eMedinewS9th February 2014, Sunday

Dr K K AggarwalPadma 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; Chairman Ethical Committee Delhi Medical Council, 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

One fourth Diagnostic Catheterizations Inappropriate: NY Study

One in four patients who underwent recent diagnostic caths in 18 New York state hospitals to detect suspected heart blockages were not appropriate candidates for this procedure, based on new criteria.

Among the patients who had undergone inappropriate diagnostic catheterization, 57% had no chest pain, no previous stress test, and a low to intermediate Framingham global CAD risk score. The study was published online January 28, 2014 in Circulation: Cardiovascular Interventions.

Of the 8986 patients who could be rated for appropriateness, 35.3% were rated as appropriate, 39.8% as uncertain, and 24.9% as inappropriate.
Of the 2240 patients rated as inappropriate:

  • 56.7% were asymptomatic, had no previous stress test, and had low or intermediate global coronary artery disease risk.
  • 36.0% had a previous stress test with low-risk findings and no symptoms.
  • 7.3% were symptomatic, had no previous stress test, and had low pretest probability
Dr K K Aggarwal on Zee TV

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 mantra
VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Prayer for Inner Happiness

sprritual blog

Stress is defined as the physical and mental reaction to the interpretation of a known situation. In absence of a known situation there cannot be a stress. One cannot be stressful for a person who has just died in New York in an accident unless he or she is a known person.

There has to be a right, conscious based interpretation of the situation as the same situation can bring happiness to one and stress to the other.

The most important consequence physical or mental of stress, therefore, depends on the right interpretation of the situation.

The interpretation or judgment in the body is governed by chemical reactions and is controlled by the balance of autonomic balance system, which in turn is governed by the interaction of parasympathetic and sympathetic nervous system.

During the phase of acute stress when the sympathetic system is predominant, heart rate and blood pressure rises and a person cannot take correct and decisive decision. He or she is likely to make mistakes, which can often be detrimental to living. Sympathetic mode is basically the mode of flight or fight reactions of the body.

Right conscious–based decisions can only be taken in a state of relaxed mind when the intention is inserted in the field of consciousness. The relaxed mind state of the body is the parasympathetic mode which is healing and is evident by reduction in heart rate, blood pressure and increase in the skin resistance. Most conscious based decisions will be based on truthfulness, will be necessary and will bring happiness to both the persons and the surroundings.

The yogic lifestyle by which a person learns the dos and don’ts of living, does regular practice of correct postures, daily pranayama and practices regular withdrawal from the outer atmosphere, helps in preparing a state of physical and mental body state, which is more receptive for conscious-based decisions. Yoga Sutras of Patanajali included them in his ashtanga yoga as the processes of Yama, Niyama, Asanas, Pranayama and Pratihyar.

Prayers have no value when the mind is not at rest. All of us have participated in hundreds of mourning prayers with two minutes of silence. This prayer has no value if the two minutes of silence is not observed. If prayer is done without it the mind will remain restless and we will keep on thinking these two minutes are not over yet. The process of silence does shift our awareness towards test and parasympathetic state and temporarily we get to be in contact with the memories of the departed soul and we pay homage to him or her.

Today a large number of organizations are teaching the process of meditation but the same cannot be taught unless a person practices procedures by which the mind gets relaxed.

The eight limbs of Patanjali focus in detail about premeditation preparations and once that is learned one can go to the other three limbs which are Dharna, Dhyana and Samadhi.

Yoga asanas are different from exercises. They stimulate and stretch all or one of the seven charkas, autonomic plexuses, and ganglion and there located ductless endocrine glands. Also during a yogasana the mind is in the exercise and not wondering here and there.

While yogic exercises at rest are termed yoga asanas and the same yogic meditative exercises with activity are called traditional Indian dances. Western exercises and dances do not follow the principles of yoga. Many international studies have shown that over one–third of the people during their lifetime pray either for their own illness or for somebody else.

All hospitals should have spirituals areas. The prayer and meditation rooms in a hospital setting invariably will provide an arena which will improve patient–doctor relationship and will reduce the rising disputes amongst them in the country.

cardiology news

Life is all About Choices

Michael is the kind of guy you love to hate. He is always in a good mood and always has something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!"

He was a natural motivator. If an employee was having a bad day, Michael was there telling the employee how to look on the positive side of the situation. Seeing this style really made me curious, so one day I went up to Michael and asked him, "I don’t get it! You can’t be a positive person all of the time. How do you do it?"

Michael replied, "Each morning I wake up and say to myself, you have two choices today. You can choose to be in a good mood or… you can choose to be in a bad mood. I choose to be in a good mood." Each time something bad happens, I can choose to be a victim or… I can choose to learn from it. I choose to learn from it.

Every time someone comes to me complaining, I can choose to accept their complaining or… I can point out the positive side of life. I choose the positive side of life. "Yeah, right, it’s not that easy," I protested.

"Yes, it is," Michael said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people affect your mood. You choose to be in a good mood or bad mood. The bottom line: It’s your choice how you live your life."

I reflected on what Michael said. Soon hereafter, I left the Tower Industry to start my own business. We lost touch, but I often thought about him when I made a choice about life instead of reacting to it.

Several years later, I heard that Michael was involved in a serious accident, falling some 60 feet from a communications tower. After 18 hours of surgery and weeks of intensive care, Michael was released from the hospital with rods placed in his back. I saw Michael about six months after the accident.

When I asked him how he was, he replied, "If I were any better, I’d be twins. Want to see my scars?" I declined to see his wounds, but I did ask him what had gone through his mind as the accident took place. "The first thing that went through my mind was the well–being of my soon–to–be born daughter," Michael replied.

"Then, as I lay on the ground, I remembered that I had two choices: I could choose to live or… I could choose to die. I chose to live." "Weren’t you scared? Did you lose consciousness?" I asked.

Michael continued, "… the paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the ER and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read ‘he’s a dead man’. I knew I needed to take action."

"What did you do?" I asked. "Well, there was a big burly nurse shouting questions at me," said Michael. "She asked if I was allergic to anything. ‘Yes, I replied.’ The doctors and nurses stopped working as they waited for my reply. I took a deep breath and yelled, ‘Gravity’." Over their laughter, I told them, "I am choosing to live. Operate on me as if I am alive, not dead!"

Moral of the story: Michael lived, thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything. After all, today is the tomorrow you worried about yesterday.

Life is about the little choices we make every day!

News Around The Globe

6th International Conference "Recent Advances in Cardiovascular Sciences" 31st January &1st February, 2014

Prof. Ramesh K Goyal Ph.D., FIC, FAMS, FIPS, FICN, FSCH, FIACS, FNASc
Former Vice Chancellor, the M. S. University of Baroda
Institute of Life Sciences, Ahmedabad University, Ahmedabad, Gujarat, India

Prof. Ramesh K. Goyal Ph.D., FIC, FAMS, FIPS, FICN, FSCH, FIACS, FNASc, Distinguished Professor, Institute of Life Sciences, Ahmedabad University, was the Vice–Chancellor of M.S. University of Baroda; Director (Pharmacology) at NMIMS University, Mumbai; Director ISF College of Pharmacy, Moga and Professor at L. M. College of Pharmacy. He has 35 years of teaching and research in Cardiovascular Pharmacology & Diabetes. He has 3 patents, 15 books, 278 full papers, 400 abstracts and guided 40 Ph.D. and 159 M. Pharm. students. He is the recipient of 61 awards including Best Pharmacy Teacher, Best Pharmaceutical Research Scientist, Life Time Achievement Awards of IACS, Canada. He has also visited several countries as Visiting scientist and for various conferences. He has been the President of Indian Pharmacological Society, Society of Pharmacovigilance (India) and Indian Society of Hypertension. He has served in several Committees of Human Clinical Trials, Animal Experiments and ‘Endosulfan Committee’ of Govt. of Gujarat.

Topic: Prevention and Treatment of Diabetes induced Cardiovascular Complications by Herbal Drugs: From Concept to Reality

Taking strategies of Reverse pharmacology and Translational Phytopharmacology, we have come up with new anti–diabetic drugs and possible leads from the herbal sources. Our earlier studies have established antidiabetic and antiobesity activities of various fractions of Enicostemma littorale using various animal models and isolated the active compound swertiamarin. This turned out to be not only the marker compound but was found to be responsible for majority of the actions studied. Our further studies reported that it is a potent HMG Co–A reductase inhibitor, increases adiponectin expressions in 3T3L1 cell lines and a possibility of some other targets enzymes in the lipid metabolism. Recently we could identify some targets that may prevent cardiovascular complications. We could have some semi–synthetic analogues and they were found to be potent antiadipogenicin 3T3 L1 cell lines. The activity of swertiamarin is identical to the most successful drug metformin that was first isolated from French plant Galelus officinale and was reported to be effective in malaria. In Ayurveda, liver is one of the principal organs described to be involved in diabetes. We also got leads from well-known plant Emblica officinale (Amla). It was gallotonnins and gallic acid that was fund to be responsible for the prevention of antidiabetic activity and cardiovascular complications. Similarly we found Rutin and Quercetin from the plant Tephrosia purpurea to be effective in diabetes–induced cardiovascular complications and cataract formation in eyes. Although evident in modern medicine, recently there is a growing interest in the liver emerging out as one of the major organs involved in the development of insulin resistance. Thus, there is an unmet scope in translating the ancient concepts in the light of recent innovations.

P38 MAPK Renders Cardio-Protection During Myocardial Infarction Via Parallel
Activation of α–Crystallin B and Nrf2

Arkadeep Mitra1, Aramita Ray1, Ritwik Datta1, Shantanu Sengupta2, Sagartirtha Sarkar1*
1Genetics and Molecular Cardiology Laboratory, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata – 700 019, India.
2Genomics and Molecular Medicine unit,CSIR–Institute of Genomics and Integrative Biology, SukhdevVihar, Mathura Road, New Delhi 110 020, India.
Introduction: Myocardial infarction (MI) is defined as cardiac cell death due to prolonged ischemia. Although necrotic cell death was considered to be solely responsible for myocyte death during MI, it was recently revealed that apoptosis also plays its part in this death process. Our laboratory has recently shown that endoplasmic reticulum (ER)–stress induced apoptosis is the predominant route for apoptosis during MI and the conventional mitochondrial pathway is bypassed by activation of a small heat shock protein α–crystallin B (CRYAB)1. Since CRYAB is a direct target of P38 Mitogen activated protein kinase (MAPK) cascade, we were prompted to check the role of P38 MAPK in 20 week old male Wister rats immediately after infarct formation.
Methods: 24 weeks old male Wister rats (n=10 in each group), were used to generate MI by intraperitoneal injection of synthetic catecholamine Isoproterenol hydrochloride (Sigma–Aldrich, MO) in sterile normal saline (100mg/kg body weight/day) a ß-adrenergic agonist for two consecutive days. A ligation model of MI was also generated by occlusion of left anterior descending coronary artery (LAD), and the animals were euthanized after 10 days of ischemic period. Two other groups of Wister rats were administered with SB203580 (1mg/kg body weight/day; Calbiochem, MA) – a specific inhibitor for P38a and P38ß along with either Isoproterenol treatment or during LAD ligation.
Results and Discussion: Interestingly, parallel activation of mitochondrial apoptotic pathway with an increase in ER–stress induced apoptotic load was observed along with decreased activation of CRYAB and Nrf2 (a prosurvival protein activated in response to ER stress) in MI rats treated with SB203580, a specific inhibitor of P38a and P38ß compared to the MI alone. As a cumulative effect, this inhibitor treatment also resulted in significant increase in the levels of caspase3 activity and TUNEL positivity, the end point apoptotic markers. Furthermore, SB203580 treated hypoxic adult cardiomyocytes showed formation of desmin aggregates which were previously associated with impaired cardiac function. Conclusion: Thus, this study shows for the first time the precise mechanism by which P38 MAPK plays a pro–survival role and confers protection of cardiomyocytes, during infarct formation.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

Can rabies vaccine be given to a child with chicken pox or measles?

As rabies is 100% fatal, there is no contraindication for antirabies vaccination. Rabies vaccine can be given to a child with chicken pox or measles and it is effective. If possible administration of measles vaccine should be postponed by a fortnight after the completion of antirabies immunization.

cardiology news

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management along with empirical treatment is unsuccessful or who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity..

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. The examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

Hurry, worry and curry are the three main factors for causing acidity apart from alcohol and smoking. People with acidity should consume less of fermented, sour, salty and pungent foods.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Swapping snacks — such as potato chips — for low–fat yogurt can cut the risk of developing type 2 diabetes by almost half, according to the results of a new observational study. The findings, involving a randomly selected subgroup from the larger EPIC–Norfolk study, were published online February 5 in Diabetologia by Nita G. Forouhi, MBB, PhD, from the Medical Research Council (MRC) Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom, and colleagues.
  • Two new studies provided support for depression as a treatable cause of coronary heart disease. The first, reported online in the European Journal of Preventive Cardiology, which relied on repeat measures of depressive symptoms over 2 decades of follow–up, demonstrated dose–response relationships between depression and both coronary death and nonfatal myocardial infarction, but not stroke. The second, a post hoc analysis of a randomized trial reported in the January issue of Psychosomatic Medicine, showed that an intervention to treat depression in older adults reduced the risk of hard cardiovascular events, but only in those who did not have pre–existing cardiovascular disease at baseline.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Half of parents with an overweight or obese child think their kids are slimmer than they actually are, according to a new review of past studies. In 69 studies of more than 15,000 children, researchers found many parents with an overweight child thought their son or daughter was at a healthy weight or below. Others with an obese kid thought the child was normal or just a bit heavy. If parents don’t recognize their child is overweight or aren’t concerned, they aren’t going to take steps to address it.
  • A randomized study of 168 children clinically diagnosed with ADHD and having severe physical aggression showed that those who received a 9–week treatment plan of risperidone (second–generation antipsychotic) in addition to a psychostimulant and behavioral parent training showed significant improvements on measures of both aggression and serious behavioral problems compared with those who received the stimulant plus PT only. The study was published in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

Heart disease starts in youth

Autopsy studies of young people who died in accidents have shown that by the late teens, the heart blockages, the kind of lesions cause heart attacks and strokes are in the process of developing, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association.

Quoting a study published in the journal Circulation, Dr Aggarwal said that it is never too early to start protective measures against heart disease.

The best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early. More than a third of children and adolescents are overweight or obese.

The first signs that men are at higher risk of heart disease than women appear during the adolescent years despite the fact that boys lose fat and gain muscle in adolescence, while girls add body fat.

Between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increases in the boys and drops in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, go down in boys but rise in girls.

Blood pressure increases in both, but significantly more in boys. And insulin resistance, a marker of cardiovascular risk, which is lower in boys at age 11, rise until the 19.

Any protection that the young women have for cardiovascular protection can be wiped out by obesity and hence obesity in girls at any cost should be handled on priority.

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 86664 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."

emedipicstoday emedipics

CPR Training, Chinmaya Vidyalaya at Vasant Vihar, Delhi 4th February 2014

press release

Depression linked to paralysis

vedio of day

today video of the dayPadma Shri & Dr B C Roy National Awardee, Dr KK Aggarwal on Tackling tension headaches

Hands only CPR 10 Utsav, 15th December 2013

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

eMedi Quiz

Which one of the following is a recognized X–ray feature of rheumatoid arthritis?

1. Juxta–articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri–articular calcification.

Yesterday’s Mind Teaser: High resolution computed tomography of the chest is the ideal modality for evaluating:

1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Answer for yesterday’s Mind Teaser: 2. Interstitial lung disease.

Correct answers received from: DR.A.K.GAJJAR, Dr.K.V.Sarma, Niraj K. Gupta, Dr.K.Raju, Dr Pankaj Agarwal, Dr.(Maj. Gen.) Anil Bairaria, Abhay Naik, Muthumperumal Thirumalpillai

Answer for 6th February Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Abhay Naik, Dr Chandresh Jardosh, Dr Prajakta Sambarey, Tukaram Pagad

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update
medicolegal update

Last year I replaced all the windows in my house with those expensive, double–pane, energy–efficient kind.

Today, I got a call from Home Depot who installed them. He complained that the work had been completed a year ago and I still hadn’t paid for them.

Helloooo… just because I’m blonde doesn’t mean that I am automatically stupid.

So, I told him just what his fast–talking sales guy told me last year… that these windows would pay for themselves in a year. Helloooo…? It’s been a year, so they’re paid for, I told him.

There was only silence at the other end of the line, so I finally hung up. He never called back. I bet he felt like an idiot.

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.

medicolegal update

It costs nothing to dream, but everything if you don’t. Rita Davenport

medicolegal update

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Make the decision to be living in love - with yourself, your life, your whole world http://bit.ly/WAYHF_DC #WAYHF

Forthcoming events

Date: Saturday 2PM–Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

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