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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)



5th November Thursday

Dear Colleague,

Dengue update

1. The WHO says some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. The disease is now endemic in more than 100 countries.
2. Dengue virus is like yellow fever virus. One should therefore try anti yellow feve anti viral drugs in dengue like ribavrin. In yellow fever the evaluated drugs are ribavirin, tiazofurin, carboxamide, pyrazoline compounds.
3. Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication. Initial experiments showed a fivefold increase in defective viral RNA production by cells treated with each drug. In vivo studies, however, have not yet been done. Unlike HIV therapy, lack of adequate global interest and funding greatly hampers the development of a treatment regime.
4. In Brazilian traditional medicine, dengue is treated with cat's claw herb, which is for inflammation and does not prevent dengue.
5. In Philippines dengue patients use tawa-tawa herbs and sweet potato tops juice to increase the platelets counts and revive the patients.
6. Some people are trying raw leaves of papaya juice for the same.
There is no benefit of prophylactic platelet transfusion in adult dengue patients

Thrombocytopenia or low platelets counts is common in dengue and there is concern about risk of bleeding, many studies and our own experience now has shown no benefit from prophylactic platelet transfusion in adult dengue patients. A retrospective paediatric intensive care study presented by Dr Lye D.C and group at the 18th European Congress of clinical microbiology and infectious diseases at Barcelona Spain has shown that there is no benefit in prophylactic platelet transfusion for thrombocytopenia less tha 30,000/uL.

In the study all dengue patients admitted were retrospectively reviewed. Patients without bleeding when their platelet count dropped less tha 20,000/uL were evaluated. Prophylactic platelet transfusion was defined as platelet transfusion without clinical bleeding excluding petechiae (skin bleeding). Baseline data on admission and clinical data when patients platelet count first dropped  less than 20,000/uL were compared. Outcome measures included: any bleeding after platelet transfusion, median platelet increase the next day, median time to platelet count 50,000/uL, median length of hospital stay, and death.

Of 1973 laboratory confirmed dengue patients, 256 developed thrombocytopenia <20,000/uL without bleeding, of whom 188 were given prophylactic platelet transfusion. Baseline demographic, clinical and laboratory features at that platelet threshold were similar, except transfused patients were significantly more likely to be febrile (33% vs. 18%).
Median platelet count on day of platelet transfusion was 15,000/uL in transfused vs. 16,000/uL in non-transfused patients. Bleeding occurred subsequently in 1 of 188 transfused (0.5%) and 2 of 68 non-transfused (3%) (p = 0.17).

Median platelet increase the next day was 6000/uL vs. 13,000/uL, and median time to platelet 50,000/uL was 3 days vs. 2 days, in transfused vs. non-transfused patients respectively. There was no difference in length of stay and death.

Dr K K Aggarwal


Can post mortem decide live vs still birth?

Case study: DMC/DC/F.14/2/Comp.344/2009/ dated 30th June, 2009. The Delhi Medical Council examined a representation from DCP Headquarters, forwarded by Govt. of NCT of Delhi, seeking medical opinion on a complaint of Shri Sandeep Kumar r/o. C-198, Vijay Vihar, Phase-II, Delhi, alleging medical negligence on the part of doctors of Dr. Baba Saheb Ambedkar Hospital, in the treatment administered to complainant?s new born baby, resulting in her death on 29.3.2006.

The patient Geeta was apparently admitted with post-dated pregnancy and during hospitalization due to features of fetal distress she underwent caesarian section for delivery of the baby.   The newborn infant was born with no spontaneous breathing and heart rate and was declared to be stillborn.  The council felt opined that post mortem finding of subdural and subarachnoid hemorrhages could occur in severe fetal hypoxia consequent to hypoxic-isehemic insult which was the most probable cause in this infant considering the clinical circumstances.  Occasionally spontaneous fetal intra-cranial hemorrhages also can occur which can result in fetal death / severe birth asphyxia.  Intra cranial hemorrhages while known to occur after instrumental deliveries, was not the cause in this case as none were used for the delivery of this infant. 

The council further felt that in cases of decomposed bodies and in cases where artificial respiration has been given, it is very difficult to differentiate between live birth and still birth based on post mortem findings in the lungs.  Hence, it is possible that this was a case of still birth even though hydrostatic test is positive.  The injuries on the face of the infant mentioned in the post-mortem report could have been caused as a result of resuscitative measures.  Based on the above facts, the council decided that there was no medical negligence in the causation of cerebral hemorrhage or the consequent death and the case was disposed off.  

Tip of the day: Low back pain  

American Academy of Orthopaedic Surgeons lists these common causes of low back pain:

  1. Lifting an object using the back, not the legs.
  2. Degenerative changes in the spine as people age.
  3. Straining the back during activity. 
  4. An injury (tear or herniation) to a disc in the spine.
  5. Spondylolisthesis, a condition in which the vertebrae slip out of place and put pressure on nerves in the spine.
  6. Spinal stenosis, which occurs when the space around the spine narrows, resulting in pressure on nearby nerves and the spinal cord.
  7. Scoliosis, an abnormal curvature of the spine.

Diet, exercise may reduce diabetes risk in certain individuals

Interventions urging people to lose weight and get more exercise reduced the incidence of diabetes, according to a new study published in the journal The Lancet. The study, known as the Diabetes Prevention Program Outcomes Study, is sponsored by the National Institutes of Health.Researchers found that lowering fat and calories in the diet and increasing regular exercise to 150 minutes a week cut the rate of developing type 2 diabetes by 34 percent in overweight and obese people. Participants who took metformin prevented the onset of type 2 by only 18 percent, compared with the control group on a placebo. Benefits of intensive lifestyle changes were most pronounced in the elderly, with people 60 or older reducing the rate of developing type 2 diabetes by half.

Children sleep late on weekends may help them avoid becoming overweight.

Letting children sleep late on weekends and holidays might help them avoid becoming overweight or obese, according to a study published in the Nov. issue of Pediatrics. Investigators found that children who got less sleep tended to be heavier (as measured by BMI) than children who slept more. However, among children who slept less than eight hours a night, those who compensated for their weekday sleep deficit by sleeping late on weekends or holidays were significantly less likely to be overweight or obese.


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Preventive antibiotics said to have modest effect for recurrent UTIs.

Children who are predisposed to recurrent urinary tract infections are commonly treated with preventive antibiotics, and a new Australian study suggests that such prophylactic therapy may have at least a modest effect.In the study, appearing in the Oct. 29 issue of the New England Journal of Medicine, researchers found that only 13 percent of youngsters who were given the antibiotic combination of trimethoprim plus sulfamethoxazole developed a urinary tract infection while on the medication, compared to 19 percent of the children on a placebo.

Sliding Scale Vs Tight Glycemic Control in the Non critically Ill pts

Development of hyperglycemia during hospitalization is an area of concern in patients with and without diabetes. Tight glycemic control has been debated for critically ill and non critically ill patients with hyperglycemia. To compare traditional sliding scale (SS) with a tight glycemic control (TC) algorithm a study was done. The primary endpoint was the percentage of total blood glucose measurements in the target range of 80-150 mg/dL. The secondary endpoint evaluated was safety, defined as percentage of all blood glucose measurements that were 0-60 mg/dL. A cohort of patients managed with SS (n 121) was compared with those treated with TC (n 210). In the TC cohort, 42.9% of blood glucose measurements were in the target range of 80-150 mg/dL compared with 30.6% of the measurements in the SS cohort (p<0.001). Regarding safety, 2% of blood glucose measurements of the TC cohort were in the range of 0-60 mg/dL versus 0.3% of the SS cohort (p<0.001). No clinical sequelae of hypoglycemia were observed. Patients achieved more blood glucose measurements in the target range when treated with TC versus SS insulin, without regard to prior history of diabetes. The study concluded that patients treated with tight control experienced more blood glucose measurements in the target range as compared with patients treated with sliding scale with relatively low hypoglycemia rates. [Source Annals of Pharmacotherapy Oct 2009]

Thought for the day

To recognize the uniqueness of one's own role is to be free from negativity. When we find things going wrong with us, we sometimes wish for a change in our role. We begin to compare ourselves with others or wish for something better in our life, which makes us lose all our enthusiasm. We then make no effort to better our role. We need to recognise the importance of our own role. Like an actor who doesn't make effort to change his role but brings perfection to his own role, we, too, need to concentrate on our own role. The recognition of the importance of our own role and the desire to bring excellence to it makes us free from negativity. ( BK Sapna)


A man speaks frantically into the phone, My wife is pregnant, and her contractions are only two minutes apart.
Is this her first child? the doctor queries.
No, No: the man shouts. This is her husband.

Mistake of the day

Never write 2.0 mg, write 2 mg. As 2.0 may be misread as 20 mg.

Bedside Tip: a new approach to percussion

We have been taught the traditional technique of percussion: strike the terminal phalanx of the middle finger of the non dominant hand with the tip of the middle finger of the dominant hand. Try striking the non dominant middle finger with a reflex hammer. It is easier to perform, is more easily reproduced, provides more audible notes (especially important in a noisy setting such as the emergency department), and is less painful to the struck phalanx. Doctors with long fingernails will most appreciate this fact. (Dr Anil Malhotra Rajisthan)

Exposure to whooping cough may provide immunity for three decades

Exposure to whooping cough will provide immunity for an average of three decades,  according to a study published in PLoS Pathogens.

The study revealed that immunity after natural infection lasts for at least three decades, on average, and maybe even as long as 70 years.

Furthermore,  people who lose some of their immunity might still have some protection and even gain more immunity when they are exposed again to whopping cough.

Researchers say MRSA strain may be partially immune to treatment.
According to research scheduled to be presented at the annual meeting of the Infectious Diseases Society of America, a strain of methicillin-resistant Staphylococcus aureus (MRSA) that infects the bloodstream is five times more deadly than other strains.

Ultrasound of axillary lymph nodes before breast cancer surgery

Ultrasound combined with fine-needle aspiration for confirmation of metastases, could spare many early-stage patients from sentinel node biopsy and reoperation. This strategy picked up 29.8% of macrometastases in women scheduled for lumpectomy, with an overall accuracy of 84.4%, Bedanta Baruah, MD, of Cardiff University in Cardiff, U.K., and colleagues reported at the ASCO Breast Cancer Symposium.

Conference Calendar

Revisiting 2009, 10th January, MAMC Delhi, emedinews@gmail.com

Advertising in emedinews

emedinews is a new venture of IJCP Group and is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. For details contact drkk@ijcp.com.

emedinews: revisiting 2009

IJCP Group is organizing emedinews: Revisiting 2009, a day-long medical conference on 10th January, 2010 at Maulana Azad Auditorium. It will be attended by over 1000 doctors. Topics will be top happenings in the year 2009. There will be no registration fee. Advanced registration required.  Top experts will deliver lectures. It will be followed with lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com

Tongue Twister
If one doctor doctors another doctor does the doctor who doctors the doctor doctor the doctor the way the doctor is doctoring doctors or does the doctor doctor the doctor the way that doctor doctors doctors


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