eMedinewS10th February 2014, Monday

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

American Diabetes Association Releases New Nutritional Guidelines

The American Diabetes Association recommends all people living with diabetes make nutrition therapy a part of their diabetes treatment plan, but emphasizes that there is no single eating pattern that is best for everyone, according to a position statement published recently in Diabetes Care (not affiliated with DiabetesCare.net).

The 2013 statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriate portion sizes as part of an eating plan that takes into account individual preferences, culture, religious beliefs, traditions and metabolic goals.

Current evidence does not strongly support one eating pattern over another.

There is no conclusive evidence of an ideal amount of carbohydrate intake for people with diabetes.

Whatever carbohydrates are eaten should come from vegetables, whole grains, fruits, legumes and dairy products, over other sources that contain added fats, sugar or sodium.

Fat quality (eating monounsaturated and polyunsaturated fats and avoiding trans fats and saturated fats) appears to be more important than quantity.

Individuals working to manage their weight should still eat even good fats in moderation.

The new recommendations also state:

1. Diabetics should limit or avoid intake of sugar–sweetened beverages (from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiovascular risk profile. 
2. The recommendation for the general population to reduce sodium to less than 2300 mg per day is also appropriate for people with diabetes, with additional reductions individualized for those who have high blood pressure.
3. Diabetics do not benefit from use of omega-3 (EPA⁄DHA) supplements for the prevention or treatment of cardiovascular disease.
4. The recommendation for the general public, to eat fatty fish at least 2 times (2 servings) per week is also appropriate for people with diabetes. 
5. There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who do not have underlying vitamin or mineral deficiencies. Nor is there evidence to support the use of cinnamon or other herbs or supplements for the treatment of diabetes.

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

Why do we not touch papers, books and people with our feet?

sprritual blog

In every traditional gurukul, no studies start without chanting the following

Saraswati namasthubhyam
Varade kaama roopini
Vidyaarambham karishyaami
Sidhirbhavatu me sadaa

O Goddess Saraswati, the giver of Boons and fulfiller of wishes, I prostrate to You before starting my studies. May you always fulfill me?

Indian Vedas consider knowledge about self as the supreme knowledge and all tools for the same are considered sacred and divine and must be given respect. The traditional custom is not to step any sacred educational tool.

cardiology news

Praying Hands

Back in the fifteenth century, in a tiny village near Nuremburg, lived a family with eighteen children. Eighteen! In order merely to keep food on the table for this mob, the father and head of the household, a goldsmith by profession, worked almost eighteen hours a day at his trade and any other paying chore he could find in the neighborhood.

Despite their seemingly hopeless condition, two of Albrecht Durer the Elder’s children had a dream. They both wanted to pursue their talent for art, but they knew full well that their father would never be financially able to send either of them to Nuremburg to study at the Academy.

After many long discussions at night in their crowded bed, the two boys finally worked out a pact. They would toss a coin. The loser would go down into the nearby mines and, with his earnings, support his brother while he attended the academy. Then, when that brother who won the toss completed his studies, in four years, he would support the other brother at the academy, either with sales of his artwork or, if necessary, also by laboring in the mines.

They tossed a coin on a Sunday morning after church. Albrecht Durer won the toss and went off to Nuremberg. Albert went down into the dangerous mines and, for the next four years, financed his brother, whose work at the academy was almost an immediate sensation. Albrecht’s etchings, his woodcuts, and his oils were far better than those of most of his professors, and by the time he graduated, he was beginning to earn considerable fees for his commissioned works.

When the young artist returned to his village, the Durer family held a festive dinner on their lawn to celebrate Albrecht’s triumphant homecoming. After a long and memorable meal, punctuated with music and laughter, Albrecht rose from his honored position at the head of the table to drink a toast to his beloved brother for the years of sacrifice that had enabled Albrecht to fulfill his ambition. His closing words were, "And now, Albert, blessed brother of mine, now it is your turn. Now you can go to Nuremberg to pursue your ream, and I will take care of you."

All heads turned in eager expectation to the far end of the table where Albert sat, tears streaming down his pale face, shaking his lowered head from side to side while he sobbed and repeated, over and over, "No …no …no …no." Finally, Albert rose and wiped the tears from his cheeks. He glanced down the long table at the faces he loved, and then, holding his hands close to his right cheek, he said softly, "No, brother. I cannot go to Nuremberg. It is too late for me. Look what four years in the mines have done to my hands! The bones in every finger have been smashed at least once, and lately I have been suffering from arthritis so badly in my right hand that I cannot even hold a glass to return your toast, much less make delicate lines on parchment or canvas with a pen or a brush. No, brother… for me it is too late." More than 450 years have passed.

By now, Albrecht Durer’s hundreds of masterful portraits, pen and silver–point sketches, watercolors, charcoals, woodcuts, and copper engravings hang in every great museum in the world, but the odds are great that you, like most people, are familiar with only one of Albrecht Durer’s works. More than merely being familiar with it, you very well may have a reproduction hanging in your home or office.

One day, to pay homage to Albert for all that he had sacrificed, Albrecht Durer painstakingly drew his brother’s abused hands with palms together and thin fingers stretched skyward. He called his powerful drawing simply "Hands," but the entire world almost immediately opened their hearts to his great masterpiece and renamed his tribute of love "The Praying Hands."

The next time you see a copy of that touching creation, take a second look. Let it be your reminder, if you still need one, that no one – no one – – ever makes it alone!

God Bless Albert and Albrecht Durer.

Blessings, too, on those who sacrifice so that another may succeed. And blessings on those who truly appreciate the sacrifices made by others on their behalf.

News Around The Globe

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

Dr. Addepalli Veeranjaneyulu
Senior Prof. & Head, Pharmacology, School of Pharmacy and Technology Management (SPTM), NMIMS, Vile
Parle (W), Mumbai

Dr. Addepalli Veeranjaneyulu is presently serving as Sr. Prof. & Head, Pharmacology and coordinating the activities of Clinical Pharmacy at SPP, School of Pharmacy and Technology Management (SPTM), NMIMS, Mumbai. Prior to this, he was Visiting Scientist ⁄Professor at Shanghai Medical Foundation, China for a year (from 2006– 07) under the auspices of Canadian Heart Foundations Dr. Addepalli has 16 yrs Industrial New Drug Discovery Research experience, over SIX yrs as Asst Director (Pharmacology and Quality Assurance), NCER, at Lupin Research park, Pune and over 10 yrs as Research Executive (Pharmacology and Pharmacokinetics) in IDPL R&D, Hyderabad. His research areas of interest are Cardiovascular dysfunction and other – complications in Diabetes, Receptor Pharmacology, Serotonin – Serotonergic receptors- modulatory role in Migraine, Psychosis and other CNS disorders. He has guided 10 Doctoral Theses and presently guiding 2 Ph.D projects, from Academia and Industry. He is recognized Ph.D guide for Pune University, BITS, Pilani, Bharatiya Vidyapeeth and NMIMS University, Mumbai.

Topic: Combating Cardiovascular Complications of Diabetes by Targeting MMP–2 and MMP–9
A major cause of morbidity and mortality in diabetic patients is macrovascular disease affecting the heart and large vessels. In diabetes there is an excessive extracellular matrix thickening with collagen deposition. We hypothesized that interruptions of Matrix Metalloproteinase–2 (MMP–2) and Matrix Metalloproteinase–9 (MMP–9) may reduce the ensuing threatening risk factors of cardiovascular complications of diabetes by alteration in Extracellular Matrix. Using various synthetic analogues and naturally available MMP–2 and MMP-9 inhibitors we have targeted MMP–2 and MMP–9 for the amelioration of cardiovascular dysfunction of diabetes. Four weeks after diabetes induction (Streptozotocin, 55 mg/kg i.p.), rats were treated with MMP–2 and MMP–9 inhibitors for a period of next four weeks. At the end of eight week arterial pressure, heart rate and left ventricular pressure were recorded. Contractile response to phenylephrine (10–5 M) and relaxation responses to acetylcholine (10–9 to 10–4 M) were obtained from aortic rings of diabetic rats. Gel zymography was performed to evaluate MMP–2 and MMP–9 levels. Heart rate, mean arterial pressure, dp/dtmax and dp/ dtmin were found significantly decreased in STZ diabetic rats when compared with normoglycemic group. Treatment with MMP–2 and MMP-9 inhibitors significantly ameliorates these compared to vehicle treated diabetic group. Endothelium–dependent relaxation responses induced by acetylcholine were decreased in diabetic rats and significantly higher in treated groups. Collagen, MMP–2 and MMP–9 levels level were significantly decreased in treated groups when compared with diabetic control. Present study revealed that MMP–2 and MMP–9 inhibition ameliorate cardiovascular dysfunction of diabetes and can be an approach for the treatment

Prof. Arunabha Ray
Head, Dept. of Pharmacology
Vallabhbhai Patel Chest Institute, Faculty of Medicine, University of Delhi.

Prof. Ray is a medical graduate from the Calcutta University, with MD and PhD degrees in Pharmacology from the Faculty of Medicine, University of Delhi, and subsequently, he had postdoctoral training/experience in the USA and Canada. He has 35 years of teaching and research experience in basic and clinical pharmacology at undergraduate and postgraduate levels, and is actively involved in the teaching and supervising biomedical research activities of postgraduate as well as doctoral students in basic and clinical pharmacology and toxicology of the University of Delhi. He is prolific researcher and is one of the pioneers of NO research in India. He is actively pursuing extramurally funded projects in the area of Stress pharmacology, neuroimmune interactions and cardiorespiratory pharmacology with special reference to NO. He has been invited to several national and international conferences (including IUPHAR) to speak and/or chair sessions in his area of research. He is member of several technical/scientific advisory committees/boards in India and abroad. He has been the recipient of several awards and honors from apex scientific and professional bodies for his contributions in the area of medical education and biomedical research. He has more than 150 research publications and also authored/edited three books in his areas of expertise.

Topic: Experimental studies on methylxanthine induced cardiotoxicity
Methylxanthines are rapidly re–emerging as alternative/adjunct treatment modalities in obstructive airway diseases like bronchial asthma and COPD. Newer modes of action viz. anti–inflammatory and immunomodulatory effects have been proposed for these drugs and studies have indicated their beneficial effects in both clinical and experimental studies. However, their narrow therapeutic index and safety concerns have been a major problem associated with the use of this pharmacoeconomically viable agent. Cardiotoxicity (arrhythmias) and neurotoxicity (seizures) are common adverse effects, particularly on extremes of age, and the mechanisms for these toxicities are not clearly defined. Earlier studies from our laboratory had shown that neither phosphodiesterase inhibition nor adenosine antagonism was able to explain theophylline induced neurotoxicity and alternative mechanisms like oxidative stress could be involved. As cardiovascular adverse effects are also very common with the use of methylxanthines, which restrict their use, experimental studies were conducted to evaluate the possible mechanisms in such drug induced untoward effects. In anesthetized rats, heart rate, blood pressure and ECG were recorded by using the software based Biopac MP-36 system after saline and aminophylline treatments. Oxidative stress markers (MDA, GSH, SOD) were measured in blood using biochemical techniques. Our data showed that there was appreciable rise in the heart rate and mean arterial pressure in aminophylline treated animals as compared to controls. ECG recording showed that aminophylline induced marked dose related tachycardia and T wave inversion was seen in majority of rats treated with higher doses of the drug. These aminophylline induced cardiac effects viz. tachycardia, ischemia, were possibly not due to adenosine antagonism or PDE inhibition, as PDE inhibitors and adenosine agonists induced inconsistent effects on these parameters. Interestingly, alpha-tocopherol attenuated cardiotoxic effects of the drug. Aminophylline also induced changes in MDA, SOD and SGOT levels which were also attenuated by the antioxidant. Similar effects on cardiac and biochemical markers were also seen with subthreshold doses of the NO precursor, l-arginine and tocopherol. It is inferred that oxidative stress and ROS-RNS interactions could have contributed to the aminophylline induced cardiotoxicity and, further, anti-oxidants and NO mimetics could be used to protect against such aminophylline induced cardiotoxic effects.

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)

Is there a one–shot ARV? Is there any ARV that offers lifelong protection?

There is no single dose vaccine or a vaccine that gives lifelong immunity.

cardiology news

Vitamin D Facts

  • Calcium has an indispensable assistant in building bones: vitamin D.
  • Vitamin D helps the body absorb calcium.
  • Increasing vitamin D can help prevent osteoporosis.
  • A small amount of sun exposure can help the body manufacture its own vitamin D.
  • Five to 30 minutes of sunlight between 10 a.m. and 3 p.m. twice a week to your face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin
  • People with fair skin that burns easily should protect themselves from skin cancer by limiting sun exposure to 10 minutes or less.
  • Food and sun exposure should suffice, but if not, get 2,000 IU of vitamin D daily from a supplement
cardiology news

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

  • The presence of preoperative dysfunction in more than any one of four key organ systems profoundly reduces survival in patients undergoing surgical aortic valve replacement, a study showed. Presenting the study at the Annual Cardiovascular Conference at Snowmass, Dr. Vinod H. Thourani said that if you have two or more dysfunctional organ systems, you really need to think about what you’re doing for this patient. At 5 years, only about 40% of these patients are alive. It makes a lot of sense to me to say that if you have a patient with severe COPD and renal dysfunction, that patient should probably never get a surgical valve.
  • Daily low–dose aspirin, defined as 75 mg/day, was followed by a 42% mortality reduction over several years in a cohort of patients participating in a heart-failure disease-management program. Aspirin prolonged survival regardless of whether patients had a standard aspirin indication, such as ischemic heart disease, peripheral vascular disease, or stroke, reported investigators in their study, published online February 3, 2014 in Circulation: Heart Failure. There was no such survival benefit, however, at dosages higher than 75 mg⁄day, although both low- and higher–dose aspirin improved heart–failure hospitalizations.
cardiology news

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

  • Parents have long poured on cheese sauce, peanut butter and the like to coax kids to eat their vegetables, but a new study in the Journal of the Academy of Nutrition and Dietetics suggests those tricks might also get children to look more favorably at the vegetables themselves. Preschoolers introduced to Brussels sprouts alongside cream cheese to spread on the bitter vegetable more often said they liked the sprouts and ate more of them, even when later served plain. According to the authors, the strategy of pairing something new with something a person already likes is known as associative conditioning and could be helpful in encouraging kids – and adults – to eat more fruits and vegetables.
  • Clonidine is not an effective treatment for adolescents with chronic fatigue syndrome (CFS), according to a new randomized controlled trial in JAMA Pediatrics. In the study, while CFS patients who received clonidine showed an attenuation of sympathetic outflow and a reduction in systemic inflammation in comparison to those given placebo, they also had a relative drop in physical activity.
cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

Cholesterol tips released

Blood lipid levels may exhibit mild seasonal variation with a peak in total cholesterol levels in the winter and a drop in the summer. The variation can be up to 5 mg⁄dL, 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. Serum total and HDL⁄cholesterol can be measured in fasting or non–fasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non-fasting state.

The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness and posture. Values may also vary between different laboratories, with data suggesting that a single measurement of serum cholesterol can vary as much as 14 percent. Therefore in an individual with "true" serum cholesterol concentration of 200 mg⁄dL the range of expected values is 172 to 228 mg⁄dL. More than one measurement of total cholesterol should therefore be obtained when treatment considerations demand a precise determination. Measurement of serum HDL–C and triglycerides may demonstrate even greater variability.

A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL–cholesterol. Lipid profile should be performed after 12 to 14 hours of fasting to minimize the influence of postprandial hyperlipidemia. One can use either a plasma or serum specimen. The serum cholesterol is approximately 3 percent lower than the plasma value.

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

Monitoring LFT in a patient on statins

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

All of the following regarding aromatase inhibitors (AIs) are correct except:

1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.
2. AIs have been shown to reduce bone density, and increase the risk of fractures.
3. Aromatase inhibitors are not indicated in premenopausal women.
4. The musculoskeletal symptoms associated with the AIs are transient.

Yesterday’s Mind Teaser: What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Answer for yesterday’s Mind Teaser: C. About 30 percent of your daily calories.

Correct answers received from: Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Pankaj Agarwal, Dr Avtar Krishan, Deepali Chatterjee, Muthumperumal Thirumalpillai, DR.A.K.GAJJAR, Abhay Naik, Dr.K.Raju, Dr.Bitaan Sen & Dr.Jayashree Sen

Answer for 8th February Mind Teaser: 3. Bone erosions.

Correct answers received from: Dr Pankaj Agarwal, Dr Avtar Krishan

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update
medicolegal update

Nobel Prize

A man is driving down a country road, when he spots a farmer standing in the middle of a huge field of grass. He pulls the car over to the side of the road and notices that the farmer is just standing there, doing nothing, looking at nothing.

The man gets out of the car, walks all the way out to the farmer and asks him, "Ah excuse me mister, but what are you doing?"

The farmer replies, "I’m trying to win a Nobel Prize."

"How?" asks the man, puzzled.

"Well I heard they give the Nobel Prize to people who are out standing in their field."

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make Sure to prescribe nimesulide as it is safe in acid peptic disease.

medicolegal update

Shame occurs when you haven’t been able to get away with the ‘who’ you want people to think you are. Carl Whitake

medicolegal update

Dr KK Aggarwal: Stress may increase smoking habits http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Fear is the memory of pain. Addiction is the memory of pleasure. Freedom is beyond both.

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. Dear sir, I am an elderly practitioner and your column really rejuvenates us in the subject and makes us stimulated to know more, Thanks for the same. Chandrika Sekhar

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