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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

12h April, 2010 Monday

Even people with normal cholesterol may require statins

The US FDA in February approved the use of a cholesterol–lowering statin drug, rosuvastatin, for some people with normal cholesterol levels. The approval of expanded use of rosuvastatin was based on results of the JUPITER study, which involved more than 18,000 people and was financed by the drug’s maker, AstraZeneca. People in the trial who took the drug for an average of 1.9 years had a 44 % lower risk of heart attack, stroke and other cardiovascular problems compared to those who took a placebo – results so outstanding that the trial was cut short. Based on JUPITER, an FDA advisory committee voted 12 to 4 in December to approve widened use of the drug.

The people in the trial included men over 50 and women over 60 with normal or near–normal cholesterol levels. These individuals also had high levels of high sensitivity C–reactive protein. They also had at least one other heart risk factor, such as obesity or high blood pressure. Over a five–year period of time, it prevents one death or minor stroke for every 25 people treated.

Lesson: Do lipid profile and hsCRP test. If hsCRP is high give statins even if the cholesterol is normal. In the west, one more risk factor is required but as being an Indian is a risk factor no other associated condition is required for Indians.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

Tableaus 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). The 1st Tableau creates awarness about the problems faced by widows and their children. The 2nd on 'Green Delhi' focuses on the DTC's preparations for 2010 Commonwealth games.

Dr k k Aggarwal

News and views

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

1. STEMI patients helped by aspirating the clot

Rheolytic thrombectomy before stenting improved outcomes over stenting alone among patients with ST–elevation myocardial infarction (STEMI), a multicenter, randomized trial showed. Removal of the thrombus with the AngioJet system was independently associated with early ST-segment resolution. (Dr David Antoniucci, Careggi Hospital, Florence, Italy)

2. Novel stents safe as current ones, may be more effective

Two new stent designs appear at least as safe as prior generations with some efficacy advantages. A novel dual drug–eluting, polymer–free stent appeared as safe as the first generation sirolimus–eluting Cypher and second–generation zotarolimus–eluting Endeavor stents over the mid–term, from one to two years (P=0.61 for death or MI and P=NS for definite stent thrombosis).

3. Cilostazol adds no benefit to dual antiplatelet therapy

Adding cilostazol –– an antiplatelet approved in the U.S. for treatment of intermittent claudication –– to standard dual antiplatelet therapy did not improve clinical outcomes in patients receiving drug–eluting stents. Six months after the procedure, patients who had received cilostazol in addition to standard therapy had significantly lower platelet reactivity compared with those receiving dual antiplatelet therapy alone. (Dr Hyo–Soo Kim, Seoul National University Hospital, South Korea)

4. Radial artery matches saphenous vein for CABG

Coronary artery bypass grafts taken from the radial artery provide short–term patency that is just as good as standard saphenous vein grafts. Radial artery grafts remained open at one week in 99% of patients, compared with 97% for saphenous vein grafts. The rates were identical at 89% after one year. (Dr Steven Goldman, Tucson VA Hospital, Arizona)

5. New anticoagulants signal start of post–warfarin era

Atrial fibrillation is both a major stroke risk and a looming public health problem since the risk of atuial fibrillation increases with age, and the standard treatment, warfarin, is often a clinical management challenge. But a number of investigational therapies suggest that a post–warfarin era is beginning. American College of Cardiology president Ralph Brindis, MD, of the University of California San Francisco, says two new compounds, betrixaban and dabigatran, have "raised the threshold" for anticoagulation therapy. But, as Brindis told Peggy Peck, MedPage Today Executive Editor, neither compound has been approved for clinical use.

Mnemonic of the Day (Dr Prachi Garg)

Minor criteria 4PA: Rhaumatic Fever


Prolonged PR

Past Hx

Positive (i.e. ) ESR/CRP


Celiac Disease (Dr Ishi Khosla)

Does celiac disease run in families?

It may have a strong genetic component but there are others factors too. If a person is diagnosed with celiac disease, there is a 20% chance that it may run in the family.

What’s New: Mild pre–eclampsia or gestational hypertension

A multicenter randomized trial (HYPITAT) found that women with mild pre–eclampsia or gestational hypertension who underwent induction of labor at ≥37 weeks gestation had a lower risk of developing severe hypertension and a lower cesarean delivery rate than women managed expectantly with maternal/fetal monitoring. (Koopmans CM, Bijlenga D, Groen H, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open–label randomised controlled trial. Lancet 2009;374:979.)

eMedinewS fact about rheumatoid arthritis

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

eMedinewS calculator

Pressure Ulcer Risk Stratification

Sensory perception

  • Completely limited (1 point)
  • Very limited (2 points)
  • Slightly limited (3 points)
  • No limitation (4 points)


  • Constantly moist (1 point)
  • Moist (2 points)
  • Occasionally moist (3 points)
  • Rarely moist (4 points)


  • Bedfast (1 point)
  • Chairfast (2 points)
  • Slight limitation (3 points)
  • No limitation (4 points)


  • Immobile (1 point)
  • Quite limited (2 points)
  • Slight limitation (3 points)
  • Normal mobility (4 points)


  • Very poor (1 point)
  • Inadequate (2 points)
  • Adequate (3 points)
  • Excellent (4 points)


  • Problematic (1 point)
  • Potentially problematic (2 points)
  • None (3 points)

Total Criteria Point Count:

Risk Score
17-23 points : Minimal risk
15-16 points :Low risk
13-14 points : Moderate risk
0-12 points : High risk

Quote of the day

"The person who gets the farthest is generally the one who is willing to do and dare. The sure–thing boat never gets far from shore." (Dale Carnegie)

Diabetes Fact

Non ketotic hyperosmolar coma: in type 2, elderly, no nausea or vomiting, no pain in abdomen, ketosis, sugar range 900–1100, profound, dehydration altered sensorium, no acidosis, no Kussmaul breathing. Prone to VTE, start  LMWH, treat with insulin.

Public Forum
(Press Release for use by the newspapers)

Maggots for therapy

Medical Maggots are a prescription only medical device used for maggots therapy said Padmashri and Dr B C Roay Awardee Dr KK Aggarwal, President Heart Care Foundation of India. 

Maggot therapy (also known as Maggot Debridement Therapy (MDT), larval therapy, larva therapy, or larvae therapy) is a type of biotherapy involving the intentional introduction by a doctor of live, disinfected maggots (fly larvae) into the non–healing skin and soft tissue wound(s) of a human or animal for the purpose of selectively cleaning out only the necrotic (dead) tissue within a wound in order to promote wound healing.

In the United States, Medical Maggots are regulated by the FDA as a prescription–only medical device.

In January of 2004, the FDA granted permission to produce and market maggots for use in humans or other animals as a prescription use medical device for the following indications:

  1. For debriding non–healing necrotic skin and soft tissue wounds

  2. Pressure ulcers

  3. Venous stasis ulcers

  4. Neuropathic foot ulcers

  5. Non–healing traumatic or post surgical wounds

Medical Maggots represent the first living organisms ever allowed by the FDA for production and marketing as a prescription medical device. The use of maggots as a form of field improvised debridement has been documented since at least the American Civil War and is currently taught to US Army Special Forces medics. In controlled and sterile settings, maggot therapy introduces live, disinfected maggots or fly larvae into non–healing skin or soft tissue wounds of a human or other animal. This practice was widely used before the discovery of antibiotics, as it serves to clean the dead tissue within a wound in order to promote healing

Question of the day

What is Laser Hair transplantation? Can artificial hair be used?

Laser was used to create recipient holes and it was claimed that the use of laser caused less bleeding. However, laser also leads to destruction of tissue which can affect growth of hair. Hence use of laser is not favoured. Artificial hair are poyproplylene fibres which look like hair, These are fixed to the inner most layer of scalp called galea in a knot in a simple procedure. However, these fibres a re on the banned list of FDA in USA and have a history of leading to frequent problems such as infections, allergy, frequent loss of fibres, cysts etc. Hence their use is not advocated. It is important to understand that many treatments are advertised in the lay press; often these treatments are costly and do not have sufficient proof. Hence patients have to be careful and seek proper information before resorting to such treatments.

eMedinewS Try this it Works

Easing the eyedrops

If your patients have trouble using eye drops, have them either lie down or tilt back their head and put the drops in the corner of the affected eye, near the nose. Then tilt the head to the left for the left eye and to the right for the right eye. The drops flow directly into the eye.

Dr Good Dr Bad

Situation: A diabetic with foot ulcer and low testosterone levels came for endothelial test prescription.

Dr Bad: There is no test available.

Dr Good: Get endothelial test (flow mediated dilation of brachial artery) done.

Lesson: Low testosterone level is an independent determinant of endothelial dysfunction in men. In a study, a low plasma testosterone level was associated with endothelial dysfunction in men independent of other risk factors, suggesting a protective effect of endogenous testosterone on the endothelium. Total and free testosterone and dehydroepiandrosterone–sulfate (DHEA–S) were significantly correlated with % FMD (flow–mediated vasodilation) of the brachial artery. %FMD in the highest quartile of free testosterone was 1.7–fold higher than that in the lowest quartile. (Hypertens Res 2007;30(11):1029–34.)

Make Sure

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, comes for follow up.

Reaction: Oh my God! Why didn’t you put him on antioxidants?

Lesson: Make Sure, to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.


Laughter the best medicine (Dr Rajeev Gupta)

A woman was out golfing one day when she hit the ball into the woods.
She went into the woods to look for it and found a frog in a trap.
The frog said to her, "If you release me from this trap, I will grant you three wishes."
The woman freed the frog, and the frog said,
"Thank you, but I failed to mention that there was a condition to your wishes.
Whatever you wish for, your husband will get ten times of it!" The woman said, "That's okay."

For her first wish, she wanted to be the most beautiful woman in the world.
The frog warned her, "You do realize that this wish will also make your husband the most handsome man in the world, an Adonis whom women will flock to".
The woman replied, "That’s okay, because I will be the most beautiful woman and he will have eyes only for me.
" So, KAZAM – she’s the most beautiful Woman in the world!

For her second wish, she wanted to be the richest woman in the world.
The frog said, "That will make your husband the richest man in the world. And he will be ten times richer than you."
The woman said, "That’s okay, because what’s mine is his and what’s his is mine." So, KAZAM- she's the richest woman in the world!

The frog then inquired about her third wish, and she answered, "I'd like to have a mild heart attack."
Moral of the story: Women are clever. Don’t mess with them.
Attention female readers:
This is the end of the joke for you. Stop here and continue feeling good

Male readers: Please continue.
The man had a heart attack ten times "milder" than his wife!!!
Moral of the story: Women are really dumb but think they’re really smart.
Let them continue to think that way and just enjoy the joke. 
PS: If you are a woman and are still reading this; it only goes to show that women never listen!!!

Formulae in Critical Care

Metabolic alkalosis
Estimated PaCO2

Formula: PaCO2 will increase by 0.75 mmHg per mmol/l increase
in bicarbonate
PaCO2 will increase by 6 mmHg per 10 mmol/l increase
in bicarbonate
PaCO2 = (HCO3) + 15

Milestones in Medicine

1952 A.D. Jonas Salk developed the first successful polio vaccine.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Levosulpride ER Tablet 100/150/200mg

For the treatment of depression and schizophrenia in adults


(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 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

Readers Responses

  1. Felicitations to you Sir: Dr. Vandana, DPC Intl. School

  2. No candle loses any of its light while lighting another candle. Never stop helping others because it makes your life more meaningful. Congratulations with loads of flowers: Aruna Tyagi

  3. Heartiest congratulations for receiving Padma Shri award. You achievement makes us proud and happy. Good wishes for future success and happiness: Shivroop Tiwari

  4. Good afternoon Dr. Aggarwal. Many many congrats for the award. May God bring in many more success in your life: Vinay Aggarwal


  1. Dear Editor, Recumbent prismatic Spectacles allow patients lying on their back in bed to read a book or watch TV more comfortably. The product is marketed by OptometryToday@gmail.com. Dr. Narendra Kumar, C4F/216 Janakpuri
    New Delhi 110058


  1. Dear KK, Your informative press release on use of honey is an excellent one. I remember, during our childhood, when there were no electrical or many diesel trains, we used to get small coal particles into our eyes, because we could not keep our heads inside. So it was a dash of honey put into eyes to cleanse them of the coal particles. All the same its use should be encouraged in daily practice, and I feel it would be safer than routinely used dressings by gps. Now coming onto consultation, can you advise what to give to person hypersensitive to Aspirin/Ecosprin in a suspected case of CVD? Will clopidrel be ok and in what dose? Thanks & Regards. KKArora

          75 mg daily clopidogrel. KK