eMedinewS14th September 2013, Saturday

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

Cardiac resynchronization therapy may be harmful in patients with narrow QRS intervals (< 130 ms)

This is the take–away message from the Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study published in the New England Journal of Medicine. The findings all but shut down hopes that the usefulness of CRT might be extended to HF patients without significant QRS prolongation who have echo evidence of ventricular dyssynchrony. The results reinforce the notion that, at least until new methods of assessment are developed, QRS width (with or without mechanical dyssynchrony) remains the primary determinant of response to CRT. ….Read More

A new test to rule out heart attack

Suspected acute coronary syndrome patients with a negative troponin test and a negative copeptin test (Brahms, Thermo Scientific) can be safely discharged from the hospital without further testing, according to the results of a new study presented at the European Society of Cardiology 2013 Congress. ….Read More

All will not benefit by reducing sodium

A new analysis from the large international PURE trial has reopened the debate over the link between sodium and blood pressure. Presenting PURE SODIUM here at the European Society of Cardiology 2013 Congress, Dr Andrew Mente (McMaster University, Hamilton, ON) and colleagues found that only certain subgroups will actually experience blood–pressure benefits from restricting their sodium consumption.

Ayurveda has been talking about it for some time. People with Kapha and pitta personalities will benefit and not those with vata personality. ….Read More

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 Why do people suffer?

1. As per Garud Puran and Hindu mythology, one of the reasons for suffering is the debts of your past birth. Your purpose of life is to face sufferings to pay these debts.

2. The second reason is your present deeds till today starting from birth. If your sum total of bad deeds is more than good deeds, they get added to your previous birth’s debts.

3. The third reason for suffering is in the form of struggle which you undertake to attain future success. Some people do not call it as suffering.

4. The last reason for suffering is that some people acquire yogic powers to take on the sufferings of others. The classical examples are Shirdi Sai Baba and Jesus Christ who were known to cure others by adding their suffering to their own account. If you see most of the Gods or holy people had suffered in their last time, be it Jesus Christ, Krishna, Buddha or Sai Baba.

Only Rishi Munis can remain alive and die at will even after they have paid for all their debts. ….Read More

cardiology news

A Violin with Three Strings

On Nov. 18, 1995, Itzhak Perlman, a violinist, came on stage to give a concert at Avery Fisher Hall at Lincoln Center in New York City.

If you have ever been to a Perlman concert, you know that getting on stage is no small achievement for him. He was stricken with polio as a child, and so he has braces on both legs and walks with the aid of two crutches. To see him walk across the stage one step at a time, painfully and slowly, is an awesome sight.

He walks painfully, yet majestically, until he reaches his chair. Then he sits down, slowly, puts his crutches on the floor, undoes the clasps on his legs, tucks one foot back and extends the other foot forward. Then he bends down and picks up the violin, puts it under his chin, nods to the conductor and proceeds to play.

By now, the audience is used to this ritual. They sit quietly while he makes his way across the stage to his chair. They remain reverently silent while he undoes the clasps on his legs. They wait until he is ready to play.

But this time, something went wrong. Just as he finished the first few bars, one of the strings on his violin broke. You could hear it snap – it went off like gunfire across the room. There was no mistaking what that sound meant. There was no mistaking what he had to do.

We figured that he would have to get up, put on the clasps again, pick up the crutches and limp his way off stage – to either find another violin or else find another string for this one. But he didn’t. Instead, he waited a moment, closed his eyes and then signaled the conductor to begin again.

The orchestra began, and he played from where he had left off. And he played with such passion and such power and such purity as they had never heard before.

Of course, anyone knows that it is impossible to play a symphonic work with just three strings. I know that, and you know that, but that night Itzhak Perlman refused to know that.

You could see him modulating, changing, re–composing the piece in his head. At one point, it sounded like he was de–tuning the strings to get new sounds from them that they had never made before.

When he finished, there was an awesome silence in the room. And then people rose and cheered. There was an extraordinary outburst of applause from every corner of the auditorium. We were all on our feet, screaming and cheering; doing everything we could to show how much we appreciated what he had done.

He smiled, wiped the sweat from this brow, raised his bow to quiet us, and then he said – not boastfully, but in a quiet, pensive, reverent tone – "You know, sometimes it is the artist’s task to find out how much music you can still make with what you have left." What a powerful line that is. It has stayed in my mind ever since I heard it. And who knows? Perhaps that is the definition of life – not just for artists but for all of us.

Here is a man who has prepared all his life to make music on a violin of four strings, who, all of a sudden, in the middle of a concert, finds himself with only three strings; so he makes music with three strings, and the music he made that night with just three strings was more beautiful, more sacred, more memorable, than any that he had ever made before, when he had four strings.

So, perhaps our task in this shaky, fast–changing, bewildering world in which we live is to make ‘music’, at first with all that we have, and then, when that is no longer possible, to make ‘music’ with what we have left.

News Around The Globe

International Lymphoma Day 14th September

Time to Create Awareness through Self Examination of Nodal Areas

For a non compliant uneducated/illiterate, careless population of the lymphoma patients who defy follow up the fault lies with medical fraternity where concepts of follow up or LOST Patient Retrieval System is nonexistent. Awareness of this needs to be raised amongst the general public, general practitioners and the healthcare community worldwide.

When one can teach a cancer breast patient the Self Examination of Breast, and husbands being taught to detect lump in breast while love making. When husbands of cancer cervix patients are educated on Self Examination of Private Parts–the "something different out there inside"… then why not to teach the Lymphoma patient the Self Nodal Area Examination.

The Development of Nodal Area Examination : (Circa 2000)

Treated cases of lymphoma were trained/educated on the self examination of nodal areas during follow–up. Interestingly most of the patients were able to report the development of new nodes during the follow–up. Unfortunately, its popularity could not pick up by fellow oncologists.

A well illustrated, demonstrative, description exemplified with the photographs of Self Nodal Examination was published. The Result was good with the Lymphoma follow up cases. Although, there was a little bit of false positive panic that this advice created, but it was needed considering the Indian scenario of non compliance of patients.

The Self Nodal Area Examinations were found useful for the patients of head and neck cancers who underwent surgery, radiotherapy or chemotherapy. This was with regards to the nodal recurrence common in these patients. Other areas of SNE application can be Ca vulva, Ca penis, skin melanomas, operated Ca Breast etc.

(Dr Manoj)

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…

  • According to a new study published September 11 in JAMA Psychiatry, the symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder. In the study, those with current overt irritability/anger were significantly more likely to have increased depressive severity, longer duration of the index MDE, poorer impulse control, and a more chronic and severe long–term course of illness. Overt irritability and anger were also associated with higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial and personality disorders, greater psychosocial impairment, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives.
  • A scoring system based on four clinical variables has the potential to pre–operatively identify patients likely to have remission of diabetes after Roux–en–Y gastric bypass (RYGB) surgery. These four variables include: insulin use, age, glycated hemoglobin (HbA1c), and combination therapy with an insulin sensitizer (not metformin) and a sulfonylurea among patients not using insulin. Of these, baseline insulin use was the strongest predictor of remission, as patients who were not using insulin preoperatively had a remission rate of 70.6% compared with 10.3% for patients who were on insulin at the time of surgery.
  • Obesity raises the risk not only of chronic migraine but also of episodic migraine (EM), even relatively infrequent ones and this association appears to be the strongest among white women younger than age 50 years. The study published September 11 in Neurology suggests that doctors shouldn’t wait until patients with migraine have more frequent or chronic migraines to counsel them on the risk for obesity. They should recommend healthy lifestyle behaviors, including healthy exercise and diet regimens
  • According to William Mitchell, MD, PhD, of Vanderbilt University in Nashville, interferon may be the next pharmaceutical barrier against a flu pandemic. Presenting his findings at the annual Interscience Conference on Anti–Microbial Agents and Chemotherapy, in isolates from patients with the H7N9 avian flu that swept China this spring, interferon alfa–n3 (Alferon) was as active as the widely used neuraminidase inhibitor oseltamivir (Tamiflu). But it was equally active against isolates that were resistant to oseltamivir. The finding is important, because the wild–type H7N9 flu needs just a single mutation in the gene for neuraminidase to make it resistant to the entire class of neuraminidase inhibitors –– oseltamivir, zanamivir (Relenza) and the investigational compounds laninamivir (Inavir), and peramivir. Since it is already resistant to the adamantane class of antivirals that would leave doctors with nothing but supportive care for H7N9 infection.
  • The rate of Clostridium difficile infections in U.S. hospitals nearly doubled in the decade between 2001 and 2010, although mortality from the disease was variable. A study based on hospital discharge data presented at the annual Interscience Conference on Anti-Microbial Agents and Chemotherapy showed the rate of C. difficile infection in 2001 was 4.5 per 1,000 hospital admissions in 2001, but rose to 8.2 per 1,000 admissions in 2010. Over the 10 years, the peak death rate from C. difficile infection was 8.7% in 2003 while the lowest rate was 5.6% in 2009.
  • India is a close second to South Africa in healthy, productive years people lose to HIV/AIDS, a 2010 study published in journal AIDS shows as reported in the Indian Express, Fri Sep 13, 2013. There were 2.4 million people estimated to have HIV in 2010 with a Disability Adjusted Life Years (DALYs) of 9,265.13 (in thousands). DALYs represent productive years lost due to premature death or disability to HIV/AIDS. In 2010, India accounted for 11.4 per cent of DALY’s global HIV/AIDS. The 5 countries with the largest percentage of total global deaths from HIV/AIDS are South Africa (14.6%), India (11.4%), Nigeria (11.1%), Tanzania (5.7%), Mozambique (4.7%.) HIV/AIDS is a formidable problem in India but no longer on the rise, showing a peak in mortality in 2007. Since 2007, HIV/AIDS deaths dropped by 8.7%.

eMedinewS e–gifts to our readers

This is the age of smartphones. To improve usability and readability, eMedinewS has launched a mobile app of the newsletter for its readers. You can now also view eMedinewS on your smart phones or iPads.

The eMedinewS app is now available for free download.

The various icons for downloading are provided on the top of the newsletter. Choose the icon that is compatible with your device, whether iPhone, Android, Blackberry, iPad, Desktop/Windows phone or GSM
Click on the icon ‘e’ from the mail and download to install the app to the home screen of your mobile phone, iPad or Desktop. After you finish downloading, you will see an icon ‘e’ on the home screen of your device. That’s it.

Now you don’t need to type the address of the website in your web browser or log in to your email account every day to read the newsletter. Just click on the app and begin reading.

Rabies News (Dr. A K Gupta)

What should be done if there is a case of human rabies?

A study on management of human rabies concluded that the dismal outcome of patients with rabies provides little optimism for heroic efforts. Palliative therapy is of paramount importance in this fatal disease.

cardiology news
  • Macitentan, a novel dual–endothelin receptor antagonist, was found to improve mental and physical functioning by up to 35% in critically ill patients with pulmonary arterial hypertension (PAH) in the SERAPHIN trial. SERAPHIN is the first randomized controlled long–term study of PAH and its efficacy and safety results were published in the New England Journal of Medicine and also presented at the European Respiratory Society (ERS) 2013 Annual Congress.
  • Premenopausal women with type 2 diabetes had a significantly higher risk of early vascular disease than women of similar age without diabetes. The diabetic women were found to have an increased risk of vascular disease across the age range from <40 to >60 years by using a traditional risk index and by ultrasound evaluation of plaque burden. For the two youngest age groups (<40 and 40 to 50), women with type 2 diabetes had a two to three times greater risk of vascular disease as compared with their counterparts without diabetes, as reported at the American Heart Association’s High Blood Pressure Research Conference in San Francisco.

Valvular Heart Disease News

The commonest source of infection in endocarditis is infected vascular catheter, dental abscess or infected skin lesion.

(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
  • About one toddler in five, undergoing adenotonsillectomy as a therapy for obstructive sleep apnea (OSA) still had significant symptoms afterward, according to a study in JAMA Otolaryngology–Head & Neck Surgery. The findings from the single–center records review showed that among 70 children younger than 3 who had the procedure as well as pre– and post–operative polysomnography studies, 15 (21%) had apnea–hypopnea index (AHI) scores greater than 5 at the later evaluation, indicating moderate to severe residual sleep apnea. But most children showed marked improvement in sleep apnea symptoms, with 30% of the children showing no symptoms at the post–operative evaluation and 49% having only mild residual sleep apnea.
  • A study published online September 9 in the journal Pediatrics reports that the chances of attempting suicide are 4 times more in adopted offspring than nonadopted offspring. Sounding a note of caution, the authors of the study said that this increased risk did not characterize adopted children as a whole. The majority of adoptees are psychologically healthy.
cardiology news

Lifestyle can prevent 50% of common cancers

More than 50% of cancer could be prevented if people simply change lifestyles according to Graham Colditz, PD, DrPH, from the Washington University School of Medicine in St. Louis, Missouri at the Union for International Cancer Control (UICC) World Cancer Congress 2012.

Among the "biggest buys" from lifestyle intervention is smoking cessation. One third of cancer in high–income countries is caused by smoking.

Being overweight or obese causes approximately 20% of cancer today. If people could maintain a healthy body mass index (BMI), the incidence of cancer could be reduced by approximately 50% in 2 to 20 years.

Poor diet and lack of exercise are each associated with about 5% of all cancers. Improvement in diet could reduce cancer incidence by 50% and increases in physical activity could reduce cancer incidence by as much as 85% in 5 to 20 years.

Eradicating the main viruses associated with cancer worldwide by implementing widespread infant and childhood immunization programs targeting 3 viruses — human papillomavirus and hepatitis B and C — could lead to a 100% reduction in viral–related cancer incidence in 20 to 40 years.

Tamoxifen reduces the rate of both invasive and noninvasive breast cancer by 50% or more, compared with placebo, at 5 years.

Raloxifene has been shown to reduce the risk for invasive breast cancer by about 50% at 5 years.

Bilateral oophorectomy in women carrying the BRCA1 or BRCA2 gene, although rare, has been associated with a 50% reduction in breast cancer risk among high–risk women.

Aspirin is associated with a 40% reduction in mortality from colon cancer.

Screening for colorectal cancer has a similar magnitude of mortality reduction (30% to 40%). Tobacco, alcohol, and diet, lack of physical activity, and obesity — accounted for more than half of all cancer.

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


Preventing a Peptic Ulcer

An ulcer is a breakdown in the lining of the stomach or the first part of the small intestine. A type of bacterial infection is the most frequent cause, but lifestyle factors may also increase the risk said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President, Heart Care Foundation of India and MTNL Perfect Health Mela.

One may follow these preventive steps to ward off a peptic ulcer:

  • Limit alcohol to no more than two drinks daily.
  • Stop smoking or chewing tobacco.
  • If you need to take painkillers, avoid anti–inflammatory drugs (NSAIDs) such as naproxen, ibuprofen or aspirin.
  • Consider, with your doctor's approval, paracetamol instead.

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

CMAAO meet is on Child Abuse

press release

Strain echo imaging for cancer chemotherapy toxicity_1–2

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 female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

a. Confusion, headache, and seizures.
b. Acute bone pain and confusion.
c. Weakness, tingling, and cardiac arrhythmias.
d. Hypotension, tachycardia, and tachypnea.

Yesterday’s Mind Teaser: After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history from the husband, Nurse Jenny inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility?

a. Chickenpox
b. Measles
c. Mumps
d. Scarlet fever

Answer for yesterday’s Mind Teaser: c. Mumps

Correct answers received from: Dr Valluri Ramarao, Subratakumar Garai, Dr Rohini Dhillon, Dr PC Das, Dr Anita Rajorhia, Medical Suprintendent, Dr Sheetal Kher, Narahari Kandakatla, Rajesh Astik, Chandulal Parmar, Kanta Jain, Dr KV Sarma, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Raghavendra Singh, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai,
Dr Bitaan Sen & Dr Jayashree Sen, Dr Minoo Bhagia.

Answer for 12th September Mind Teaser: a. Continuous inflow and outflow of irrigation solution.

Correct answers received from: Dr T Rajan John, Dr Avtar Krishan, Daivadheenam,
Dr Pooja Khullar.

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Customer: Can’t get on the Internet.
Tech support: Are you sure you used the right password?
Customer: Yes, I’m sure. I saw my colleague do it.
Tech support: Can you tell me what the password was?
Customer: Five stars.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make Sure to prescribe nimesulide as it is safe in acid peptic disease.

medicolegal update

Spectacular achievement is always preceded by spectacular preparation. Robert H. Schuller

medicolegal update

Dr KK Aggarwal: Monsoon Reduces The Immunity Of The Body

Dr Deepak Chopra: Our growing, evolving universe is much more like an organism than a machine. http://bit.ly/DpkBook #ScienceSetFree

medicolegal update

Sir, the information delivered on daily basis cannot be described in words–"hats off to you Sir". Dr Pankaj Gupta Jabalpur MP

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

eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

medicolegal update

Our Sites