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



 emedinews is now available online on www.emedinews.in

17th December Thursday

Dear Colleague,

                 Should a diabetic with tight sugar control drive?
Worldwide, diabetics are required to produce proof of good blood sugar control to keep their driving license. A new study by Dr. Donald A. Redelmeier, professor of medicine at the University of Toronto has shown that diabetics who keep their blood sugar tightly controlled run the risk of having traffic accidents due to low blood sugar. The risk was substantial, accounting for almost 50 percent of the accidents. The accidents were mostly related to severe hypoglycemia in association with strict blood sugar control. The findings were published online Dec. 8 in PLoS Medicine.

For the study, Redelmeier's team collected data on 795 diabetic drivers. They found that one in 14 of the drivers had been involved in car accidents. Those with low blood sugar were more likely to have had an accident than were diabetics whose blood sugar was not as well controlled. Moreover, the risk for having a car accident increased fourfold if the person had a history of hypoglycemia.

Diabetics should not to drive if they feel dizzy or have other symptoms of hypoglycemia. If some one has had a hypoglycemic episode yesterday, he or she should not drive the car next day.
Patients with diabetes should drive only if diabetes is under control and there is no evidence of end organ disqualifying disease. Definitive criteria for are not available but an American Diabetes Association table indicates upper limits for acceptable control as follows

1.Fasting sugar: Normal 115 mg/dL, acceptable 140 mg/dL
2.2 hour postprandial plasma glucose: normal 140 mg/dL, acceptable 200 mg/dL
3.Glycosylated hemoglobin A1C: normal 6 percent, acceptable 8 percent

Dr KK Aggarwal 





Clinical tip
Infection is not a primary cause of nappy rash, though secondary infection by Candida albicans can occur. Midwives (Lond.) 2004 July;7(7):288 290.

Funny clinical notes (Dr. Minakshi)
Between you and me, we ought to be able to get this lady pregnant.

Health Tip: Check Your Blood Glucose (Dr Prachi Garg)
Anyone who is diabetic can benefit from blood glucose checks, especially if the person:
1. Takes insulin or medication to manage diabetes.
2. Is pregnant.
3. Has difficulty keeping blood glucose stable and under control.
4. Has dangerously low blood glucose, or develops ketones from high levels of blood glucose.
5. Develops low blood glucose without the typical warning signs.

VIVA Tips (Dr Mukesh Bhatia)

1. Drug of choice in a patient  with unilateral renal artery stenosis is Ace inhibitor
2. In bilateral renal artery stenosis Ace inhibitors are contraindicated.

Dr Good Dr Bad
Situation: A patient had raised urea and creatinine
Dr Bad: You have CKD
Dr Good: you have renal dysfunction. I need to differentiate it further by kidney ultrasound
Lesson: as CKD can only be diagnosed if the renal dysfunction lasts more than 3 months, the best spot test is kidney ultrasound. CKD usually will have a shrunken small kidneys.

Make Sure
Mistake: A CKD patient with normal kidney size was diagnosed as non CKD
Reaction: why was this mistake done
Make sure that ultrasound reports is interpreted properly as in CKD, size of kidney can be normal or increased in diabetes, amyloid, multiple myeloma, bilateral hydronephrosis and polycystic kidney.
Clinical Formula

Transferrin saturation index is serum iron divided by serum iron binding capacity. A value less than 20 suggest iron deficiency anemia.
Calculation: TFS = 100 x  serum iron (ug/dl) /TIBC (ug/dl)
1. Normal range: 15% to 55%
1. Chronic iron deficiency anemia
2. Chronic infection
3. Advanced malignancy
4. Collagen Vascular Disease
5. uremia
6. Third trimester of pregnancy
1. Hematochromatosis
2. hemolytic anemia
3. Starvation
4. Nephrotic syndrome
5. Cirrhosis
6. Acute viral hepatitis
7. Thalassemia minor
8. Megaloblastic anemia
9. Aplastic anemia
References (Ravel (1995) Clinical Lab Medicine, Mosby, p. 662) 

Why BLS is more important than ALS
For now, the cornerstones of optimal cardiac resuscitation include high quality cardiopulmonary resuscitation with minimal interruptions for anything, including any drug administration, and early defibrillation. SO: From Heartwire CME : Hold the Epi: No Advantage Seen With IV Drugs at Out of Hospital Cardiac Arrest CME; News Author: Steve Stiles; CME Author: Dr Penny Murata (Dr Vivek Chhabra)

Experts View
What is the effect of fasting and exercise on insulin?
After several days of fasting the insulin basal level decreases, similar decrease occurs after prolonged exercise. Plasma insulin levels increase after a meal and usually peak 30- 60 min after eating is initiated.  Obesity markedly increases insulin secretion and physical exercise decreases it. During exercise insulin levels decline a response which facilitates mobilization of fuels.  (Dr Surrinder Singh)

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medinews: revisiting 2009
IJCP Group is organizing emedinews: revisiting 2009, conference on 10th Jan 2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts (Dr KK Aggarwal, Dr Naresh Trehan, Dr Ajay Kriplani, Dr Praveen Chandra, Dr Harsh Mahajan, Dr Kaberi Banerjee, Dr N K Bhatia, Dr V Raina, Dr Ajit Saxena, Dr S C Tewari, Dr Vanita Arora, Dr Subramanium, Dr Neelam Mohan, etc) will deliver lectures. CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and top singers of our medical profession), doctors of the year award, dance and dinner. For registration mail 
emedinews@gmail.com. We have crossed 1200 registrations. 

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Letter to the editor

 Dear Dr. K K Aggarwal: I am a regular follower of your EMedinews. I am compiling extraordinary personal experiences of medical practitioners of different specialities. I believe that every medical practitioner at sometime in his or her practice has had some extraordinary experience where only the bookish knowledge did not suffice. I am looking forward for your members to share similar experiences with me. They can email me directly at drmcjha@yahoo.com. Here, I will like to share my experiential knowledge of managing an eye lid injury from a bamboo shoot.

A villager while working with bamboo sticks injured his right upper eye lid. There was swelling of eye lid and after few days there was suppuration. He visited a nearby eye hospital where X ray right orbit was taken to discover a faint shadow of a foreign body in the right upper eye lid. He was put on antibiotics but the swelling and suppuration wasn't alleviated. Later he visited a reputed eye hospital at Lahan in Nepal. He was further investigated and was diagnosed with traumatic cataract. Because of infection and continued suppuration, no further treatment was given. He later attended my clinic where I could feel a foreign body in affected eye lid from the skin surface. The patient informed that the stick caused hurt to the inner side of the lid. I put an incision on the skin but the foreign body was not traceable. Here I thought that like in everyday life, a rat or a lizard always flees the house from the same route that it enters from, the foreign body will be easily removed if approached from the inner side of the lid. Hence I applied lid spatula, very much as we do for Chalazion. I was pleasantly surprised to see the head of the foreign body (bamboo twig) peeping through the wound and was removed by forceps, thereby curing the disease that had lasted for over 6 months. Sincerely, Dr. M. C. Jha



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