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Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



13th November Friday 

Dear Colleague,

Treating hypertension in children

Treatment decisions depend on the severity of HTN, the underlying cause, and the presence of other CVD risk factors. Treatment includes both nondrug and drug interventions. Non drug therapy (ie, lifestyle changes) includes weight reduction if overweight, regular aerobic exercises, dietary measures (eg, salt restriction), and avoidance of excess alcohol consumption and smoking. 
Drugs are used that are efficacious and safe include thiazide diuretics, ACE inhibitors, beta blockers, and calcium channel blockers.

In children and adolescents with HTN and no evidence of target organ damage or comorbid cardiovascular conditions, the targeted goal for blood pressure is less than the 95th percentile based upon age, height, and gender. If there are comorbid CVD conditions (eg, obesity, dyslipidemia, or diabetes mellitus) and/or evidence of target-organ damage (eg, left ventricular hypertrophy, renal scarring, or retinopathy), the BP targeted goal is lowered to below the 90th percentile for age, height, and gender).

  • Treat children and adolescents with prehypertension with lifestyle changes. Do not start drugs in such patients even if lifestyle changes are ineffective.
  • Treat children and adolescents with asymptomatic stage I HTN and no comorbid conditions with lifestyle changes. In cases where BP does not come down to the targeted BP goal with lifestyle changes alone, start drugs.
  •  Treat children and adolescents with stage I HTN with other CVD risk conditions (eg, dyslipidemia or diabetes mellitus). Start drugs rather than a trial of lifestyle changes alone.
  •  Treat children and adolescents with stage I HTN with symptoms or evidence of target -organ damage, or with stage II HTN.  Start drugs rather than a trial of lifestyle changes alone.
  •  In secondary HTN, therapy should be directed to correcting the underlying cause, if possible. If the underlying cause cannot be corrected start treatment with both antihypertensive drugs and lifestyle changes.
Which drugs

  •  In adolescents with essential HTN without target organ damage, start with low dose thiazide diuretic therapy. 
  •  In children with chronic kidney disease, start with ACE inhibitors.
  •  In patients who cannot tolerate ACE inhibitors, angiotensin receptor blockers (ARBs) are a reasonable alternative.
  •  In children with either type 1 or type 2 diabetes mellitus, ACE inhibitors should be used as the initial antihypertensive agent. In patients who cannot tolerate ACE inhibitors, ARBs are a reasonable alternative.
 Dr K K Aggarwal


Improving water and sanitation
Yet despite the known benefits of improving water supply and sanitation, some 88 per cent of diarrhoeal diseases worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people were not using improved sanitation facilities, and nearly 1 in every 4 people in developing countries was practicing open defecation.

Early PSA Rise Predicts Mortality
A rising PSA value within 18 months after radiation therapy predicts an increased risk of prostate cancer metastasis and mortality. Early biochemical failure predicted more than a 25% decline in five-year survival compared with failure after 18 months. In a multivariate analysis, time to PSA failure trumped Gleason score, tumor stage, age, and PSA doubling time as a predictor of cancer specific mortality, according to a presentation at the American Society for Radiation Oncology meeting.

Antibiotics Top Cause of Drug Induced Liver Failure

Antimicrobial agents are the most common cause of drug induced liver failure, with most cases ending in death or transplant.

A prospective analysis of some 1,200 cases of acute liver failure found that half of those caused by drugs were associated with antituberculosis, antifungal, sulfa drugs, and other antibiotics, according to Adrian Reuben, MBBS, of the Medical University of South Carolina in Charleston.

Herbal supplements, anticonvulsants, and statins also were relatively common causes of drug induced liver injury (DILI).

Only 27% of DILI patients in acute liver failure recovered spontaneously. About 40% had successful transplants, while another 30% died either waiting for transplant or were too ill to be wait listed. Overall, 66% of patients with DILI associated liver failure survived.

Tip to Prevent Childhood Migraines:
  • Eat regularly
  • Maintain a regular sleep schedule.
    Get frequent and consistent exercise.
  • Recognize what triggers migraines (examples may include stress or overexertion, food like chocolate, caffeine, cheese and processed meats. ) and try to avoid those triggers.
  • Talk to the child's pediatrician about medication if migraines can't be controlled by other methods.
Reducing childhood deaths from diarrhoea
The report, Diarrhoea: why children are still dying and what can be done, lays out a seven-point plan that includes a treatment package to reduce childhood diarrhoea deaths and a prevention strategy to ensure long-term results. The seven specific points are:
1. fluid replacement to prevent dehydration;
2. zinc treatment;
3. rotavirus and measles vaccinations;
4. promotion of early and exclusive breastfeeding and vitamin A supplementation;
5. promotion of hand washing with soap;
6. improved water supply quantity and quality, including treatment and safe storage of household water; and
7. community-wide sanitation promotion.

Treatment with ORS and zinc tablets
WHO and UNICEF recommend treating diarrhoea with low-osmolarity ORS and zinc tablets, which decrease the severity and duration of the attack. These treatments are simple, inexpensive and life-saving. Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths from this neglected killer.

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Wisdom Quotes (Dr Arun Jain)

If you don't find God in the next person you meet, its a waste of time looking for him further.

There are only two ways to live your life. One is as though nothing is a miracle, the other is as though everything is a miracle.


Situation : An HIV positive pregnant woman comes for advice.

Dr Bad: Take only iron and folate supplements
Dr Good: You need iron, folate and multivitamin supplementation

Lesson :  Multivitamin supplementation is essential in HIV-positive pregnant women as it has been found to substantially decrease adverse pregnancy outcomes and increase T cell counts.


A patient with PUO developed enteric perforation.

OH my God! Why did you not suspect the possibility of typhoid earlier?

Make sure: In India, enteric fever is one of the possibilities in every case of PUO.

Precautions in clinical practice

Intracardiac adrenaline 
A patient was brought to the emergency room and was found to be in asystole. The patient was immediately intubated and cardiac massage was started. Adrenaline 1 mg/i.v. was given every 3 minutes. Atropine i.v. was also added. No response was seen. The Doctor on duty then gave the patient intracardiac adrenaline. Patient did not show any response and finally the efforts were terminated and patient declared dead.

Various trials all over the world have shown that use of intracardiac adrenaline offers no advantage. Rather has shown to cause injury of the myocardium. It can also lead to cardiac rupture. Hence this step should be clearly avoided in Cardiopulmonary resuscitation of patients during clinical practice.

Clinical tips

Effective asthma control requires long-term anti-inflammatory controller medications for patients with mild-persistent to severe-persistent disease, and quick-relief bronchodilator medication for all patients with asthma to control intermittent symptoms of cough, wheeze and bronchoconstriction, as well as acute exacerbations. J. Am. Osteopath. Assoc. 2004 July;104(7):288-293.

Formula to know
Formula: 30 calories per kg body weight, to maintain
that weight.

Two psychologists meet at their twentieth college reunion. One of them looks like he just graduated, while the other psychologist looks old, worried and withered.

The older looking one asks the other, What's your secret? Listening to other people's problems every day, all day long, for years on end, has made an old man of me.

The younger looking one replies, 'Who listens?'

Letter to the editor
Respected sir, emedinews has been a great initiative from the pioneer in medicine (dr.k.k. aggarwal) who has always been an ardent, dedicated scholastic teacher whose few words have always dropped the nectar of knowledge. Dr Aggarwal has always been with the novice ideas & i remember the old days when i was under echocardiography training at moolchand. at that time no centre in india had an as extensive library on echo with real time vcds collections. a rare thing in those days. i would request dr k.k. aggarwal to start online cme & webcasting with due cme hours accreditation from Delhi medical council.
If we have followed the western pattern then let us complete it. Such a pattern is being followed by American medical association, American heart association & many medical schools. "leaders pave a path for the benefit. "Regards to Dr Aggarwal & all the seniors who have dedicated their lives for advancements in profession. (

Clinical Context (Dr GM singh)
More than 10% of older adults experience current major or minor depressive disorders with a high morbidity and mortality rate, and preventive measures should include use of predictors to identify subgroups of patients most at risk for incident depression. Studies have suggested that preexisting subsyndromal depression and a high burden of medical illness are risk factors for major depression.

our factors most predictive of incident major depressive episodes in elderly patients are minor or subsyndromal depression, functional impairment, and a history of major or minor depression.
2. Effective treatment of 5 individuals with these risk factors would prevent 1 new case of incident depression.

 Wisdom quotes (Dr. Arun Jain)

Change direction, or you may end up where you are heading.
When you are in doubt do it.

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emedinews: revisiting 2009

IJCP Group is organizing emedinews: Revisiting 2009, a day -long conference on 10th Jan  2010 at Maulana Azad Auditorium. It will be attended by over 1000 doctors. Topics will be top happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts will deliver lectures. CME will be followed by lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com. We have crossed 550 registrations in 3 days.  

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