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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)



17th November Tuesday 

Dear Colleague,

 The Top 10 Medical Innovations for 2010

 Cleveland Clinic's Top 10 Medical Innovations for 2010 list features a wide range of new techniques and therapies that are being developed to treat everything from deafness and Parkinson's disease to pneumonia and sleep disorders.

10. Whole Slide Imaging for Management of Digital Data In Pathology: A technology for creating digital pathology slides with excellent image quality that can be viewed, stored, streamed over the Internet, and analyzed on a computer.

9. Devices for Occluding Left Atrial Appendage to Reduce Stroke Risk: Device alternatives to long term warfarin use that can prevent clots from developing in patients with atrial fibrillation.

8. Oral Thrombopoeitin (TPO) Receptor Agonist That Stimulates Platelet Production: A recently approved drug that stimulates production of cells in bone marrow that form platelet cells in the blood.

7. Outpatient Diagnosis of Sleep Related Breathing Disorders: Self contained, reliable, at home sleep monitoring devices for screening, diagnosing, and treatment assessment of sleep related breathing disorders.

6. Forced Exercise To Improve Motor Function in Patients With Parkinson's: Pedaling at 90 RPMs on a tandem bike to dramatically improve motor functioning of patients with Parkinson's disease.

5. Fertility Preservation Through Oocyte Cryopreservation: A rapidly improving technology that allows eggs of a healthy woman to be safely frozen and stored, ready to be thawed and fertilized at a later date.

4. Non Vitamin K Antagonist Oral Anticoagulants: Predictable and well tolerated alternatives to the oral anticoagulant warfarin that provide a more convenient    and safe    way for patients to dose themselves and prevent blood clot formation.

3. Continuous Flow Ventricular Assist Devices: Tiny 3 ounce devices surgically attached alongside the heart that quietly and effectively take over the pumping ability of the heart.

2. Low Volume, Low Pressure Tracheal Tube Cuff To Reduce Ventilator Associated Pneumonia: A device that dramatically reduces the risk of ventilator associated pneumonia and death in the hospital ICU by providing continuous effective airway seals.

1. Bone Conduction of Sound For Single Sided Deafness: A new non surgical, removable hearing and communication device designed to imperceptibly transmit sound via the teeth to help people with single sided deafness.

Dr K K Aggarwal


Letter to the editor (Diabetes guidelines)

 Dear Dr. Aggarwal: I really compliment you ou your efforts of this educational endeavour and that too bringing this information brochure on a daily basis. I would suggest that it can also be brought out in a booklet form every few months. I need a clarification on the following points mainly from GP's point of view:
  1) Normally(not in emergent situations) we put patients on insulin when life style measures and oral drug therapy fails.In other sense it means that beta cells are 'exhausted' and do not produce insulin.You have mentioned in this news letter : Insulin + 2 or 3 drugs. Talking to various specialists one gets different answers.I would like to know which drugs should be given with insulin, because beta cells have already failed.Would your recommended drugs reduce the need of dosage of insulin or potentiate its action / how effective will they be.
  2) Whenever a new drug is introduced in the market, it is randomly used with less experience.The same is happening with Jenumet of Jenuvia. Can you elucidate on its precise indications.
  3) In your practice what drugs and doses you try before putting the patient on insulin  
  Thanking you, Dr. Parashar,MD.FACC, Past President, CSI 

Editors's response:   In the absence of contraindications, start with metformin as initial therapy in most patients. Insulin can also be considered a first line therapy particularly patients presenting with A1C >10 percent, fasting plasma glucose >250 mg/dL, random glucose consistently >300 mg/dL, or ketonuria.

Initiate metformin at diagnosis, along with lifestyle interventions. The dose of metformin should be titrated to its maximally effective dose (usually 2000 to 2500 mg per day in divided doses) over one to two months, as tolerated. Metformin should not be administered when conditions predisposing to lactic acidosis are present. 

In the presence of contraindications to metformin, one should start with shorter-duration sulfonylurea for initial therapy. In patients who are intolerant of or are not candidates for metformin or sulfonylureas, repaglinide is a reasonable alternative, particularly in a patient with chronic kidney disease at risk for hypoglycemia.

Another alternative is a thiazolidinedione, which may be considered in patients with lower initial A1C values or if there are specific contraindications to sulfonylureas. If a thiazolidinedione is to be used as initial therapy, pioglitazone is preferred.

Sitagliptin can be considered as monotherapy in patients who are intolerant of or have contraindications to metformin, sulfonylureas, or thiazolidinediones. Sitagliptin might be a good choice as initial therapy in a patient with chronic kidney disease at risk for hypoglycemia. It is however, more expensive and less potent in lowering glycemia than the glinides, such as repaglinide, which can also be used safely in patients with chronic kidney disease.

In patients in whom it is difficult to distinguish type 1 from type 2 diabetes, initial treatment with insulin is required. 

Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result, aiming for levels as close to the non diabetic range as possible, and with A1C values >7 percent suggesting need for further adjustments in the diabetic regimen. 

If inadequate control is achieved (A1C remains >7 percent), another medication should be added within two to three months of initiation of the lifestyle intervention and metformin. 

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Dr. K.K. Aggarwal Awarded

Saturday 14th November 2009: Dr. K.K. Aggarwal was awarded with ?Acharya Sushil Muni Sadhna Jain Vibhushan Award? by the Acharya Sushil Muni Trust during its annual day function held at Acharya Sushil Muni Ashram for his contribution to the social field.


A psychologist was walking along a Hawaiian beach when he kicked a bottle poking up through the sand. Opening it, he was astonished to see a cloud of smoke and a genie smiling at him.

"For your kindness," the genie said, "I will grant you one wish!" The psychologist paused, laughed, and replied, "I have always wanted a road from Hawaii to California."

The genie grimaced, thought for a few minutes and said, "Listen, I'm sorry, but I can't do that! Think of all the pilings needed to hold up the highway and how long they'd have to be to reach the bottom of the ocean. Think of all the pavement. That's too much to ask."
"OK," the psychologist said, not wanting to be unreasonable. "I"m a psychologist. Make me understand my patients. What makes them laugh and cry, why are they temperamental, why are they so difficult to get along with, what do they really want? Basically, teach me to understand what makes them tick!"
The genie paused, and then sighed, "Did you want two lanes or four?"

Make Sure

Mistake: A patient of duodenal ulcer on H2 blocker therapy came with recurrence.

Reaction: Oh My God! Why Did You Withdraw His Treatment

Make Sure: That all patients receive full treatment. Most duodenal ulcers recur, if treatment is withdrawn.

Dr Good Dr Bad

Situation:  A 30-year-old female with pain in her right toe, was being treated clinically as a case of acute gout.
Dr Bad:  Get serum uric acid done and continue with antigout therapy

Dr Good: I disagree with the diagnosis of gout, will not send blood for uric acid and look for some other cause of pain in the toe

Lesson:  Gout does not occur in children and in women before menopause. Checking uric acid levels in such patients is poor clinical judgment.

Try this: Avoiding Tummy Tickles

Examination of the abdomen can be difficult in a ticklish patient. Try this. Place your hand on top of the patient's hand, with your fingers between the patient's fingers. You can then easily reach into the depths of the patient's abdomen without resistance.

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: 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.  

You can gift emedinews to some one just write to emedinews@gmail.com 


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