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  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com

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)



15th November Sunday 

Dear Colleague,

Panic and Rumors are contagious

Both rumors and panic reactions are contagious. It takes one percent of the population to create rumors. Most rumors are not facts. The best way to know whether it's a rumor or not is to ask, "Who told you". The answer will be some one. Unless some body has heard it from the horses' mouth do not believe it. It is a human tendency to speak extra with what you have heard from some one.

Rumors are scientific and are based on the 100th Monkey Phenomenon. Once the target population is sensitized the rumor spreads like wild fire. In a gathering of 1000 people  only 10 persons are required to spread the rumors and the resultant panic. In a war like situation, it is easy to spread rumors as the public is sensitized for the same and living in an unknown fear.

Panic attacks are an unexplained and unprovoked fight or flight response. The body suddenly has the physical reaction of a life threatening situation. Panic attack is usually mistaken (by the sufferer) as a heart attack and can be very frightening. Anxiety can sometimes lead to panic attacks therefore a lot of people with anxiety disorder tend to unfortunately develop panic attacks.

Anxiety is a feeling everyone suffers from at one time or other. It is an emotion most people experience when they feel they are in danger. The heart rate increases, the muscles tense up, one get a rush of adrenaline and one is ready to fight for the life. This is called the "Fight or Flight" reaction and it gives one the extra strength needed to overcome or escape a dangerous situation.

On the other hand anxiety disorder is when you have the symptoms but the reason for feeling the "Fight or Flight" reaction is unclear.

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is a far more intense than the feeling of being 'stressed out' that most people experience. Symptoms of a panic attack include: Racing heartbeat; Difficulty in breathing, feeling as though you can't get enough air; Terror, that is almost paralyzing; Trembling, sweating, shaking; Choking, chest pains; Hot flashes, or sudden chills; Tingling in fingers or toes (pins and needles); Fear that you're going to go crazy or are about to die.

In addition to the above symptoms, a panic attack occurs suddenly, without any proportion to the actual situation; often, in fact, it's completely unrelated. And it passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks can continue to recur for hours. A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control'. Panic disorder is frightening because of the panic attacks associated with it, and also because if often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.

Be prepared for the emergencies. Always keep the first aid kit and a supply of goods and medicines for 1-2 weeks handy than to panic when they are needed.

Dr K K Aggarwal


 Hyperuricemia the new epidemic of the society

1. Uric acid linked to meatbolic syndrome: In particular, elevated serum uric acid in young adulthood appears to predict metabolic diseases later on, as per researchers at the American College of Rheumatology meeting. Early metabolic abnormalities are a risk factor for gout in later life. The risk for gout can be modified by targeting metabolic risk factors for intervention.
2.  Hyperuricemia predicts type 2 diabetes: In a prospective cohort study of some 5,000 young adults, those with serum uric acid  of 7.0 mg/dL or higher were twice as likely to develop type 2 diabetes during 15 years of follow-up, as per Dr Eswar Krishnan of Stanford University. Each 1 mg/dL increase in serum uric acid increased the odds of developing diabetes overall by 18%.
3.  High cholesterol in youth, later gout: Young men with high total cholesterol has about twice the incidence of gout before reaching age 60 relative to those with normal or low cholesterol when they were young, as per Dr Allan C. Gelber, of Johns Hopkins University.
4. Risk factors for gout in women: Dr Vidula Bhole, of the Arthritis Research Centre of Canada in Vancouver, has shown that the prevalence of gout in women has doubled in recent years.
5.  Weight loss reduces hyperuricemia: Yanyan Zhu, MSc, of Boston University, and colleagues has shown that individuals who lost weight, as little as 5 kg, significantly decreased the rate of hyperuricemia, defined as serum uric acid of 6 mg/dL or more. Those losing at least 10 kg (22 lb) cut their risk of hyperuricemia by more than half.
6.  Uric acid waist interlink: Data on body weight and serum uric acid  collected at baseline and then annually over a six-year period, giving a total of more than 79,000 observations has shown that each 1 kg change in weight is associated with a 5% change in the risk of hyperuricemia (P<0.0001).

Second generation antipsychotic agents (Dr G M  SINGH)
Are used with increasing frequency in children and adolescents to address psychotic disorders, bipolar disease, and non psychotic mental disorders, but youth are especially vulnerable to antipsychotic medication induced weight gain.

  • The atypical antipsychotic agents olanzapine, quetiapine, risperidone, and aripiprazole are associated with significant weight gain and an increase in body mass index, waist circumference, and fat mass in youth at 11 weeks of treatment.
  •  Panic attack is associated with a higher incidence of MI in patients younger than 50 years, especially in women.
  •  Panic attack is associated with an increased rate of CHD but not an increased rate of CHD related mortality.

IBS Tips
The American Academy of Family Physicians offers these suggestions
1. Limit fats in your diet, and stick to a variety of healthy foods.
2. Boost dietary fiber or take a fiber supplement.
3. Avoid foods that seem to trigger your IBS symptoms.
4. Drink lots of water each day.
5. Break your meals into six smaller ones, instead of three big meals.
6. Don't use laxatives to treat constipation. Their use can weaken the intestines and make your body dependent on them.
7. Learn and adopt stress management techniques.
( Diana  Kohnle Wednesday, October 14, 2009)

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Precautions in Clinical Practice
A case of IV aminophlylline push: A 55-year-old male patient with COPD was brought to the emergency room with severe breathlessness. He was started on IV theophylline and beta 2 agonists. The intern calculated the dose of theophylline and gave it as rapid IV injection. Sometime later the patient complained of chest pain and developed asystole.

Comments: This is a very common mistake, out of lack of time, panic or sometimes even over enthusiasm a simple message of slow IV infusion is often neglected leading to drastic consequences in our day to day practice. It is very important to remember that though most but not all drugs can be pushed IV, drugs like aminophylline which have a narrow therapeutic index and high irritant properties need to be given slowly under strict monitoring and drastic clinical events as mentioned above can be prevented. Following is the list of other drugs which need to be given slowly over a given time as infusion: Calcium gluconate (1 cc/mt);  Isoprenaline; Oxytocin; KCI{10mEq/hr); Dopamine and Dobutamine. 

Clinical Tip
Causes of an acute cough: inhaled foreign bodies, aspiration, infections like pertussis, pneumonia and asthma. Aust. Fam. Physician 2004 May; 33(5):312-315.

Dr Good Dr Bad
Situation:  A postmenopausal female was found to be osteoporotic. She was a social drinker, smoker and a non vegetarian.
Dr Bad:  Prescribes her drugs. 
Dr Good:  Prescribes her drugs and also asks her to reduce salt, excess proteins, excess fiber in diet, caffeine, alcohol and  to stop smoking

Lesson:  Salt, excess protein, phosphorous (meat) and caffeine increase loss of calcium in the urine. Excess fiber also reduces calcium absorption.

Make Sure

Mistake:A patient presents with recurrent chest symptoms suggestive of pneumonia inspite of antibiotic treatment.

Reaction: OH MY GOD! This patient needed a thorough investigation.

Make Sure: That  a patient with recurrent attacks of pneumonia is fully evaluated for immunosuppression, foreign body in the bronchi, bronchiectasis, endobronchial tumors, etc.

In a psychiatrist' waiting room two patients are having a conversation. One says to the other, 'hy are you here?'

The second answers, "I"m Napoleon, so the doctor told me to come here."
The first is curious and asks, "How do you know that you're Napoleon?"
The second responds, "God told me I was."
At this point, a patient on the other side of the room shouts, "NO I DIDN?T!"

Letter to the editor
Dear Dr Aggarwal
1. My heartiest congratulations for emedinews, its indeed so rewarding, here in Canada.Thanks for all updates, Ifeel so proud being a life member of I.M.A.
Dr urmila Johri (

2. Dear Dr. Aggarwal: I really appreciate the fact that you spend both time & effort on educating the Medicos in India through a very simple, yet effective daily CME newsletter. There are a lot of Doctors in India who wish to practice the best Evidence based Medicine that they can; but are not able to do so due to a scarcity of resources to keep them Up To Date.
A foremost concern for all Doctors should be selecting the right antibiotic for the illness. (Appropriate-spectrum as opposed to Broad-spectrum) Antibiotics are a non renewable resource & should be used judiciously. Unfortunately, for the average Non hospital based G.P ; there are very few Indian resources available freely that inform him/her of the Microbiological Sensitivity & Resistance trends in various Infectious diseases.
There are no National Guidelines on Antibiotics usage; couple this with the cheap availability of Generic Higher antibiotics like 2nd/3rd Gen Cephalosporins, self-medication by patients and we have a situation where we fuel Antibiotic resistance like no other nation.
I would request emedinews to mobilize opinion for formulating a National Antibiotic Guideline Policy which are India specific & are updated continuously. (Dr. Kapil Aggarwal)

3. Dear Dr Aggarwal, It is nice to read  humor in your e-journal. Keep it up. Prof. (Dr). N. R. Biswas, AIIMS. 

4. Dear Dr Aggarwal: Kudos to you for being so persevering in bringing out this useful e Paper day after day. It is indeed very useful and very often, this is the first document that I open in my mailbox. A dash of humour along with serious medical stuff is a very good idea. Please keep it up. I would be glad to contribute some pieces to this venture. Dr Bir Singh, AIIMS.

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emedinews: revisiting 2009

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