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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

22nd August 2010, Sunday

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

Why create an H1N1 panic?

The furore that the H1N1 virus created last year ended up with the virus generating more hype than bite. The US experience has shown that the total number of deaths caused by pandemic H1N1 influenza A have been lower than the number of deaths caused by seasonal influenza during non-pandemic years.

Hospitalization is required only in 2-5% of confirmed cases. The case fatality rate in symptomatic illness is only 0.048%, which is much lower than the mortality with seasonal flu.

H1N1 flu can be classified as mild or uncomplicated illness; progressive illness and severe or complicated illness. Unless the patient has progressive or severe illness, no treatment, monitoring or admission is required.

Mild illness is characterized by fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, vomiting and diarrhea. But, there will never be shortness of breath. These patients require no treatment, no monitoring, no testing and no antiviral drugs.

Only if the patient has chest pain, breathlessness or sign or symptom of involvement of any other organ, he or she needs hospitalization and treatment. Apart from that, children who are less than 5 years of age and pregnant ladies require confirmation, treatment and admission.

If people who have been previously vaccinated for H1N1 develop a progressive or severe systemic H1N1 illness, they will need treatment. Mild cases of H1N1, therefore, should not be treated with anti viral drugs.

All the general practitioners must know when not to refer a patient to H1N1 screening centre. Most of them in the private sector will charge Rs. 2 to 3 thousand for registration, 1 to 2 thousand for consultation, 1 to 1500 for consumables, 4 to 10 thousand for testing, 200 for H1N1 mask, 5-10 for disposable mask and 500 for ‘Fluvir’ (oseltamavir), the antiviral drug.

A simple consultation to rule out H1N1 in a non-governmental H1N1 centre may cost a patient Rs. 15000/-, and if he is hospitalized for any other classical indication, the expenditure may be more than Rs. 1.5 lakh.

The lesson, therefore, must be not to learn when to refer but to learn when not to refer.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  


Photo Feature


Weird X-ray 

A historical X-ray of the foot of a Boer War (1899-1902) soldier, showing a gunshot wound. A Mauser bullet has become lodged between the metatarsal bones of the big and second toes. The bullet has not broken any bones; but the end phalanges of the toes are deformed, perhaps from tight army boots and long marches. This radiograph was made by the soldier positioning his foot above a photographic plate, while an open electric discharge tube emitted the X-rays.

Dr K K Aggarwal


News and Views (Dr Brahm and Monica Vasudev)

Drug–resistant superbugs join the list of flesh–eating bacteria

Obese individuals, diabetics, cancer patients, transplant recipients, and immunocompromised people are especially vulnerable to necrotizing fasciitis. It kills 20 percent of its victims and disfigures others horribly. Earlier, it used to be caused almost exclusively by one type of strep bacteria. However, a frightening trend is being noticed now. Drug–resistant superbugs like the staph germ MRSA increasingly are able to produce ‘flesh–eating’ toxins and cause severe infections.

High doses of UDCA not beneficial for NASH patients

Ursodeoxycholic acid (UDCA) in high doses does does not appear to improve overall histology compared with placebo in patients with nonalcoholic steatohepatitis (NASH), according to a study published in the August issue of Hepatology.

Thiazolidinediones may up fracture risk in older women

In type 2 diabetes patients, thiazolidinediones (TZDs), especially in higher doses, are associated with an increased risk of fracture in women age 50 and older and in men who are concurrently exposed to loop diuretics, according to research published online July 14 in the Journal of Clinical Endocrinology and Metabolism.

Coronary artery bypass graft volume affects costs

Hospitals, and to a lesser extent surgeons, who have a low volume of coronary artery bypass graft surgeries tend to incur higher costs, according to research published in the July 26 issue of the Archives of Internal Medicine.

Some epilepsy drugs linked to self–harm, suicidal behavior

Newer antiepileptic drugs that are associated with a high risk of depression may have an elevated risk of self–harm or suicidal behavior, but other groups of antiepileptic drugs do not appear to carry this risk, according to research published in the July 27 issue of Neurology.


Legal Column

Forensic Column: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

WMA Declaration of Malta on Hunger Strikers – Guidelines for medical management

Continuing communication between physician and hunger strikers is critical. Physicians should ascertain on a daily basis whether individuals wish to continue the hunger strike and what they want to be done when they are no longer able to communicate meaningfully. These findings must be appropriately recorded. When a physician takes over the case, the hunger striker may have already lost mental capacity so that there is no opportunity to discuss the individual's wishes regarding medical intervention to preserve life. Any advance instructions made by the hunger striker should be given due consideration. Advance refusals of treatment demand respect if they reflect the voluntary wish of the individual when competent.

In custodial settings, the possibility of advance instructions having been made under pressure needs to be considered. Instructions must be treated with great caution if physicians have serious doubts about the individual’s intention. If well–informed and voluntarily made, however, advance instructions can only generally be overridden if they become invalid because the situation in which the decision was made has changed radically since the individual lost competence.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology : Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

Chronic Pancreatitis: Imaging Studies

Computerized Tomography

CT should be the first test in the evaluation of possible chronic pancreatitis because it is noninvasive, widely available, and has relatively good sensitivity for diagnosing moderate to severe chronic pancreatitis. Pancreatitis is diagnosed by CT with the identification of pathognomonic calcification within the pancreatic ducts or parenchyma and / or dilated main pancreatic ducts combined with parenchymal atrophy. A helical CT Scan is preferred. In early chronic pancreatitis the role of CT is limited.

Question of the day

What are the common misconceptions about diet in diabetes mellitus?

(Ms. Sonal V Modi)

Artificial sweeteners are harmful and should be completely avoided

Direct sugar is usually omitted from diet in diabetes; therefore, artificial sweeteners may be used as an alternative. The level at which sweetness is appreciated is elevated in the case of a person with diabetes. Thus, they got to have their foods sweeter than usual to satisfy their palate.

There are calorigenic sweeteners e.g. fructose, honey, sorbitol which may be avoided in uncontrolled diabetes as in large quantities they may cause hypertriglyceridemia. On the other hand, there are noncalorigenic sweeteners e.g. saccharin, aspartame, sucralose, stevia found widely in various commercial products from the bakery, confectionery and the pharmaceutical industry. Each of the non–nutritive sweeteners have their undesirable side effects and limitations. One has to assess these aspects and incorporate it into daily use judiciously and with ingenuity.


Public Forum (Press Release for use by the newspapers)

Gift for your Sister a health check on Rakhi

The best gift you can give your sister on Rakhi is a health check or a blood donation coupon, recommends Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela. Most diseases remain silent for years or decades. Blood pressure, diabetes and high cholesterol may remain silent for over two decades.

The doctors recommend an annual physical checkup after the age of 30 for Indians as against 40 in Americans.

If there is a family history, the checkup may be done earlier starting at age 20 and if normal every three years till the age of 30 when one should start annual checkups.

Special tests needed by women are breast mammogram, ultrasound of the pelvis, bone and fat densitometry, cervical cancer checkups and special antenatal checkups if they are pregnant.

If detected early in time, both cancer of the breast and cancer of the cervix are curable.

Osteoporosis is another condition rampant in women and needs a regular checkup. The disease may remain silent till a fracture occurs. In India, heart disease amongst women is also rising. Collectively more women die of heart attack than all types of cancers combined together.

Most corporate hospitals today can either give a coupon or issue an advance receipt which can be utilized by the sister for a checkup.

Coronary heart disease (CHD) is the leading cause of death among women. Between the ages of 45 to 64, one in nine women develop symptoms of some form of cardiovascular disease. After age 65, the ratio climbs to one in three women. 

The best gift one can give to a middle–aged sister is to have her get a cardiac checkup done using a stress echocardiography.

Diagnosing coronary heart disease in the woman who presents with chest pain can be a difficult problem. Coronary angiography is considered the "gold standard" for diagnosis but is an invasive and costly test.

The initial evaluation of patients presenting with chest pain and suspected heart disease often includes some form of stress testing. Ordinary stress treadmill test in the women maybe unreliable. The best answer is to get a stress exercise echocardiography done. The sensitivity and specificity of stress echocardiography is high.


Conference Calendar

The 4th World Congress on
Date: January 14-16, 2011
Early Bird Registration: September 15, 2010
Last Date for Abstract Submission: September 30, 2010
Congress President: Dr Sudarsan Ghoshdastidar
E-mail: secretariat@ismaar-india2011.com
Website: www. Ismaar-india2011.com


An Inspirational Story

Self Appraisal

A boy went into a drug store, reached for a soda carton and pulled it over to the telephone. He climbed on to the carton so that he could reach the buttons on the phone and proceeded to punch phone numbers.

The store owner observed and listened to the conversation:

Boy: Lady, can you give me the job of cutting your lawn?
Woman: I already have someone to cut my lawn, now.

Boy: Lady, I will cut your lawn for half the price of the person who cut your lawn now.
Woman: I am very satisfied with the person who is presently cutting my lawn.

Boy: (With more perseverance) Lady, I will even sweep your crub and your side walk, So on Sunday you will have the prettiest lawn in all of the town.
Woman: No, thank you.

With a smile on his face, the boy replaced the receiver.

The Store owner who was listening to all this, walked over to the boy. He said, " Son… I liked your attitude. I like that positive spirit and would like to offer you a job.
Boy: No thanks.

Store owner: But you were really pleading for one.

Boy: No Sir, I was just checking my performance at the job I already have.
I am the one who is working for the lady I just spoke to!!

That is what is called SELF APPRAISAL.


IJCP Special

Dr Good Dr Bad

Situation: A female with diabetic kidney disease wanted to know whether she could take OCP (Oral contraceptive pills).
Dr Bad: You can.
Dr Good: You cannot.
Lesson: There is a link between OCP and diabetic kidney disease.

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Rection: Oh my God! Why was flu vaccine not given?
Lasson: Make sure that all diabetics are given flu vaccine every year.

Quote of the Day

Shakespeare …"Coin always makes sound but the currency notes are always silent. so when your value increases keep yourself calm silent ".

Asthma Alert

How to use a metered dose inhaler

When using a metered dose inhaler for the FIRST TIME (with or without a spacer), prepare the inhaler first.

  • Shake the inhaler for 5 seconds.
  • Prime the inhaler by pressing down the canister with the index finger to release the medication. Hold the inhaler away from your face to prevent medication from getting into your eyes. Press the canister down again 3 times.
  • After an inhaler is used for the first time, it does not need to be primed again unless you do not use it for 2 weeks or more.

International Medical Science Academy (IMSA) Update

Childhood absence epilepsy

A randomized clinical trial, in 453 children with childhood absence epilepsy showed that Ethosuximide and valproic acid were found to be more effective than lamotrigine in eliminating seizures; ethosuximide had a more favorable adverse event profile compared with valproic acid.


1. Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010; 362:790.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Spironolactone 25mg + Furosemide 20mg tablets

For treatment of resistant oedema associated with secondary hyperaldosteronism; resistant hypertension, chronic cardic failure and hepatic cirrhosis



Medi Finance

Q. Is there any time limit to file the return for the assessment year 2009-2010?

Ans. Yes, the due date for filing the return is 31st July. Income tax returns can be filed after the due date upto end of assessment year i.e. March 31, 2011.


Lab Test


To determine lithium levels in the blood in order to maintain a therapeutic level or to detect lithium toxicity.


Mind Teaser

Find the C below


(Contributed by Vivek Kumar)

The answer for yesterday’s Lateral Thinking: "standing ovation"

Correct answers received from: Dr Ashok Wasan, Dr. M M Siddiqui, Dr R.S. Bajaj, Dr Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, DR. A. K. GUPTA, Dr (LtCol) Gopal Agarwal, DR. K. L. JINDAL, Dr. A. K. Saxena, Dr Anurag Jain, Dr. Rohini Vaswani, Dr. Dinesh Kumar S, Dr Sunita Kalra, Dr. Susheela Gupta, Dr. Akshay Bharadwaj, Dr.R K Goel, Dr Yogesh Saxena, Dr. Noopur Gupta, Dr. Suman Kumar Sinha, Dr Virender Prakash Gautam

Correct answer received for 20th August Puzzle from: Dr Singh Simran, Dr Anurag Jain, Dr Rajeev Sethi, Dr S.L. Margekar, Dr. Ashok Kumar

Send your answer to ijcp12@gmail.com


Humor Section


The Census Taker!

An old man was sitting on his porch, when a young man walked up with a pad and pencil in his hand.

"What are you selling, young man?" he asked.

"I‘m not selling anything, sir," the young man replied. "I‘m the census taker."

"A what?" the man asked.

"A census taker. We are trying to find out how many people are in the United States."

"Well," the man answered, "you’re wasting your time with me; I have no idea."

( Contributed by Dr Chandresh Jardosh)

Funny One Liner

Why don’t dogs marry? Because they are already leading a dog’s life!

(Contributed by Dr Chandresh Jardosh)

  Readers Responses
  1. Honab'le sir, E-medinews is a breakthrough in medical world. I open this mail as I read my morning newspaper. It has become so near to us. It adds to our clinical practice too. However I would like you to add from time to time the nectar of your astound clinical experience of years as I have been your great fan right from the beginning of my medical career. Above all, in contrast to the previous days practice, the role of medicine in applied medicine is changing very fast considering the mutation in strains and advent of new antibiotics. I would request you to include the tips on current scenario of use of treatment guidelines in seasonal infectious diseases every day. So that all the clinicians are aware of the medicines working/responding for a particular disease in a given season. It shall also be nice if case series of common diseases with complications are taken up; viz hepatitis in a patient of typhoid; else relapsing malaria; resistant malaria. Plz include a column on the medical problems that could be commonly seen during commonwealth games in local population and special cases in foreign delegates: viz communicable & non communicable diseases being brought by them & how to treat in cases like malaria in a foreign delegate already coming with malaria prophylaxis or hepatitis in immunized person or gastroenteritis. Dibendujoy Verma.
  2. Dear Dr. K.K. Aggarwal, I had gone to USA for two months and returned last week July. I have been going through e-medinews even in USA which has been quite educative. Our Asian ENT Journal is being read by various ENT specialists & I am getting ENT articles regularly for publication in this Journal. (Dr V P SooD)

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi 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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