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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; Chairman Ethical Committee 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

18th July, 2010, Sunday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Managing diabetes in 2010

  • Start with lifestyle intervention first, at the time of diagnosis. If lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in sugar values after one or two weeks, add the first drug.

  • If no contraindications, always start with metformin in most patients with type 2 diabetes. But, consider insulin as first-line drug in those presenting with A1C >10%, fasting sugar >250 mg/dL, random sugar consistently >300 mg/dl, or ketonuria.

  • Avoid metformin if predisposing factors to lactic acidosis are present; instead consider a shorter-duration sulfonylurea. Those who cannot be given metformin or sulfonylureas, repaglinide is an alternative, particularly in patients with chronic kidney disease at risk for hypoglycemia.

  • Pioglitazone may also be considered in patients with lower initial A1C values or if there are specific contraindications to sulfonylureas. There is a concern about atherogenic lipid profiles and a potential increased risk for cardiovascular events with rosiglitazone.

  • Consider sitagliptin as monotherapy for those intolerant to or with contraindications to metformin, sulfonylureas, or thiazolidinediones. It may be the initial choice in a patient with chronic kidney disease at risk for hypoglycemia.

  • It is however, less potent than repaglinide. Start therapy with insulin if it is difficult to distinguish type 1 from type 2 diabetes.

  • Adjust therapy every three months based on the A1C result aiming it close to the non diabetic range. If A1C remains >7 %, another drug should be added within two to three months of initiation of the lifestyle intervention and metformin.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

Doctors' Day Function

Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal  receiving  'DMA Chikitsa Ratna Award' on the occasion of Doctors' Day celebration held at DMA .

Dr k k Aggarwal


News and Views


"Eighty percent of medical expenditure in India is spent on only 20% of the people” Minister of State for Health and Family Welfare, Dinesh Trivedi.

"In the Monsoon session the clinical establishment bill is likely to be passed" - Dr Sujatha Rao

" I am excited to be in Medanta" - Dr Neelam Mohan

"There is a need to increase the doctor-patient ratio and this can be done only by increasing hospital facilities across the country" - CII National Health Council Chairman Dr Prathap C Reddy

International ( Dr Brahm and Monica Vasudeva)

Weight loss may help reduce menopausal hot flashes in overweight or obese women.

Losing weight may help overweight women who experience hot flashes –– the uncomfortable flushing and sweating spells that accompany menopause, according to a study published in the July 12 issue of the Archives of Internal Medicine.

Eating foods rich in vitamin E associated with lower dementia risk

Consuming more dietary vitamin E is associated with a lower risk of dementia and Alzheimer’s disease. This was reported in a study published in the July issue of Archives of Neurology.

Smoking–related colorectal cancer in older women is associated with molecularly defined DNA changes

An online study published June 29 in the Journal of The National Cancer Institute reports that smoking, which is an established risk factor for colon cancer, may produce specific epigenetic changes and gene mutations that may be involved in the development of colon cancer.

One in four individuals do not cover coughs and sneezes

Approximately 1 out of every 4 people observed in a public setting failed to cover their mouth when they coughed or sneezed. Less than 5 percent of people covered their mouth using methods recommended by public health officials. These were among the finidngs presented July 12 at the International Conference on Emerging Infectious Diseases.


Legal Column

Forensic Column (Dr Sudhir Gupta, MBBS (Gold Medal), MD (BHU), DNB, MNAMS, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medical Testimony of Doctor in the Court of law

The doctor should acquire the habit of making a careful note of all the facts observed by him. Vagueness and theory have no place in legal medicine. He should examine the facts which come to his knowledge in his special capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and indicate to the Court that interpretation, along with the grounds on which it is based. Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

Dr. Neelam Mohan
Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

Fads About Figure

  • Girls today acquire wrong ways to achieve so called "size zero".

  • Boys too work out in a wrong manner for muscular physique.

Question of the Day

How frequently and at what times should blood glucose be monitored? (Dr G M Singh)

The American Association of Diabetes Educators recommends that all patients should be encouraged to selfmonitor blood glucose (BG), regardless of whether they are being treated with insulin or oral agents. The American Diabetes Association recommends that patients with type 2 diabetes who are taking multiple insulin injections should monitor BG at least 3 times in a day, but they also note that the optimum frequency for selfmonitoring is not clear for patients taking oral drugs or less frequent insulin injections. Others have suggested that patients taking insulin should selfmonitor BG at least 4 times a day, before meals and bedtime; and that patients with type 2 diabetes should check their BG at least 4 times per week (twice fasting and twice after meals).


Public Forum (Press Release for use by the newspapers)

Stress management programs for heart patients a must

Beta blockers and psychosocial interventions can reduce the physiologic response to some forms of stress. In patients with known coronary disease, the cardioprotective effect of beta-blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamicinduced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India & MTNL Perfect Health Mela. In premature heart attack, the mean age is 5354 yrs. In general, the goal of a stress management program is to reduce the impact in the individual of stressful environmental events and to better regulate the stress response.

Interventions may be considered at several levels: Removal or alteration of the stressor, Change in perception of the stressful event, Reduction in the physiologic sequelae of stress and Use of alternative coping strategies. Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude, and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity. Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg. Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.


Evidence-Based Medicine: Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College, New Delhi

New drug helps patients lose weight and maintain the loss

Lorcaserin, a selective serotonin 2C receptor agonist, helps patients both lose weight and maintain their weight loss, according to a phase III study conducted by the drug’s manufacturer and published in the New England Journal of Medicine. Some 3200 overweight or obese adults were randomized to take lorcaserin or placebo twice daily for a year, after which lorcaserin recipients continued the drug or switched to placebo for another year. All participants also received nutrition and exercise counseling. At 1 year, more patients in the lorcaserin group than placebo group had lost at least 5% of their body weight (48% vs. 20% of patients; mean weight loss: 5.8 kg vs. 2.2 kg). In addition, lorcaserin patients who stayed on the drug for a second year were more likely to maintain their weight loss than those who switched to placebo. Serious adverse events did not differ between lorcaserin and placebo recipients. Unlike some other serotonergic agents, lorcaserin did not increase risk for valvular heart disease.


An Inspirational Story

Did you know that an eagle knows when a storm is approaching long before it breaks?

The eagle will fly to some high spot and wait for the winds to come. When the storm hits, it sets its wings so that the wind will pick it up and lift it above the storm. While the storm rages below, the eagle is soaring above it. The eagle does not escape the storm. It simply uses the storm to lift it higher. It rises on the winds that bring the storm.

When the storms of life come upon us and all of us will experience them we can rise above them by setting our minds and our belief toward God. The storms do not have to overcome us. We can allow God’s power to lift us above them. God enables us to ride the winds of the storm that bring sickness, tragedy, failure and disappointment in our lives. We can soar above the storm. Remember, it is not the burdens of life that weigh us down, it is how we handle them.


IJCP Special

Dr Good Dr Bad

Situation: A patient with heat stroke had fever > 106°F.
Dr Bad: Give Inj paracetamol.
Dr Good: Do cold sponging.
Lesson: Paracetamol is not effective in heart stroke till the fever is brought down to < 103°F.

Make Sure

Situation: A foreigner with 2 loose motions developed sepsis.
Reaction: Oh my God! Why was antibiotic not started early.
Lesson: Make sure that all cases of travelers' diarrhea (foreigners) are treated with antibiotics.

Quote of the Day (Dr. Santosh Sahi)

"Constant dripping hollows out the stone" Lucretius

Are you fit to fly?

Can pregnant females fly?

  1. The American College of Obstetricians and Gynecologists does not recommend flight restrictions on women with uncomplicated pregnancies less than 36 weeks gestation, but it does recommend air travel be avoided after 36 weeks.

  2. Many airlines require medical certificates for women who are pregnant beyond 36 weeks gestation.

Myths about Aging

Women fear aging.

Milestones in Orthopedics

James Syme (17991870) was a Scottish surgeon. He is known for introducing conservative alternatives to the major amputations that were carried out at that time. In 1831, he released a booklet, which detailed cases where joint excision could be used instead of amputation for grossly diseased joints, as in tuberculosis, and injured joints. In 1842, he described amputation at the ankle with removal of the malleoli and formation of a heel flap which is known as Syme's amputation.


International Medical Science Academy Update (IMSA)

Evidence suggests that statin therapy does not reduce the incidence of adverse cardiovascular outcomes in most patients with heart failure.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Risperidone long acting injection (Addl. Indication)

Indicated as monotherapy or as adjunctive therapy in lithium or valproate for the maintenance treatment of Bipolar1 disorder.



Medi Finance

Q. What are the provisions if an individual merges his profession with the profession of his friend who is also in the same profession?

A. No capital gain will be charged in the event of transfer of asset by proprietor to partnership if it is transferred at book value..


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Laboratory tests for lung diseases

  • ABG (arterial blood gases)
  • CBC for anemia
  • Cystic fibrosis tests (CF Gene Mutation Testing, Alpha1 antitrypsin to determine if patient has AAT deficiency)
  • Sputum culture
  • AFB smear and culture
  • Blood cultures
  • Blood Influenza tests
  • Lung biopsy and sputum cytology

Humor Section


Teacher: ‘I killed a person.’ convert this sentence into future tense
Student: The future tense is ‘u will go to jail.’

Medical bloopers on medical charts!

Node…………………………I knew it


Readers Responses

  1. Hi Dr. KK, I am clarifying the query raised by Dr. KK Arora regarding use of rank by TA officers. TA officers on completion of their tenure can also write the last rank held by them if they go on superannuation.  If they do not earn the pension but go on premature retirement, then they can write their rank with a prefix Ex. Lt. Col. (TA). TA officers are also authorized to write their decoration if any awarded to them while they were in service. They are entitled for all benefits i.e. medical, canteen/mess facility etc as is given to regular service officers. Lt. Col rank is generally given after putting in 15-20 years of service which means the officer must have gone on retirement under normal circumstances. The question of extra curriculum, that is correct because anybody can join TA if he is medically fit and accepted by the Army and has to put in two months of regular service PA to earn all the benefits and since it is not a regular 12 months job, it is counted as extra curriculum. If, however, Dr. Arora still has some doubts about the person in question using the rank falsely then he can report the matter to TA HQ to get the clarification. I hope this clarification will satisfy Dr. Arora and the matter will get settled: Ashok Ahooja, Sqn. Ldr (Retd). Advisor

Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

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 daylong 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.

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