eMedinewS 8th August 2013, Thursday

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

Former US President George W Bush gets a heart stent

Former US President George W Bush received a heart stents in Texas (Dallas) after a blockage was discovered during a routine physical examination.

As a part of annual examination, he underwent a stress test which was positive. The CD angio of the heart was done which confirmed presence of blockages. Stent in him has started a debate in the medical community and raised a question whether he should have had the procedure or should have continued on medical treatment only. 

As per American Heart Association guidelines in asymptomatic individuals, even a stress test should not be a part of routine screening.

Most lifestyle interventional cardiologists would agree that only symptomatic patients should receive stents because the point of the procedure is to relieve the symptoms. You cannot make somebody who is not having any symptoms feel any better because they are already feeling great.

Doing routine screening without symptoms can end up with unnecessary procedures. Bush stent can only be termed as a VIP syndrome. Bush had no hypertension or any other modifiable risk factors and had low to very low heart blockages risk profile.

The medical reports also showed that he had only minimal calcification of the coronary arteries. Instances like this send wrong message to the society and thousands of people will end up into unnecessary coronary stenting just because Bush got it. (with some inputs taken from Heart Wire).

Mediterranean diet and prevention of cardiovascular disease

A large randomized trial compared three diets in patients at high cardiovascular risk

  • A Mediterranean diet supplemented with olive oil
  • A Mediterranean diet supplemented with mixed nuts
  • Advice to reduce dietary fat

For the primary composite cardiovascular endpoint of heart attack, paralysis, and sudden death event rates were similar for the Mediterranean diets supplemented with olive oil and mixed nuts, and lower than for the control diet. Although this trial suggests possible substantial cardiovascular benefits from a Mediterranean diet, there was a surprisingly large reduction in events, a low total number of events, and the trial was stopped early for benefit after a median follow–up of 4.8 years.

A Mediterranean diet is typically high in fruits, vegetables, whole grains, beans, nuts, and seeds and includes olive oil as an important source of fat; there are typically low to moderate amounts of fish, poultry and dairy products, and there is little red meat. …Read More

Artificial sweeteners can cause diabetes

Consumption of non-caloric, artificially sweetened beverages is associated with an increased risk for obesity, type 2 diabetes, metabolic syndrome and cardiovascular disease.

This counterintuitive result reflects negative consequences of interfering with learned relationships between sweet tastes and typical postingestive outcomes, which may result in impaired ability to compensate for energy provided when caloric sweeteners are consumed.

The study by Dr Susan E Swithers at Purdue University, West Lafayette, IN published in July issue of Trends in Endocrinology & Metabolism found an elevated risk for weight gain and obesity, metabolic syndrome, type 2 diabetes, coronary heart disease, and hypertension in those who consumed ASBs. No decreased risk for weight gain or increased body fat percentage was associated with ASB intake. …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 Spiritual prescription: Meditation vs Concentration

Meditation is not concentration. Concentration is holding the mind to something within or outside the body. On the other hand, meditation is an unbroken flow of thoughts towards the object of concentration. It can be called prolonged concentration. Meditation is like pouring of oil from one vessel to another in a steady unbroken stream.

Samadhi or absorption is when the object of concentration and the mind of the perceiver becomes one. When Concentration, Meditation and Samadhi are brought to bear upon one subject it is called Samyam.

According to yoga sutras of Patanjali, (3.1–3.6), meditation needs to be learnt and applied step by step. The practice starts by sitting straight with erect spine, preferably in Padmasana (one can also sit on the chair) and concentrate on the breathing or on a primordial sound given by the teacher.

When the mind can be made to flow uninterruptedly towards the same object for 12 seconds, one is said to have learnt the process of concentration.

When the mind can continue in that concentration for 12 times (12 seconds × 12 i.e. 2 minutes 24 seconds), one is said to be practicing meditation.

When the mind can continue in that concentration for 12 times (12 minutes 24 seconds × 12 i.e. 28 minutes 48 seconds), one is said to be in Samadhi.

And if this lower Samadhi can be maintained for 12 times, i.e., for 5 hours 45 minutes and 36 seconds, one is said to be in Nirvikalpa Samadhi.

The mind becomes one-pointed when similar thought waves arise in succession without any gap between them.
One should remember that during meditation, the object of concentration may change in form, time and rhythm.

The whole process of meditation, therefore, varies from person to person and day to day. During meditation some may only concentrate, some may actually meditate and some may go into Samadhi. Most of us wander from concentration to meditation.

Once in meditation or Samadhi, by fixing the mind on various structures, internal or external, one can achieve siddhi powers. For e.g., by concentrating on the tip of nose one can acquire better smelling powers; by concentrating on the tip of the tongue, one can acquire supranormal tasting powers; by concentrating on the middle part of the tongue, one can acquire supranormal powers of sensation; by concentrating on the root of the tongue, one can acquire supra normal hearing; and by concentrating on palate one can acquire supra natural colour perceptions. With experience, one can concentrate upon any object of any size, from the atom to the infinity.

Just as pure crystal takes colour from the object nearest to it, the mind when cleared of thoughts achieves identity with the object of concentration.

Primordial sound (beej mantra) meditation is based on the principle that the initial one–point concentration on a particular sound (seed) over a period of time becomes seedless or thoughtless (yoga sutras of Patanjali 1.51).

Swami Vivekananda co–related it with Raj Yoga and said that our average span of attention on a particular object is only around three seconds. He said that if one is able to increase this attention span and concentration at an object of our choice for 12 seconds then we are practicing Patanjali’s sixth stage of yoga or ‘dharana’, which translates as contemplation. And if we can further increase our concentration ability to 12 × 12 seconds or for 144 seconds, then we have reached the mental plateau of meditation or ‘dhayana’. Swami Vivekananda further went on to attribute values to the exalted state of samadhi or transcendental conscious mental state which in value is termed as arising from a meditative or concentration span of 12 × 12 × 12 seconds, which is 30 minutes or half an hour.

Vedanta describes it in terms of units. It says that if you can concentrate 12 seconds on a subject uninterruptedly, it becomes one unit of concentration; 12 such units of concentration make one unit of meditation; 12 units of meditation lead to the first stage of samadhi and 12 units of this samadhi lead to the highest samadhi, the supreme realization of Atman. Dharana is concentration; Dhyana is meditation and Samadhi is trance.

Patanjali called them as ‘Matra: If you are able to sit, withdraw the mind and fix it upon a focal point within (it may be gross, subtle or anything), and are able to keep the mind fixed like that for a period of twelve Matras – a Matra is approximately a moment or a second – it is counted as ‘one concentration’. It says "If you can keep the mind steady without moving, without any contrary thoughts coming in, and without moving away from the object of concentration for a period of twelve Matras, it is regarded as ‘one Dharana or one concentration". He further says that one should go on practicing this Dharana for days and weeks and months so that it becomes longer and longer. By continuous practice, if one is able to keep the mind focused upon one single point without moving here or there, for 144 seconds (a period of twelve Dharanas), then the person is called Dhyani or a Dhyana Yogi.

Yoga sutra of Patanjali (3.6) clearly says that meditation must be learnt in stages. It calls for repeated practice of meditation. The three basic components of meditation are: The subject of meditation, the center of consciousness at which the mind is held, and the method employed to guide the mind to concentration. The subject of meditation may be the non–dual all–pervading Self, any specific aspect of the divine, or any divine incarnation. The center of consciousness may be at the heart, or between the eyebrows, or at the crown of the head. The method employed to invoke concentration may be any of the following: Japa, or repetition of a sacred word; discrimination between the real and the unreal; dispassion, which is knowing the evil effect of sense–enjoyment; pranayama, or control of breath and ceremonial observances.

But regularity is most important. One can start with looking at any object – flame, idol, or picture for 12 seconds with total concentration and without blinking eyelids (concentration). And then one practices 12 concentrations to make one meditation. The proper meditation thus need not last more than 2 minutes 24 seconds. ….Read More

cardiology news

Helping old people without spending money

  1. Give up seat to an old person on a crowded bus or train
  2. Let older people into queue in front to you
  3. Invite them to join in celebrations or cook a little extra food and share with an older person
  4. If you can sew, help repair their clothes or help them with other practical repairs or cleaning
  5. Together, community could repair their homes or even build them new ones
  6. Young people could visit people and talk with them
  7. A lot of older people have led very interesting lives. Interview them and write down their stories
  8. Look out for lonely older people and visit them. Include all older people in the life of community.

….Read More

News Around The Globe

  • MCI News: 30. Violation of MCI’s code of ethics by the Indian Academy of Pediatrics (IAP)–Reg: The Ethics Committee considered the matter with regard to violation of MCI’s Code of Ethics by the Indian Academy of Paediatrics and noted that this item needs detailed study of all records and accordingly, it was decided to be sent to one of the Ethics Committee Members viz. Dr. Rama V. Baru, for its presentation in the next meeting.
  • The current standard of treatment for colorectal cancer is dependent on the stage of cancer at the time of diagnosis but may involve chemotherapy, radiation, surgical resection, or a combination of these therapies. Aspirin, widely used for its antiplatelet and anti–inflammatory effects, has been studied as adjuvant therapy for colorectal cancer, with promising results.
  • In a study reported in JAMA Ophthalmology, women with dry eye disease had a greater overall sensitivity to pain and lower pain tolerance than women without the condition. They had significantly lower scores on tests for heat pain sensitivity (a measure of overall pain sensitivity) and heat pain suprathreshold (a measure of pain tolerance) than women who did not have dry eyes.
  • Exercise may be no better than sitting on the sidelines when it comes to relieving hot flashes during menopause. In the study, women participating in a 12–week exercise program did not report significant changes in the number or intensity of hot flashes, or vasomotor symptoms (VMS), compared with sedentary women who followed their usual level of activity. (Source: Medscape)
  • In patients with celiac disease (CD), persistent villous atrophy may be associated with certain types of lymphoma, according to the findings of a population–based cohort study reported in the August 6 issue of the Annals of Internal Medicine. (Source: Medscape)
  • The FDA has issued new standards for labeling foods as ‘gluten–free’ to protect patients with celiac disease. Under the new rules, any food bearing a gluten–free label must contain less than 20 parts per million. The European Union and Canada have implemented the same gluten–free standards. Food manufacturers have one year to comply with the rule. Foods labeled "no gluten," "free of gluten" and "without gluten" must also meet the standard. (Source: Medscape)
  • A new study published in the August issue of the American Journal of Infection Control has observed that even a moderate increase in vancomycin–resistant enterococci (VRE) in a single hospital can significantly increase rates in other hospitals in the same region. According to Bruce Y. Lee, MD, from the Public Health Computational and Operations Research and the Graduate School of Public Health, University of Pittsburgh, Pennsylvania, and colleagues, being aware of dynamic relationships among hospitals within the same region could have important implications for developing policies and making decisions regarding infection control. (Source: Medscape)

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Rabies News (Dr. A K Gupta)

Why do some people fear the vaccine?

In the past, rabies vaccine was a sheep brain derived Nerve Tissue Vaccine (NTV) and was associated with considerable side effects. Large volumes and a number of injections were required. So, rabies vaccine acquired the dubious reputation of a dangerous vaccination. However, these fears are no longer justified with modern rabies vaccines that are very safe.

cardiology news
  • A new scientific statement from the American Heart Association says that better communication is the key to improving patient outcomes after cardiac surgery. A wide–ranging review of evidence published online in the journal Circulation, led by Joyce Wahr, MD, of the University of Michigan Ann Arbor, called for such things as checklists, preoperative and postoperative briefings, and team training in communication skills. (Source: Medpage Today)
  • Riociguat (proposed trade name Adempas), the soluble guanylate cyclase (sGC) stimulator, won the unanimous support of the FDA Cardiovascular and Renal Drugs Advisory Committee to recommend approval of the drug for both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). If ultimately approved, it would join three classes of drugs already cleared for use in PAH –– phosphodiesterase type 5 (PDE5) inhibitors, prostanoids and endothelin–receptor antagonists –– and become the first pharmacologic therapy for CTEPH, for which the standard treatment is pulmonary endarterectomy. (Source: Medpage Today)

Valvular Heart Disease News

Mitral valve repair produces good results in elderly patients. The operative mortality is 3.8 percent and 1.3 percent required reoperation for residual mitral regurgitation.

(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
  • A study by autism expert Simon Baron–Cohen at Cambridge University’s Autism Research Centre found that compared to typical girls, those with anorexia have an above-average number of autistic traits. They were also found to have an above–average interest in systems and order, and below-average scores in empathy – a profile similar, but less pronounced, to that seen in people with autism, suggesting the two disorders may have common underlying features. (Source: Medscape)
  • Two controlled trials observed similar outcomes with use of nasal prongs or face masks in preemies who needed respiratory support in the first 24 hours after birth. According to Dr. C. Omar F. Kamlin and colleagues, this can be interpreted as the study provides evidence not to change practice – if you are a center who routinely uses a nasal tube and train your staff accordingly, then continue. The vast majority of health care providers use a face mask, so the same logic applies here. (Source: Medscape)
cardiology news

Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.

  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or UC.
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of ulcerative colitis (UC) was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non-significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.

…Read More

cardiology news

The effect of viewing violence depends upon the amount, the context in which it is seen, and the social message that accompanies the presentation. Televised violence differs from real violence in ways that affect its impact on children and adolescents. Media violence often is perceived as socially acceptable and without consequence.

cardiology news


CPR 10 Camp – E Book Balwant Rai Mehta School, G K – 2, New Delhi

Total CPR since 1st November 2012 – 59389 trained

CPR Classes: Persons trained (3193)

5th August: CPR 10 at Universal Public School (1078)

6th August: CPR 10 at Moolchand (30)

7th August: CPR 10 at Moolchand (27)

CPR VIP Sensitization

CPR Classes 59389

Video Chats and uploads

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News JULY

Media advocacy through Print Media

2nd August: Hari Bhumi, 3rd August: Vir Arjun , 4th August: Amarujala , 4th August: Dainik Jagran , 4th August: Deshbandhu , 4th August: Hindustan, 4th August: Hindustan Times, 4th August: Loksatya, 4th August: Rashtriya Sahara, 4th August: Rastriya Sahara, 4th August: Shah Times, 4th August: Veer Arjun, 4th August: Virat Vaibhav , 6th August: Saha Times , 6th August: Veer Arjun , 7th August: Loksatya, 7th August: Just Zindagi–Sunday Navbharat Times

Media advocacy through Web Media

Low BP may be normal 7th August


Eating refined sugar can cause diabetes 6th August


Shorter acting calcium channel blockers linked to breast cancer

As per a report published in the journal JAMA Internal Medicine, risk of breast cancer more than doubled in post–menopausal women who took calcium channel blockers for 10 years or longer, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

No increased risk of breast cancer was observed among women taking diuretics, beta blockers, ACE inhibitors or AR blockers.

This is another study which confirms that no drugs are safe if taken for longer period of time.

Every effort should be made to reduce or get rid of them by adopting to proper lifestyle interventions.

The study needs a replication because if the study is true, it will mean that a major modifiable risk factor for breast cancer will be Calcium Channel Blockers.

The data also suggests a great risk of the cancer among current users of shorter acting calcium channel blockers which are fortunately not in popular use for the management of hypertension in today’s practice.

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 59389 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 10×10 i.e. 100 per minute."

today emedipics

Heart Care Foundation of India Organizes a CPR 10 Training camp at Balwant Rai Mehta School, Greater Kailash, Part 2, New Delhi on 2nd August 2013.

press release

Statins may worsen asthma

today video of the dayDr KK Aggarwal on Doctors Day SAHARA SAMAY News

Dr KK Aggarwal on How to Stay Fit

Smart Phones Benefits and Hazards

eMedi Quiz

Read this…………………

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?

a. Encouraging coughing and deep breathing
b. Promoting carbohydrate intake
c. Limiting fluid intake
d. Providing pain–relief measures

Yesterday’s Mind Teaser: A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the clientís risk of:

a. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
b. A decreased serum phosphate level secondary to kidney failure.
c. An increased serum calcium level secondary to kidney failure.
d. Metabolic alkalosis secondary to retention of hydrogen ions.

Answer for yesterday’s Mind Teaser: a. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

Correct answers received from: Dr Arpan Gandhi, Dr Jainendra Upadhyay, Dr. V.P. Thakral, Rajeev Karvande, Dr.K.V.Sarma, DR AVTAR KRISHAN, Dr Pankaj Agarwal, Dr Chandresh Jardosh Muthumperumal Thirumalpillai, daivadheenam, Dr Kanta Jain, Dr B K Agarwal, drpksahu, Dr Valluri Ramarao

Answer for 6th August Mind Teaser: c. an increased serum calcium level secondary to kidney failure.

Correct answers received from: DR AVTAR KRISHAN, Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

eMedi Apps

medicolegal update

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medicolegal update

Getting Dressed

Hospital regulations required a wheelchair for patients being discharged. However, while working as a student nurse, I found one elderly gentleman – already dressed and sitting on the bed with a suitcase at his feet – who insisted he didn’t need my help to leave the hospital.

After a chat about rules being rules, he reluctantly let me wheel him to the elevator. On the way down I asked him if his wife was meeting him.

"I don’t know," he said. "She’s still upstairs in the bathroom changing out of her hospital gown."

medicolegal update
medicolegal update

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medicolegal update

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough is mostly due to viral infection.

medicolegal update

A successful person is one who can lay a solid foundation from the bricks what others have thrown at them.

medicolegal update

Dr KK Aggarwal: Low BP may be normal By Dr K K Aggarwal http://bit.ly/16wknsh #Health

Dr Deepak Chopra: Those who make wise choices in life should wind up happier & more successful

medicolegal update

One rarely finds doctors like Dr. NK Gupta and Dr. Rustogi these days. Hope your inspirational story will give some inspiration to this generation to live a bit for others too. Dr. Sushma Chawla

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