eMedinewS14th October 2013, Monday

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

Clinicians Should Aggressively Treat Unhealthy Lifestyles

Health care providers should treat unhealthy behaviors as aggressively as they treat hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create "interprofessional practices" to connect patients with behavior–change specialists.

They must implement five As when caring for patients

  1. Assess a patient’s risk behaviors for heart disease
  2. Advise change, such as weight loss or exercise
  3. Agree on an action plan
  4. Assist with treatment
  5. Arrange for follow–up care.

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

Leverage your strengths

sprritual blog

• Know your strengths.
• According to a British study, only about one-third of people have a useful understanding of their strengths.
• If something comes easily, you may take it for granted and not identify it as a strength.
• If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
• Strengths most closely linked to happiness are gratitude, hope, vitality, curiosity and love.
• Strengths are so important that they are worth cultivating and applying in your daily life, even if they donít come naturally to you.

cardiology news

The Chinese farmer

There is a Chinese story of an old farmer who had an old horse for tilling his fields. One day the horse escaped into the hills and, when all the farmer’s neighbors sympathized with the old man over his bad luck, the farmer replied, ‘Bad luck? Good luck? Who knows?’

A week later the horse returned with a herd of wild horses from the hills and this time the neighbors congratulated the farmer on his good luck. His reply was, ‘Good luck? Bad luck? Who knows?’

Then, when the farmer’s son was attempted to tame one of the wild horses, he fell off its back and broke his leg. Everyone thought this very bad luck. Not the farmer, whose only reaction was, ‘Bad luck? Good luck? Who knows?’

Some weeks later the army marched into the village and conscripted every able–bodied youth they found there. When they saw the farmer’s son with his broken leg they let him off.

Now was that good luck? Bad luck? Who knows?

News Around The Globe

20th MTNL Perfect Health Mela Programme Brouchure

20th MTNL Perfect Health Mela 2013 Hangout on Air with Google

The Immune System of the Soul

October 17, 2013, Siri Fort Auditorium

Organised by Brahma Kumaris

In this fast paced world, where we all are running in the rat race to acquire all sorts of gadgets, luxuries and comforts of life, and have actually forgotten about our ‘being’, our ‘soul’ per se. None of us have the time to sit back and ponder on the very basic questions which arise even in a small child’s mind, as in who we are? Where we have come from? What is the purpose of our being? How our soul dwells in our daily activities? How can we charge up our soul or what makes it low? Do we actually listen to our inner/soul’s voice? If yes, there is still some hope, and if not, then what happens to our inner voice in return? All of us are bothered about materialistic possessions and all we care about is that we should be free from physical ailments. Does that suffice our existence? The answer is NO, as emotional ailments take its toll when we stop caring about our soul or the inner voice. To answers these questions and to help people get enlightened, Mike George, an author, spiritual leader and management consultant, has organized a workshop titled ‘The Immune System of the Soul’ which will take you to a journey from awareness to realization and finally to transformation. The workshop is scheduled on October 17, 2013, 6–8 PM at Siri Fort Auditorium, Delhi. Come and be a part of this divine experience.


  • For HIV–infected patients with cancer undergoing chemotherapy, the integrase strand–transfer inhibitor raltegravir is the best choice for viral suppression, according to a new study presented at the 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy. The efficacy of raltegravir is similar to that of non–nucleoside reverse–transcriptase inhibitors, but the rate of adverse events is lower.
  • A new study, published online September 24 in Archives of Disease in Childhood has concluded that Turner syndrome is tied to an increased risk for 16 autoimmune disorders. Turner syndrome is an X chromosome abnormality that affects about 1 in 2500 live–born girls and may lead to reproductive abnormalities as well as congenital heart disease, along with autoimmune disorders. The highest relative risks in the Turner syndrome patients were for celiac disease (RR 14.0) and Hashimoto’s thyroiditis (12.5). Relative risks were elevated for many other autoimmune conditions including Crohn’s disease (5.3), ulcerative colitis (3.9), hypothyroidism (8.8) and hyperthyroidism (4.9).
  • Among intensive care unit (ICU) patients with hypovolemia, treatment with colloids vs crystalloids was associated with similar 28–day mortality, according to a multicenter, randomized clinical trial published online October 9 in JAMA.
  • Brain wave patterns from an electroencephalogram (EEG) were able to differentiate between two subtypes of attention deficit hyperactivity disorder (ADHD). Teens ages 12 to 17 were asked to perform tasks on a computer that involved perceiving a visual stimulus that would then trigger brain regions involved in decision making, which in turn led to physical action –– pressing a button, according to Ali Mazaheri, PhD, a postdoctoral scholar at University of California, Davis, and colleagues who published the study online in the journal Biological Psychiatry.
  • New criteria for the use of ultrasonography to assess prenatal viability, introduced by the Society of Radiologists in Ultrasound, will help ensure obstetricians are not too hasty in determining that an embryo has ceased developing. The guidelines were published as a review article in the October 10 issue of the New England Journal of Medicine. Implementation of new diagnostic thresholds for transvaginal ultrasound and not basing decisions solely on hCG test results may avoid situations such as inappropriate administration of intramuscular methotrexate for a suspected ectopic pregnancy or of evacuating the uterus when the embryo is indeed viable. The new, more stringent, diagnostic criteria are:
    • "Crown–rump length of ≥7 mm and no heartbeat
    • Mean sac diameter of ≥25 mm and no embryo
    • Absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
    • Absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac."

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Rabies News (Dr. A K Gupta)

Can rabies vaccine be given to a patient with jaundice?

Rabies vaccine can be given to a patient with jaundice.

cardiology news
  • A blood test that measures the expression of 23 genes to gauge the likelihood of obstructive coronary disease is less expensive than standard diagnostic testing, and reduces the rate of unnecessary invasive tests in women with symptoms of coronary artery disease (CAD). The Corus CAD gene–expression test, developed by CardioDx, is "the only sex–specific test — accounting for biologic differences between genders — making it ideal as a first–line diagnostic modality, ahead of noninvasive imaging, to rule out CAD,& said Joseph Ladapo, MD, from the NYU Langone Medical Center in New York City. Dr. Ladapo presented the findings at the North American Menopause Society 2013 Annual Meeting.
  • Rates of all–cause death, stroke, or reinfarction among patients discharged from the hospital following revascularization for ACS are lowest among patients taking dual antiplatelet therapy (DAPT) (clopidogrel and aspirin) for more than six months, according to a new analysis from the large SWEDEHEART. The retrospective cohort study, which cut the data in different ways, also found lower ischemic event rates for patients who took DAPT for >3 months vs <3 months. The results are published online in the European Heart Journal. SWEDEHEART is a national registry of all patients hospitalized for ACS in Sweden; the current analysis considered 56 440 ACS patients hospitalized between 2006 and 2010.

Valvular Heart Disease News

Given the association with dilatation of the aortic root, patients with congenital bicuspid aortic valves undergoing transesophageal echocardiography should have careful examination of the aortic root and ascending aorta.

(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
  • A new study presented at IDWeek 2013 shows that human metapneumovirus appears to spread from children to adults. The virus was first identified in The Netherlands in 2001. It is one of the chief causes of respiratory illness in children, and leads to lower–respiratory infections, including bronchiolitis and pneumonia. Treatment is supportive and there is no vaccine for the virus.
  • A new study shows why breastfeeding is generally safe even when mothers are infected with the hepatitis C virus (HCV). The reason is that human breast milk inactivates hepatitis C virus (HCV) infectivity by disrupting its envelope, researchers from Germany have found.
cardiology news

Potassium Tricks

  • Dealing with hemolysed sample: One can get a hemolyzed sample, where the serum on top of the clot may artificially have an increase in potassium owing to lysis of cells. It is not possible to assess the quantity of potassium when it is hemolyzed, so you always have to repeat the sample.
  • When the platelet count is high: There are issues of thrombocytosis in a platelet count above 5 00,000 cells/μL. If it participates in the clotting process (in a red–top tube), then what lies on top of it (the serum) will have a higher potassium concentration.
  • Serum or plasma: If the potassium level is high, then both serum and plasma potassium should be measured. If the platelet count is up, one can see a 0.3– to 1–mEq/L difference between serum (higher) and plasma (lower). Remember that plasma would be a purple top or a green top.
  • High K (> 6) get ECG done: Never ignore high potassium. Get an ECG to see whether it is really a problem. An ECG can show you that it is not cardiotoxic.
  • Look for aldosterone blockers (spironolactone or eplerenone). The RALES data showed that patients in systolic forms of heart failure with an average dose of about 25 mg of spironolactone clearly had more frequent hyperkalemia. When you start spironolactone, you should make an assessment of the risk factors for an inordinate increase in potassium. You are going to look at the glomerular filtration rate (GFR) and try to estimate the prevailing intake, the fluid status of the patient, other medicines that may influence potassium, and the sampling conditions in which you can obtain it. There is a finite rise that occurs. Not everyone goes up to 2 mEq/L. An average increase might be 0.5–1.2 mEq/L, so if you start out at 4 mEq/L, you are in a safe range. If you start at 4.5 mEq/L, you are beginning to run into the chance that you may get closer to 6 mEq/L, which would be a problem area. If you are at 4.8 mEq/L, then that is going to dictate earlier surveillance.
  • How soon should K levels be checked after starting aldosterone blockers? If you have a reduction in GFR to start with, somewhere between 3 and 7 days would be reasonable.
  • Is eplerenone better? This has never been studied. But it is safer. Someone is given 25 mg of spironolactone. The patient becomes unnecessarily hyperkalemic. The potassium level goes to 5.7 mEq/L. You decide to make a switch to eplerenone, one can start on eplerenone 25 mg twice daily.
  • What about low K levels: Treatment of low K levels is a tricky issue. One should determine the threshold below which you want to treat. If it is a clearly reversible cause, short–lived in nature, and you could remedy it, then you may not need the supplement. Or it might be something more permanent in nature. One may be dealing with potassium–wasting disorders that occur sometimes with gentamicin therapy with certain cisplatin chemotherapy agents, in which case you are obligated to keep treating almost for perpetuity. If you are going to be on diuretic therapy persistently, you take certain steps, you limit the salt intake, and you limit the dose of the agent in question. If you have to give a potassium supplement, you give potassium chloride rather than potassium acetate or potassium citrate.
  • Why limit salt? Sodium exposure to the distal tubule creates the need to absorb, creating an intraluminal electronegativity in the distal tubule. Because potassium is a cation, it is secreted down an electrochemical gradient. If you limit sodium, there is less sodium to resorb, less electronegativity in the distal tubule, and less potassium loss or kaliuresis.
  • Why magnesium should be measured? In the presence of low magnesium levels, low K will not be corrected
  • When to look for primary aldosteronism? If the patient is on a low–dose diuretic, sodium intake is not that high, and the potassium level is very low –– 3 mEq/L or below –– that is a consideration for checking for aldosteronism.
  • What do you do if you suspect hyperaldosteronism? The screening test is a random plasma aldosterone/renin activity ratio.
cardiology news

Total CPR since 1st November 2012 – 63425 trained

CPR Classes 63425

Media advocacy through Print Media

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Media advocacy through Web Media

Shorter the waist line, longer the life line 2nd PR


Dussehra is the most auspicious day to learn CPR 10.

There are only three days in a year that are considered as 100% auspicious where one can start a new work without asking a priest or a pandit and Dussehra is one of them.

Spiritually, Dussehra means that one has been able to detoxify one’s mind, body and soul and able to kill oneís ego and attained a healing parasympathetic state of mind.

This Dussehra should be devoted to learning how to revive a person after sudden cardiac death. Most of the people equate the festival of Dussehra with punishing or killing of people who are bad in the society. But the real meaning of Dussehra is to kill what is bad in you.

Dussehra is different from Holi festival as in Holi you remove negativity from others’ mind; whereas, in Dussehra you remove negativity from your own mind.

Both take 8 to 9 day process of purification. Holi is preceded by eight days of Holashtak and Dussehra by nine days of Navratri.

On the day of Dussehra, one must have a positive affirmation to learn that it is possible to revive a person even after death.

Chandokya Upanishad talks about process of death where it says that Vak Vriti merges into Manu Vriti and that merges into Prana Vriti that finally merges into Tejas, which leaves the body to merge with the Ultimate, the Sat.

If the heart and respiration have stopped, the process of Prana Vriti merging into Tejas may take many minutes. During this period if the heart can be revived the personís life can be revived back.

Also if during this period if the merger of Prana Vriti with Tejas can be delayed, then one can postpone death and a successful CPR can be done even hours after death.

Dr. Aggarwal said that in the forthcoming 20th MTNL Perfect Health Mela every person will be trained in CPR 10 and every person in the city should visit Mela with their family and learn hands only cardiac pulmonary resuscitation 10.

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 63425 people since 1st November 2012.

The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10minutes, 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

Padma Shri and Dr. B.C. Roy National Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Mr Shankar Sahni announces the dates of 20th MTNL Perfect Health Mela in a Press Conference

press release

Weight loss may improve sexual health of obese diabetes

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…………………

What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Yesterday’s Mind Teaser: A 25 years old male is undergoing incision and drainage of abscess under general anesthesia with spontaneous respiration. The most efficient anaesthetic circuit is:

1.Mapleson A.
2.Mapleson B.
3.Mapleson C.
4.Mapleson D.

Answer for yesterday’s Mind Teaser: 1.Mapleson A.

Correct answers received from: Dr Arpan Gandhi, Dr Kanta Jain, Dr Avtar Krishan, Dr Chandresh Jardosh, Dr.K.Raju, Dr Sunil Malik, Supriya Chandra, Dr.A.K.Gajjar

Answer for 12th October Mind Teaser: 2.Induction with intravenous protocol and N2O; and oxygen for maintenance.

Correct answers received from: Dr Arpan Gandhi, Dr Kanta Jain

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

A group of expectant fathers sat nervously in the hall. A nurse beckoned to one of them and said, "Congratulations, you have a son!"

Another man dropped his magazine, jumped up and said, "Hey, what’s the idea? I got here two hours before he did!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

medicolegal update

When the character of a man is not clear to you, look at his friends. Japanese Proverb

medicolegal update

Dr KK Aggarwal: Relieve Stress by Changing the Interpretation http://bit.ly/15Lvpwx #Health

Dr Deepak Chopra: How can I make people understand that spirituality is the ultimate goal? http://tinyurl.com/koc7b7n #askdeepak

medicolegal update

Dear Sir, Very informative Newsletter. Regards: Dr Tripti

Forthcoming Events

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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