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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; Member 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


Dear Colleague

23rd April, 2010 Friday

Training your bladder (from HEALTH BEAT)

Choices for urinary incontinence range from lifestyle changes to surgery depending on the underlying problems.

  1. A woman may be a candidate for either injections of bulking agents or a sling procedure. If she is in her 40s and likes to do kickboxing for exercise, she may not be dry enough with the injections and may choose sling surgery. A woman with similar exam and test results but a less active lifestyle might get along fine with injections.

  2. Less invasive treatments, such as biofeedback or pelvic floor exercises, are a good first step and can be helpful, but may not be as effective as some surgical procedures.

  3. Bladder training: Some bad habits—habits can gradually result in incontinence or frequent bathroom breaks.

  4. If you routinely urinate before your bladder is full, it learns to signal the need to go when less volume is present. That can set up a vicious cycle, as you respond to the new urges and teach your bladder to cry "run" when less and less urine is present.

  5. Luckily, old bladders can learn new tricks. Bladder training is a program of urinating on schedule. It enables one to gradually increase the amount of urine one can comfortably hold.

  6. Bladder training is a mainstay of treatment for urinary frequency and overactive bladder in both women and men, alone or in conjunction with medications or other techniques.

  7. It can also help prevent or lessen symptoms of overactive bladder that may emerge after surgery for stress incontinence.

Step–by–step bladder–training technique

  1. Keep track: For a day or two, keep track of the times you urinate or leak urine during the day.

  2. Calculate: On average, how many hours do you wait between urinations during the day?

  3. Choose an interval: Based on your typical interval between urinations, select a starting interval for training that is 15 minutes longer. If your typical interval is one hour, make your starting interval one hour and 15 minutes.

  4. Hold back: When you start training, empty your bladder first thing in the morning and not again until the interval you've set.

  5. If the time arrives before you feel the urge, go anyway.

  6. If the urge hits first, remind yourself that your bladder isn’t really full, and use whatever techniques you can to delay going.

  7. Try the pelvic floor exercises sometimes called Kegels, or simply try to wait another five minutes before walking slowly to the bathroom.

  8. Increase your interval.

  9. Once you are comfortable with your set interval, increase it by 15 minutes.

  10. Over several weeks or months, you may find you are able to wait much longer and that you experience far fewer feelings of urgency or episodes of urge incontinence.

Keeping a bladder diary

  1. Complete the information for two consecutive 24-hour periods. Record both day and night.

  2. Begin with first urination upon arising.

  3. Record intake amount in ounces and type of fluid (for example, coffee, juice, water, etc.).

  4. Record approximate urine output and time of urination.


Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

Dr KK Aggarwal being felicitated on World Earth Day by the DPS Society, for being awarded the prestigious Padma Shri at DPS, Mathura Road. Also in the picture are Mr M I Husain, Principal, DPS Mathura Road and Mr Pramod Grover, Vice Chairman, DPS Society.

Dr k k Aggarwal

International Medical Science Academy (IMSA) Column: What's new

The Advisory Panel of the United States Department of Health and Human Services now recommends initiation of antiretroviral therapy in patients infected with HIV with a CD4 count less than 500 cells/mL. (DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. www.AIDSinfo.nih.gov.)

News and Views (Dr Monica and Dr Brahm Vasusdeva)

FDA urged to curb salt content in processed food.

The FDA has received a recommendation from the Institute of Medicine to cut back the amount of salt that goes into all kinds of processed foods. The new proposal is to cut one–third of the salt out of what we buy at groceries or eat at restaurants. In an effort to help Americans combat high blood pressure, heart disease, strokes, and other health problems that have soared to near–epidemic proportions, the agency’s efforts will begin by seeking voluntary cutbacks by the food industry.

Once–monthly peginesatide may be safe, effective for treating anemia in hemodialysis patients.

According to an abstract poster presented at the National Kidney Foundation Spring Clinical Meetings, peginesatide an investigational peptide–based erythropoiesis–stimulating agent (ESA), given once monthly, is effective and tolerable in treating anemia in patients on hemodialysis.

Early screening for type 2 diabetes cost effective, may prevent complications.

According to a study published online March 30 in The Lancet, early screening for type 2 diabetes is cost effective and prevents diabetes–related complications, including myocardial infarction and blindness. The most cost–effective approach is to begin screening patients for type 2 diabetes between ages 30 and 45, with follow–up every three to five years.

FDA increases scrutiny of rosiglitazone

FDA is increasing its scrutiny of rosiglitazone as the agency prepares to either withdraw the drug or cancel a clinical trial assessing its risks against a rival treatment.

Dutasteride may help lower prostate cancer risk in men at high risk

Dutasteride can reduce cancer risk. A new study by Dr. Gerald Andriole, Washington University, said that dutasteride reduces a man’s chance of being diagnosed with prostate cancer. The study, published in the New England Journal of Medicine, showed that men at an above–normal risk of prostate cancer may be able to reduce their risk of developing the disease by taking the drug. It lowered the risk of prostate cancer by about a quarter in high–risk men.

Mnemonic of the Day (Dr Prachi Garg)

Confusion – DIM FACES

Drugs / Dehydration


Metabolic / Myocardial Infection

Fracture / Failure

Alcohol / Anemia

Cerebrovascular Accident

Electrolyte disturbances

Space occupying lesion.

What’s new

Oseltamivir for the treatment of influenza

The US FDA has issued an Emergency Use Authorization to permit the use of oseltamivir for the treatment of influenza in infants younger than one year of age. (United States Food and Drug Administration. Emergency use authorization (EUA) review – oseltamivir phosphate for swine influenza A. www.fda.gov/ downloads/ Drugs/ DrugSafety/ Informationby DrugClass/ UCM153547.pdf. (Accessed September 24, 2009).

Quote of the day

"Death comes to all. But great achievements build a monument which shall endure until the sun grows cold." (George Fabricius)

Diabetes Fact

Duloxetine, is now approved for painful neuropathy. It has long been used to treat conditions such as depression, stress disorders, and anxiety disorders. In adults with diabetes, and associated neuropathic pain, the use duloxetine may be used to manage pain by decreasing the stimulation of nerves and the pain signals sent to the brain.

Public Forum (Press Release for use by the newspapers)

Benefits of smoking cessation

Addressing a seminar organized by Delhi Medical Association on Tobacco Smoking, Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal said that benefits of quitting cigarette smoking are formally established. Those with heart disease, reduction in cardiac events associated with smoking cessation range from 7 to 47%. Similar benefits are noted with patients with heart disease.

The earlier you quit, greater the benefits

  1. People who quit smoking before the age of 50 reduce their risk of dying over the next 15 years as compared to those who continue to smoke.

  2. Cigarette smoking develops the risk of developing heart disease and smoking cessation can rapidly reduce this risk.

  3. One year after quitting smoking, the risk of dying from heart disease is reduced by 50% and if continued, the risk could decline further overtime.

  4. The risk of heart attack is reduced to that of non-smokers within two years of quitting smoking.

  5. In patients with asthma and COPD, stopping smoking can reduce further damage to lungs.

  6. Cigarette smoking is responsible for 90% of lung cancers. Smoking cessation reduces the risk of lung cancers by five years and to that of non–smokers by 15 years.

  7. The risk of osteoporosis is reduced to that of non-smokers by 10 years.

  8. Weight gain can occur while trying to quit smoking because people tend to eat more after stopping. It is typically 2–5 pounds in the first two weeks followed by an additional 4–7 pounds over the next 4–5 months. The average weight gain is 8–10 pounds. Smoking cessation, therefore, should be associated with exercise programme and a proper diet plan to minimize weight gain. However, it should be emphasized that the benefits of quitting smoking are far greater than the risk of gaining weight.

Smoking and Heart

  1. Smoking 20 cigarettes a day increases the risk of heart attack in women by 6 folds.

  2. Smoking 20 cigarettes a day increases the risk of heart attack in men by 3 folds.

  3. Smoking is responsible for 36% patients of first heart attack.

  4. Heart patients who continue smoking have more chances of second heart attack, increased risk of death and sudden cardiac death.

  5. Persistent smoking after bypass surgery leads to increased mortality, cardiac deaths and re–bypass.

  6. Persistent smoking after angioplasty leads to greater risk of death and heart attack.

  7. In patients with heart functioning of less than 35%, smoking leads to high mortality.

  8. Blood pressure medications may not work properly in patients who continue to smoking.

Question of the day

Has imiquimod made a lot of difference in management of venereal warts?

Yes, it has, due to its enhanced efficacy and ease of use, patients can apply imiquimod themselves. Irritation is a problem and can be averted by judicious use.

eMedinewS Try this it Works

The cough of congestive failure

A persistent night cough can be a symptom of subtle congestive heart failure, especially in the elderly.

Dr Good Dr Bad

Situation: A diabetic foot ulcer on treatment did not reach 50% area reduction after 4 weeks of treatment.

Dr Bad: Its ok

Dr Good: You need further evaluation

Lesson: The calculation of the percentage of ulcer area reduction after 4 weeks of treatment can be used as a surrogate marker to estimate the probability of healing. It helps to categorize patients as healers and non healers. In an analysis, the probability of healing was significantly decreased for ulcers that did not reach 50% area reduction after 4 weeks of treatment. A re–evaluation of the treatment schedule is recommended for wounds that do not reach 50% area reduction within the first 4 weeks of therapy. (J Diabetes Complications 2009;23(1):49–53.)

Make Sure

Situation: A patient of COPD and hypertension put on atenolol developed cute bronchospasm

Reaction: Oh my God! You should have known that atenolol is not COPD–friendly. 

Make sure that in hypertensive patients with airway dysfunction nebivolol a beta–1 adrenoceptor blocking agent that modulates endogenous production of nitric oxide is used and not conventional beta–1 blockers.


Laughter the best medicine : IMANDB Joke of the day

Shortly after the 911 emergency number became available, an elderly and quite ill lady appeared in a hospital emergency room, having driven herself to the hospital and barely managing to stagger in from the parking lot. The horrified nurse said, "Why didn’t you call the 911 number and get an ambulance?" The lady said, "My phone doesn’t have an eleven."

Formulae in Critical Care

Total body water (TBW)

Formula: TBW = Weight (kg) × 60 for males


= Weight (kg) × 50 for females

Milestones in Medicine

Pierre Deniker, who ran the first trial on psychotic patients, published in 1952, wrote that "aggressiveness and delusive conditions of schizophrenia improved", and contact with patients was re–established.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Adrenocorticotropic Hormone (ACTH) is odne to help diagnose adrenal and pituitary diseases such as Cushing’s syndrome, Cushing’s disease, Addison’s disease, adrenal tumors, and pituitary tumors.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Bosentan (as monohydrate) Tablets 62.5/125mg

For the treatment of pulmonary arterial hypertension (WHO Group I) in patients with WHO Class III or IV symptoms, to improve exercise ability and decrease the rate of clinical worsening


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eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second 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.

IMANDB Annual Day Meet : Scientific feast, in association with Board of Medical Education Moolchand Medcity, emedinews and IMSA (Delhi); No fee SMS 9811090206 for registration

Date: Sunday April 25, 2010,

Venue: Moolchand Medcity Auditorium, New Delhi

Scientific Program: 4–7 PM

4.00 PM–5.00 PM: Fatty Liver, Workshop for GPs: Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal

5.00 PM–6.00 PM:

Cardiac Update (Max Hospital)

a. Dr JJ Sood Oration: Cardiac Interventions: Dr Mohan Bhargava

b. Dr K L Chopra Oration: Endovascular Approach to Aortic Aneurysm: Dr Kumud Mohan Rai, (Max Hospital)

6.00 PM – 6.30 PM

Dr Sheila Mehra Oration: Management of osteoporosis: Dr Ramneek Mahajan

6.30 PM –7.00 PM

Medical Ethics: A panel discussion: Dr Ashok Seth, Dr Sudesh Ratan, Dr Rajiv Khosla, Dr KK Aggarwal, Dr Girish Tyagi, Dr Sanjiv Malik, Dr H K Chopra, Dr Madhu Handa, Dr Kumud Mohan Rai, Dr Archna Virmani

Annual Day Function: 7–8 PM

Eminent Guests: Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, Dr Narender Saini (President DMA), Dr Vinod Khetrapal (President–Elect DMA), Dr Girish Tyagi (Registrar DMC), Dr Ashwini Dalmiya (Secretary DMA), Dr Naresh Chawla (Immediate Past President DMA)

Dinner: 8.00 PM onwards...

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Readers Responses

  1. Presswatch: Mother’s milk ‘can help to kill off cancer’ Researchers from the University of Gothenburg and Lund University in Sweden have claimed that a substance found in breast milk, named Hamlet, can kill cancer cells. Patients with bladder cancer who were treated with Hamlet managed to expel dead cancer cells through their urine after each treatment, raising hopes it could be a potential cure. HAMLET – Human Alpha–lactalbumin Made Lethal to Tumour cells – was discovered unintentionally when researchers were investigating the antibacterial properties of breast milk. Assistant Professor Roger Karlsson, from the University of Gothenburg’s department of chemistry, said he hoped Hamlet could be developed into a cancer drug.: Dr Vivek Chhabra

  2. Sir Very good information on heat stroke and right in time. God bless long life to you. Satish

  3. Congrats. It was great.: Dr Saket Bhardwaj

  4. Congratulations on receiving Padma Shri.: Chandrika Jain