eMedinewS12th September 2013, Thursday

Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at
www.facebook.com/Dr KKAggarwal

Dengue taking its toll

Fifteen dengue patients in the ward and 2 deaths in ICU in my hospital, one of them being a surgeon, our own colleague, within a period of 24 hours has shaken all of us. These numbers only serve to reemphasize that dengue fever cannot be and should not be taken lightly.

It may not be easy for hospitals to manage a large number of patients who get admitted in a day, especially when all of them require intensive rehydration therapy with IV fluids.

The cause of death in both the cases was multiorgan failure, which in any case has a very high mortality.

Multiple organ failure invariably occurs after there is plasma leakage, which leads to intravascular dehydration. The only strategy to reduce mortality is to prevent intravascular dehydration and following is my approach:

  • Do not bother about transfusing platelets as platelet deficiency is not the cause of multiorgan failure. However, a rapid fall of platelets is a warning sign of impending severe dengue.
  • If the patient has a PCV of more than 50 or the pulse pressure is less than 20, the patient is in a state of impending shock and needs rapid intravenous fluid resuscitation, which may mean up to 2 liters of fluid in the first hour.

When the volume of patient is large it is impossible to manage pulse pressure, PCV and rapid fall in platelets in all the patients.

My formula is: Let the patient be given IV plus oral fluids to such an extent that he passes urine every 3 hours as the first sign of intravascular dehydration will be reduction in urination output. I have found that this works. I only ask my patients to continue taking fluids, especially lemon water with salt and sugar till they pass urine and then to continue fluids so that they pass urine every 3 hours.

The critical period is when fever is settling down and a period of 24 to 48 hour after the fever has subsided.


cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi

Ringtone – CPR 10 Mantra English

sprritual blog Dealing with Stress

Stress may be broadly defined as comprising of three components, namely a "known situation, interpretation of a situation and the physical and mental reaction to that interpretation of the situation".

Stress is a situation: There cannot be a stress without a situation. One cannot be stressed about some event occurring in USA without knowing the person or the situation. The situation requires familiarity with the particular sensory object (known situation).

Stress is an interpretation of a situation: Without interpretation, stress is not possible. The same situation can be interpreted differently by different people. A stimulus may be stressful to one but not to the other.

Stress is a physical and mental response to the interpretation of the situation: Stress manifests because of a chemical imbalance resulting due to sympathetic over-activity, which manifests as mental and or physical symptoms.

Stress, therefore, is the body’s physical and mental response to the interpretation of a situation. Management of stress, therefore, involves either changing the situation, changing the interpretation of the situation or making the body resistant to physical and mental changes in the situation.

Practicing Patanjali’s eight limbs of yoga via living a yogic lifestyle, adhering to the various Dos and Don’ts in life as taught in various religious teachings, and learning to meditate helps our body to resist these sympathetic–activating changes and handle the stressful situation. These involve proper diet, exercise, meditation and relaxation exercises.

Changing the interpretation of a situation involves counseling. Cognitive behavior therapy used in counseling is one such example. Change in interpretation requires deeper understanding of the problem and removal of the obstacles. This can be done by using Ganesha’s principles of stress management, Rosenburg’s Principle of Non–Violent Communication, or the principles of counseling from Bhagwad Gita.

Change of the situation is the final resort for solving the problem, even though this may not be always possible. For example, in a dispute between husband and wife, divorce should be the last choice, after all counseling efforts have failed to resolve the issue.

cardiology news

A Poor Young Boy and the Dog

A few days ago I landed at the Bombay Airport (India) and took a cab to my scheduled destination in South Bombay. I was enjoying the busy traffic with people rushing in every possible direction then we got stranded at a very busy intersection.

As we waited for the signal to turn green, my eyes met up with a poor young boy, about 12 years old. He removed a piece of bread from his pocket and took a bite. As he was about to take his next bite, a stray dog wagged his tail looking at him. Without hesitation, he sat down and put the bread on the road for the dog to eat. The dog sniffed the bread and walked away. The boy waited until he was sure the dog was gone then he picked up the bread and ate it!

My heart cried and wanted to walk up to the boy but before I could open the door the signal turned Green and our car drove away. I kept thinking about the boy and later during my evening meal I realized that I was thinking of approaching the boy but never did, I could have stopped the car and walked up to him which again I never did.

All I did was "thinking" and this poor little boy who had only one piece of bread without any hesitation sharing it with the dog, though he himself seemed to be very hungry.

I learnt one of the biggest lessons in my life which that boy taught me without a conversation. He taught me to share with love and happiness. I am so blessed to have learnt this beautiful lesson from my ‘little unknown master’. It is my moral duty to share this incident with all my friends across the globe and be blessed with happiness.

News Around The Globe

5th Dil Ka Darbar

Date: Sunday, 29th September 2013, Venue: Constitution club of India, Rafi Marg, Time: 8 AM to 6 PM

Programme: A non stop question answer–session between all top cardiologists of the NCR region and the public.

The focus of the discussions will be prevention of heart diseases in women and young men. Special discussion will be held on Sex and Heart Diseases. Practical training will also be given to people on Hands–only Cardiopulmonary Resuscitation. Another focus of the discussion will be the launch of the Project Dhadkan (Palpitations) and Project Murmur (Congenital and valvular heart diseases in children).

Entry free…

  • The investigational SGLT2 inhibitor empagliflozin lowers HbA1c as well as the widely used DPP–4 inhibitor sitagliptin (Januvia), and may work better than the incretin stimulator among patients with worse disease control. In a large, randomized, controlled trial, patients with an HbA1c of 8.5% or higher treated with 10 mg or 25 mg daily of empagliflozin had significantly greater reductions than those on daily sitagliptin (–1.44% and –1.43% versus –1.04%, P=0.0077 and P=0.0119, respectively.
  • Clinically depressed patients with severe and brittle asthma often have their psychiatric symptoms left untreated, according to a study presented at the European Respiratory Society annual meeting. Of 57 severe asthma patients taking steroids who had depressive symptoms, just seven patients were on antidepressant medication. And only nine of 83 patients with depressive symptoms but not on steroid therapy were being treated with antidepressants.
  • The combination of a long–acting beta2 agonist (LABA) and long-acting muscarinic antagonist (LAMA) in a single inhaler offers enormous advantages with good safety profile, as per the SPARK trial. The combination reduced exacerbations in severe COPD more than single bronchodilator inhalers. A fixed-dose inhaler with indacaterol (Arcapta) and the novel long-acting beta2 agonist glycopyrronium (marketed in Europe as Seebri Breezhaler) was associated with 12% fewer moderate to severe exacerbations than glycopyrronium alone. The combination also reduced that rate 10% compared with standard tiotropium.
  • Individuals who smoke e–cigarettes appear to have decreased in lung function and other adverse effects irrespective of tobacco smoking history. According to a study presented at the European Respiratory Society (ERS) meeting, about 90% of individuals with asthma and 63% of COPD patients reported a sore throat and/or cough when they were smoking e–cigarettes.
  • The FDA has restricted the use extended–release and long–acting (ER/LA) opioid pain relievers to stop the misuse and abuse of the drugs. They are no longer indicated for merely moderate pain. Previously, the labels for ER/LA opioid analgesics stated that they were indicated for "moderate to severe pain in patients requiring continuous, around–the–clock opioid treatment for an extended period of time." The labels now will state that the drugs are indicated "for the management of pain severe enough to require daily, around–the–clock opioid treatment and for which alternative treatments are inadequate." The new labeling emphasizes first considering potentially less addictive measures.

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Rabies News (Dr. A K Gupta)

What is the approach to a person who has consumed milk of a rabid animal?

If a person has consumed milk of a rabid animal, counseling should be done. If counseling is not effective, then PEP by IM or ID route or as a last resort, a course of PEP (only vaccine) should be given.

If the milk is boiled or heated then only counseling or at the most a course of PEP should be given only due to compulsions in medical practice in Indian setting.

cardiology news
  • Using a score derived from 13 widely available clinical characteristics may help predict the likelihood coming out of an in–hospital cardiac arrest relatively unharmed. The pre–arrest variables included in the GO–FAR (Good Outcome Following Attempted Resuscitation) score identified 28.3% of patients who had a very low or low likelihood of leaving the hospital with no more than mild neurological deficits. The best model included the following 13 pre–arrest variables (with points toward the GO–FAR score):
    • Neurologically intact or with minimal deficits at admission (–15)
    • Major trauma (10)
    • Acute stroke (8)
    • Metastatic or hematologic cancer (7)
    • Septicemia (7)
    • Medical noncardiac diagnosis (7)
    • Hepatic insufficiency (6)
    • Admission from a skilled nursing facility (6)
    • Hypotension or hypoperfusion (5)
    • Renal insufficiency or dialysis (4)
    • Respiratory insufficiency (4)
    • Pneumonia (1)
    • Age (ranging from 2 to 11 points depending on age from 70 to 85 or older)
  • Intensively lowering blood sugar after myocardial infarction did not minimize the size of the infarct, and but did increase the risk of death or recurrent MI. In the single–center BIOMArCS–2 study reported online in JAMA Internal Medicine, there were no significant differences in high–sensitivity troponin T at 72 hours (hsTropT72), a biomarker of infarct size, between patients with hyperglycemia who were randomized to intensive insulin therapy compared with standard glucose management (1,197 ng/L versus 1,354 ng/L in the conventional arm). Additionally, there was a significantly higher rate of a composite endpoint of death or a spontaneous second MI among patients in the intensive arm (5.7% versus 0.7%).

Valvular Heart Disease News

Mitral vegetation is always on the LA surface.
Aortic vegetation is always located on the ventricular surfaces.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • Missing some doses of the diphtheria, tetanus toxoid and acellular pertussis (DTaP) vaccine greatly increases the risk of whooping cough in young children. In a case–control study reported online in JAMA Pediatrics, children aged 3 to 36 months who missed three doses of the DTaP vaccine were nearly 19 times more likely to develop pertussis than those appropriately vaccinated, and those who missed four doses were 28 times more likely to develop the disease.
  • Children living in orphanages, foster care, and similar settings had higher rates of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) compared with those in the general population, according to a meta–analysis. The pooled prevalence from 33 international studies of FAS and FASD among children in one of six different types of childcare settings were 6.0% and 16.9%, respectively, which were roughly nine to 60 times the rate of FAS, and 17 to 19 times the rate of FASD, among the general U.S. population
cardiology news

A1c: Points to Remember

The A1c test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months.

The A1c test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. Thus, the A1c test reflects the average of a person’s blood glucose levels over the past 3 months.

In 2009, an international expert committee recommended the A1c test be used as one of the tests available to help diagnose type 2 diabetes and prediabetes.

Because the A1c test does not require fasting and blood can be drawn for the test at any time of day, experts hope that its convenience will allow more people to get tested thus decreasing the number of people with undiagnosed diabetes.

In the past, the A1c test was not recommended for diagnosis of type 2 diabetes and pre-diabetes because the many different types of A1c tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1c tests. Blood samples analyzed in a health care provider’s office, known as point–of–care (POC) tests, are not standardized for use in diagnosing diabetes.

The A1c test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy known as gestational diabetes.

The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetes, the fasting plasma glucose (FPG) test and the OGTT, are still recommended. The random plasma glucose test may be used for diagnosing diabetes when symptoms of diabetes are present. The A1c test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results.

The ADA recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels have the A1c test twice a year.

Estimated average glucose (eAG) is calculated from the A1c to help people with diabetes relate their A1c to daily glucose monitoring levels.

People will have different A1c targets depending on their diabetes history and their general health.

People should discuss their A1c target with their health care provider.

cardiology news

Mrs. Sheila Dikshit, Chief Minister of Delhi to inaugurate the CMAAO India conference

The CMAAO India conference will be inaugurated by Chief Minister of Delhi Smt. Sheila Dikshit on 12th September at Hotel Shangri La at 1.30pm. Dr. Naresh Trehan, CMD Medanta – The Medicity will be the Guest of Honour. Dr. Vinay Aggarwal, Past President, IMA will take over as CMAAO President.

cardiology news

Total CPR since 1st November 2012 – 63400 trained

CPR Classes 63400

Media advocacy through Print Media

sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping
sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping

29th August: Veer Arjun

Media advocacy through Web Media

When Constipation May be a Serious Problem 30th August


TB more dangerous than FLU 29th August


Second attack of dengue is more dangerous

If you have suffered from dengue last year, you need to be more careful as the second attack of dengue may be more dangerous than the first attack. This was stated by Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, & MTNL Perfect Health Mela.

Elaborating on this, Dr. Aggarwal said that there are four different types of dengue and one can, therefore, suffer with dengue four times in his or her lifetime. Subsequent dengue infections are always more serious and are more likely to end up with deadly combinations.

Dr. Aggarwal said that a person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to dangerous level leading to complications.

In a dengue season nobody should take aspirin for fever as it can precipitate bleeding. Most complications in dengue occur within two days of the fever subsiding and most people are careless during this period. Any type of abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to shift of blood volume and patient requires rapid infusion of oral or intravenous fluids in large quantity.

Dr. Aggarwal said that there is no need for giving platelets even if the count is as low as 10000 unless there is an associated bleeding.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 63400 people since 1st November 2012.

The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

today emedipics

A press conference was organized by Heart Care Foundation of India to announce the date of Dil Ka Darbar to earmark the World Heart Day on Sunday, 29th September, 2013 at the Constitution Club of India Auditorium.

press release

Dr KK Aggarwal Birthday 5th September

today video of the dayDr KK Aggarwal Birthday 5th September

Cultural Evening at IMA

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

A triple–lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include:

a. Continuous inflow and outflow of irrigation solution.
b. Intermittent inflow and continuous outflow of irrigation solution.
c. Continuous inflow and intermittent outflow of irrigation solution.
d. Intermittent flow of irrigation solution and prevention of hemorrhage.

Yesterday’s Mind Teaser: A 26–year–old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She’s placed on trimethoprim–sulfamethoxazole to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed?

a. Nitrofurantoin
b. Ibuprofen
c. Acetaminophen with codeine
d. Phenazopyridine

Answer for yesterday’s Mind Teaser: d. Phenazopyridine

Correct answers received from: Dr.Rohini Dhillon, Narahari Kandakatla, daivadheenam, DR ABBAS VAKIL, Dr Chandresh Jardosh, DR AYYAVOO ERODE, chandulal parmar, Dr PC GOYAL, Dr. P. C. Das, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr.Bitaan Sen & Dr.Jayashree Sen, DR AVTAR KRISHAN, Muthumperumal Thirumalpillai, Dr Kanta Jain, Dr B K Agarwal, Dr pooja khullar

Answer for 10th September Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr pooja khullar, Muthumperumal Thirumalpillai, Dr Kanta Jain, Dr B K Agarwal

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!

Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

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

medicolegal update

If we wait until our lives are free from sorrow or difficulty, then we wait forever. And miss the entire point. Dirk Benedict.

medicolegal update

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer http://bit.ly/16wknsh #Health

Dr Deepak Chopra: Those who make wise choices in life should wind up happier & more successful http://tinyurl.com/l6x3eo4

medicolegal update

Dear Sir, Nice Updates. Regards: Dr tarun

Forthcoming Events

29thSeptember–Dil Ka Darbar at Constitution Club of India,New Delhi

20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India

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medicolegal update

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