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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

26th April, 2010 Monday

Prevention update: Reducing salt: make it a prescription

1. Using a computer simulation model, it has been shown that a reduction in dietary salt by 3 gm per day has the same benefits as quitting smoking, normalizing obesity or high cholesterol levels.1

2. A meta–analysis using international data has shown that after implementation of smoking restriction laws, there has been a significant reduction in hospitalizations for acute heart attack over a period of 12 months.2

3. Combined analysis of two trials in patients with coronary artery disease, has shown that people who are receiving folic acid (1 mg per day) + Vitamin B12 (0.4 mg per day) have an increased risk of primary lung cancer and cancer mortality at 3 years follow up.3


  1. Bibbins–Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590.

  2. Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smoke–free laws and individual risk attributable to secondhand smoke. Circulation 2009;120:1373.

  3. Ebbing M, Bonaa KH, Nygard O, et al. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA 2009;302:2119.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

VIPs at the World Earth Day function organized by Heart Care foundation of India in association with Ministry of Env. & Forests, GOI and DPS Mathura Road, New Delhi on 22nd April 2010.

From Left to Right: Dr Sudesh Ratan, VP DMA; Dr Sanjay Sood, President IMA New Delhi Branch; Sh Pramod Grover, Vice Chairman DPS Society, MI Hussain, Principal DPS Mathura Road, Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal, Mr R Mehta, Advisor Min. of Env. & Forests, GOI; Dr T Meinya, MP, Manipur; Mr Virindra Kataria, Sr. Statesman, Former MP; Dr HT Sangliana, Vice Chairman, Minority Commission, GOI.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): What’s New

Although statin therapy does not appear to improve outcomes in most patients with heart failure (HF), a subset analysis of a randomized trial suggested that statins may be beneficial in those patients with the least severe HF (Am Coll Cardiol 2009;54:1850.)

News and Views (Dr Brahma and Dr Monica Vasudeva)

Elevated glucose in AMI patients undergoing angiography linked to increased risk of kidney injury.

Elevated glucose levels in acute-MI patients undergoing coronary angiography is associated with an increased risk of contrast–induced acute kidney injury, according to a study published in the Journal of the American College of Cardiology. Hyperglycemic patients without diabetes are a high–risk group for kidney injury. These patients should be treated the same way as diabetics.

High cortisol concentration associated with greater age–related cognitive decline in type 2 diabetes

As per a study published in Diabetes Care, high morning levels of the glucocorticoid cortisol in elderly individuals with type 2 diabetes are associated with greater estimated cognitive decline.

Glimeperide better in CAD

According to a study published online March 9 in the journal Diabetes Care, the risk for overall mortality is similar in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy. However, in CAD patients, glimepiride may be the preferred sulfonylurea in patients with underlying CAD.

Pregnancy–specific anxiety associated with lower mental development scores in offspring

According to a study recently published in the journal Child Development, excessive worry about pregnancy itself in mothers–to–be, called pregnancy–specific anxiety, was associated with lower 12–month mental development scores in their babies.

Routine PET use may help improve outcomes in patients with heart failure

Significantly fewer patients (60% less) with heart failure had cardiac events when myocardial viability imaging with positron emission tomography was integrated into clinical management (April 2010 issue, Journal of Nuclear Medicine).

Mnemonic of the Day (Dr Prachi Garg)

Small Pupils – HAPPY



Pontine hemorrhage


Happy (morphine)

What’s New

Type 1 diabetes

The incidence of childhood type 1 diabetes is rising rapidly worldwide, particularly in younger children. (Patterson CC, Dahlquist GG, Gyurus E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009;373:2027.)

Quote of the day

"It’s your aptitude, not just your attitude that determines your ultimate altitude." Zig Ziglar

Diabetes Fact

Ruboxistaurin; new investigatory drug, which prevents microvascular complications, including diabetic retinopathy. Ruboxistaurin inhibitors of the enzyme called protein kinase C–beta. It works by blocking one of the pathways by which sustained excess glucose causes microvascular complications, including eye and kidney disease.

Question of the Day

How do you deal with a foreign body in the ear?

  • Pain is reduced by instillation of local (Xylocaine) drops into the ear.

  • In case it is an insect and it is felt to be moving, then liquid paraffin drops are used, which would first kill the insect.

  • Syringing the ear for atraumatic removal of foreign body.

  • However, for hygroscopic (organic) foreign bodies, a wax hook or vectis or ring curette can be used. The instrument is passed carefully behind the foreign body and then both (instrument and foreign body) withdrawn together.

  • After removal, the ear is made dry (of water) and if bleeding occurs, a gelfoam pack is placed in the ear canal.

Role of healthcare professionals: tobacco (Dr G M Singh)

As individual

  1. Ask about tobacco use.

  2. Advise all users to quit.

  3. Assess willingness to make a quit attempt.

  4. Arrange follow up contact.

Public Forum (Press Release for use by the newspapers)

Diesel bad for the Heart

Diesel exhaust particles contain a chemical component called phenanthraquinone (PQ) that can harm the ability of arteries to regulate blood flow to bone marrow. This can have a number of long–term health effects, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Men, postmenopausal women, and elderly people are most likely to be affected. The doctors at West Virginia University School of Medicine conducted tests with rats. They found that exposure to PQ reduced by about 65 percent the ability of arteries to regulate blood flow to bone marrow in six– month–old male rats. PQ had a similar effect in older male and female rats and in young female rats whose ovaries had been removed.

Because young female rats with intact ovaries were not affected, it appears that estrogen may provide protective effects against PQ.

Previous research has found that PQ impaired the ability of larger blood vessels to relax and that exposure to particle pollution may worsen cardiovascular diseases in certain people.

eMedinewS Try this it Works

Remedy for proctalgia fugax

Break the spasm with an enema of a few ounces of warm water. The spasm subsides within 10 or 20 seconds as the water is being expelled.

Dr Good Dr Bad

Situation: A diabetic came with day-time sleepiness.

Dr Bad: Do not worry it may be due to fluctuations in glucose.

Dr Good: Get sleep apnea ruled out.

Lesson: Type 2 diabetes mellitus adversely affects breathing during sleep, becoming an independent risk factor for severe nocturnal hypoxemia in obese patients. Since sleep apnea–hypopnea syndrome (SAHS) is a risk factor of cardiovascular disease, the screening for SAHS in such patients is mandatory.(PLoS ONE 2009;4(3):e4692.)

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.

Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.

Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.


Laughter the best medicine

A Professor of Critical Care Medicine, a man well known for his earnest and oft–proclaimed Temperance views, was (yet again) lecturing the medical students on the damage that alcohol can do. To demonstrate its effect on the nervous system, he took a worm and dropped it into a glass of gin and tonic. The worm wriggled around for a few minutes before finally giving a few convulsive twitches and dying.

"And can we deduce anything from this?", asked the Professor with a triumphant air implying that only the obvious conclusion could be drawn.

"Yes," came a voice from the back, "if you’ve got worms, drink alcohol."

Formulae in Critical Care

Urea:creatinine ratio

Normal value: 20:1

if >20:1 – Prerenal failure
20:1 maintained – Normal or renal disease
<20:1 – Obstructive uropathy, postdialysis, toxemia

Milestones in Diabetes

French physician, Bouchardat (1870s), first noticed the disappearance of glycosuria in his diabetes patients during the rationing of food in Paris while under siege by Germany during the Franco–Prussian War, which formulated the idea of individualized diets for his diabetes patients.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Stool Examination

Diarrhea is a common symptom of a gastrointestinal disturbance. O & P (Ova and Parasite) testing. A microscopic evaluation of your stool for parasites and the ova (eggs, cysts) of parasites. A BASIC TEST BUT VERY IMPORTANT!

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Theophylline 400mg SR + Montelukast 10mg Tablet

For the treatment of patients with bronchial asthma


(Advertorial section)



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Readers Responses

  1. Dear Sir, I liked the information on "Training your bladder". Thanks for this rare to find information. Regards: Dr. Sujata Natarajan

  2. Dear Dr Agarwal, Thank you for the great job you have done. I will send you a few lines on serum beta crosslaps which we have just started. The test is not done by anyone in Delhi: Dr Asha Bhatnagar, Lifeline Laboratory

  3. Dear Sir, Thanks. The stress management seminar at the Om Shanti Retreat was a life time experience. My take home was Monday–Nonviolent Speaking, Tuesday–Confessing, Wednesday–Gifting/Appreciating, Thursday–Logical Reasoning, Friday–Fasting, Saturday–Serving, Sunday–You can ‘CHEAT’. I have been trying to apply these principles this week. Thanks a lot. Dr Sushrut Almast