5th November 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

Diabetes Update

  • Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications
  • India may soon be the diabetic capital of the world.
  • People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications. Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.
  • World Diabetes Day is on November 14.
  • In type 1 diabetes, the body does not make insulin. In type 2 diabetes the body does not make or use insulin well. Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.
  • Type 2 diabetes has begun to affect young people.
  • Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually cut your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.
  • In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.
  • Choose healthy foods to share.
  • Take a brisk walk together every day.
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.
Mela 2014

News Around The Globe

  • Across five countries, hospital costs per patient were a median of $39,508 with dalteparin (Fragmin) compared with $40,805 on unfractionated heparin, Robert A. Fowler, MDCM, of the University of Toronto, and colleagues reported online in the Journal of the American Medical Association and at the Critical Care Canada Forum in Toronto.
  • A newly proposed psychotropic drug reclassification system, complete with app, has been unveiled that intends to reclassify psychotropic drugs from symptom-based to pharmacology-based. The first phase of the new Nomenclature Project was unveiled at the 27th European College of Neuropsychopharmacology (ECNP) Congress.
  • Patients with rheumatoid arthritis (RA) report significant improvement of fatigue after beginning anti–tumor necrosis factor a (TNF-α) therapy, suggested a new study published online in Rheumatology. Employed women with a low level of disability were the most likely to experience an improvement in fatigue.
  • The inclusion of lamivudine (3TC) in first-line tenofovir-based regimens is associated with a greater risk for virologic failure as compared to those containing emtricitabine (FTC) at 48 weeks, suggests a study presented at the HIV Drug Therapy Congress.
  • A new study suggests that the ability to remember locations and directions may suffer when deep sleep is disrupted by breathing difficulties. Researchers noted that subjects with sleep apnea scored worse on spatial memory tests after sleeping without continuous positive airway pressure (CPAP), compared to mornings after they had used their CPAP devices at night. The study is published online in The Journal of Neuroscience.

Dr KK Spiritual Blog

Is it necessary to take a dip in Ganga to remove your sins?

Ganga, Jamuna and Saraswati, the sangam of the three rivers in Allahabad is believed to be the holiest place in the country where if one takes a dip, then one washes away his or her past sins.

After death, ashes are also submerged in the Ganga with an assumption that the past sins will be removed.

In Vedic era, what was the intention of the rishis and munis while making this ritual?

In mythology, moon represents cool mind and Ganga represents the positive flow of thoughts. And sea turmoil indicates the disturbed state of mind.

Hanuman’s samudra yatra indicates the meditative journey through the flow of thoughts. Samudra manthan represents the journey of the mind during meditation.

Taking a dip can be equated to shifting your mind towards your consciousness. This may occur when you introspect in a relaxed state of mind or when you practice meditation. Meditation is defined as a journey from sympathetic and parasympathetic state of mind or a journey from disturbed state of consciousness to undisturbed state of consciousness.

Every time you meditate, you dip into your consciousness and clean your guilt and negative thoughts. It is something like reformatting your hard disk and removing the bad sectors and viruses in your software.

It is, therefore, possible for you to do Ganga snan (bath) at your house in the morning while meditating or during pooja by drifting away from disturbed state of mind to non disturbed relaxed state of mind clearing your guilt and negative thoughts.

Inspirational Story

10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren’t caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free

Don’t take things so personally

Most people, even your friends and colleagues, aren’t talking about you, thinking about you, or concerned with you at all for 99% of the time. The ups and downs of life, the warmth and coldness of others, aren’t personal at all. Pretending that they are will only make you more miserable than is needed.

Don’t assume your emotions are trustworthy

How you feel isn’t always a good indicator of how things are. Just because you feel it, that doesn’t make it true. Sometimes that emotion comes from nothing more profound than being tired, hungry, annoyed, or about to get a head–cold. The future won’t change because you feel bad—nor because you feel great. Feelings may be true, but they aren’t the truth.

Rabies News (Dr A K Gupta)

What are the initial (prodromal) symptoms of rabies?

  • Pain or paresthesiae at the site of the bite is well–known as a diagnostically useful prodromal symptom occurring in one–third to two–thirds of cases.
  • In Thailand, however, a specific type of paresthesiae – itching – was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesiae may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in three of the four patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.

Cardiology eMedinewS

  • The new Canadian Cardiovascular Society guidelines for the management of patients with heart failure have been updated and are the first to include a recommendation on the use of the new angiotensin receptor-neprilysin inhibitor (ARNI). The new heart failure guidelines were presented at the 2014 Canadian Cardiovascular Society Congress.
  • Two new studies have provided more data on the bleeding risks among patients with atrial fibrillation (AF) treated with dabigatran, with one showing that the oral anticoagulant carries a significantly higher risk of major bleeding, as well as gastrointestinal bleeding, when compared with warfarin. The first report is published in JAMA: Internal Medicine while the second one is published in Circulation. In the second report, there was no increased risk of major bleeding with dabigatran, but there was a 28% greater risk of gastrointestinal hemorrhage.

Pediatrics eMedinewS

  • Conflicts in a teen's life can spill over at school and at home for days afterward, suggests a new study published online in Child Development.
  • Low birth weight and preterm birth appear to be positively correlated with the incidence of hip replacement in adulthood, suggests a new study published in Arthritis Care & Research.

Quote of the Day

  • Winners compare their achievements with their goals, while losers compare their achievements with those of other people.

Wellness Blog

Smoking makes you 5 years older

Men have a greater chance of dying then women, and smoking increases any adult's risk of death just as if five years were suddenly added to their age.

  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

ePress Release

More women than men die from severe heart attack in hospitals

Winter months are heart attack months, said Padma Shri and Dr B C Roy National & DST National Science Communication Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association.

Men and women have about the same adjusted in-hospital death rate for heart attack. But, women are more likely to die if hospitalized for a more severe type of heart attack.

According to a report in Circulation, the Journal of the American Heart Association:

  • Women are twice as likely as men to die if hospitalized for a type of heart attack known as ST-elevation myocardial infarction (STEMI).
  • Women are also less likely to receive appropriate and timely treatment for heart attack.
  • Women with STEMI have a 12 percent higher relative risk for in-hospital death compared to men.
  • Compared to men, women are 14 percent less likely to receive early aspirin; 10 percent less likely to receive beta blockers; 25 percent less likely to receive reperfusion therapy (to restore blood flow); 22 percent less likely to receive reperfusion therapy within 30 minutes of hospital arrival; and 13 percent less likely to receive angioplasty within 90 minutes of hospital arrival.
  • Women admitted with a STEMI are about twice as likely to die in the first 24 hours of hospitalization as men.

eMedi Quiz

A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1.Pain sensation on the ipsilateral side.
2.Proprioception on the contralateral side.
3.Pain sensation on the contralateral side.
4.Propriception on the ipsilateral side.

Yesterday’s Mind Teaser: A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anesthesia. Intra operatively, her end-tidal carbon-dioxide decreased to 20 from 40mmHg followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1.Fat embolism.
4.Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2.Hypovolemia.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Najib Khatee.

Answer for 3rd November Mind Teaser: 3.Atracurium.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan.

Send your answer to email

Dr Good and Dr Bad

Situation: A patient with stable angina with heart rate 80 per minute was put on ivabradine
Dr Bad: Continue it
Dr Good: Stop it
Lesson: Ivabradine has not shown to be an anti angina drug (N Engl J Med 2014).

eMedinewS Humor

Mr. Smith is Dead

A law firm receptionist answered the phone the morning after the firm's senior partner had passed away unexpectedly.

"Is Mr. Smith there?” asked the client on the phone.

"I'm very sorry, but Mr. Smith passed away last night," the receptionist answered.

"Is Mr. Smith there?” repeated the client.

The receptionist was perplexed. "Perhaps you didn't understand me I'm afraid Mr. Smith passed away last night."

"Is Mr. Smith there?” asked the client again.

"Ma'am, do you understand what I'm saying?” said the exasperated receptionist. "Mr. Smith is DEAD!"

"I understand you perfectly," the client sighed. "I just can't hear it often enough."

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21st Perfect Health Mela 15th October 2014



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Avoid these foods for a healthier heart

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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 – 101090 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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Hands–only CPR 10 English
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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 of pulmonary Koch on ATT complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

Twitter of the Day

Dr KK Aggarwal: Keep the label of bad cholesterol in your body <80mg %
Dr Deepak Chopra: The bond between God and humankind is a living one. Faith alone will not bring it into your life

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 an opinion on phone has no legal liability

No legal liability will fall upon the doctor as there is no contract between him and the patient. For negligence to be proved there has to be a duty, breach of that duty and resultant damage. In this case there will no breach of duty. Only if the specialist has charged fee for his opinion from the patient (patient can sue) or from the physician (patient and doctor both can sue), he or she is liable. If the fee has been paid by the referring physician, it will be deemed to be paid by the patient.

medicolegal update
  1. Dear Dr. Aggarwal, Please accept my sincere congratulations for sharing such an important piece of information. I fully agree with your view and will definitely like to provide my input on the MOH website. I feel there should be separate criteria and rules for doing abortions before and after 12 weeks of pregnancy. I feel only Gynecologists (MD/MS) should have right to perform MTP after 12 weeks and only MBBS with training before 12 weeks. Some may argue about availability of these types of doctors in the interiors/countryside but this cannot be an excuse to everything. Does this mean if we do not have trained people to perform surgeries in very part of country, would Govt. allow alternative medicine doctors to perform surgeries? With kind regards, Dr. Ashutosh Aggarwal.

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues 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)