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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)


28th October

Dear Colleague,

BREAKING NEWS: Stroke window now 4.5 hours, TIA window 1 hour
The treatment of acute stroke is thrombolysis with tPA within three hours. A new German study has shown that this window can now be increased to 4.5 hours. According to the study tissue plasminogen activator treatment benefits stroke patients when used up to 4.5 hours after a stroke. Primary as well as secondary analysis from ECASS III study indicated that tPA treatment led to better outcomes than placebo in stroke patients treated from three hours to 4.5 hours post-stroke.
When we were students the definition of TIA was transient reversible focal neurological deficit lasting less than 24 hours. The same window now has changed to less than one hour. 

IMA Working Committee Meeting will be held on 31st October & 1st November at Nagpur. It will consider important agendas. A gist of the same, we will inform our readers through emedinews column. Also the last DMC Council meeting of the existing council will be held today at Dean Office at Maulana Azad Medical College. This will probably be the last meeting before the new council takes over. The new council is still waiting for 4 nominations from Delhi Government. . The representatives from medical colleges have already been elected.

PERAMIVIR approved for flu: The FDA has approved emergency use of experimental antiviral drug PERAMIVIR. The drug has already been given to at least 8 people who were near death from H1N1 and all of them are surviving. The existing tamiflu may have side effects and the nasal spray Relenza may not go deep enough into the lungs in flu pneumonia.

Dr KK Aggarwal


H1N1 advice from Dr. Oz (Source Dr V Bhagia)
The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.
While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu): 
1. Frequent hand-washing especially after nose blowing
2. Cough into crook of arm, instead of hands or into the air, A sneeze into the air can contaminate a whole room. 
3. Hands-off-the-face approach:  Resist all temptations to touch any part of face (unless you want to eat or bathe.)
4. Gargle twice a day with warm salt water (use Listerine or Hydrogen Peroxide if you don't trust salt).  
5. H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
6. clean your nostrils at least once every day with warm salt water, or hydrogen peroxide.
7. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose softly once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
8. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

Or in case of emergency is the name one can feed in your mobile so that some one can contact you when in need.

Health Tip: You Need Vitamin B-12
Vitamin B-12 is an essential vitamin found in dairy foods and many types of meat. It plays a role in the health of nervous system and in the production of red blood cells. The American Academy of Family Physicians says here are the possible health consequences of a vitamin B-12 deficiency: Dementia; Depression; Anemia; Nervous system abnormalities and Possible increased risk of heart disease and stroke, if you also have above normal levels of an amino acid called homocysteine.

Giving seriously ill patients high-intensity dialysis is no better
Giving seriously ill patients high-intensity dialysis is no better at saving lives or speeding recovery than a lower-intensity version of the same treatment. The patients in question were the sickest of the sick; all were in hospital intensive care units (ICUs). Approximately half had overwhelming infection, causing multiple body organs to fail. Others had complications following major surgery, most commonly for heart surgery, and some were admitted to ICU following severe trauma or injury, explained Dr. Alan Cass, co-author of the study published in the Oct. 22 issue of the New England Journal of Medicine.

Wight loss surgery not safe for the super obese
People who are super obese and those with the most chronic health problems face an increased risk for dying within a year after weight-loss surgery. The research involved 856 men and women who had bariatric (weight-loss) surgery at 12 Veterans Affairs medical centers between 2000 and 2006. They averaged 54 years old and had an average body-mass index (BMI) of 48.7. BMI is a measurement based on height and weight, and a BMI of 40 or greater is considered class 3 or morbid obesity. About 36 percent of the group was considered super obese, with a BMI of 50 or higher. In addition, 8 percent also had such chronic diseases as diabetes and heart disease. During the follow-up, 54 people died, including 1.3 percent who died within 30 days of their surgery, 2.1 percent who died within 90 days of surgery and 3.4 percent who died within a year.[JAMA/Archives, news release, Oct. 19, 2009]

Life style effective for diabetes
Research presented Tuesday at the 20th World Diabetes Congress in Montreal provides further evidence that healthy behaviors reduce mortality in people with and without diabetes. The study included 1,177 people with diabetes and 15,217 without diabetes who took part in the Third National Health and Nutrition Examination Survey from 1988 to 1994 and were followed through 2001.
A greater number of healthy behaviors was linked to a 15 percent reduced risk of dying from any cause in diabetics and a 17 percent reduced risk in non-diabetics, after adjusting for various factors that might influence the results. Subjects in the top 20 percent of healthy behavior summary scores had a 58 percent lower death rate than those in the bottom 40 percent.
Five self-reported healthy behaviors were assessed at the start of the study: physical activity, not smoking, higher healthy eating index, moderate alcohol intake (1-2 drinks per week), and maintaining weight or trying to lose weight in the past 12 months. Among the healthy behaviors studied, regular, moderate to vigorous physical activity was most protective for those with diabetes. Moderate to vigorous physical activity significantly reduced the risk of dying in both adults with and without diabetes, whereas moderate alcohol use, was only protective only in people with diabetes. In diabetes-free adults, current smoking and fewer healthy eating habits were both linked to increased risk of death, whereas the impact of diet on death in people with diabetes was inconclusive.

CRP raises risk of heart attack but not stroke
High blood levels of C-reactive protein may increase a person's risk for heart attack and death, but not for stroke. A study included 2,240 people in New York City who were 40 or older and stroke-free. At the start of the study, the participants blood was checked for levels of CRP (a marker for inflammation) and their heart attack and stroke risk factors were evaluated by researchers. During an average follow-up of eight years, there were 198 strokes, 156 heart-related events and 586 deaths. People with CRP levels greater than 3 milligrams per liter of blood were 70 percent more likely to have a heart attack and 55 percent more likely to die than those with CRP levels of 1 milligram per liter or less, the researchers reported in the Oct. 20 print issue of Neurology. After they took other risk factors into account, the study authors concluded that CRP levels didn't influence stroke risk.

Extended use of sucking outside of breast-feeding may have detrimental effects on speech
A pacifier is fine for a while, but don't let your child use one too long. In a study of 128 children aged 3 to 5 in Patagonia, Chile, researchers found that children who used a pacifier or sucked their fingers for more than three years were three times as likely as other kids to develop speech impediments.  The study, published online in the journal BMC Pediatrics, also found that children will have a lower risk of developing speech disorders if they don't start using bottles until they're at least 9 months old.

What's the difference between an oral thermometer and a rectal thermometer?
The taste.

Formula to know: Mentzer Index
Is used to differentiate Thalassemia from iron deficiency anemia. In Thalassemia RBC count is preserved but MCV is low. The formula is to divide MCV by RBC count. If the value is more than 14 it is iron deficiency anemia.

You can advertise in emedinews

emedinews is the first emedical newspaper of the country. Advertisement opportunities are available. One can advertise with a singe insertion or with 30 insertions in a month (contact drkk@ijcp.com)

Medinews Doctor of the Year Awards
Will be given on 10th Jan 2010 to eminent doctors who have done outstanding work in the year 2009. The award will be a part of day long CME: MEDINEWS 2009 ? Revisiting 2009. The award will carry a citation, shawl, coconut kalash, scenery and a memento.

Letter to the editor

Dear Dr KK
Your untiring, workaholic character is fascinating. I feel that no work  on a particular day will make you sick; so go on working. Any way, I went through emedinews dated 27-10-2009; write up about Winter SAD is probably a wake up call for physicians to pile up their stocks of inject-able cardio protective and neuroprotective drugs. One thing which I shall like to add about alcohol and smoking consumed together is that chances of cerebral stroke rises by 14 times in a person who is consuming cigarette at the same time while is he/she is drinking alcohol (Goodman & Gilman tenth edition). Asians are mainly protected from alcoholism. This has been found to be caused by genetic differences in alcohol- and aldehyde- metabolizing enzymes (Goodman & Gilman). We, Asians have high levels of alcohol dehyrogenases and have variants of aldehyde dehydrogenases which have low activity. This combination protects us from high consumption of alcohol.
with regards (Dr Satish Chugh)


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