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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

13th June, 2010, Sunday

Preventive aspirin reasonable for high–risk diabetics

Dear Colleague

Guidelines on how to use aspirin for primary prevention of cardiovascular events in diabetics were released in a recent statement from the American Diabetes Association, the American Heart Association and the American College of Cardiology Foundation.

Aspirin use results in about 10% reduction in cardiovascular events overall, but its effect as primary prevention in diabetics is unclear.

It's reasonable to use low–dose (75 to 162 mg/d) aspirin as prevention in diabetics who have a high risk of cardiovascular disease (a 10–year risk over 10%). That would include most men over 50 and women over 60 who have one or more additional risk factors: smoking, hypertension, dyslipidemia, family history of premature cardiovascular disease or albuminuria.

For patients at intermediate risk (younger patients with one or more of the risk factors, older patients with no risk factors, or anyone with a 10–year risk of 5% to 10%), preventive aspirin might be considered. However, patients at low risk (those with a 10–year risk under 5%) should not be advised to take aspirin, as the potential adverse effects from bleeding offset the potential benefits. The statement noted that patients with diabetes are at higher risk for adverse events from aspirin than nondiabetics.

Physicians should also consider the beneficial effects of other treatments such as statins, blood pressure control and smoking cessation. When calculating a patient’s risk of cardiovascular disease, If these other treatments are adopted first, then there may be less need for aspirin.

The statement was published online by the Circulation, a journal of the American Heart Association, on May 27, 2010.

Comment: These international guidelines may need to be interpreted differently in India as being Indian is a risk factor by itself.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Use of Playing Cards as Health Awareness Module

Heart Care Foundation of India (HCFI) has tried innovative methods of communicating health messages recurrently for it’s varied campaigns. Playing cards, which are commonly used in India and worldwide for entertainment and indoor recreation in rural and urban areas, were modified by HCFI to pictorially convey health messages with each card.

In the photo: Ms Meghna Kothari, Actor, showing the playing cards with health messages to create awareness. Also in the photo, Padma Shri & Dr BC Roy Awardee Dr KK Aggarwal, President HCFI

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update


Several cases of severe optic neuropathy have been reported in patients treated with bevacizumab for glioblastoma. The mechanism is uncertain, however, and vascular etiologies, drug–induced sensitivity to radiation, and direct toxic effects are possible.


  1. Sherman JH, Aregawi G, Lai A, et al. Optic neuropathy in patients with glioblastoma receiving bevacizumab. Neurology 2009;73:1924.

Mnemonic of the Day

Placenta–crossing substances – "WANT My Hot Dog":

Hormones/ HIV

News and views (Dr Monica and Brahm Vasudeva)

1. Defibrillator deactivation rarely mentioned during end–of–life discussions

The number of patients receiving defibrillators is continually rising. End–of–life concerns like withdrawing medications and resuscitation attempts are often routinely discussed, the subject of defibrillators rarely comes up for such discussion. According to a research from the Mount Sinai School of Medicine in New York, only 10% of some 400 hospitals that responded to a survey had formal policies in place to discuss defibrillator deactivation.

2. New study recommends against routine use of axillary dissection

A study presented at the American Society of Clinical Oncology (ASCO) 2010 Annual Meeting finds no improvement in survival with completion axillary lymph node dissection in women with breast cancer who have only 1 or 2 positive sentinel lymph nodes and so recommends against its routine use. There was no significant difference in overall survival between patients treated with SLND alone vs those treated with complete axillary lymph node dissection, 92.5% vs 91.8%, respectively at 8 years (P = .25). There was also also no significant difference in disease–free survival between the two treatment groups.

3. Diabetics also more prone to oxalate kidney stones

A new study published in the June 2010 issue of Journal of Urology reports that diabetics are at higher risk for calcium oxalate stones in addition to their recognized risk for uric acid nephrolithiasis. According to Dr Marshall L. Stoller and co researchers at the University of California–San Francisco, urinary oxalate levels were higher with lower urine pH in stone formers with type 2 diabetes compared to nondiabetic stone formers. Diabetic patients excreted around 15% more urinary oxalate daily than nondiabetics.

4. Lesogaberan may be useful in acid reflux refractory to PPIs

In a phase IIa crossover trial, Lesogaberan, gamma–aminobutyric acid type B (GABA–B) receptor agonist, decreased the number of reflux episodes compared with placebo when used as add–on therapy in patients who are refractory to treatment with PPIs or proton pump inhibitors. It also reduced the number of transient LES relaxations, which are believed to cause reflux. The trial is published online May 7, 2010 issue of Gastroenterology.

Dr KK Aggarwal on the Net Today

Check out the folowing links

HT Saket Connect Pg 6––How many multivitamins a day? (The author Dr K K Aggarwal, is a Padmashree awardee and Chief Editor, emedinews)


HT Gurgaon Connect Pg 8––How many multivitamins a day? (The author Dr K K Aggarwal, is a Padmashree awardee and Chief Editor, emedinews)


Interesting tips in Hepatology & Gastroenterology (Dr Neelam Mohan)

Button (Disk) Battery ingestion

  • Impaction can lead to tracheo-esophageal fistula (TEF), esophageal perforation, severe burns, aortoenteric fistula and death.

  • Severity of injury is influenced by battery size, duration of contact, and type of heavy metal.

  • Injury results from liquification necrosis, direct pressure necrosis, and electrical current / pH changes.

If impacted in esophagus, severe mucosal burns can occur within 4 hours and perforation can occur within 6 hours. There is 100% risk of perforation for impaction, if lasts for more than 12 hours, according to a study.

Esophagus: if the battery is lodged in esophagus, immediate endoscopic removal should be performed.

Stomach: Once battery is in the stomach, endoscopic retrieval is recommended only if there is, localized epigastric pain; coffee ground emesis; melena; battery>15mm diameter; does not pass pylorus after 48 hours or the battery contains mercury

Intestine: Once the battery is beyond pylorus, explorative laprotomy should be performed if there are signs of obstruction or perforation.

Conference Calendar

Central and Arterial Line Training (CART)
Target Audience – Doctors Only
Date: June 17, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the day (Dr Santosh Sahi)

"There is always a way, You just have to find it." Paul Briganti

Question of the Day

What are the common complications in type 1 diabetes mellitus? (Dr Uma Mahesh, Chennai)

The result of imperfect treatment is novel milieu that includes various combinations of metabolic, hormonal and physiologic alterations. These include hyperinsulinemia, hyperglycemia, hyperlipidemia, abnormalities in blood flow and formation of glycation end-products. As a consequence of this exposure, diverse functional and morphological alterations develop which lead to several complications affecting eyes, kidney and heart. The most commonest complication is retinopathy.

The level of glycemia seems to be the strongest factor in influencing the onset of microalbuminuria. The risk of microalbuminuria increases almost 20–fold faster between HbA1C values of 8–10% than between 6–8%. Other risk factor include systolic and essential hypertension, elevated systolic blood pressure, cigarette smoking, elevated triglycerides and cholesterol and genetic susceptibility to diabetic nephropathy.

The risk of CAD in type 1 diabetes mellitus is very high. The risk increases after the age of 30 years. The risk factors for CAD includes low insulin sensitivity and diabetic nephropathy.

MedinewS Try this it Works

A second look at the eyes

After staining an eye with fluorescein, always check it with UV light as usual, then irrigate the eye to remove the stain. Check it again with the UV light. Many times an abrasion or defect that did not show up originally can be seen with the second look. This also helps demarcate the abrasion.


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 emedinews@gmail.com


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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Dr Good Dr Bad

Situation: A patient came with heart failure.
Dr Bad: Start statins.
Dr Good: No statins are needed.
Lesson: Despite strong evidence of benefit for statins in most subsets of patients with established cardiovascular disease, two large randomized trials (CORONA and GISSI–HF) found no benefit from initiating statin therapy in patients with symptomatic systolic heart failure (ischemic or nonischemic) and a mean left ventricular ejection fraction ≤33 percent.

Make Sure

Situation: A diabetic hypertensive was denied a beta–blocker because of traditional teaching. Reaction: Oh my God! You should have used nebivolol.
Lasson: Make sure that diabetics are not denied beta–blockers when indicated. Nebivolol has no effect on glucose metabolism unlike atenolol. (Source: Am J Hypertens 2005;18 (12, pt. 2):169S–176S)

Humor Section

IMADNB Joke of the Day (Dr Tarun)


A thriving baseball club is one of the features of a boy’s organization connected with a prominent church. The team was recently challenged by a rival club. The pastor gave a special contribution of five dollars to the captain, with the direction that the money should be used to buy bats, balls, gloves, or anything else that might help to win the game. On the day of the game, the pastor was somewhat surprised to observe nothing new in the club’s paraphernalia. He called the captain to him.

"I don’t see any new bats, or balls, or gloves," he said.

"We haven’t anything like that," the captain admitted.

"But I gave you five dollars to buy them," the pastor exclaimed.

"Well, you see," came the explanation, "you told us to spend it for bats, or balls, or gloves, or anything that we thought might help to win the game, so we gave it to the umpire."

Funny Definitions

Mistress – something between a mister and a mattress

Formulae in Clinical Practice

Metabolic acidosis

Expected PaCO2 in mmHg
Formula: PaCO2 = {(1.5 × HCO3 + 8} + 2

Milestones in Diabetology

Nicolae Paulescu (1869 –1931) was a Romanian physiologist and professor of medicine. He was the first to discover insulin, which he termed pancreatine. In 1916, he developed an aqueous pancreatic extract which, when injected into a diabetic dog, proved to have a normalizing effect on blood sugar levels. He secured the patent rights for his method of manufacturing pancreine on April 10, 1922 (patent no. 6254) from the Romanian Ministry of Industry and Trade.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Renal Biopsy, Light Microscopy

Kidney biopsy has proven to be of value in the clinical evaluation and management of patients with undiagnosed kidney disease. The clinical setting may include acute renal failure, nephrotic syndrome, asymptomatic proteinuria and hematuria. Biopsy of the transplanted kidney is important in the determination of the presence of acute rejection, infection, or recurrent disease. Optimal interpretation of a kidney biopsy requires integration of clinical and laboratory results with light microscopic, immunofluorescent histology, and electron microscopy findings.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Paliperidone ER Tablets 1.5mg

Addl. Strength


Public Forum (Press Release for use by the newspapers)

MTNL Perfect Health Mela from 23rd October

The much awaited 17th MTNL Perfect Health Mela, an annual event of Heart Care Foundation of India in association with various departments of Govt. of Delhi and NDMC is being organized from 23rd – 31st October 2010 at NDMC Ground, Laxmi Bai Nagar, New Delhi.

The Mela will create awareness about all aspects of health for people from all sections of the society and all walks of life incorporating all ‘pathies’ under one roof using cost–effective infotainment modules. The focus of the Mela this year will be on the rising lifestyle disorders. There will be no entry fee, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. The mela will be mix of exhibitions, checkups competitions, education and infotainment under one roof and will be a perfect picnic spot. Health infotainment is the only way of creating health awareness amongst masses.

The general public is advised to keep their dates free in advance for the event. The major activities of the Mela will be Swagat (inaugural function), Harmony (inter school festival), Heritage (inter dancing school festival), Divya Jyoti (inter nursing college/school festival), Medico Masti (inter medical college and other college festival), Anmol (festival for children with special needs), Eco–Festival (involving various eco school clubs), Kaviyon Ki Kushti (Kavi Sammelan), Swasthya Pavilion Heart Check Up camp, (general and specialty checkups), Health Darbar (public audience with medical experts), Medline (live video conferencing between Delhi & Mumbai doctors interacting with patients), Jaago India (media festival), Bid Adieu (valedictory function), etc.

A day–long conference on women related issues and an all dharma Sarva Dharma Samellan is also been planned at the venue.

The Mela will provide free education, exhibition, competition opportunities, general and specialty checkups, ECG, Colour Doppler Echocardiography, etc. Highly subsidized executive blood tests will be available to the general public at a nominal registration fee of Rs. 110/– (market cost 1500/–)

One of the principle of health education is to communicate field–tested expert–devised health messages in the form of one line ‘sutras’ through the mouth of people who count, at a time and place when they are needed. Celebrity endorsement of Health Sutras will be one of the main attractions of the event.


Forthcoming eMedinewS Events: Register at emedinews@gmail.com

13th June: IMSA Sunday Workshop with Dr KK Aggarwal, Moolchand Hospital 8-10am

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Response

Dear KK, Your suggestions in the Editorial is welcome and is food for thought and can be used beneficiallyt in bettering medical practice for the masses, provided we the doctors rise above dirty politics.
Dr K K Arora