8th November 2014, Saturday

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

IMA Alert: Supplements and Drugs Can Be Dangerous Mix as the Combination can Alter Drug Absorption

Taking vitamins or other dietary supplements along with medications can be dangerous, warns Indian Medical Association. Dietary supplements can alter the absorption and metabolism of both prescription and over-the-counter medications. Dietary supplements may increase or decrease the effect of drugs.


  • St. John's Wort, a supplement, can make birth control pills less effective.
  • Both the herbal supplement ginkgo biloba and vitamin E can thin blood and if mixed with blood thinner warfarin or aspirin could increase the risk of internal bleeding or stroke.
  • Warfarin is the most frequent pharmaceutical implicated in interaction and St. John's wort the most frequent herb.
  • Herb-induced alteration in the metabolism of cytochrome P450 enzymes is the most common mechanism implicated in herb-drug interactions.
  • The hyperforin component of St. John's wort induces the CYP3A4 system which metabolizes a number of drugs including protease inhibitors, cyclosporine, oral contraceptives, irinotecan, warfarin, and digoxin. Failure of anti-retroviral therapy, transplant rejection, and contraceptive failure have been reported. In addition, St. John's wort may produce the serotonin syndrome when taken with other serotonergic medications.
  • Ginkgo biloba has antiplatelet and antithrombotic effects and therefore has the potential to interact with anticoagulants such as warfarin, NSAIDs, and aspirin, leading to an increased risk for spontaneous hemorrhage and bleeding.
  • Concomitant ingestion of grapefruit juice and certain dihydropyridine calcium channel blockers may elevate the plasma concentration of the latter, possibly leading to hypotension.
  • Grapefruit juice increases the bioavailability of certain calcium channel blockers by inhibiting the cytochrome P450 3A4 (CYP3A4) isoenzyme found in the liver and gut wall. The result of this inhibition is that more drug is absorbed and plasma concentrations increase.3. In US alone over 72 million people in the United States who are on a prescription medication also took some type of dietary supplement.


  • There is no substitute for eating a healthy diet, and products labeled as "natural" or "herbal" are not necessarily harmless. Natural does not always mean safe.
  • Children's metabolisms are so unique, that at different ages they metabolize substances at different rates. Parents should be cautioned about the relative lack of studies demonstrating efficacy and safety of herbal medicines in infants and children. Additional concerns are proper dosing in this age group, greater susceptibility to potential contaminants, and uncertainty of product quality
  • Caution should be exercised in the elderly due to possible decreased renal and hepatic clearance of herb and drug metabolites. In the elderly population taking multiple medications, there is a greater potential for herb-drug interactions
  • Herbs may impact surgery through altered coagulation (ginkgo, ginseng, garlic), cardiovascular stability (ephedra), glucose control (ginseng), anesthesia (valerian, kava), and increased metabolism of perioperative medication (St. John's wort). Case reports of perioperative bleeding associated with ginkgo biloba and saw palmetto have been reported. IMA recommends avoiding herbs for at least two weeks prior to surgery
  • People planning to have surgery should inform their doctor of every medication and supplement they use. It may be necessary to stop taking supplements a few weeks before an operation to avoid potentially serious changes in heart rate, blood pressure or bleeding risk.
  • Given the current paucity of data women who are pregnant, contemplating pregnancy, or lactating should generally be discouraged from using herbal treatments. Women who are pregnant or breast-feeding should talk to their doctor about any supplements they take.
  • Before you take any dietary supplement or medication -- over-the-counter or prescription -- discuss it with your doctor. Every time you visit the doctor, bring a list of all the dietary supplements and medications you take. This list should include dosages and frequency.
  • Tell your doctor if your health has changed, including any recent illnesses, surgeries or other procedures.
  • You should also tell your doctor if you are pregnant or breast-feeding.

(Source: USFDA)

News Around The Globe

  • The Society for Integrative Oncology (SIO) has published the first clinical practice guidelines on integrative therapy in breast cancer, which allow specific therapies to be recommended as evidence-based supportive care options. The guidelines are published in the Journal of the National Cancer Institute Monographs.
  • A prophylactic hepatitis C virus (HCV) vaccine, ChAd3/MVA, produces a long-lasting, sustained T-cell response that is characteristic of the T-cell response associated with a controlled HCV infection. The vaccine has been evaluated in humans, and is now ready for phase 2 efficacy studies. Results from the phase 1 trial were published online November 5 in Science Translational Medicine.
  • A new study published online November 5 in Neurology has suggested that cyclooxygenase-2 (COX-2) inhibitors are associated with an increased risk for stroke mortality. Researchers noted that 30-day mortality from stroke increased by around 20% if patients were taking a COX-2 inhibitor before admission.
  • For patients with early rheumatoid arthritis (RA) who achieve remission with etanercept/methotrexate therapy, continuing the combination at a lower dose results in better disease control than treatment with methotrexate alone or placebo, suggests a study published in the November 6 issue of the New England Journal of Medicine.
  • Preoperative vitamin D deficiency significantly increases the risk for postoperative hypocalcemia in thyroid-cancer patients undergoing total thyroidectomy and central compartment neck dissection (CCND), suggests new research presented at the 2014 Annual Meeting of the American Thyroid Association.
  • Diabetics do not fast for lipid tests as per an article in November issue of Postgraduate Medicine. There is little difference in LDL-cholesterol levels between tests done in fasted vs nonfasted states and the two testing modes equally predict mortality. In addition, capturing postprandial triglyceride spikes may actually better predict cardiovascular risk. Fasting is inconvenient and can even be dangerous, because of the risk for hypoglycemia in patients with type 1 diabetes and in those with type 2 diabetes who use insulin or sulfonylureas.
  • The ACEP board of directors approved five recommendations for patients seen in the emergency department.

Choosing Wisely in the Emergency Department

Avoid ordering head CT in asymptomatic adults with syncope, insignificant trauma, and normal results of a neurologic evaluation

Avoid ordering CT pulmonary angiography in patients with a low probability of embolism who either meet the Pulmonary Embolism Rule-out Criteria or have a negative D-dimer test

Avoid ordering lumbar spine imaging for adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition

Avoid prescribing antibiotics for patients with uncomplicated acute sinusitis

Avoid ordering CT of the abdomen and pelvis in young, otherwise healthy patients with known histories of ureterolithiasis who present with symptoms consistent with uncomplicated kidney stones

Dr KK Spiritual Blog

The Science of Power

Power is the ability to influence others to get a work done the way you want it.

We have seen evolution in the way power works. There was an era when Brahmins ruled using the power of knowledge, then came the era of Kshatriyas, who ruled using physical power. This was followed by the age of Vaishyas ruling the world with the power of money and a time will come when Shudras will rule with the power of their work.

In one of his lectures, Deepak Jain from Kellogg’s said that the world has seen eras of physical power, economical power and the time has come that it will now be ruled by the power of human resources.

Former Governor of Mizoram A R Kohli, in one of his talks, said that there are four types of powers which govern the universe and these are – physical power, economical power, the power of the chair (ego) and the power of the human resource, which is based on consciousness.

Everyone has these four inherent powers. The physical power is based on fear, tamas and rajas. The economical and the power of chair are linked to one’s ego and rajas. It is the power of human resource which is linked to the soul, consciousness and Satva.

The physical power is at the level of body, economic power is at the level of mind, the power of chair is at the level of intellect and ego and the power of human resources is at the level of soul. It is the power of human resource, which is based on Dharma and is universally accepted by all religions.

As per Mahabharata, the powers are the power of human resource (righteousness or Yudhishthir), power to remained focused (Arjun), power to fight injustice (Bheem), power to help others (Sahdev) and power to remain neutral during any adversity (Nakul).

In Vedic sciences, these powers are also defined as Ichhashakti (the power of desires to be with the consciousness), Kriyashakti (the power to do selfless work), gyanshakti (the power to learn about consciousness), chitta shakti (the power to take conscious based decisions) and anand shakti (the power for inner happiness).

The power of human resources talks about cultivating relationships. It is not based on the principles of survival of the fittest which is an animal behavior. The power of human resource believes in training and developing everyone to survive and become the fittest of the fit.

Inspirational Story


There are times when as a "stay at home Mom" I feel guilty. I sometimes feel as if I don't contribute enough to this family.

I have female friends who are in the field of education and in the medical field. I have female friends who are police officers and attorneys. I have friends that work through the church. Reverends, Nuns, Missionaries. Many of my female friends are waitresses, secretaries and bank tellers. I have a friend that owns her own cleaning business. Another that operates her own courier business.

All of them are making a contribution to mankind, to the world in which we live. Serving the average Joe and the elite.

Sadly, I sit and ponder what do I do for my family. Then it hits me! What am I thinking? How can I possibly even think that I don't contribute to this family!? No, I'm not paid a weekly wage but on a job application when the paper reads previous position held I could write the following:

I am currently employed by a small business operated by eight people. I volunteer many hours per week at my children's school. I am the cook, maid, laundress and seamstress. I also act as a nurse and at times a doctor. I am the gardener, the mail lady, and the exterminator. I drive a taxi making frequent trips throughout my tri-county area. I am the entertainment coordinator & dietician. I am a cheerleader, a coach and a referee. I am a teacher and a preacher. I am a hairstylist and a fashion designer. I am a psychologist, a psychiatrist and a pharmacist. I am honorable as the judge, jury & warden!

My list of qualifications can go on and on and on.

Okay, so I don't receive a paycheck to deposit in the bank every Friday...But then again, there isn't anyone that could afford to pay me an hourly wage based on my qualifications!

All those qualifications can be summed up in one word..."MOM"!

The Mom's job is one that offers the most joy & the most heartache. The most smiles & the most tears. The most laughs & the most arguments. All rolled into one.

I shouldn't feel guilty about not helping financially. I should just count my blessing that I am able to be home at any beckon call from my children.

Nope, I wouldn't trade my job for any other in the world!

Rabies News (Dr A K Gupta)

What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.

Cardiology eMedinewS

  • HbA1c levels predict left ventricular diastolic dysfunction and impaired filling pressures following ST-segment-elevation MI (STEMI), whereas fasting plasma glucose levels have poor prognostic value, suggests a new report published in the Canadian Journal of Cardiology.
  • A small molecule agent appears promising as a reversal agent for the novel anticoagulant edoxaban, suggest early-stage results. The synthetic agent, dubbed PER977, brought the whole-blood clotting time back to within 10% of an individual's normal baseline value within 10 minutes when given atop the factor Xa inhibitor. The findings are published online in the New England Journal of Medicine.

Pediatrics eMedinewS

  • Children with asthma who undergo adenotonsillectomy show significant improvements in several measures of disease severity, suggests a new study published November 4 in PLoS Medicine.
  • Infants with congenital human herpesvirus 6 (HHV-6) infection tend to have lower scores on a test of mental development at 12 months than babies without the infection, suggests new research published online in Pediatrics.

Quote of the Day

  • Of all the properties which belong to honorable men, not one is so highly prized as that of character. Henry Clay

Wellness Blog

Check your BMI to know chances of future heart attack

If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by body mass index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore this and go to your cardiologist to reduce your chances of a future heart attack.

A BMI of 20 to 23 kg/m2 is associated with little or no increased risk unless visceral fat is high, or the subject has gained more than 10 kg since 18 years.

  1. Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk.
  2. Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity.
  3. At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:

BMI = body weight (in kg) ÷ square of stature (height, in meters)

Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2.

ePress Release

Asthma patients should check with their doctor before going for holiday

People with COPD, emphysema and other serious lung diseases can safely travel by airplane, but they should be evaluated by their doctor before travel, 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 a study of 500 lung disease patients surveyed after a planned flight, British researchers reported in the European Respiratory Journal that 18 percent travelers suffered some type of respiratory symptom on the plane, most commonly shortness of breath, coughing and chest pain. However, the symptoms were typically moderate, and there were no serious incidents requiring an emergency landing.

eMedi Quiz

Injury to radial nerve in lower part of spiral groove:

1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Yesterday’s Mind Teaser: The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

1. Transitional
2. Stratified squamous
3. Stratified cuboidal
4. Stratified columnar

Answer for yesterday’s Mind Teaser: 1. Transitional

Correct answers received from: Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Avtar Krishan, Dr Poonam Chablani.

Answer for 6th November Mind Teaser: 3.Lateral rectus and abducent nerve.

Correct answers received from: Dr G Sahadevudu Geliv, Archna Parwani, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Poonam Chablani, Daivadheenam Jella, Dr Bipin Vyas, Dr Dushyant Kothari.

Send your answer to email

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21st Perfect Health Mela 15th October 2014



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Ventilator–associated tracheobronchitis

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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.

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Dr Good and Dr Bad

Situation: A patient on HCQS developed high fever.
Dr Bad: This is classical malaria.
Dr Good: Rule out other causes also.
Lesson: HCQS is hydroxychloroquine sulfate and effective against malaria.

Make Sure

Situation: A patient with large intestinal diarrhea developed sepsis after he was given antimotility drugs.
Reaction: Oh my God, Why was an antibiotic not given?
Lesson: Make sure that if antimotility drug is given in a large intestinal diarrhea, it is always given with an antibiotic.

eMedinewS Humor


A businessman called and had a question about the documents he needed in order to fly to China. After a lengthy discussion about passports, I reminded him he needed a visa.

"Oh no I don’t, I’ve been to China many times and never had to have one of those."

I double checked and sure enough, his stay required a visa.

When I told him this he said, "Look, I’ve been to China four times and every time they have accepted my American Express!"

Twitter of the Day

Dr KK Aggarwal: Walk at least 80min the a day brisk walk at least 80 min a week
Dr Deepak Chopra: Unless you devote time and attention to inward things, you are not seeking

medicolegal update

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

Not disclosing the names of doctors in the surgical team may be deficiency of service

Recently, the Kerala State Consumer Disputes Redressal Commission presiding members M.K. Abdulla Sona and A. Radha directed the Travancore-Cochin Medical Councils-Kerala (TCMC-K) to instruct all doctors to display their medical council registration numbers on their signboards and quote the register numbers in all prescriptions and all case sheets. The commission said that using the registration number in the doctors’ prescriptions, case-sheets and signboards would help patients to get all information about the doctor including their competency and possessed the required qualifications.

The commission said that the patient/consumer has the right to know the details of each doctor who accompanied the leader of the surgical team, including the anaesthesiologist. Any denial of this would be considered a deficiency of service and an unfair trade practice under the provisions of the Consumer Protection Act.

medicolegal update
  1. Dear Sir, very informative newspaper. Regards: Dr Shagun

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