29th October 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, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, 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.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Legal Dangers of 'Safe' Social Media

Social media actions could end up causing you legal trouble.

  • HIPAA rules apply to everyone: According to lawsuits, a female patient's ex-boyfriend convinced two UC Medical Center employees to post a screenshot of the patient's medical records on Facebook.
  • Physicians who own a practice can be sued for the social media activities of their employees if those employees violate privacy laws.
  • Train all your staff on privacy issues.
  • Potential legal issues with online physician reviews: There are dozens of websites that offer reviews and ratings of physicians and medical facilities. Some may be specific to healthcare. Inaccurate, hurtful, and even malicious patient reviews and ratings are easy to find on the Internet. Understandably, many physicians want to "set the record straight" by posting a response to an objectionable review or rating. Sometimes you might even recognize the specific patient and be tempted to respond specifically about the circumstance. But a response might trigger liability.
  • A patient's protected health information, like their name or photograph, linked to a review may end up with legal disputes.
  • Do not engage in social media discussions with patients. Do not attempt to specifically address patients' complaints about you online in any sort of review site. No matter how much you want to air the real facts, regret will replace that desire in time.
  • Even if the patient review is entirely anonymous, do not enter into a debate online.

7th Asia-Pacific Heart Rhythm Scientific Session New Delhi, India

Radiofrequency catheter ablation (RFCA) is an effective strategy in the elimination of right ventricular outflow tract (RVOT) ventriculararrhythmias but early and late recurrences are common. The study published in Heart Rhythm. 2014 Oct; 11(10):1760-9 enrolled 220 patients with acute successful RFCA of RVOT ventricular arrhythmias; mean follow-up period was 34.15 ± 33.74 months. In the study, patients with early and late ventricular arrhythmias recurrences demonstrated nonuniform patterns of clinical characteristics and electrophysiological properties.

Dr. Mohan Nair
Chairman, Organizing Committee of the 7th Asia Pacific Heart Rhythm Society's  (APHRS) Scientific Sessions, being organized simultaneously at the Taj Palace Hotel and ITC Maurya in New Delhi from October 29th to November 1st, 2014.

Be a part of the discussions regarding Arrhythmia Management with global experts at the 7thAsia Pacific Heart Rhythm Society Meeting from October 29th – November 1st at New Delhi.

News Around The Globe

  • Ebola may not be serious for non African countries: The scorecard for Ebola in the U.S. is overwhelmingly positive. Despite widespread concern, the country has had only nine confirmed cases of the disease. Of those, just one has died. Seven have been cured and the ninth remains in treatment. A child in New York is reportedly being tested for Ebola and would be the 10th case, but a CDC official said late today the pattern of symptoms doesn't suggest the disease. In contrast, the WHO said at the weekend that in the three West Africa countries with intense transmission -- Liberia, Guinea, and Sierra Leone -- there have been 10,114 cases and 4,912 deaths. Crudely, those numbers yield a mortality rate of 49% -- markedly higher than the 12.5% fatality rate in the U.S. (MedPage)
  • The CDC has announced recommendations for some US healthcare workers who have battled Ebola in West Africa that stop just short of the outright 21-day quarantine instituted by several states. It recommends voluntary “at-home isolation” upon return to the United States for asymptomatic clinicians who had a high risk for exposure to the virus in Sierra Leone, Liberia, or Guinea, perhaps because of a needle sticky. These clinicians should avoid public transportation, public places such as shopping centers, public gatherings, and outside workplaces. However, the CDC is not necessarily recommending that they should be strictly homebound.
  • In the Mendelian randomization study -- using genetic allocation conferred at conception akin to trial randomization -- weighted genetic risk scores for predisposition to high LDL cholesterol were linked to 28% higher incident aortic stenosis risk per mmol/L LDL and 2.78-fold higher incidence per genetic risk score increment (both P=0.02). (Each mmol/L of LDL cholesterol equals about 39 mg/dL.). Genetic risk scores for HDL and triglycerides held no such link, George Thanassoulis, MD, of McGill University Health Center and Research Institute in Montreal, and colleagues reported in JAMA.
  • Herpes simplex virus infection appears to double the risk of developing Alzheimer’s disease (AD), suggest two new studies. Both studies are published in the journal Alzheimer’s and Dementia.
  • The results of a new US study have shown that only 58% of individuals with type 2 diabetes were started on metformin as their first oral glucose-lowering medication, despite the fact that this drug is widely recommended as the initial therapy of choice in several diabetes guidelines. The research is published October 27 in JAMA Internal Medicine.

Dr KK Spiritual Blog

The Right Action

Dharma is the path of righteousness and living one's life according to the codes of conduct as described by the Vedas and Upanishads. Its western equivalents might include morality, ethics, virtue, righteousness and purity. The term dharma can best be explained as the “law of being” without which things cannot exist.

The word dharma is derived from dhri, which means “to hold”. It literally means “that which holds” the people of this world and the whole creation. The same is described in the Vedic Text, in Atharva Veda as: Prithivim dharmana dhritam, i.e. “this world is upheld by dharma”.

In Hinduism, Dharma is the very foundation of life. Tulsidas, the author of Ramcharitmanas, defined the root of dharma as compassion. Buddha has also described this principle in his book Dhammapada. According to Hindu philosophy, it's GOD who holds us through “Truth” and/or “Love”. “Dharma prevails” or “truth prevails” is the essence of Hinduism.

In order to achieve good karma, Vedas teach that one should live according to dharma (the right action). This involves doing what is right for the individual, the family, the class or caste and also for the universe.

According to the Bhagavat Purana, righteous living or life on a dharmic path has four pillars: truthfulness (satya), austerity (tap), purity (shauch) and compassion (daya). It further adds that the adharmic or unrighteous life has three main vices: pride (ahankar), bad company (sangh), and intoxication (madya).

Manusmriti prescribes ten essential rules for the observance of dharma: Patience (dhriti), forgiveness (kshama), piety or self control (dama), honesty (asteya), sanctity (shauch), control of senses (indriya-nigrah), reason (dhi), knowledge or learning (vidya), truthfulness (satya) and absence of anger (krodha). Manu further writes, "Non-violence, truth, non-coveting, purity of body and mind, control of senses are the essence of dharma”.

In Bhagwad Gita, Lord Krishna says that in the society dharma is likely to fall from time to time, and to bring dharma back, a GOD representative is born from time to time.

The shloka “parithraanaaya saadhoonaam vinaasaaya cha dhushkr.thaam| dharma-samsthaapanaarthaaya sambhavaami yuge yuge” (Chapter IV - 8)” says that “For the protection of the virtuous, for the destruction of evil-doers, and for establishing the rule of righteousness (Dharma), I am born from age to age [in every age]”. Another shloka “yada yada hi dharmasya glanir bhavati bharata abhyutthanam adharmasya tadatmanam srjamy aham” means that O descendant of Bharata “Whenever and wherever there is a decline in religious practice, and a predominant rise of irreligion - at that time I descend Myself”.

Deepak Chopra in his book Seven Spiritual Laws of Success talks about the “Law of ‘Dharma’ or Purpose in Life’”. According to him, everybody should discover his or her divinity, find the unique talent and serve humanity with it. With this, one can generate all the wealth that one wants.

According to him, when your creative expressions match the needs of your fellow humans, then wealth will spontaneously flow from the un-manifest into the manifest, from the realm of spirit to the world of form. In spiritual terms this is an attempt to find out whether one’s life is progressing as per the Laws of Dharma (Dharma in Sanskrit means ‘purpose in life’) which, according to the scriptures, is said to be the sole purpose for a human being to manifest in this physical form.

For one to achieve ‘DHARMA’ he suggests the following affirmative exercises:

  • Today I will lovingly nurture the god or goddess in embryo form that lies deep within my soul. I will pay attention to the spirit within me that animates both my body and my mind. I will awaken myself to this deep stillness within my heart. I will carry this consciousness of timeless, eternal being in the midst of time-bound experiences.
  • I will make a list of my unique talents. Then I will list all of the things I love to do while expressing my unique talents. When I express my unique talents and use them in the service of humanity, I lose track of time and create abundance in my life as well as in the lives of others.
  • I will ask myself daily, ‘How can I serve?’ and ‘How can I help?’ The answers to these questions will allow me to help and serve my fellow human beings with love.

Karma, dharma and samsara are three fundamental aspects of Hinduism. Buddhism, Jainism and Hinduism are all built on these aspects. Dharma is one’s appropriate role or attributes. Karma measures how well one performs one’s dharma, explains why one is born where he or she is, and why there is suffering and seeming injustices. Samsara is the continuous cycle of birth, death and rebirth, and the context for all experience.

Dharma sutras from Dharma Shãstras are the basic texts which talks about the morality of individuals and the society. Most Indian laws are made from these Shãstras.

In Jainism also, the wheel of Dharma (Chakra) with 24 spokes represents the religion preached by the 24 Tirthankaras consisting of nonviolence (Ahimsa) and other virtues.

The very first word of the Gita is “Dharma”. The Gita concludes with the word “Mama”. The whole of Bhagavad Gita is contained in the two words ‘Mama’ and ‘Dharma’. When you join these two words it becomes mamadharma, meaning ‘your true Dharma’. This is what the Gita teaches. ‘What is your Dharma?’

How to achieve your dharma?

  • Do unto others what you do unto yourself and satisfy your conscience. That is your Dharma.
  • The word ‘Living Dharma’ signifies right action in every moment of the life.
  • Do not follow the dictates of body, and do not indiscriminately follow the mind, for the mind is like a mad monkey. Hence, follow the conscience.

Inspirational Story

Learn from Mistakes

Thomas Edison tried two thousand different materials in search of a filament for the light bulb. When none worked satisfactorily, his assistant complained, “All our work is in vain. We have learned nothing.”

Edison replied very confidently, “Oh, we have come a long way and we have learned a lot. We know that there are two thousand elements which we cannot use to make a good light bulb.”

Rabies News (Dr A K Gupta)

A pregnant woman develops rabies. What should be done?

The rabies virus is not known to cross placental barrier, and so if the mother develops rabies, the fetus is safe. Hence, the pregnant woman with rabies should be clinically managed and if induction of pregnancy or cesarean section is possible, the obstetrician should do it with some "personal precautions" and immunoprophylaxis (usually three doses of modern vaccine or if there is any accidental exposure, then full course of post–exposure vaccination either by IM or ID route should be given to the obstetrician.) Later, the newborn may be given a full course of rabies PEP vaccination.

Cardiology eMedinewS

  • Patients with psoriasis have increased odds of suffering from uncontrolled hypertension, with higher risks seen among patients with moderate to severe psoriasis affecting more than 3% of the surface of their bodies, suggests a population-based, cross-sectional study published online in JAMA Dermatology.
  • Individuals with a genetic predisposition to high levels of LDL cholesterol are at risk for aortic-valve calcification and aortic stenosis, revealed a new study presented recently at the Canadian Cardiovascular Congress and published concurrently in the Journal of the American Medical Association.

Pediatrics eMedinewS

  • Ibuprofen appears to be as effective as morphine for pain control in children with uncomplicated fractures, and leads to significantly fewer adverse effects, suggests a study published online October 27 in the Canadian Medical Association Journal.
  • In some babies conceived by in vitro fertilization (IVF), cardiac dysfunction might be linked to excessive maternal hormone levels at conception and during pregnancy, suggests new research. The results were presented at the American Society for Reproductive Medicine 2014 Annual Meeting.

Quote of the Day

  • Worry does not empty tomorrow of its sorrow; it empties today of its strength. Corrie Ten Boom


NDTV: A leading body of Indian-American physicians plans to hold its 9th annual Global Healthcare Summit aimed at bringing accessible, affordable and quality world-class healthcare to India in Mumbai from Jan 2-4. The Association of American Physicians of Indian Origin (AAPI), one of the largest ethnic professional bodies, is organizing the summit at Trident Oberoi Hotel in collaboration with the Indian Ministries of Health and Family Welfare and Overseas Indian Affairs. The Indian Medical Association (IMA), Global Association of Physicians of Indian Origin (GAPIO), Indian Surgical Association and several other national and international organizations are also collaborating in the venture, according to an AAPI media release.

Wellness Blog

Salt restriction increases efficacy of RAAS blockade

Eggs do not have an adverse effect on lipid levels in patients with type 2 diabetes. Researchers also found that an egg-rich diet for 3 months was associated with better appetite control and may provide greater satiety. “These findings suggest that a high egg diet can be included safely as part of the dietary management of patients with type 2 diabetes,” remarked Nicholas Fuller, PhD, from the Boden Institute Clinical Trials Unit, University of Sydney, Australia.

ePress Release

Kidney patients can have pregnancy

Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease) 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.

Maternal and peri-birth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to non-diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre-conceptional treatment with drugs like angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.

emedipicstoday emedipics

21st Perfect Health Mela 16th October 2014



press release

Monitoring LFT in a patient on statins

video of day video of day

Other Blogs

Video Library

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 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

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

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


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 :


Dr Good and Dr Bad

Situation: An elderly patient after IV ondansetron 16 mg dose developed irregular heart rhythm
Dr Bad: It cannot be due to the drug
Dr Good: It is due to the drug
Lesson: ECG interval changes, including prolongation of the QTc interval, are a class effect of the first-generation serotonin antagonists, including ondansetron; potentially fatal cardiac arrhythmias may result. QTc prolongation occurs in a dose-dependent manner, and is expected to be greater with faster rate of infusion and larger doses for IV administration. The current recommendation is to limit single IV doses to no more than 16 mg. Canadian guidelines place additional dosing restrictions on IV ondansetron to mitigate the risk of QT prolongation, particularly in older adults, in whom the initial dose should not exceed 8 mg (Source: healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2014/39943a-eng.php (Accessed on June 16, 2014).

Make Sure

Situation: A 36–year–old truck driver had severe allergic rhinitis and came for treatment.
Reaction: Oh my God, why was he not prescribed azelastine nasal spray?
Lesson: Make sure to avoid oral antihistamines in persons who perform tasks like driving as they may cause sedation and drowsiness; instead prescribe azelastine nasal spray which is effective and non–sedating.

eMedinewS Humor

Santa calls up the doc at 2 AM. "Doc, my wife is having severe abdomen pain. I think it's her appendix."

"What nonsense!" says the doc sleepily.

"I took out your wife's appendix two years ago. Go back to sleep."

Five minutes later, the phone rings and it's Santa again.

"Doc, I'm sure it's her appendix."

"Oh God!" the doctor groaned.

"Did you ever hear of anyone having a second appendix?"

"No...," says Santa. "But I'm sure you must have heard of someone having a second wife..!!!!"

Twitter of the Day

Dr KK Aggarwal: Longer the waist line shorter the brain size
Dr Deepak Chopra: Finding your center means settling into a stable, coherent state of awareness. Outer forces do not dominate you

eMedi Quiz

An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde-3-phosphate dehydrogenase.
3.Lactate dehydrogenase.

Yesterday’s Mind Teaser: Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Answer for yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr.K.V.Sarma, Dr Abbas Vakil, Dr Avtar Krishan.

Answer for 27th Oct Mind Teaser: 1. X recorded an increase in MBP but Y recorded a decrease in MBP.

Correct answers received from: Dr Jainendra Upadhyay, Dr.K.V.Sarma, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Avtar Krishan.

Send your answer to email

medicolegal update

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

Giving wrong advice on email is liable for negligence

If the doctor has charged his/her full fees for the email consultation from the patient or a referring physician regarding a patient, he/she will be liable as if he or she has seen the patient. When giving a written opinion through email one can take the following precautions and write:

  1. “Expert opinion provided as a professional courtesy only”
  2. “Nominal fee charged is only to cover the secretarial / incidental expenses involved and does not count towards a consideration or contract”
  3. “This is only an opinion based on the information provided to me. It is not a final opinion which cannot be given without seeing the patient physically.
  4. “This is not a final opinion and you may use this opinion at your own responsibility and discretion”
  5. “As it is an opinion given without seeing the patient I take no legal responsibility for the opinion given”.
medicolegal update
  1. Dear Sir, Thanks for providing the information. Regards: Dr Karan

eMedinewS Special

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