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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)



22nd November Sunday

Dear Colleague,

PAP Smear at age 21: New guidelines

 And now the new guidelines advise women to undergo first Pap test at 21

New guidelines for cervical cancer screening from the American College of Obstetricians and Gynecologists say women should delay their first Pap test until age 21.

The panel emphasize the risk  associated with annually screening millions of people who will never get cervical cancer.

The ACOG guidelines also suggest that most women in their 20s can have a Pap smear every two years instead of annually.

Women 30 and older should wait three years between Paps once they have had three consecutive clear tests.

The guidelines, published in Obstetrics & Gynecology, also reveal that those with HIV, other immune -weakening conditions, or previous cervical abnormalities may need more frequent screening.

These suggestions are said to reflect better understanding of HPV. The younger the woman, the more likely that HPV is going to be transient.

Dr KK Aggarwal


 Now you do not need to fast before cholesterol test

A new study published in the Journal of the American Medical Association reports that now patients do not need to fast prior to getting a cholesterol test. Analysis of data from 300,000 people showed that results were just as accurate if the patient had eaten before the test. Cholesterol levels are an integral part of work up for heart diseases. Earlier it was believed that the body required adequate time to digest food and wash away fat from the blood. Hence, overnight fasting was recommended to get accurate levels of LDL cholesterol. According to Professor John Danesh, the study findings suggest that cholesterol measurements are at least as good and probably somewhat better, when done without fasting. As a byline, the data also found analysis of HDL or good cholesterol plus LDL cholesterol was as useful as apolipoproteins AI and B levels in predicting risk of heart diseases.

Stem cells now come to the rescue of type 2 diabetics, says PGI study

A study from the Depts. of Endocrinology, Transfusion Medicine and Radio Diagnosis, PGIMER has used stem cell transplantation as an effective solution for type 2 diabetes. The study is published in the journal Stem Cells Development, September this year.
Ten diabetic patients, taking treatment for minimum five years underwent the new technique, which involved autologous bone marrow transplantation in which stem cells taken from a patient’s hipbone can be injected peripherally or targeted at the pancreatic artery. The study subjects were followed up for six months. Insulin intake decreased considerably in seven, whereas three patients stopped using insulin. Quality of life improved in all seven patients. Three patients showed no response. The scientists now plan to study 50 patients aided by funds from DRDO.

Lysteda FDA approved for menorrhagia

On November 13, 2009, the US FDA announced the approval of Lysteda (tranexamic acid) for the treatment of menorrhagia. In 1986, tranexamic acid was first approved by the FDA as an injection, under the brand name Cyklokapron. Lysteda acts by stabilizing a protein involved in the blood-clotting process. However, the FDA has cautioned women receiving hormonal contraception as it may increase the blood clots, stroke, or myocardial infarction.

Probiotics may prevent pneumonia in the critically ill

Lactobacillus GG, a probiotic, reduced rates of ventilator-associated pneumonia (VAP) and Clostridium difficile disease in critically ill patients on mechanical ventilation. The study results have paved the way for a new, inexpensive, and non antimicrobial option to prevent nosocomial infections including VAP. The rate of clinically diagnosed VAP using the American College of Chest Physicians (ACCP) criteria was 25% in the probiotic group vs 47% with placebo. ACCP criteria consist of a new infiltrate on chest x-ray plus any two of the following three clinical criteria: fever, purulent sputum, or leukocytosis. The study results were presented at the annual meeting of the American College of Chest Physicians.

Now a band aid to monitor patients

A smart plaster, a sensor-studded band aid that can wirelessly monitor vital signs and other health indicators is undergoing clinical trials at Imperial College's Institute of Biomedical Engineering. Its creators hope that in due course of time, the new smart band aid would take over from the wired devices that restrict movements of a patient. The basic device monitors temperature, heart rate and respiration. Preliminary trials will investigate the authenticity of the data being generated and transmitted by the plaster to ensure it gives accurate readings of a patient's condition. In the next phase, the band aid would be tested on patients who are recovering from minor illnesses and assess how it does when the patient has a shower or undergoes an x ray. According to Dr. Oliver, finally it would be utilized to monitor the health of patients recuperating from more serious respiratory illnesses.

Mobile phones can teach good habits

Mobiles phones are not a nuisance; rather they can be a useful guide to building and improving healthy habits, especially facilities like 'reminders and text messages'. These can help people take their medicines prescribed by doctors on time. Researchers studied 70 people about the use of sunscreen, dividing them into two groups. The class that received reminder messages had a 56.1% obedience rate, while the other section without the reminders adhered poorly, i.e. only 30%. The messages were kept short so that they could be read at a glance. This study simply heralds the benefits of modern gadgets in improving people's wellbeing. The study is published in the November issue of Archives of Dermatology.

Some clues to help differentiate osteoarthritis from other types of arthritis

1. Morning stiffness that lasts more than 30 minutes is less likely to be a symptom of osteoarthritis, as stiffness of osteoarthritis usually clears up within this time.
2. If many different joints are affected on both sides of the body, osteoarthritis is less likely to be the cause. 
3. Osteoarthritis rarely affects the wrist, elbow, or ankle. If you have joint pain in these areas, it’s unlikely to be caused by osteoarthritis.
4. Unless osteoarthritis is sever or advanced, it is not likely to cause nocturnal pain.
5. Joint pain associated with other symptoms viz. rash or fever, is not likely to be caused by osteoarthritis.

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 Do not be afraid...

Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt… William Shakespeare

"Doctor, doctor, my hair's coming out. Can you give me something to keep it in?
Certainly - how about a paper bag?"

Mistake to avoid
A 50-year-old male patient suffering from COPD was admitted in the ward. The patient was unable to sleep the Doctor on duty was informed who left the orders for the sister on duty that the patient should be given .25 mg alprazolam. The patient was given 25 mg of alprazolam.Two hours later the patient wasfound to have respiratory depression and hypotension.

This is a very common error. Drugs which have their dose in decimals, the decimal should always be preceded by a zero.

.25 mg was misread as 25 mg (instead of 0.25 mg) leading to alprazolam overdose. Such errors can very easily be prevented by uniform hospital instructions and problems of overdose can be totally avoided.

Funny clinical notes (Dr Minakshi)
On the second day the knee was better, and on the third day it disappeared.

Letter to the editor

1. Dear Dr Aggarwal, is there any research done which tells tea and coffee are not good for health? (Dr Pankaj Budhiraja)

Editors comments: People who drink lots of coffee and do not take healthy diet which is rich in whole grains, olive oil, fruits and vegetables and includes little red meat  are more likely to have atrial fibrillation. A study has shown that patients with atrial fibrillation consumed more red meat and full fat dairy products. The heaviest coffee drinkers were also more likely to have atrial fibrillation than those who drank less.(European Society of Cardiology)

2. My dear Dr. K. K. Aggarwal: Heartiest congratulations on your very well deserved Acarya Sushil Muni Sadhna Jain Muni award for your contributions  in social functions. You can speak on any subject be it related to medicine, religion,  unity of faiths and believe firmly in dissemination of knowledge and for which purpose you daily get up so early  Your life is your message and is based on the discipline that Seva to humanity is holier than the lips that pray. You are a real Karama Yogi. After attending your clinical meeting on Pneumonias, I wondered as for the senior citizens, above the age of 85 years who are suffering from diabetes, bronchial asthma, C.O.P.D, IHD, compensated heart failure etc and are in remission, as to how safe is it for them to attend meetings in multi specialty hospitals and how to safeguard himself against various hospital acquired infections, especially when they are very keen to attend such meetings. What precautions do you recommend that should be taken? Warm regards
 Dr K. Kanwar
Emedinews comments: Thanks. The only answer is to get fully vaccinated against pneumonia, flu, and typhoid. (to be contd.....below)

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 1500 doctors. Topics will be 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 700 registrations.

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

 Letter to the editor contd.

 3. Dear Dr. Aggarwal: Thanks for your regular updates which are really thought provoking and very much informative. I would appreciate a note on antibiotic policy in tertiary care hospital set up and how to prevent indiscriminate use of antibiotics, through your forum. Thanking you, Prof. S.K Bhattacharya, Deptt. of Pharmacology, UCMS &GTB Hospital, Delhi 110095,
Emedinews comments: will include them. Basics are rational use, avoid indiscriminate use, follow evidence based guidelines, follow hospital antibiogram policy, switch IV to oral early, emphasize on home IV antibiotics wherever possible etc. We must also learn the difference between community acquired infections, hospital acquired infections and health care associated infections as the antibiotic policed differ. 

4. Respected Dr Aggarwal Ji, My sincere congratulations to you for your efforts. In context with your article entitled paracetamol may cause asthma; I would add for the knowledge of the esteemed readers of emedinews that it may cause exfoliative dermatitis. I do not think that many dermatologists even would have come across it. I have a publication in the year 1984 in Indian Journal of Dermatology, Veneorology and Leprology under my senior Dr. B. K. Girdhar published by me at Central JALMA Institute for Leprosy (now National Instt. for Research in Leprosy and other mycobacterial diseases, located at Tajganj, Agra). If somebody will be interested I may give further details of the paper.  At the end, I once again thank you, Sir. With regards, Dr. A. K. Bagga

5. Respected Dr KK Aggarwal: Thanks so much for forcing me to read new things which I would otherwise, not do! Your effort is extremely appreciated. Can you please include the following topics if possible: importance of GPs in a society dominated by specialists, future of GPs in big cities of India, like Delhi and qualities of a good, successful GP.
Thank you so much in advance! DR YATISH SHARMA
Emedinews comments: Good GPs are lacking so are good physicians. They have a great future.  In fact no specialist should see a case without a GP, this is how lawyers practice. The definition of a good GP is that he knows 10 things about 1000 conditions and specialist know 1000 things about 10 diseases. Its tea work of a good GP and a specialist which is required for a good care.

6. Respected sir, great topic on pioglitazone and vitamin E. But could you kindly comment on CHF effect induced by pioglitazone. Dr. Anshul.
Emedinews comments: I agree one must be careful. But its rosiglitazone (not pio) which, has been linked to heart failures.

7. Heartiest congratulation for another award, for serving the social cause. My best wishes. Dr O P Gupta, MGIMS Wardha.

8. Small tips of great clinical significance. Congrats on being felicitated. Dr. H.L. Kapoor



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