% for perfectly disassembling the car engine. I awarded another 50% for perfectly reassembling the engine. I gave you an additional 50% for having done all of it through the muffler."

Formulae in Imaging
A common bile duct greater than 7 mm in diameter is seen in (a) nonjaundiced patients with gallstones and/or pancreatitis, or (b) jaundiced patients with common duct obstruction by stone or tumor.)

SMS Anemia
For those with unexplained and symptomatic anemia, options include red cell transfusions or erythropoiesis–stimulating agents (ESAs, eg. erythropoietin, darbepoetin).

Milestones in Neurology
Hans Gerhard Creutzfeldt (1885 – 1964) was a German neuropathologist, who first described the Creutzfeldt–Jakob disease. He was born in Harburg upon Elbe and died in Munich. Sir James Crichton–Browne FRS (29 November 1840 – 31 January 1938) was a British psychiatrist remembered for the scientific study of brain tissue in cases of psychiatric disorder, for his concepts of mental illness in relation to evolutionary theory and for the development of medical psychology in public health and education.

Mistakes in Critical Care
Never use ‘/’ slash mark for ‘per’. It can be mistaken for ‘1’. For example '25 units/10 units’ can be misread as ‘25 units and 110 units’


(Advertorial section)

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Phosphate and Ammonium Chloride may help boost Body Metabolism to aid weight loss, block allergic response, slow down the growth of tumours, protect bones, fight bad breath, improve Skin, protect against Alzheimer's and Parkinson's disease and even delay the onset of Diabetes. The Combination is known to reduce the VLDL and LDL Levels and thus reduce the incidence of Stroke and Heart disease.

Advertising in emedinews
emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS–PadmaCon 2010 
Will be organized at MAMC on July 4, 2010, Sunday to commemorate Doctors′ Day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

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 hangama and live webcast. Suggestions are invited.

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 Dr. K K Aggarwal: I take this opportunity to felicitate you on being conferred the Padma Shri in the field of Medicine. I am confident that your consistent pursuit of excellence in the field of medicine would benefit millions of countrymen in the years to come. Regards; Yours sincerely: Meira Kumar (Smt.): Speaker Loksabha
  2. Dear Dr Aggarwal, emedinews is serving the imp function as served by formal CME activities. It is not only important to busy clinicians, but to preclinical faculty and senior scientists who distanced from such imp information because of paucity of time. Best wishes. I will be forwarding emedinews to some of my colleagues with due information to you. Dr. KK Deepak MD, PhD, MNAMS, Professor of Physiology, Medical Education Unit, Item Bank Administrator ( IDEAL Consortium) College of Medicine, King Fahd Hospital of University (Al–Khobar), Dammam University, Dammam, Kingdom of Saudi Arabia
  3. Dear Dr.K.K.Aggarwal, thanks for sending informative mails. Complete details of latest immunisation schedule for children and adults would be greatly apprecialed. regards: Dr.Mukesh Sharma.
  4. Dear Dr.K.K.Aggarwal: Heartiest congratulations to receive the National Award Padamshri: Dr. B.B. Sahi and Dr.Santosh Sahi
  5. Great effort .................. another milestone covered.............emedinews is a brilliant n unique concept of imparting knowledge n awareness..............Sonia Madan
  6. What is febrile fit ( DR G M Singh)
    Febrile convulsions occur in young children when there is a rapid increase in their body temperature. It affects only a small percentage of three to four–year–olds. Children who are at risk may naturally have a lower resistance to febrile convulsion than others. Children may inherit the tendency to suffer febrile convulsion from their parents. Nevertheless, the child′s susceptibility also depends on whether he or she frequently gets infections.