eMedinewS 29th July 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; 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

Ethylene oxide used in baby powder by MNCs can cause allergy, cancer and blood abnormalities in long run

Multinationals should stop treating Indians as guinea pigs, the FDA told the Bombay HC on Friday, while opposing Johnson & Johnson's plea to restart its Mulund facility as reported in TOI. A division bench of Justice S J Vazifdar and Justice M S Sonak, the court heard J&J's plea challenging FDA's order directing closure from June 24.

In 2007, J&J had used ethylene oxide (EtO) treatment for 15 batches of baby powder and did not check for residue. But J&J argued that it had checked three of the batches for residue in 2009, and had found none.

To check for contamination, instead of the steam sterilization treatment, they sent the bottles for EtO treatment to a lab.

After the treatment, they were no checks for residue. As per FDA, the company was required to test each batch they put into the market.

About EtO

  • Hypotension, dyspnea, and chest pain may be produced by sensitivity to the ethylene oxide used as a membrane sterilant (1).
  • Chemicals that have been associated with sporadic spontaneous pregnancy loss include anesthetic gases (nitrous oxide), arsenic, aniline dyes, benzene, ethylene oxide, formaldehyde, pesticides, lead, mercury and cadmium (2).
  • A variety of other medications and agents have been implicated in anaphylaxis or reactions resembling anaphylaxis in susceptible individuals: The sterilization agents EtO and ortho-phthalaldehyde (3)
  • Type A allergic reactions during dialysis are caused by leachable substances from the dialyzer or by contamination with bacterial peptides. A classic cause of this type of reaction is ethylene oxide, which is used to sterilize hollow fiber dialyzers. Reactions to ethylene oxide, which are now uncommon, occur exclusively during the first use, usually when there has been inadequate rinsing of the dialyzer prior to use. IgE antibodies directed against ethylene oxide are present in some cases, particularly those with more severe reactions. One study, found that 16 of 106 unselected patients developed mild allergic symptoms after hemodialysis; 10 of these patients also developed eosinophilia (4). Two observations suggested an important role for ethylene oxide in this response: allergy to ethylene oxide could be demonstrated in seven of the cases; and the symptoms and eosinophilia were ameliorated in three patients by ethylene oxide-free hemodialysis.
  • Spina bifida patients have been reported to be at increased risk of anaphylactic reactions during general anaesthesia. Following a reaction, latex is often incriminated as spina bifida patients are known to have an increased incidence of latex allergy. Ethylene oxide (EO) has recently been suggested to be an alternative cause. EtO is a highly reactive gas widely used to sterilise heat-sensitive medical devices, and traces of EtO can be found in many of the same products as latex. (5)
  • There is a link between low dose EtO exposure and breast cancer. (6)
  • For breast cancer the substances classified as "carcinogenic to humans" (Group 1) include EtO. (7)
  • Chronic exposure to EtO causes elevation in the absolute mean number of monocytes and eosinophils and a decrease in the absolute mean number of lymphocytes. There is also an elevation in the percentage of hematocrit and the mean absolute number of the red blood cells, and a decrease in the mean absolute number of platelets, in the exposed group compared with the control group. (8)


  1. Nicholls AJ, Platts MM. Anaphylactoid reactions due to haemodialysis, haemofiltration, or membrane plasma separation. Br Med J (Clin Res Ed) 1982;285:1607.
  2. Savitz DA, Sonnenfeld NL, Olshan AF. Review of epidemiologic studies of paternal occupational exposure and spontaneous abortion. Am J Ind Med 1994;25:361.
  3. Ebo DG, Bosmans JL, Couttenye MM, Stevens WJ. Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy 2006;61:211.
  4. Röckel A, Klinke B, Hertel J, et al. Allergy to dialysis materials. Nephrol Dial Transplant 1989;4:646.
  5. Anaphylaxis to ethylene oxide - a rare and overlooked phenomenon: Bache S, Petersen JT, Garvey LH. Acta Anaesthesiol Scand 2011;55(10):1279-82.
  6. Mikoczy Z, Tinnerberg H, Björk J, Albin M. Cancer incidence and mortality in Swedish sterilant workers exposed to ethylene oxide: updated cohort study findings 1972-2006. Int J Environ Res Public Health 2011;8(6):2009-19.
  7. Weiderpass E, Meo M, Vainio H. Risk factors for breast cancer, including occupational exposures. Saf Health Work 2011;2(1):1-8.
  8. Shaham J, Levi Z, Gurvich R, et al. Hematological changes in hospital workers due to chronic exposure to low levels of ethylene oxide. J Occup Environ Med 2000;42(8):843-50.

.... 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 10x10 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 don’t we light a lamp in Mandir with Vanaspati Ghee?

Only Satvik and health-friendly offerings are made to God. Whatever is not offered to God should not be taken or taken only in a limited quantity. Vanaspati ghee is hydrogenated oil and is linked to heart attack, diabetes, blood pressure, paralysis and cancer. Lighting of a lamp in a mandir is always done either with oil or clarified butter (pure ghee).

....Read More

cardiology news

Appreciate Life’s Annoying Little Things

Lessons from 9/11, the annoying little things:

  • As you might know, the head of a major company survived the tragedy of “9/11” in New York because his son started kindergarten.
  • Another fellow was alive because it was his turn to bring donuts.
  • One woman was late because her alarm clock didn’t go off in time.
  • One was late because of being stuck on the NJ Turnpike due to an auto accident.
  • One of them missed his bus.
  • One spilled food on her clothes and had to take time to change.
  • One’s car wouldn’t start.
  • One went back to answer the telephone.
  • One had a child that dawdled and didn’t get ready as soon as he should have.
  • One couldn’t get a taxi.
  • The one that struck me was the man who put on a new pair of shoes that morning, took the various means to get to work but before he got there, he developed a blister on his foot. He stopped at a drugstore to buy a Band-Aid. That is why he is alive today.

Now when I am stuck in traffic…

  • Miss an elevator…
  • Turn back to answer a ringing telephone…
  • All the little things that annoy me…
  • I think to myself…

This is exactly where God wants me to be at this very moment.

The next time your morning seems to be going wrong,

  • The children are slow getting dressed,
  • You can’t seem to find the car keys,
  • You hit every traffic light…

Don’t get mad or frustrated; God is at work watching over you.

May God continue to bless you with all those annoying little things – and may you remember and appreciate their possible purpose.

News Around The Globe

  • National Board of Examination (NBE) is holding a CME (14.5 credit hours) on Current clinical practices in infectious diseases on 17th and 18th August 2013 at Dwarka campus. Details are at NBE website.
  • Memish and colleagues have reported online in The Lancet Infectious Diseases that the novel coronavirus MERS-CoV has similar clinical characteristics as SARS, but they are not identical. There are also some important differences, including a much higher death rate. According to Ziad Memish, FRCP, Saudi Arabia's Deputy Minister for Public Health, and colleagues, at the moment it seems "unlikely" that the new virus will follow the same path of global illness as SARS. (Source: Medpage Today)
  • The US Food and Drug Administration (FDA) has approved the first test (Xpert MTB/RIF Assay) that detects tuberculosis (TB) bacteria as well as determines whether they are resistant to the antibiotic rifampin. The results are obtained in about 2 hours. (Source: Medscape)
  • Weekly or even more frequent debridement (removal of necrotic tissue and foreign bodies from a wound that isn't healing on its own) led to Faster and more complete wound healing regardless of wound type, size, or duration compared with less frequent debridement. Scott Covington, MD, of Healogics in Jacksonville, Fla., and colleagues have reported their observations online in JAMA Dermatology. (Source: Medpage Today)
  • New practice bulletin on the management of gestational diabetes mellitus have been issued by the American College of Obstetricians and Gynecologists (ACOG). According to one of the authors, this new bulletin is mainly an update to incorporate new clinical trials and whether or not they shed any additional light, or would change management. The bulletin is published in the August issue of Obstetrics & Gynecology. (Source: Medscape)
  • A new retrospective 20-year follow-up study published online July 11 in Diabetes Care has found that type 2 diabetes is associated with twice the death rate of type 1 diabetes among adolescents or those diagnosed in early adulthood. Cardiovascular mortality is the major driver of this increased mortality. (Source: Medscape)

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Happy reading…

Infertility News (Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you understand by Dilatation and Curettage?

Dilatation and curettage (D&C) is a minor (short) surgical procedure that removes tissue from your uterus (womb). D&C also is done to remove pregnancy tissue remaining from a miscarriage or an abortion.

Rabies News (Dr. A K Gupta)

Are there any survivors of human rabies?

Till date only seven survivors have been recorded. These patients survived not due to any specific anti-rabies therapy but following intensive life support and excellent nursing care. These patients survived for variable periods with residual neurological deficits. All the survivors had paralytic form of rabies and majority had history of some anti-rabies vaccination in the past.

cardiology news

Thrombolytic Therapy For Acute Stroke

  • Women are less likely than men to receive intravenous thrombolytic therapy for acute stroke, researchers reported online in Stroke: Journal of the American Heart Association. This could be due to the delayed arrival at the hospital. In a group of patients presenting within 24 hours of stroke onset, IV tissue plasminogen activator (tPA) was used in 11% of women and 14% of men. But this gender difference was not found in the subgroup of patients who presented with an acute ischemic stroke within 4 hours of symptom. (Source: Medpage Today)

Patients with pulmonary arterial hypertension (PAH)

  • Two phase III trials reported in the July 25 issue of the New England Journal of Medicine state that riociguat (proposed trade name Adempas), an investigational agent improved exercise capacity and other outcomes in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Compared with placebo, riociguat provided net gains in the 6-minute walk distance of 36 and 46 meters in patients with PAH and CTEPH, respectively (P<0.001 for both). (Source: Medpage Today)

Valvular Heart Disease News

Echocardiography is indicated for formal diagnosis in patients with clinical examination suggestive of mitral valve prolapsed (MVP) or those with a family history of MVP.

(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
  1. Jane F. Knapp, MD, from the Department of Pediatrics at Children's Mercy Hospitals and Clinics in Kansas City, Missouri, and colleagues report that the use of chest x-rays in children who visited the ED with moderate to severe asthma increased 2.4-fold over a 15-year period. Asthma, bronchiolitis, and croup accounted for 13.3 million ED visits by children from 1995 to 2009The findings are reported online July 22 in the journal Pediatrics.
  2. A post-exposure prophylactic against varicella can be given up to 10 days after exposure, according to the CDC. But the agency still recommends giving the varicella zoster immune globulin preparation VariZIG, approved late last year by the FDA, within 96 hours (4 days) of exposure noted in the July 19 issue of Morbidity and Mortality Weekly Report.
cardiology news

Do not ignore anxiety attacks

Do not ignore attacks of anxiety or irritability as these may be an indication of underlying hyperfunctioning of a thyroid, a butterfly–shaped gland in the middle of the neck, located below the larynx (voice box) and above the clavicles (collarbones).

The thyroid produces two hormones, triiodothyronine (T3) and thyroxine (T4) that regulate how the body uses and stores energy (also known as the body’s metabolism). Thyroid function is controlled by a gland in the brain, known as the pituitary. The pituitary produces thyroid stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4. When the thyroid hyper functions, it produces too much thyroid hormone. When this occurs, the body’s metabolism is increased, which can cause a variety of symptoms.

Most people with hyperthyroidism have symptoms, including one or more of the following:

  • Anxiety and irritability
  • Weakness (in particular of the upper arms and thighs, making it difficult to lift heavy items or climb stairs)
  • Tremors (of the hands)
  • Perspiring more than normal
  • Difficulty tolerating hot weather
  • Rapid or irregular heartbeats
  • Fatigue
  • Weight loss in spite of a normal or increased appetite
  • Frequent bowel movements.
  • In addition, some women have irregular menstrual periods or stop having their periods altogether. This can be associated with infertility.
  • Men may develop enlarged or tender breasts, or erectile dysfunction, which resolves when hyperthyroidism is treated.

...Read More

cardiology news

Both women and men should be aware that childbearing after the age of 40 years is associated with higher rates of subfertility and adverse pregnancy-related outcomes.

cardiology news
  1. 23rd July: HCFI Executive Meeting


CPR 10 Training Camp, EPFO, 30th May 2013

CPR 10 Camp - Police Training Center Najafgarh


CPR Classes: Persons trained (1336)

19th July: CPR Moolchand 29

20th July: CPR Moolchand 28

22nd July: CPR Moolchand 26

23rd July: CPR Moolchand 26

24th July: CPR Moolchand 27

25th July: CPR Sahodaya Sr. Sec. School, SDA, New Delhi (1200)

26th July: CPR Moolchand (20)

CPR VIP Sensitization

24th July: Imtiaz alam from pakistan doing CPR

Total CPR since 1st November 2012 – 56831 trained

TV and Radio Coverage

24th July: Interview in Sahara TV on iron tablets

Video Chats and uploads

Dr KK Aggarwal on NEWS 24

Dr KK Aggarwal on Monsoon Take Care

Dr KK Aggarwal on Danger of Epidemics (Uttarakhand Disaster)

1308 students learnt CPR at Abhinav Public School, Rohini

CPR Utsav 6th April 11543 men and women Trained in 1 day

Dr KK Aggarwal on 4 REALNEWS JUNE 26 2013 On Uttarakhand Disaster

Symposium on Prayer, Faith, Meditation and healing part 9

Symposium on Prayer, Faith, Meditation and healing Part 8

Advocacy through

Print Media

21st July: Saha Times

21st July: Viraat Vaibhav

22nd July: Veer Arjun

22nd July: Viraat Vaibhav

23rd July Veer Arjun

24th July: Veer Arjun

25th July: New Ad n Face-year-14, issue-7

26th July: Hindustaan

26th July: Rastriya Rakshak

Media advocacy through Web Media

Eating Disorders are contagious 24th July


You are at risk for osteoporosis if…

Osteoporosis affects many women and men as they age, reducing bone density and increasing the risk of bone fractures, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela and National Vice President IMA.

Following features may put you at risk

  • Being older or female.
  • Having osteoporosis in the family.
  • Having a small stature or thin frame.
  • Being Indian
  • Having a previous bone fracture.
  • Having low sex hormone levels.
  • Getting insufficient exercise.
  • Getting insufficient dietary calcium and vitamin D.
  • Eating a diet that is high in caffeine, sodium and protein.
  • Using alcohol or tobacco.
  • Having eating disorders or rheumatoid arthritis.
  • Use of long-term drugs such as steroids.
  • Staying indoor most of the times
  • Bed-ridden for a long time

Four healthy habits

Dr Aggarwal said that it's still not too late. If you make healthy changes now, they will have a tremendous impact particularly on the heart, even in middle age. Dana E King, from Medical University of South Carolina, evaluated almost 16,000 men and women who were between the ages of 45 and 64 and specifically looked at four heart-healthy habits:

  • Eating at least five servings of fruits and vegetables a day
  • Exercising at least 2.5 hours a week
  • Keeping a healthy weight and
  • Not smoking.

During four years of follow-up, they found that those who adopted the four healthy habits were 40 percent less likely to die and 35 percent less likely to suffer heart problems than those who did not adopt the beneficial habits.

The findings were published in The American Journal of Medicine.

The diet should not only be rich in fruits and vegetables but also whole grains, omega 3 fatty acids and other poultry and unsaturated fats -- like vegetable oils and nuts.

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 56831 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 10x10 i.e. 100 per minute.” ...Read More

today emedipics
Heart Care Foundation of India Organizes a CPR 10 Training camp at Sahodaya Sr Sec. School, SDA, New Delhi on 25th July 2013.

press release

Ventilator-associated tracheobronchitis.

today video of the dayDr KK Aggawral on Say No To Tobacco

Smart Phones Benefits and Hazards

Beware of Artificial Medicine

eMedi Quiz

Read this…………………

Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely?

a. 1 to 2 years
b. 1 week to 1 year, peaking at 2 to 4 months
c. 6 months to 1 year, peaking at 10 months
d. 6 to 8 weeks

Yesterday’s Mind Teaser: A mother and grandmother bring a 3-month-old infant to the well-baby clinic for a routine checkup. Nurse Aimee weighs the infant, the grandmother asks, “Shouldn’t the baby start eating solid food? My kids started on cereal when they were 2 weeks old.” Which response by the nurse would be appropriate?

a. ”The baby is gaining weight and doing well. There is no need for solid food yet.”
b. ”Things have changed a lot since your children were born.”
c. ”We’ve found that babies can’t digest solid food properly until they’re 3 or 4 months old.”
d. ”We’ve learned that introducing solid food early leads to eating disorders later in life.”

Answer for yesterday’s Mind Teaser: c. ”We’ve found that babies can’t digest solid food properly until they’re 3 or 4 months old.”

Correct answers received from: : Dr.Bitaan Sen & Dr.Jayashree Sen, DR AVTAR KRISHAN, DR AYYAVOO ERODE, Dr kanta jain, DR SANTHAKUMARI, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr. Thakor Hitendrsinh G, Dr Jainendra Upadhyay, daivadheenam, Dr B K Agarwal

Answer for 27th July Mind Teaser: c. On an empty stomach

Correct answers received from: Dr P C Das, Dr Prakash Khalap, DR ABBAS VAKIL, Dr.K.Raju

Send your answer to ijcp12@gmail.com

eMedi Apps

medicolegal update

Click on the image to enlarge

medicolegal update

A Dollar Per Point

A professor was giving a big test one day to his students. He handed out all of the tests and went back to his desk to wait.

Once the test was over the students all handed the tests back in. The professor noticed that one of the students had attached a $100 bill to his test with a note saying "A dollar per point."

The next class the professor handed the graded tests back out. This student got back his test, his test grade, and $64 change.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lesson: Make sure to remember that there is a higher incidence of hepatitis with cholestatic jaundice in pregnancy with erythromycin estolate.

medicolegal update

Love is a fruit in season at all times, and within the reach of every hand. Mother Teresa

medicolegal update

Dr KK Aggarwal: More women than men die in hospital from severe heart attack
http://bit.ly/12vFIfq #Health

Dr Deepak Chopra: Do you think it's possible to encompass the full experience of spirituality without having a mentor? http://tinyurl.com/nsoww5o

medicolegal update

Dear Sir, Thanks for the nice updates. Regards: Dr SK Mishra

Forthcoming Events

29th September -Dil Ka Darbar at NDMC Convention Centre, CP New Delhi

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

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

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medicolegal update

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