12th December 2014, Friday

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

3 simple ways for a restful sleep

  • Cut down on caffeine: Caffeine drinkers may find it harder to fall asleep. Even a single cup of coffee in the morning may lead to a sleepless night. Caffeine blocks the effects of adenosine, a neurotransmitter thought to promote sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night. Because caffeine withdrawal can cause headaches, irritability, and extreme fatigue, it may be easier to cut back gradually rather than to go cold turkey. Those who can’t or don’t want to give up caffeine should avoid it after 2 p.m., or noon if they are especially caffeine–sensitive.
  • Stop smoking or chewing tobacco: Nicotine is a central nervous system stimulant that can cause insomnia. If you continue to use tobacco, avoid smoking or chewing it for at least one to two hours before bedtime.
  • Limit alcohol intake: Alcohol depresses the nervous system, so a nightcap may seem to help some people fall asleep. Alcohol suppresses REM sleep, and the soporific effects disappear after a few hours. Alcohol also worsens snoring and other sleep breathing problems.


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

Guidelines or Godlines? (Dr Natesa G Pandian, USA)

Experience based medicine is based on lessons from teachers, knowledge from literature, personal experience and standards of practice. Experience based practice depends on how much you extract from cases, how much you reflect on the cases. It is not the number of years that make up experience.

Evidence based medicine is the conscientious, explicit and judicious use of current best evidence in making decision about the care of individual patients. It has made a difference and there is evidence in favor of evidence based medicine. But, there are criticisms too. Grading system was largely designed to questions of effectiveness, where RCTs are accepted as the most robust study design. It is very important to look at the level of supporting evidence. Also, it may not be practical or ethical to undertake randomized trials in many areas of medical practice.

Guidelines are explicit and reproducible globally. They make available the same choices and possibilities for all patients. There are fewer differences for patients who refer to different hospitals, cities and countries. However, outdated guidelines perpetuate outmoded practices and technologies. Also, healthcare professionals may be sued for not adhering to guidelines.


Guidelines are for diseases
Management is for patients

How to use guidelines

  • Know the guidelines
  • Understand the problems of the patient
  • Decisions should consider the guidelines as well as the individual patient’s issues

What is the role of left main stenting in contemporary practice? (Dr Vijay Kumar, New Delhi)

  • Technically feasible strategy with high procedural success rate
  • PCI of LM extending to more complex lesions
  • “Challenging lesions” but simple to do by experienced hands
  • Mortality and MI rates similar for CABG and DES - PCI
  • Baseline clinical risk (clinical presentation, comorbidities, etc) predicts safety end points
  • “Patient selection” is important.
  • TVR/TLR higher compared to CABG but, offsets the high risk of morbidity associated with CABG
  • Optimized procedure and technique for bifurcation stenting narrows the gap between CABG and PCI.
  • “Proper lesion and technique selection” determines restenosis rate.
  • Overall incidence of adverse events appears to be rather low after 1 year

Ostial LAD stenting (Dr Sunip Banerjee, Kolkata)

Only correct way to cover true ostial LAD disease is to bring the proximal end of the stent proximal to the ostium (and not at the ostium) into the left main. (Perform LCX intervention before working on LAD).

Nightmare in Cathlab: Broken Jailed PTCA wire (Dr. Jayesh Prajapati, Dr. Abhishek P Raval, Ahmedabad)

  • Never jail reuse PTCA wire (coiled).
  • Take care that junction of coil and shaft of the wire should not be kept at jailed site.
  • Always keep coronary snare in Cathlab.
  • It is very difficult to snare once the broken PTCA wire is elongated from coil.

News Around The Globe

  • Plasma cytokine levels may be markers for, and play a role in, alcoholism and common substance abuse behaviors, suggests new research presented at the American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting.
  • The US Food and Drug Administration (FDA) approved Gardasil 9, a human papillomavirus (HPV) vaccine that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against.
  • New treatment recommendations appearing online in JAMA Dermatology state that treatment of nail psoriasis poses a clinical challenge and may ultimately require more than one approach.
  • The risk for prostate cancer is not increased in hypogonadal men treated with testosterone therapy, suggest the results of a long-term registry-based study published in the January issue of the Journal of Urology.
  • Dentists can safely place dental implants in patients with uncontrolled diabetes, reports a new study, thereby contradicting common recommendations. The report is published in the December issue of the Journal of the American Dental Association.

Dr KK Spiritual Blog

Neti Neti (Not This Not This)

(The Main Principle of Knowing the Truth)

The main figure in the Upanishads is that of the sage Yajnavalkya. Most of the great teachings of later Hindu and Buddhist philosophy and 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 recognized as the most important of all the Upanishads, Brhadaranyaka derives its name from the “great forest-book”.

The greatest of Upanishadic philosophers, sage Yajnavalkya’s dialogues with his wife, Maitreyi are featured in the Muni Kanda or Yajnavalkya Kanda. The doctrine of “Neti, Neti” in this Upanishad suggests the indescribability of the Brahman, the Absolute. It is possible to describe Brahman as what ‘It’ is not but not as to what ‘It’ is. Yajnavalkaya makes an effort to define Brahman. The three cardinal virtues of self-restraint (DSmana), alms giving (DAna) and compassion (DAya) are also mentioned here (the three ‘DA’s).

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

After knowing the Atman in this manner, you will develop the attitude 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, it is pervasive, unseen and indescribable.

  1. Neti-neti Meditation: The principle of Neti Neti has been used in meditation involving gnana yoga. Whenever a thought or feeling which is not the goal of the meditation — which is not the soul or the inner self — comes to the mind, 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 discarded — patiently discarded — again and again if necessary, until the mind is clear and the soul/or the self is revealed.
  2. 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.
  3. Neti-Neti and Medical Profession: One of the basic medical teaching is to diagnose a condition by way of excluding other similar conditions. This is called differential diagnosis and this is the main stay of allopathy. This also makes one investigative-oriented but is the only scientific way of knowing the truth.
  4. Neti neti and multiple-choice questions: In any modern exam today, the principle of Net 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.
  5. Neti Neti and police investigations: This principle is also used while handling a criminal case. One suspects everyone on the crime and then starts elimination one by one.

Inspirational Story

Life Is a Gift

Today before you think of saying an unkind word – think of someone who can’t speak. Before you complain about the taste of your food – think of someone who has nothing to eat.

Before you complain about your husband or wife – think of someone who is crying out to God for a companion. Today before you complain about life – think of someone who went too early to heaven.

Before you complain about your children – think of someone who desires children but they’re barren. Before you argue about your dirty house, someone didn’t clean or sweep – think of the people who are living in the streets.

Before whining about the distance you drive – think of someone who walks the same distance with their feet. And when you are tired and complain about your job – think of the unemployed, the disabled and those who wished they had your job.

But before you think of pointing the finger or condemning another – remember that not one of us are without sin and we all answer to one maker. And when depressing thoughts seem to get you down – put a smile on your face and thank God you’re alive and still around.

Life is a gift – Live it, Enjoy it, Celebrate it, and Fulfill it.

Rabies News (Dr A K Gupta)

What is the role of monoclonal antibodies in Rabies?

Monoclonal antibodies against rabies virus have been widely used in the diagnosis and immunological analysis of rabies. Human monoclonal antibodies to rabies virus G protein are also expected to be used as a replacement for rabies immunoglobulin (RIG) in the post–exposure treatment of rabies. In 1978, Wiktor reported the preparation of rabies virus monoclonal antibodies. Since then, rabies virus monoclonal antibody (mAb) technology has been more and more widely used in basic research and diagnosis of rabies.

Cardiology eMedinewS

  • Statin therapy significantly increases the risk of developing cataracts severe enough to warrant surgery, suggest analyses of two distinct cohorts. The report is published in the December issue of the Canadian Journal of Cardiology.
  • The time to transfer a patient with ST-segment-elevation MI (STEMI) from a community hospital to a hospital with around-the-clock PCI seems to be a major obstruction to providing optimal care for MI patients, reports a new analysis conducted in the US, published online December 8 in JAMA Internal Medicine.
?Pediatrics eMedinewS
  • A new study states that children with autism spectrum disorder are more than twice as likely to be born to mothers with preeclampsia during pregnancy, suggesting a link between the two. The study is published in the journal JAMA Pediatrics.
  • A new study indicates that current clinical prediction rules used by physicians to determine whether children have "strep throat" caused by group A streptococcal infection may not be accurate. The study is published in the Canadian Medical Association Journal.
emedipicstoday emedipics

Health Check Up and CPR 10 Camp at Sarvodaya Kanya Sec. School, Pushp Vihar on 7th November 2014

video of day
press release

Obesity reduces life expectancy

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 middle–aged patient was found to have central obesity.
Dr Bad: It is normal.
Dr Good: Rule out diabetes.
Lesson: Findings of a prospective cohort study (1989–2007) of 4,193 men and women 65 years of age and older in the Cardiovascular Health Study suggest that among older adults, overall and central adiposity and weight gain during middle age and after the age of 65 years were associated with risk of diabetes.

Make Sure

Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin (macrolide) 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

eMedinewS Humor

Santa calls up the doc at 2 AM. "Doc, my wife is having severe abdomen pain. I think it's her appendix."

"What nonsense!" says the doc sleepily.

"I took out your wife's appendix two years ago. Go back to sleep."

Five minutes later, the phone rings and it's Santa again.

"Doc, I'm sure it's her appendix."

"Oh God!" the doctor groaned.

"Did you ever hear of anyone having a second appendix?"

"No...," says Santa. "But I'm sure you must have heard of someone having a second wife..!!!!"

Twitter of the Day

Dr KK Aggarwal: Avoid alcohol - if you cannot ask your doctor for your limit
Dr Deepak Chopra: Read about The Importance of A Strong Support Network in Recovering from Addiction here

Quote of the Day

  • All human power is a compound of time and patience. ~ Honor de Balzac

Wellness Blog

First aid for poisonous bites and stings

People often panic if they have been bitten or stung. You should tell the patient that many snakes, spiders, insects and sea creatures are harmless and that even the bites and stings of dangerous animals often do not cause poisoning.

Keep the patient calm and still. Moving the bitten or stung limb speeds up the spread of venom to the rest of the body. Fear and excitement also make the patient worse. The patient should be told not to use the limb and to keep it still and below the level of the heart. The limb may swell after a while, so take off the patient’s rings, watch, bracelets, anklets and shoes as soon as possible. A splint and a sling may help to keep the limb still.

Avoid doing the following:

  • Do not cut into the wound or cut it out.
  • Do not suck venom out of the wound.
  • Do not use a tourniquet or tight bandage.
  • Do not put chemicals or medicines on the wound or inject them into the wound (for e.g., potassium permanganate crystals).
  • Do not put ice packs on the wound.
  • Do not use proprietary snake bite kits.
  • The patient should lie on one side in the recovery position so that the airway is clear, in case or vomiting or fainting.
  • Do not give the patient anything by mouth – no food, alcohol, medicines or drinks. However, if it is likely to be a long time before the patient gets medical care, give the patient water to drink to stop dehydration.
  • Try to identify the animal, but do not try to catch it or keep it if this will put you, the patient or others at risk. If the animal is dead take it to hospital with the patient, but handle it very carefully, because even dead animals can sometimes inject venom.
  • As soon as possible, take the patient to a hospital, medical dispensary, or clinic where medical care can be given. The patient should not walk but should keep as still as possible. If there is no ambulance or car, carry the patient on a stretcher or trestle, or on the crossbar of a bicycle.
  • Antivenom should only be given in a hospital or medical Centre where resuscitation can be given, because the patient may have an allergic reaction. If available, antivenom should be used if there is evidence of severe poisoning. It should not be used when there are no signs of poisoning.

ePress Release

Heart patients warned to stay more cautious during Xmas time

In the emergency room heart attacks can be both over and under diagnosed. 10% of heart attacks are over diagnosed and equivalent number can be missed as the ECG can be normal in the first six hours after an heart attack, 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.

Most heart attacks occur in winter all over the world including India. Missing heart attacks during this period in the early hours of the morning can lead to spurts in number of cases of sudden cardiac death.

Every effort should be taken to reduce the number of false positive or false negative diagnosis of heart attack.

In a study published in JAMA Henry and group studied the medical records of 1,345 people treated for suspected heart attacks in a regional system between 2003 and 2006, looking at emergency room decisions. In the study all patients had classical heart attack called STEMI heart attack characterized by a specific ECG pattern. 14 % of heart attacks were over diagnosed.

During Xmas most senior doctors maybe on vacation making the situation further bad for the common man.

Men and women have about the same adjusted in-hospital death rate for heart attack — but women are more likely to die if hospitalized for a more severe type of heart attack

eMedi Quiz

The parameters of sensitivity and specificity are used for assessing:

1.Criterion validity.
2.Construct validity.
3.Discriminant validity.
4.Content validity.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4.X-ray diffraction.

Correct answers received from: Dr K V Sarma, Dr Rakesh Sharma Nohar, Dr Avtar Krishan.

Answer for 10th December Mind Teaser: 3.Gelfiltration chromatography.

Correct answers received from: Dr Rakesh Sharma, Dr Avtar Krishan, Poonam Chablani, Manoj Kumar Bhatt, Dr Jainendra Upadhyay, Raju Kuppusamy.

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)

Choosing the best option in the judgment of the doctor is not medical negligence

In the case of Charan Singh vs Healing Touch Hospital And Ors on 24 April, 2003 (III(2003) CPJ 62 (NC)), the National Consumer Disputes Redressal Commission observed “it is a settled law when two choices are available, exercise of one, which is the best in the judgment of the doctor and anything else is available to contradict this, doctor in such circumstances cannot be held negligent.

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)