eMedinewS24th September 2014, Wednesday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group; Senior National Vice President & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06); President IMA New Delhi Branch (94–95, 02–04).
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

press release
press release

Statins may worsen asthma

Healthy diet, no smoking, doing regular exercise and keeping AC less than 95 cm can prevent heart attack

Adhering to a healthy diet and lifestyle could prevent as many as four out of five heart attacks in men, according to a population-based, prospective cohort study of Swedish men, as reported in Medpage today.

Practicing just two of five low–risk behaviors –– a healthy diet and moderate alcohol consumption –– was associated with a relative risk of 0.65 (95% CI: 0.48–0.87) for myocardial infarction (MI) compared with men who practiced none of the low-risk behaviors.

Following all five low–risk factors –– refraining from smoking, being physically active and having no abdominal adiposity, in addition to the other two –– was associated with a relative risk of 0.14 (95% CI: 0.04–0.43), wrote Agneta Åkesson, PhD, of the Karolinska Institute in Sweden and her co–authors online in The Journal of the American College of Cardiology.

"This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34–93) of the MI events on the basis of the study population," they said.

Each of the five lifestyle factors was inversely and independently associated with the risk of MI after adjustment for the other aspects of the low–risk profile. This reduction in risk corresponded to 18% for the healthy diet, 11% for moderate alcohol consumption, 36% for no smoking, 3% for being physically active, and 12% for having a low abdominal circumference.

The study followed 20,721 Swedish men between the ages of 45 and 79 with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol from 1997-2009. The men were asked to complete a detailed questionnaire addressing their diet and lifestyle at baseline in 1997.

The authors defined the five low–risk behaviors as: being in the top quintile of the Recommended Food Score; consuming 10 to 30 g/day of alcohol; not smoking; walking or bicycling more than 40 minutes a day and exercising for at least an hour a week; and having a waist circumference of less than 95 centimeters.

The Healthy Food Score was developed for the National Health and Nutrition Examination Survey, and is highly predictive of mortality, the authors said. Points are given for servings per week of foods with beneficial effect on cardiovascular health, such as fruit, vegetables and whole grains, with a maximum score of 25. (Excerpts from Medpage today)

News Around The Globe

  • Patients with chronic lower back pain and opioid addiction show regional brain activity on MRI that corresponds with disease severity, and changes in behavioral therapy, compared with patients who do not receive the therapy, suggests a new study presented at the American Academy of Pain Management (AAPM) 25th Annual Clinical Meeting.
  • Patients with hemorrhagic stroke who received a statin while in the hospital appeared to have better survival rates and were more likely to be discharged home or to a rehabilitation center as compared to those who did not get a statin while an inpatient, suggested a new study published online September 22 in JAMA Neurology.
  • Results of a modeling–based study suggest that routine MRI is not a cost–effective diagnostic tool in the evaluation of idiopathic olfactory loss. The findings were published in JAMA Otolaryngology – Head & Neck Surgery.
  • A new population–based study from 5 countries has noted that overall, new cancer incidence appears to be about the same for type 1 diabetes as for type 2 diabetes patients. The findings also possibly exclude any major carcinogenic effect of insulin in type 1 diabetes patients. The findings were presented at the European Association for the Study of Diabetes 2014 Meeting.
  • In patients with neuromyelitis optica spectrum disorder, treatment with the immunosuppressant mycophenolate mofetil appears to reduce the frequency of relapse, stabilizes or improves disabilities, and is well tolerated, suggests a new retrospective study published online in JAMA Neurology.

National news

  • IMT Ghaziabad organizing Cyclathon 2014 to raise awareness against lifestyle diseases is deeply inspiring. The event will be flagged off at 6:30 am on 28th September from Rashtrapathi Bhavan. The cyclists will then proceed to Nehru Park at Vinay Marg. Dr K K Aggarwal, Padma Shri Awardee, will be the Chief Guest and will deliver a note of encouragement to the participants and flag–off the event. The flag-off is scheduled at Rashtrapathi Bhavan at 6:30 am on 28 September.
  • Lipid Association of India is organizing Run for Heart 2014 on World Heart Day on Sunday September 28th 2014 at 6. 30 a.m. at Talkatora Stadium Gate No –2 with the slogan Healthy life ki recipe, blood LDL cholesterol around 70!
  • U.N. Mehta Institute of Cardiology and Research Centre is organizing "Healthy Heart Awareness Exhibition" as a part of World Heart Day celebration, from 22nd September 2014 to 1st October 2014 (9:00am to 5:00pm) at 3rd Floor, New Building, UN Mehta Institute of Cardiology and Research Centre, Ahmedabad.

MCI News

Landmark Interim Order of SC on MBBS Admission

SUPREME COURT OF INDIA: Hind Charitable Trust Shekhar Hospital Pvt. Ltd.vs. Union of India & Ors., Writ Petition (Civil) No. 469 of 2014, Date of Judgment: September 18, 2014.

Heard the learned senior counsel appearing for both the sides.

Looking at the peculiar facts and circumstances of the case and, especially, when several seats for medical admission are likely to remain vacant for the academic year 2014–15, we are of the view that these matters require urgent consideration and we are giving these interim directions under the provisions of Article 142 of the Constitution of India.

There is one more reason for passing this interim order. We are conscious of the fact that number of physicians in our country is much less than what is required and because of non-renewal of recognition of several medical colleges, our citizens would be deprived of a good number of physicians and therefore, we are constrained to pass this order, whereby at least there would be some increase in the number of physicians after five years. We are running against time because the last date for giving admissions to MBBS Course for the academic year 2014–15 is 30th September, 2014.

We also desire to reconsider the directions given by this Court in the judgment of Priya Gupta vs. State of Chhattisgarh ((2012) 7 SCC 433), but at this juncture, as we do not have sufficient time to decide all these petitions finally, we are passing this interim order and the matter with regard to reconsideration of the aforestated judgment would be considered while finally disposing of this group of petitions.

It has been submitted on behalf of the learned senior counsel appearing for all the petitioners/ respondents, who are managing medical colleges, that the defects which had been recorded at the time of the last inspection by the representatives of the Medical Council of India have been duly rectified and at present, the defects pointed out in the reports do not exist. The said fact can be ascertained only by having a fresh Compliance Verification/Inspection. However, the stand taken by the Central Government and the Medical Council of India is to the effect that no such inspection can be undertaken in the present academic session because of paucity of time and it would violate the time schedule laid down by this Court in the case of Priya Gupta (supra).

The learned senior counsel appearing for the Medical Council of India has also submitted that the petitioners do not have any legal right for getting renewal of the recognition, especially in view of the fact that the Verification/Inspection Reports are not available for the period in question. The learned senior counsel has relied upon some of the Judgments to substantiate his case and according to him, it would not be just and proper to permit the said medical colleges to take fresh batch of students.

Looking at the peculiar facts of the case and the circumstances stated hereinabove, we direct the petitioners to file undertakings by President/Chairman and Secretary of the petitioners’ institutions running medical colleges within 10 days from today, to the effect that there is no defect in the medical colleges run by them and they would also state that their deposit with the MCI, which is around Rs.10 crores, be forfeited by way of penalty if the statement made in the undertaking is found to be incorrect at the time of the next inspection. A draft undertaking has been given to this Court. A copy of the undertaking, which might be filed by the institutions, shall be served upon the office of the Medical Council of India as well as to the Ministry of Health and Family Welfare, Govt. of India, New Delhi.

We also record the fact that in the recent past, the Medical Council of India has renewed recognition of Government Medical Colleges on the basis of undertakings and therefore, we see no reason not to permit the private colleges to admit students on the basis of undertakings given by their office bearer as a special case.

Notwithstanding any direction given in the case of Priya Gupta (supra), if undertakings as stated hereinabove are filed by the institutions managing medical colleges for the academic year 2014–15,admissions shall be given to the students from the merit list prepared by the States and they shall be charged fees prescribed by the Government Medical Colleges of their respective States.

The State Authorities, i.e., the Directorate of Medical Education & Research, of the respective States shall send students, in order of their merit, to the medical colleges run by the petitioners, which are situated within their States, within one week from the date of receipt of a copy of this order and the said students shall be admitted to the MBBS Course in accordance with the rules and regulations of the MCI and also regulations dated 16.04.2010 framed by the Medical Council of India, provided undertakings as mentioned above are filed on behalf of the concerned institutions.

It is also clarified that there would be no further counselling in respect of the students who are to be given admission, even if it might result into some heart burning among other students, but in the peculiar facts of the case, we give this direction.

In no case, the admission shall be given after 30th September, 2014. This order shall also apply to all the institutions which had filed their petitions earlier for renewal of their recognition for the academic year 2014–15, but their petitions were rejected or withdrawn for whatever reason, provided undertakings as stated hereinabove are filed by President/Chairman and the Secretary of those institutions. All those petitions shall be deemed to have been revived and this order shall be deemed to have been passed in those cases also. This order shall only be in respect of renewal of recognition and not for creation of additional seats or for new colleges.

We also record that the Union of India has supported the petitioners in the interest of students. We also direct the Union of India to give wide publicity to this order in print as well as electronic media in the interest of the concerned students.

It is directed that the list of students getting admission in pursuance of this order shall be placed on record of this Court by 1st October, 2014 by the concerned institutions and a copy thereof shall also be sent to the MCI.

These matters shall be treated as part–heard and shall be notified for further hearing in the month of December, 2014. ( J . (ANIL R. DAVE); J. (VIKRAMAJIT SEN); J. (UDAY UMESH LALIT)
(Source Quality of Medical News)

Rabies News (Dr. A K Gupta)

Does treatment of provoked bites differ from unprovoked bites?

Provocation is subjective and relative and specific to each dog/cat. However, obvious gross provocation viz., stamping, hitting, chasing, etc. possibly suggest that the animal may not be rabid. However, the wound treatment of animal bites is the same

Cardiology eMedinewS

  • New research from the UK has found that heart attack patients have a greater chance of dying after discharge from the hospital if they miss even one component of their after–care. Heart attack patients had a 46% higher chance of dying within a month, and a 74% chance of dying within a year of discharge, if any one of the elements of care is missed. The findings were published in the European Heart Journal: Acute Cardiovascular Care.
  • A daily small serve of dairy food could possibly reduce the risk of heart disease or stroke, even in communities where such foods are not traditionally part of the diet, suggests a new study published in the Journal of the American College of Nutrition. Study authors noted that increased dairy consumption translated into lower risks of mortality from cardiovascular disease.

Pediatrics eMedinewS

  • Data from children with severe asthma have shown that findings from adults cannot be translated to children, and that steroid–resistant eosinophilic inflammation appears central to the pathogenesis of paediatric disease. Age–appropriate experimental models and use of airway samples from children are critical to understanding the underlying mechanisms and identifying novel therapeutic targets. (Curr Opin Allergy Clin Immunol. 2014;14(2):143–148.)
  • In–flight pediatric deaths higher among lap infants. The article quoted a study that found that 90% of airline deaths occurred in children under age 2 years, and it recommended that parents should reconsider bringing little ones on vacations that involve flying to various destinations. (Science World Report. August 4, 2014.)

Dr K K Spiritual Blog

Why Spirituality is wellbeing-friendly

  1. What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  2. Positive thinking produces nearly a 30 percent drop in perception of pain.
  3. Spirituality and the practice of religion are associated with a slower progression of Alzheimer’s disease.
  4. Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12 percent a year.
  5. People who undergo cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  6. Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  7. Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  8. Spirituality can affect immune-system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  9. Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  10. Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.
Self-Assessment-Quiz Self-Assessment-Quiz




Zee News – Health Wealth Shows

Cancer Prevention
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Fluid Intake


Total CPR since 1st November 2012 – 98440 trained

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."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

N P CO-ED Sr. Sec School Aurangzeb Lane, New Delhi 12th September 2014

press release

Should I be registered with MCI

video of day video of day


IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :


Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

eMedinewS Humor

Threatening Letters

The fellow stormed into the postmaster’s office in a fury. "I’ve been getting threatening letters in the mail for months and I want them stopped."

"Of course," said the postmaster. "Sending threatening letters through the mail is a federal offence. Do you know who's sending them?"

"Yes," shouted the man. "It’s those idiots down at the Internal Revenue Service."

Quote of the Day

A successful man is one who can lay a firm foundation with the bricks others have thrown at him. David Brinkley

Twitter of the Day

Dr KK Aggarwal: Monsoon reduces the immunity of the bodyhttp://Blogz.org/A/885894
Dr Deepak Chopra: In every perceived failure or setback is the seed of success. http://tinyurl.com/mwjtqc

Wellness Blog

Heart attack symptoms in women and elderly are different

Winter is the month for heart attacks and the symptoms in women and the elderly may be different

  • Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in the Archives of Internal Medicine, researchers examined 35 years of research that yielded 69 studies and found that, between 30 and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 to 27 percent of men did not experience chest discomfort.
  • Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.
  • Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome (ACS). They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.
  • Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18

Inspirational Story


A young lady named Sally relates an experience she had in a Seminary Class, given by her teacher, Dr. Smith. She says Dr. Smith was known for his elaborate object lessons.

One particular day, Sally walked into the seminary and knew they were in for a fun day. On the wall was a big target and on a nearby table were many darts. Dr. Smith told the students to draw a picture of someone that they disliked or someone who had made them angry, and he would allow them to throw darts at the person's picture.

Sally's girlfriend drew a picture of a girl who had stolen her boyfriend. Another friend drew a picture of his little brother. Sally drew a picture of a former friend, putting a great deal of detail into her drawing, even drawing pimples on the face. Sally was pleased at the overall effect she had achieved.

The class lined up and began throwing darts, with much laughter and hilarity. Some of the students threw their darts with such force that their targets were ripping apart. Sally looked forward to her turn, and was filled with disappointment when Dr. Smith, because of time limits, asked the students to return to their seats. As Sally sat thinking about how angry she was because she didn't have a chance to throw any darts at her target.

Dr. Smith began removing the target from the wall. Underneath the target was a picture of Jesus…… A complete hush fell over the as each student viewed the mangled picture of Jesus; holes and jagged marks covered His face and His eyes were pierced. Dr. Smith said only these words…… "In as much as ye have done it unto the least of these my brethren, ye have done it unto Me." Matthew 25:40

No other words were necessary; the tear–filled eyes of each student focused only on the picture of Christ.

ePress Release

Stress management programs for heart patients a must

Drugs such as beta–blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta–blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association. In premature heart attack, the mean age is 53–54 years.

In general, the goal of a stress management program is to reduce the impact in the individual of stressful environmental events and to better regulate the stress response.

Interventions may be considered at several levels:

  • Removal or alteration of the stressor
  • Change in perception of the stressful event
  • Reduction in the physiologic sequelae of stress
  • Use of alternative coping strategies

Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg.

Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.

eMedi Quiz

Strong correlation with colorectal cancer is seen in:

1. Peutz–Jegher’s polyp.
2. Familial polyposis coli.
3. Juvenile polyposis.
4. Hyperplastic polyp.

Yesterday’s Mind Teaser: Medullary carcinoma of the thyroid is associated with which of the following syndrome:

1. MEN I.
2. MEN II.
3. Fraumeni syndrome.
4. Hashimoto’s thyroiditis

Answer for yesterday’s Mind Teaser: 2. MEN II.

Correct answers received from: Dr Poonam Chablani, Dr. Sushma Chawla, Dr Jainendra Upadhyay, Najib Khatee, Dr Avtar Krishan, Dr Chandresh Jardosh.

Answer for 21st September Mind Teaser: 1. Phenytoin.

Correct answers received from: Dr Manoj Vithalani, Dr Pankaj Agarwal, Dr Sushma Chawla, Tukaram Pagad, Dr Jainendra Upadhyay, Dr KV Sarma, Dr Raghavendra Jayesh, Dr G Sampath Kumar, Dr Bitaan Sen, Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Is it necessary to have the opinion of an expert in every case?

In B. Krishna Rao Vs. Nikhil Super Specialty Hospital, III (2010) CPJ 1(SC) the Hon’ble Apex Court held; "It is not necessary to have opinion of the expert in each and every case of medical negligence."

Is there any impunity to a doctor while handling emergent cases?

We have relied upon various judgments of Hon’ble Apex Court. In Jacob Mathew’s case, the Hon’ble Supreme Court has observed as following: "A medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence, before a medical practitioner is charged with or proceeded against criminally. A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient."

Is medical accident same as medical negligence?

"In our opinion it was just accident or an error of judgment which is not medical negligence. We put reliance upon Jacob Mathews vs. State of Punjab AIR (2005) SC 3180, State of Punjab vs. Shiv Ram AIR (2005) SC 3280, in which Hon’ble Supreme Court has differentiated the issue of medical negligence. In para 34 the Hon’ble Supreme Court in Jacob Mathew’s Case states that: "Accident during the course of medical or surgical treatment has a wider meaning. Ordinarily, an accident means an intended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonably anticipated (See Black’s Law Dictionary, 7th Edition). Care has to be taken to see that the result of an accident which is exculpatory may not persuade the human mind to confuse it with the consequence of negligence."


medicolegal update

Situation: A patient had mandibular respiration.
Dr Bad: It’s normal in asthma.
Dr Good: It’s a bad terminal sign.
Lesson: Five of the signs that emerged mostly during the last three days of life had both high specificity (i.e., >95 percent chances that the patient would not die within three days if the symptom was absent) and high positive likelihood ratios, including pulselessness of the radial artery (positive LR 15.6, 95% CI 13.7’17.4); respiration with mandibular movement (positive LR 10, 95% CI 9.1–10.9); decreased urine output (positive LR 15.2, 95% CI 13.4–17.1); Cheyne–Stoke breathing (positive LR 12.4, 95% CI 10.8-13.9), and death rattle (positive LR 9, 95% CI 8.1-9.8). However, sensitivity was limited; these signs were present in fewer than 27 percent of the patients who died. (Hui D, dos Santos R, Chisholm G, et al. Clinical signs of impending death in cancer patients. Oncologist 2014;19:681)

medicolegal update
  1. Dear Dr KK Aggarwal, Vanakkam, Hearty congratulations. I am very happy that you are going to lead us at the National level, as the Administrative Head of our great organization. Your commitment to reach the members with your e news and information for the profession speaks so much about your desire to use the latest technology for effective and easy communication. LET IMA'S LIGHT ALWAYS SHINE! (This is the slogan I gave for the first time in the history of TN State IMA, when I was the President, which is being continued till now) through your leadership. Best regards Rtn. PHF Dr LVK Moorthy, PP, IMA. TNSB; Past Chairman PPLSSS; Chairman MDC TN IMA; Chairman. National Standing Committee for Rural Health. IMA H Qrs. New Delhi

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