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Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: , Website:


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)



6th December Sunday

Dear Colleague,

 Flu treatment (H1N1 or seasonal no difference)

All patients with flu (seasonal or H1N1 flu) requiring hospitalization or evidence of lower tract infection or at high risk for complications should receive antiviral therapy. Do not keep anti viral drugs only for the H1N1 flu.
Groups at high risk for complications from 2009 H1N1 influenza are essentially the same at those at such risk from seasonal influenza.
Antiviral therapy, when indicated, should be initiated as promptly as possible.  Start with oseltamivir for all admitted patients, confirmed or suspected influenza patients who are severely ill, such as those with lower respiratory tract infection (eg, dyspnea, tachypnea, unexplained oxygen desaturation), and those who are showing signs of rapid clinical deterioration. Oseltamivir should be considered for outpatients with confirmed or suspected influenza virus infection who are at increased risk for complications.

Patients with mild illness do NOT need to be tested or treated unless they have risk factors for complications. Patients who are recovering from influenza generally do not require antiviral therapy.
Oseltamivir should also be given to OPD patients who are not improving after several days.

Obese patients (morbid) are at increased risk of hospitalization and death due to flu. Many obese persons have underlying conditions that increase the risk of influenza complications, such as diabetes mellitus, asthma, chronic respiratory illness, or liver disease. Thus, patients with morbid obesity (BMI >40) and possibly those with obesity (BMI 30 to 39) with suspected or confirmed flu should be carefully evaluated for the presence of conditions that confer an increased risk of influenza complications. If any such conditions are present, treatment should be given.
One should treat all pregnant women with suspected or confirmed influenza. Comorbidities that increase the risk of influenza complications in pregnant women include chronic cardiac or pulmonary disease, diabetes mellitus, chronic renal disease, malignancy, and immunosuppression.

Definition of high risk

1. Adults ≥65 years of age
2. Pregnant women
3. Individuals with chronic medical conditions requiring ongoing medical care, including:  lung disease, including asthma (particularly if systemic steroids have been given during the past year); Cardiovascular disease (except isolated hypertension); Active malignancy; Chronic renal insufficiency; Chronic liver disease; Diabetes; Sickle cell disease;  Immunosuppression, HIV infection (CD4 <200 cells/microL), organ or hematopoietic stem cell transplantation, inflammatory disorders on  immunosuppressants; cognitive dysfunction, spinal cord injuries, seizure disorders, neuromuscular disorders, asplenic patients and residents of nursing homes and chronic care facilities.

Those at highest risk for flu complications are those with underlying lung disease and/or severe immunosuppression (eg, lung transplant recipients, individuals with advanced HIV infection [CD4 <200 cells/microL]).


Dr KK Aggarwal


 H1N1 vaccine certified ok by CDC

The first vaccination campaign report in US says that no serious side effects were seen after the shot. It began in early October and by mid November; some 22 million Americans had taken the vaccine. Of these, about 3200 were reported experiencing minor changes like bumps and soreness. Results so far indicate that the vaccine is safe. Officials were in particular looking for Guillain Barre syndrome, a paralyzing phenomenon that developed in a large number of patients which ultimately led to the cancellation of a swine flu vaccination campaign in 1976. So far only 10 patients with Guillain Barre syndrome have been intimated with the new vaccine. After the vaccination, 177 cases were reported serious, 11 of who succumbed to the virus. But there is no proof that the deaths are because of the vaccine.

Transdermal capsaicin patch approved for postherpetic neuralgia: FDA

The US Food and Drug Administration (FDA) approved Qutenza (capsaicin) 8% patch for treating post-herpetic neuropathic pain (PHN). The Qutenza patch releases a synthetic form of capsaicin, a chemical in chili peppers that gives them their heat sensation, through a dermal delivery system. According to NeurogesX, a single one-hour use of Qutenza can dramatically lessen pain of PHN for upto 12 weeks. Up to 4 patches may be used, and patches may be cut to conform to the size and shape of the painful area. Treatment with Qutenza may be repeated every 3 or more months as warranted by the return of pain. Qutenza will be launched in the United States in the first half of 2010

Brazilians minting analgesics with mint

A cup of Brazilian mint tea is claimed to contain pain relieving property that is as effective as the commercial analgesics, says a new study published in the journal Acta Horticulturae. The mint, Hyptis crenata, is used by traditional Brazilian healers to treat sicknesses like fever, flu and headache. It is consumed as decoction. The dried leaves are boiled for half an hour, finally drinking the solution as a green tea. Graciela Rocha, the lead researcher, says it is as effective as indomethacin (synthetic aspirin drug). If clinical trials on people go well, then pain in the future will be greatly reduced.

ACOG revises guidelines for cervical screening

In its revised guidelines, the American College of Obstetricians and Gynecologists (ACOG) now recommends delaying the start of cervical cancer screening until age 21 and then screening most patients every other year instead of annually. Women between ages 21 and 29 years should undergo screening every 2 years. Women aged 30 or older who have had three consecutive normal results can be screened every 3 years if they have no history of cervical intraepithelial neoplasm (CIN) 2 or 3, HIV, immunocompromise, or in utero exposure to diethylstilbestrol. According to experts, these recommendations are also applicable to women vaccinated against human papillomavirus. Conventional and liquid based cytology are both accepted by the ACOG for the screening.

Any knee pain can't be from knee, see a doctor

See a doctor if you have the following symptoms.

1. Difficulty walking:  if the pain in your knee is preventing you from walking or causing you to walk with an obvious limp, this could be a sign of a serious condition like a bone injury.
2. Sudden onset of other symptoms like sudden swelling, redness, or a warm feeling on the affected area: this could be a sign of infection i.e. ‘septic joint’. Infections can also cause fever, chills
3. Pressing on the knee does not cause pain: the injury may have come from somewhere else such as sciatica, hip problems
4. Pain lasts for weeks:  this could be a sign of a torn muscle or torn cartilage.

Know your Cholesterol levels
Peoples' lives can be determined by their cholesterol levels. Therefore, it's wise to know what cholesterol levels signify. They are expressions of cholesterol in blood, stated in milligrams per deciliter, or mg/dL.

Total cholesterol levels
1. Total cholesterol levels of 240 or higher: means that you have a greater risk of developing heart disease.
2. Levels between 200 and 239: exercise caution and consult a doctor. Risk of heart diseases is moderate without other associated risk factors.
3. Levels below 200 are healthy, with little risk of heart disease based on cholesterol alone.

HDL or high-density lipoprotein (good cholesterol) 
1. HDL below 40 mg/dL increases risk of heart disease.
2. Levels between 41 and 59 denote intermediate risk of heart disease without any other risk factors.
3. Levels higher than 60: low risk for heart disease, if not other associated risk factors

LDL or low-density lipoprotein (bad cholesterol)
1. LDL at 190 mg/dL and higher:  extremely high risk of heart disease.
2. Levels between 160 and 189: high risk of heart disease, even in the absence of other risk factors.
3. Levels between 130 and 159: intermediate risk.
4. Levels between 100 and 129: low risk if no other heart disease risk factors.
5. Levels below 100: healthy LDL cholesterol levels.

7 warning signs of cancer

1. Unusual bleeding or discharge: look for blood in urine or stool or discharge from nipple, penis etc.
2. A sore which does not heal: look for sores that don't seem to be getting better over time, are starting to bleed and are getting bigger and more painful
3. Change in bowel or bladder habits: look for changes in the color, consistency, size, or shape of stools (diarrhea, constipation) or blood present in urine or stool
4. Lump in breast or other part of the body:  look for a lump in the breast when doing a self examination or any lump in the scrotum or other areas of the body
5. Nagging cough: look for change in voice/hoarseness, cough that persists or sputum with blood
6. Difficulty in swallowing: look for any feeling of pressure in throat or chest which makes swallowing uncomfortable or feeling full without food or with a small amount of food
7. Any obvious change in a mole or wart: Use the ABCD Rule

Asymmetry: Does the mole look the same in all parts or are there differences?
Border: Are the borders sharp or ragged?
Color: What are the colors seen in the mole?
Diameter: Is the mole bigger than a pencil eraser (6 mm)?

Interesting facts about Blood

1. Seven percent of body weight is made up of blood.
2. Every second 2 million red blood cells die.
3. The human body has approximately 100,000 miles of blood vessels.
4. Four lives can be saved by donating just one pint of blood.
5. The average life span of a single red blood cell is 120 days.
6. If all the blood vessels in the body are stretched out, they would be about 60,000 miles long.... enough to go on an excursion around the world twice.
7. Half your body's red blood cells are replaced every seven days.

For a successful life

1. Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitu....Thomas Jefferson

2. Keep steadily before you the fact that all true success depends at last upon yourse....Theodore T. Hunger

How's that......

The doctor said he would have me on my feet in two weeks. And did he? Yes, I had to sell the car to pay the bill.

Psychiatrist to his nurse: Just say we’re very busy. Don’t keep saying….its a madhouse.


Humor (

Interviewer: What is your birth date?
Santa: 13th October
Which year?

Manager asked Banta at an interview.
Can you spell a word that has more than 100 letters in it?
Santa replied: -P-O-S-T-B-O-X.

Letters to the editor
1. Hello Dr. Aggarwal: Wonderful work on your part. The emedinews always keeps me updated in spite of my busy schedule. Thanks so much for your endeavor. Dr. Suchanda
2.  Dear Dr Aggarwal, after getting a regular mail of Emedinews, I have developed an archive for my library with latest information in medicine. My suggestions are to make it more academic by submitting a case as a puzzle with its history, DD, Investigations. Final D and treatment. You can choose from any field i.e from skin to cardiology. Also discuss some disease of practical importance in detail. E g multiple myeloma, PUO, Headache, Hospital infections etc.  These patterns are followed in BMJ and are quite soothing. Dr Bharat Bhushan 

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