11th December 2014, Thursday

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

Have Leg Artery Blockages? Walk on a Treadmill

A planned program of walking is good for people with blockage of leg blood vessels called peripheral arterial disease (PAD).

Normally when there is pain in the calf muscles in the leg on walking, the usual tendency is to rest and not walk. A study of 156 people with PAD published in JAMA showed that regular six-minute walks on a treadmill improved their endurance and quality of life. The study examined patients with symptoms and without symptoms. Over the six months of the study, the participants who did their regular six-minute treadmill walks increased their walking distance by about 69 feet, while those who did not walk regularly saw a decrease of 49 feet. There is the potential for greater oxygen extraction from the blood under maximum exercise conditions. The muscles can make better use of blood flow and the oxygen release that comes from it.

Such exercise leads to improvement in "collateral circulation" -- growth in the number of blood vessels supplying the legs. Clinicians should urge all PAD patients, whether or not they have symptoms, to engage in a regular, supervised exercise program.

Walking is a standard recommendation for people with PAD. A recommended regimen is a 40-minute walk three times a week for at least six months.

Persistent leg pain is an indication that help is needed. In the absence of that symptom, physicians can test for PAD by measuring the difference in blood pressure between an ankle and an arm.


Proceedings of 66th Annual Conference of Cardiological Society of India (4-7th December, Hyderabad)

Statins: The Holy Grail (Dr PK Deb, Kolkata)

  • The pathogenesis of atherosclerosis is not completely explored with cholesterol theory alone. The storyline is too complicated. Dyslipidemia is only a part of the story. The benefits of statins have been optimally achieved.
  • By further manipulation of statin therapy, further improvement in clinical outcome is unlikely.
  • Statin is not a magic bulletin, nor water from any magic fountain, nor the Holy Grail. It has its own strengths and limitations.

HCTZ vs indapamide vs chlorthalidone: Is there a clear winner? (Dr Sandeep Bansal, New Delhi)

  • Diuretics in the long run reduce peripheral resistance.
  • Diuretic with a long half life is more effective.
  • All thiazide diuretics are not the same.
  • Indapamide and chlorthalidone have survival benefit data.
  • Non diuretic effects like CA and rho kinase inhibition by indapamide and chlorthalidone make them a better choice.
  • There is minimal metabolic and electrolyte disturbance with indapamide.

As standalone drug

  • HCTZ has no standing and is at best to be avoided.
  • Chlorthalidone: use routinely as first line in low risk, run of the mill HT/80 years/CKD 3
  • Indapamide in >80 years/ post CVA/higher metabolic risk

As an add on drug

  • HCTZ: Poor choice but may be used in low risk patients
  • Chlorthalidone: With ACEI/ARB/CCB in high risk patients
  • Indapamide: There is evidence with perindopril

Choosing the appropriate antihypertensive based on patient’s comorbidity: Additional considerations (Dr A Sreenivas Kumar, Hyderabad)

Potential favorable effects

  • Thiazide type diuretics are useful in slowing demineralization in osteoporosis.
  • Beta blockers are useful in treatment of AF/atrial tachyarrhythmias, migraine, thyrotoxicosis (short term), essential tremors.
  • CCBs are useful in patients with Raynaud’s syndrome and certain arrhythmias.
  • Alpha blockers are useful in prostatism.

Potential unfavorable effects

  • Use thiazide diuretics with caution in patients with H/O significant hyponatremia.
  • Avoid beta blockers in patients with asthma, reactive airway disease or heart block (20 or 30)
  • Avoid ACEIs in H/O angioedema.
  • Aldosterone antagonists and potassium-sparing diuretics can cause hyperkalemia.
  • ACEIs and ARBs are contraindicated in pregnant women or those likely to become pregnant.

News Around The Globe

  • For most patients with drug-refractory epilepsy who are eligible for surgical treatment, their outcomes end up better than continuing on medical therapy in most cases, as suggested by two new studies presented at the American Epilepsy Society's (AES) annual meeting.
  • Patients who are allergic to penicillin can tolerate aztreonam and carbapenems, suggest new findings published online in the Journal of Allergy and Clinical Immunology.
  • British scientists have found a brain mechanism that may drive our desire for glucose-rich food; the discovery could lead to better treatments for obesity. The research is published in the Journal of Clinical Investigation.
  • Treatment with an antisense oligonucleotide that inhibits factor XI in patients undergoing primary unilateral total-knee arthroplasty significantly reduced the risk of venous thrombosis compared with enoxaparin without increasing the risk of bleeding, reported a phase 2 study published online December 7 in the New England Journal of Medicine.
  • The WHO fracture risk assessment tool FRAX is better than lumbar spine and femoral neck T-scores at identifying women with vertebral fractures, suggests new study published online in BMC Musculoskeletal Disorders.
  • The National Comprehensive Cancer Network (NCCN) has updated prostate cancer guidelines. The 2015 update of the guidelines contains three major changes related to imaging, molecular testing, and the systemic treatment of castration-resistant disease. The guidelines are available on the NCCN website.

Dr KK Spiritual Blog

Be Positive, Be Different and Be Persistent

You should be not only positive, different but also persistent. In ten incarnations of Lord Vishnu, the first is a fish, which indicates to be different in life. The second incarnation is the tortoise, which indicates that you should be different but learn to withdraw when the need arises. The third is a boar which indicates persistence.

The mantra of a successful life is to be positively different and persistent and yet learn to withdraw when the situation arises.

Inspirational Story

The Story of a Blind Girl

There was a blind girl who hated herself just because she’s blind. She hated everyone, except her loving boyfriend. He’s always there for her. She said that if she could only see the world, she would marry her boyfriend.

One day, someone donated a pair of eyes to her and then she can see everything, including her boyfriend. Her boyfriend asked her, “now that you can see the world, will you marry me?”

The girl was shocked when she saw that her boyfriend is blind too, and refused to marry him. Her boyfriend walked away in tears, and later wrote a letter to her saying: “Just take care of my eyes dear.”

This is how human brain changes when the status changed. Only few remember what life was before, and who’s always been there even in the most painful situations.

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 eMedinewS

  • Screening asymptomatic persons with diabetes using coronary computed tomographic angiography (CTA) may improve their cardiovascular risk profile by guiding them toward more aggressive therapy, but this may have little effect on mortality or nonfatal CV events over 4 years, reports a randomized trial presented at the American Heart Association (AHA) 2014 Scientific Sessions.
  • Chronic kidney disease (CKD) increases the risk of stroke and systemic thromboembolism in patients with atrial fibrillation (AF) independently of other stroke risk factors, especially in those needing renal replacement therapy (RRT), suggests an observational cohort study published in the December 16 issue of the Journal of the American College of Cardiology.

Pediatrics eMedinewS

  • Intranasal ketamine and fentanyl provide similar pain relief in children suffering from moderate to severe pain from limb injuries, suggests a study published online in Annals of Emergency Medicine.
  • Adolescents who are prescribed anxiolytics or sleep medications are substantially more likely to misuse these medications for either sensation-seeking or self-treating reasons as compared to their counterparts who have never been prescribed these agents, points new research published online in Psychology of Addictive Behaviors.

Quote of the Day

  • Act with kindness, but do not expect gratitude. Confucius

Wellness Blog

Depression Should Be Treated In Patients with Diabetes

Presence of depression in diabetic patients is the most important factor leading to erectile dysfunction in such patients.

An India cum US study published in the Journal of Urology suggested that depression and erectile dysfunction are related to each other in the form of a vicious cycle. Depression instigates erectile dysfunction and erectile dysfunction perpetuates the symptoms of depression.

  • India is the diabetic capital of the world and both the incidence and prevalence of diabetes are increasing day by day.
  • It is, therefore, important for the family physician to look for presence of depression in patients with diabetes.
  • Diabetic patients who complain of erectile dysfunction in the study also have higher prevalence of high blood pressure and cholesterol abnormalities. These patients were also of older age with uncontrolled diabetes, history of smoking and longer duration of diabetes.

It was also shown that patients who develop erectile dysfunction also had diabetes, eye disorders, neuropathy and peripheral vascular disease.

Effective control of diabetes may reduce both depressive symptoms and erectile dysfunctions in such cases.

ePress Release

Medanta – The Medicity joins hands with Heart Care Foundation of India to launch the Betiyan Hain Anmol, Bachao Dil Se Campaign - An initiative under the Sameer Malik Heart Care Foundation Fund aimed at helping save lives of young girls who are suffering from heart ailments & cannot afford treatment

As a step towards breaking away from the shackles of gender inequality in Haryana and working towards providing better healthcare facilities for all, Medanta – The Medicity jointly with the Heart Care Foundation of India, today launched the Betiyan Hain Anmol, Bachao Dil Se Campaign. The Chief Guest for the launch was none other than the Chief Minister of Haryana, Mr Manohar Lal Khattar and the Guest of Honor, the Health Minister – Mr Anil Vij. The Chairman of Medanta – The Medicity, Dr Naresh Trehan and the President of Heart Care Foundation of India, Dr KK Aggarwal, chaired the event.

The main ideology behind the campaign is that according to article 21 of our constitution every person has a right to live irrespective of their gender, case, religion or economical background. Despite this, Haryana has the lowest sex ratio in the country and hundreds of girls continue to die of heart disease just because they cannot afford treatment.
As an initiative under the Sameer Malik Heart Care Foundation Fund, a project to provide financial and technical assistance to those belonging to economically weaker sections of the society, the ‘Betiyan Hain Anmol, Bachao Dil Se’ campaign would focus particularly on the daughters of Haryana who often lose their life battle to the sons of the family. All girls suffering from congenital heart and rheumatic valvular heart disease, and otherwise cannot afford treatment, can apply for the benefits of the fund by calling on its helpline number +919958771177 or logging on to its website, http://heartcarefoundationfund.heartcarefoundation.org/.

Speaking on the occasion, the President of Heart Care Foundation of India and Secretary General Elect of the IMA - Dr KK Aggarwal said, “Every year about 78,000 infants born with congenital heart disease in India die due to lack of medical care. Majority of these are girls because parents do not like to spend the enormous amount of Rs. 3 to 5 lakh towards the surgery of a girl child, which they would do so readily if it were their son suffering from the ailment. We at Heart Care Foundation of India believe that no person, irrespective of their gender deserves to die just because they can’t afford treatment. Towards this endeavor we have saved over 300 lives in the past 6 months through a key project, the Sameer Malik Heart Care Foundation Fund. We are now extending this project to the young girls and women in Haryana with the generous support of Dr Trehan, Mr Khattar and Mr Vij and hope that together we can help reduce the gender inequality in the region and help save as many lives as possible”.

Adding to this, the Chairman and Managing Director of Medanta – The Medicity, Dr Naresh Trehan said, “There has been a sharp decline in the female population in Haryana over the years and it deeply saddens me to see that even in the 21st century, people think of girls as a liability and not an asset. I jumped at the opportunity of supporting Heart Care Foundation of India’s project, the Sameer Malik Heart Care Foundation Fund when Dr Aggarwal approached me 6 months back. I strongly believe that equality is essential for our country to progress and hope that through this project we can help make a difference to Haryana’s daughters. I would like to express my gratitude to Mr Manohar Lal Khattar and Mr Anil Vij for joining hands with us in this initiative.”

Congratulating the initiative, the Chief Minister of Haryana, Mr Manohar Lal Khattar said, “I am very happy to know that the Sameer Malik Heart Care Foundation Fund has already provided assistance to more than 300 patients, who required a heart surgery in association with Medanta – The Medicity. On behalf of the Government, I promise full support in whichever way we can to make this campaign a success.”

Applauding the cause, the Health Minister of Haryana, Mr Anil Vij said, “I congratulate this noble initiative by the Heart Care Foundation of India and Medanta – The Medicity and believe that it is extremely crucial to spread awareness about this cause and the need to end gender discrimination in the state. Every child deserves the right to live and I extend my best wishes and support towards this cause.” The helpline number +919958771177 for the Sameer Malik Heart Care Foundation Fund is open from Monday through Saturday from 9 AM to 5 PM. Individuals who wish to apply online can download the application form from the website, http://heartcarefoundationfund.heartcarefoundation.org/. An expert committee comprising of notable individuals would assess all applications received by the fund. Once sanctioned, the funds would be directly deposited in the bank account of the medical establishments treating the patient.

Also present on the occasion were Mr Vivek Kumar, Trustee Heart Care Foundation of India and Mr Vipin Malik from the Malik family.

emedipicstoday emedipics

Medanta – the Medicity joins hands with Heart Care Foundation of India to launch the Betiyan Hain Anmol, Bachao Dil Se Campaign

video of day
press release

Depression linked to paralysis

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)


IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :


Dr Good and Dr Bad

Situation: A patient with mediclaim of Rs. 2 lakhs has used a cumulative bonus of Rs. 40000 after 8 years. How much can he claim next year?
Dr. Bad: Same as 2.4 lakhs.
Dr. Good: It will be 10% less.
Lesson: In case of claim under the policy in respect of insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of claim of sum insured on the next renewal. However, basic sum insured will be maintained and will not be reduced.

Make Sure

Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lesson: Make sure to remember that the incidence of hepatitis with cholestatic jaundice in high with erythromycin estolate in pregnancy.

eMedinewS Humor

Boss: There are 50 bricks on an aeroplane. If you drop 1 outside. How many are left?
Employee: That's easy, 49.

Boss: What are the three steps to put an elephant into a fridge?
Employee: Open the fridge. Put the elephant in. Close the fridge.

Boss: What are the four steps to put a deer into the fridge?
Employee: Open the fridge. Take the elephant out. Put the deer in. Close the fridge.

Boss: It's lion's birthday, all animals are there except one, why?
Employee: Because the deer is in the fridge.

Boss: How does an old woman cross a swamp filled with crocodiles?
Employee: She just crosses it because the crocodiles are at the lion's birthday.

Boss: Last question. In the end the old lady still died. Why?
Employee: Ere.... I guess she drowned.... errr...

Boss: No! She was hit by the brick fallen from the aeroplane. That’s the problem; you are not focused on your job.... You may leave now!

Moral: No matter how much you know or how much you are prepared. If your Boss has decided to screw you then you are surely screwed.

Twitter of the Day

Dr KK Aggarwal: Sudden Cardiac Death By Dr k k Aggarwal
Dr Deepak Chopra: When the world “out there” is as filled with God as the world “in here,” faith has fulfilled its role

eMedi Quiz

The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X-ray diffraction.

Yesterday’s Mind Teaser: The following separation technique depends on the molecular size of the protein:

1. Chromatography on a carboxymethyl (CM) cellulose column.
2. Iso-electric focusing.
3. Gelfiltration chromatography.
4. Chromatography on a diethylaminoethly (DEAE) cellulose column.

Answer for yesterday’s Mind Teaser: 3.Gelfiltration chromatography.

Correct answers received from: Dr Rakesh Sharma, Dr Avtar Krishan.

Answer for 9th December Mind Teaser: 1.Glyceraldehyde-3-phosphate Dehydrogenase.

Correct answers received from: Dr Rakesh Sharma Nohar, Dr Avtar Krishan, Dr Poonam Chablani, Dr Jainendra Upadhyay.

Send your answer to email

medicolegal update

(Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

What is exhumation for reburial?

  • During World War II, many innocent civilians were shot summarily or killed otherwise and then buried in mass graves without coffins and even without proper last rites. After the war was over, many such bodies were exhumed and reburied with proper rites.
  • Keith mant mentions this fact in his classical paper on adipocere, because a number of these bodies were found to be converted into adipocere.
  • Exhumation for reburial means posthumous pardon (Timothy John Evans (20 November 1924 – 9 March 1950, a Welshman was hanged in the United Kingdom in 1950 for the murder of his infant daughter at 10 Rillington Place, London. An official inquiry conducted 16 years after Evans’s hanging determined that his daughter had in fact been killed by his co–tenant, serial killer John Christie, and Evans was subsequently recommended and granted a posthumous pardon. His body was thereupon exhumed and reburied outside Pentonville Prison).
medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

eMedinewS Special

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

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)