12th November 2014, Wednesday

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

Unjustified remarks against medical profession by the Hon’ble Bombay High Court

It was disturbing to read the remarks reportedly made by Justice Kanade in a PIL as reported in Times of India on Nov 11 2014 where he has pronounced in open court his views against the medical profession in the following words--“All of us have suffered, one time or the other, at the hands doctors”. “Less said the better… what doctors do and what they should do”.

In a letter to the Chief Justice Dr Neeraj Nagpal stated " The statement made in the open court by the higher judiciary is factually wrong, inappropriate, unnecessary, uncalled for, derogatory and even slanderous / defamatory against the medical profession which has been traditionally labeled as a noble profession all the world over".

Such unwarranted views in the form of obiter dicta are likely to influence the minds and judgments of lower judiciary. Coming from a High Court, which is held in respect by the public in general, such views are likely to colour the perception of the general public against doctors.

Such remarks should be brought to the notice of higher courts and President of India.

The remarks are against the medical profession and humiliating to its members. Medical profession is the noblest of all professions. Doctors command great love affection and respect from people for the work they do in dire circumstances.

This defamatory statement should have been best avoided. Such remarks tarnish the image of all doctors in the eyes of the general public.

It is correct that there may be few black sheep in the society but one cannot blame the whole profession for the same.

Judges are suppose to communicate using non violence language which involves observations but not judgment.

(In the morning I got a call from Dr CM Bhagat and later I saw a communication by Dr Neeraj Nagpal, the same transpired me to write this editorial.)

News Around The Globe

  • The current guidelines from the ACP recommend polysomnography (PSG) as a first-line means to diagnose OSA. Among clinical outcomes, OSA is most associated with a higher risk for mortality. According to the ACP, treating OSA with CPAP is most effective for alleviating daytime sleepiness. Overall, the ACP makes 2 major recommendations based on its review of the evidence for the diagnosis of OSA:
  • Patients with unexplained daytime sleepiness should undergo a sleep study. PSG should be a first-line test to diagnose OSA. Portable monitors may be substituted for PSG among patients without serious comorbidities when PSG is unavailable. Regarding the association between OSA and clinical outcomes, the strongest evidence demonstrates that OSA with an AHI of more than 30 is associated with a higher risk for all-cause mortality. Nonfatal cardiovascular disease and type 2 diabetes may be more common among patients with untreated OSA, but this is based on poor evidence. It is unclear if OSA promotes hypertension or higher rates of cardiovascular mortality, and no association has been found between OSA and the risk for stroke or overall quality of life.
  • The New England Journal of Medicine reported last week a phase I study of a new drug (PER977, Aripazine) that may be effective as an antidote for several of the new oral anticoagulants, as well as some of the established anticoagulants.
  • Shift work chronically impairs cognition, with potentially important safety consequences, not only for the individuals concerned but also for society. The harmful effects on the brain can be reversed when shift work ends, but it may take up to 5 years to achieve full recovery. Shift work is also associated with chronic health complaints (e.g., cardiovascular disease, metabolic syndrome, breast cancer and reproductive problems) (Philip Tucker, PhD, Psychology Department, College of Human and Health Sciences, Swansea University, United Kingdom, in November 3 in the journal Occupational and Environmental Medicine).
  • Symptoms associated with AF: Dr. Green’s Response: (Philip Green, MD, Assistant in Clinical Medicine, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York) Yes! There certainly is a problem here. The way in which patients experience symptoms related to atrial fibrillation can be assigned to 1 of 3 categories. Indeed, the minority of patients experience classic palpitations with or without associated shortness of breath or chest discomfort and they know they are in atrial fibrillation. In those patients, the timing of AF onset and the frequency of fibrillation episodes can influence the rhythm control and even the anticoagulation strategy. Those patients should pay special attention to the symptoms associated with AF. The remaining patients either experience non-specific symptoms including shortness of breath or fatigue that may be related to but not exclusive to their AF. The last group experiences no symptoms at all. In those patients, our fear is that the first symptom or sign of AF will be a stroke. It is therefore extremely important to understand that AF often poses risk even in the absence of symptoms. (October 2014)

IMA News

I am surprised at the project of Punjab Government to translate medical books in Punjabi and teach medical students in Punjabi and think it as a retrograde step. Question is, how translation of medical books into Punjabi will make it convenient for students from Punjab, especially from rural areas to understand concept. Such an idea exposes the bankruptcy of thoughts because to get in to medical colleges most of the 10+2 exams and all the entrance tests are in English and how on earth translation of medical books in Punjabi will help medical students understand medical concepts when they have already studied in English. Even if the medical students or nurses learn medical syllabus in Punjabi, how they are going to cope up with using all the equipment, medicines, medical software and lab investigations expressed in English or presenting their lectures or research work nationally and internationally or write prescription in Punjabi. What about medical students coming to Punjab Medical Colleges on central and NRI category. More over Punjab is an Indian state teaching Punjabi and what will happen when Punjab doctors and nurses trained using Punjabi medical books venture out of Punjab. It is an idea very good on paper to express love for Punjabi language but very childish when it comes to practical use realizing ground realities where majority of teaching institutions in Punjab are teaching English from primary level. Dr. Vitull K. Gupta MD (Medicine)

Dr KK Spiritual Blog

Neti-Neti (Not This Not This)

The Main Principle of Knowing the Truth

The main figure in the Upanishads is sage Yajnavalkya, known as one of the greatest philosophers. Most of the great teachings of later Hindu or Buddhist philosophy are derived from him. He taught the great doctrine of neti-neti, the view that truth can be found only through the negation of all thoughts about it.

Brhadaranyaka Upanishad is the oldest and the most important of all the Upanishads. Its name actually means the great forest-book.

Sage Yajnavalkya’s dialogues with his wife, Maitreyi are featured in the Muni Kanda or Yajnavalkya Kanda. The doctrine of neti-neti suggests the indescribability of the Brahman, the Absolute. Yajnavalkaya attempts to define Brahman.

Atman is described “neither this, nor this” neti-neti. The Self cannot be described in any way. Na-iti - that is Neti. Through this process of neti-neti you give up everything - the cosmos, the body, the mind and everything - to realize the Self.

Once the Atman is defined in this manner are you become familiar with it, a transformation takes place as realization dawns that the phenomenal world and all its creatures are made up of the same essence of bliss.

Brahman is infinite, amorphous, colorless, characterless and formless Universal Spirit, which is omnipresent and omnipotent, and like cosmic energy, is pervasive, unseen and indescribable.

  • Neti-neti Meditation: The principle of neti-neti has been used in meditation involving gnana yoga. Whenever a thought or feeling comes to mind that is not the goal of the meditation, or is not the soul or the inner self, the meditator simply has to say, “Not this, not this,” and dismiss the thought, image, concept, sound, or sense distraction. Any thought, any feeling, is patiently discarded — again and again if necessary, until the mind is clear and the soul/or the self is revealed.
  • Neti-neti and the mind: When you get into the habit of neti-neti, you can also discard thoughts of worry, doubt, or fear, and become established in the light of your inner self. You can, then, look back at worries and fears with deep insight and handle them.
  • Neti-neti and the medical profession: One of the basic medical teachings is to diagnose a condition by way of excluding other similar conditions. This is called differential diagnosis and this is the mainstay of allopathy. This also makes one investigative-oriented but is the only scientific way of knowing the truth.
  • Neti-neti and multiple-choice questions: In any modern exam today, the principle of neti-neti is used. A question has about four nearly similar answers and the student has to answer the correct one. He can only answer by the principle of negation.
  • Neti-neti and police investigations: This principle is also used while handling a criminal case. Everyone is a suspect in the crime initially, till a process of elimination clears them.

Inspirational Story

The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene.

So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.” With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude! She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes.

If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

Rabies News (Dr A K Gupta)

Is there carrier state of rabies in dogs?

A carrier state of rabies in dogs/cats has not yet been conclusively proven and established.

Cardiology eMedinewS

  • Based on data from the National Cardiovascular Data Registry (NCDR) Cath-PCI Registry, a screening tool has been developed that calculates a patient's bleeding risk during PCI, based on nine clinical variables. When high-risk patients are identified before the procedures, strategies to avoid bleeding can be put in place to use afterward. The report is published in Circulation: Cardiovascular Quality Outcomes.
  • Age should not be a barrier to aortic valve replacement (AVR), suggest researchers from the Mayo Clinic in Rochester, Minnesota. Researchers state that AVR can be done safely in select patients aged 90 and older, leading to increased quality of life. The report is published in the November issue of the Annals of Thoracic Surgery.

Pediatrics eMedinewS

  • The introduction of pneumococcal conjugate vaccine (PCV) was linked to a decrease in hospitalizations for sinusitis among children younger than 2 years and pneumonia among children younger than 5 years, reported a retrospective population-based study in Sweden. The report was published online November 10 in Pediatrics.
  • A new study, presented at the American Academy of Ophthalmology 2014 Annual Meeting, has shown that nonmydriatic imaging could be a helpful addition to the standard clinical examination of children with type 1 diabetes mellitus.

Quote of the Day

  • We are accountable only to ourselves for what happens to us in our lives. Mildred Newman

Wellness Blog

Lifestyle can prevent 50% of common cancers

More than 50% of cancers could be prevented if people simply change lifestyles, according to Graham Colditz, PD, DrPH, from the Washington University School of Medicine in St. Louis, Missouri at the Union for International Cancer Control (UICC) World Cancer Congress 2012.

Among the "biggest buys" from lifestyle intervention is smoking cessation. One third of cancer in high-income countries is caused by smoking.

Being overweight or obese causes approximately 20% of cancers today. If people could maintain a healthy body mass index (BMI), the incidence of cancer could be reduced by approximately 50% in 2 to 20 years.

Poor diet and lack of exercise are each associated with about 5% of all cancers. Improvement in diet could reduce cancer incidence by 50% and increases in physical activity could reduce cancer incidence by as much as 85% in 5 to 20 years.

Eradicating the main viruses associated with cancer worldwide by implementing widespread infant and childhood immunization programs targeting three viruses — human papillomavirus and hepatitis B and C — could lead to a 100% reduction in viral-related cancer incidence in 20 to 40 years.

Tamoxifen reduces the rate of both invasive and noninvasive breast cancer by 50% or more, compared with placebo, at 5 years.

Raloxifene has been shown to reduce the risk for invasive breast cancer by about 50% at 5 years.

Bilateral oophorectomy in women carrying the BRCA1 or BRCA2 gene, although rare, has been associated with a 50% reduction in breast cancer risk among high-risk women.

Aspirin is associated with a 40% reduction in mortality from colon cancer.

Screening for colorectal cancer has a similar magnitude of mortality reduction (30% to 40%).

emedipicstoday emedipics

21st Perfect Health Mela 17th October 2014



press release

Weight loss may improve sexual health of obese diabetes

video of day

Other Blogs

Video Library

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

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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 hypertension had non–responding cough.
Dr. Bad: Take an X–ray.
Dr. Good: Stop ACE inhibitors.
Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

Make Sure

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why was he not put on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

eMedinewS Humor

The Anesthesiologist

Jill received a bill from the hospital for her recent surgery, and was astonished to see a $900 fee for the anesthesiologist. She called his office to demand an explanation.

"Is this some kind of mistake?" Jill asked when she got the doctor on the phone.

"No, not at all," the doctor said calmly.

"Well," said Jill, "that's awfully costly for knocking someone out."
"Not at all," replied the doctor. "I knock you out for free. The 900 dollars is for bringing you back around."

Twitter of the Day

Dr KK Aggarwal: Stress can increase your BP
Dr Deepak Chopra: When the world “out there” is as filled with God as the world “in here,” faith has fulfilled its role.

ePress Release

The five C’s of five a day in selecting fruits and vegetables

The current recommendation is to eat 5 or more servings of fruits and vegetables daily to prevent cancer and heart disease. Fruits and vegetables contain vitamins, minerals, phytochemicals, and antioxidants and are low in calories. Those with the most color – dark green, red, yellow, and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "C" which can be incorporated in the five a day diet. As per Ayurveda one should mix all seven colours and six tastes when choosing fruits and vegetables.

As per The USDA Food Guide Pyramid one should take 5-9 servings of fruits and vegetables every day. Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber-containing grain products, fruits and vegetables also reduce the risk of some cancers, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

A serving size is: one medium-size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw leafy vegetables, 1/4 cup dried fruit.

5 serving's means 2 fruits and 3 vegetables, 7 servings means 3 fruits, 4 vegetables and 9 servings means 4 fruits, 5 vegetables

Tips for safe eating

  1. Snack with raw vegetables instead of potato chips
  2. Add fruits in breakfast
  3. Eat salad bar when you go out for lunch
  4. Prefer juice instead of a usual coffee, tea or soda.
  5. Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
  6. Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  7. Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  8. Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been held at an improper temperature
  9. Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
  10. Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.

eMedi Quiz

Brocq's phenomenon is analogous to which clinical sign in psoriasis?

a. Olfleck's phenomenon
b. Auspitz sign
c. Salmon patch
d. Candle wax scales

Yesterday’s Mind Teaser: Epidermodysplasia veruniciformis is caused by which of the following HPV serotypes:


Answer for yesterday’s Mind Teaser: c.5

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella.

Answer for 10th November Mind Teaser: 4.Vertebral venous plexus.

Correct answers received from: Dr BB Aggarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan.

Send your answer to email

medicolegal update

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

(Contributed by Dr MC Gupta, Advocate)

A patient was advised admission but he declined to be admitted. His condition deteriorates. He files a complaint against the doctor alleging negligence, saying that the doctor should have advised admission but he never did so. The doctor has a carbon copy of the prescription given to the patient where he has written that "Advised admission. Refused." It does not bear the signature of the patient. What is its legal validity?

It may have some validity but the patient is likely to say that:

  • He was not given any prescription slip at all.
  • He has lost the slip but it did not contain the words "Advised admission. Refused" and that these words have been added later on.

It is advisable that the refusal should be signed by the patient. If he refuses to sign, this fact should be testified by somebody else such as another doctor or staff member.

medicolegal update
  1. Dear Sir, I am a regular reader of your eMedicalnewS-one of the rare, very informative and a complete journal In itself, since we met in Sewagram when Jain Sir called 100 pg's of Medicine from our dept. Ur spiritual blog on Muslim patient was very well written and I feel it will go a long way in putting forth the true picture of one of the most God fearing communities on earth to the society and will help withering off the misconceptions of our fellow brothers. Keep it up sir! M A Sami

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