eMedinewS12th May 2014, Monday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Dramatic Rise in Extensively Drug-Resistant Tuberculosis

Almost half (43.7%) of patients with multidrug–resistant (MDR) tuberculosis in 8 countries studied were resistant to at least 1 second–line drug, and 6.7% had extensively drug–resistant (XDR) tuberculosis, according to a study published online August 30 in the Lancet by Tracy Dalton, PhD, a senior service fellow in the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention in Atlanta, Georgia. MDR tuberculosis is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin. XDR tuberculosis is caused by M tuberculosis strains that are resistant to isoniazid, rifampicin, and at least 1 drug within the fluoroquinolones and 1 antituberculosis injectable drug. Fluoroquinolones and injectable drugs are second-line antituberculosis drugs.

Most international recommendations for tuberculosis control have been developed for (MDR) tuberculosis prevalence of up to around 5%. Yet we now face prevalence up to 10 times higher in some places, where almost half of the patients with infectious disease are transmitting MDR strains of Mycobacterium tuberculosis.

According to data from the World Health Organization, 5.4% of patients with MDR tuberculosis have XDR tuberculosis.

News Around The Globe

  • A study presented at the American Academy of Neurology (AAN) 66th Annual Meeting has stated that patients with relapsing–remitting multiple sclerosis (RRMS) who had confirmed improvement in walking speed (CIWS) reported better self–reported physical functioning, and treatment with natalizumab improved the likelihood of achieving a CIWS.
  • Malalignment of the knees may trigger osteoarthritis in middle aged, obese women, and these women should be appropriately screened for knee malalignment and treated preventively, reports a new study published online in Rheumatology.
  • A new research from Taiwan has revealed that random urine albumin concentration (UAC) performs as well as albumin to creatinine ratio (ACR) for detecting microalbuminuria in patients with diabetes. Specificity for both approaches was 88%, and there was no significant difference in diagnostic odds ratio between UAC and ACR (39.7% vs. 46.4%).
  • A novel phase III study has revealed that about 58% of the patients with hypoparathyroidism treated with recombinant human parathyroid hormone, rhPTH(1–84), could do away with all active vitamin–D and oral calcium supplementation, and 96% could cut vitamin D requirement alone.
  • A study presented at the American Psychiatric Association’s 2014 Annual Meeting has stated that late menopausal transition (MT) period and early postmenopausal time point could severely increase the risk for depression as well as mania. Subjects in the late MT and early postmenopausal group had higher mean depression scores on the MADRS (14.0±9.9) than those in the early MT group (10.4±7.8).

Rabies News (Dr A K Gupta)

Can the vaccine be injected in gluteal region?

Rabies vaccine must not be administered in gluteal region as the gluteal fat may retard vaccine absorption resulting in delayed and lower seroconversion.

Cardiology eMedinewS

  • A report published online in Nature Reviews Cardiology has put forward some new signs on coronary computed–tomography angiography (CCTA) that can help identify coronary plaques at risk of rupture. Authors suggested that low CT attenuation, positive remodeling, and the napkin–ring sign indicate 5– to 20–fold increase in the risk of suffering ACS.
  • The US Food and Drug Administration (FDA) Circulatory System Devices Advisory Panel has voted in favor of approving the ResQCPR System to perform CPR. The system includes two devices—the ResQ POD impedance threshold device (or valve), which is already approved by the FDA, and the ResQ PUMP active compression/decompression device.

Pediatrics eMedinewS

  • A study presented at the American Psychiatric Association’s Annual Meeting has revealed that the observed link between asthma and suicide risk in adolescents could be mediated by comorbid sadness and substance use. Data from the Youth Risk Behavior Survey (YRBS) highlighted that respondents with a current or previous history of asthma were 50% more likely to have attempted suicide than those without.
  • A study published online in Lupus Science & Medicine reported that children with lupus commonly have vitamin D deficiency that contributes to their intensified inflammatory status and cardiovascular risk.

Dr K K Spiritual Blog

Do Your Duty with Discipline And Devotion: The Triad Represents Rama, Lakshmana and Hanumana

"Vasudhaiva kutumbakam" (the whole world is one family) and "Ekam Sat Viprah Bahudavanti" (truth is one but the wise call it by various names) are two basic statements, which come from the ancient Rig Veda and form the fundamentals of Vedic philosophy.

One should do one’s duty with devotion and discipline. This principle can be remembered as the principle of three Ds.

In daily routine ‘one should remember the purpose for which one is born, which to fulfill Dharma (duty), Artha (wealth), Kama (desire) and Moksha (liberation). To achieve them, one needs to follow the four Fs: (i) Follow the teacher (ii) Face the negative devils of the mind (iii) Fight till the end, and (iv) Finish at the goal.

The essence of Bhagwad Gita can be summarized in one shloka (Chapter 2.48) where Krishna says to Arjuna "yogastha kuru karmani", which means ‘concentrate on actions’ (do all actions while remaining in yoga). He further says that one should take success and failure in the same stride. (yogastha: = steadfast in yoga, kuru = perform, karmani = duties or action).

To acquire spiritual health, one should follow three Ss which are: (i) Satsang (company of good people) (ii) Sadhna (hard work), and (iii) Sanskar (good deeds). Adi Shankaracharya in Bhaj Govindam describes them as Satnam or Simran (bhakti, or reciting the name of their God), Satsang (company of good people) and Seva (good karmas).

Before doing any work, one should follow the principles of three Hs: (i) listen with the Head, (ii) follow the Heart to choose one of the choices and (iii) order the Hands to take an action.

The ABCs of a good professional are Availability, Behavior and Competence. Competence comes last; the first is the availability of the professional.

An action should be based on Truth; it should be coming from consciousness and should end in internal bliss. Various Vedic literatures have termed this triad by different names like satha, chitha, ananda, and satyam, shivam sundaram.

Wellness Blog

Cinnamon in diabetes

In a new meta–analysis of 10 studies in patients with type 2 diabetes, taking cinnamon supplements improved fasting blood glucose and cholesterol levels, but not HbA1c levels. The report is published in September 9 issue in the Annals of Family Medicine.

Small doses of a cinnamon supplement could be used along with traditional diabetes medication, Cinnamomum cassia, either as natural supplement powder or capsule, was the most common form of cinnamon that was studied in the trials, and 1 tsp of cinnamon is approximately 3 g.

Cinnamon effect is attributed to its active component cinnamaldehyde.

The advantages of cinnamon are its cost, tolerability, and relatively safe profile.

Long–term administration of high–dose cinnamon may possibly be unsafe due to the coumarin content of cinnamon, which has been associated with liver damage in animal studies.

Inspirational Story

Don’t change the world

Once upon a time, there was a king who ruled a prosperous country. One day, he went for a trip to some distant areas of his country. When he returned, he complained that his feet were very painful, because it was the first time that he went for such a long trip, and the road that he went through was very rough and stony. He then ordered his people to cover every road of the entire country with leather. Definitely, this would need thousands of cows’ skin, and would cost a huge amount of money.

Then one of his wise servants dared himself to tell the king, "Why do you have to spend that unnecessary amount of money? Why don’t you just cut a little piece of leather to cover your feet?"

The king was surprised, but he later agreed to his suggestion, to make a "shoe" for himself.

There is actually a valuable lesson of life in this story: to make this world a happy place to live, you better change yourself – your heart; and not the world…

ePress Release

Take Care of your Mother

New Delhi: Over 60% of mothers believe their biggest health threat to be breast cancer but heart disease kills 6 times as many women as breast cancer, 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.

Some risk factors are different for women than for men. Heart disease symptoms may be milder in women. Heart attacks often strike without warning. If a woman does not realize heart disease is a health threat, she will not make heart healthy changes or respond to symptoms once they occur.

The woman is at risk if:

  1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to secondhand smoke every day.
  4. Her blood pressure is over 135/85 mmHg. Optimal blood pressure is 120/80 mmHg. Drug therapy is indicated when blood pressure is >140/90 mmHg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mmHg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise with 60–90 minutes with moderate–intensity activity on most days. About 70% of American women don’t exercise regularly.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL (High Density Lipoprotein or "good" cholesterol) is less than 50mg/dL. LDL goals are dependent upon risk. T The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C<100mg/dL; HDL–C>50mg/dL; triglycerides <150mg/dL; and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3T of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  8. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight).
  9. Early menopause before the age of 40, either natural or through surgery is associated with increased risk for cardiovascular disease.
  10. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  11. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  12. She does not eat a healthy diet.
    • A healthy diet consists of eating fruits, vegetables and whole–grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily).
    • Eating fish, especially oily fish, at least twice a week
    • Limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL.
    • Limiting alcohol intake to no more than 1 drink per day
    • Limiting sodium intake to <2.3 g/d (approximately 1 tsp salt)
    • Avoiding all trans–fatty acids (listed as "hydrogenated oil" in the ingredients section)
  13. Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  14. Having at least three of a cluster of symptoms that are listed below put her at risk:
    • High blood sugar >100 mg/dL after fasting;
    • High triglycerides – at least 150 mg/dL;
    • Low HDL (<50 mg/dL in women);

Blood pressure of 130/85 or higher and waist circumference >35 inches. A waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels.

Zee News – Health Wealth Shows

Cancer Prevention
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Fluid Intake


Total CPR since 1st November 2012 – 88972 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)

emedipicstoday emedipics

World Earth Day Celebration at DAV Public School, RK Puram, New Delhi.

press release

Five Things Physicians and Patients should question

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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 :


Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

eMedinewS Humor

Price you Pay for being Good

Three men were waiting to go to heaven. St Peter was at the gate and said, "However good you were to your wife that is the vehicle you will get in heaven".

The first guy comes up to the gate and says, "I never, ever cheated on my wife and I love her". So St. Peter gives him a Rolls Royce.

The next man comes up and says, "I cheated on my wife a little but I still love her." He gets a mustang and drives off into heaven.

The next guy came up and said, "I cheated on my wife a lot". He gets a scooter.

Next day the guy that got the scooter was riding along and he saw the guy who owned the Rolls Royce crying.

He asked, "Why are you crying you have such a nice car?!" and the man sobbed, "My wife just went by on roller skates".

Quote of the Day

Money is not the most important thing in the world. Love is. Fortunately, I love money. Jackie Mason


Twitter of the Day

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Empirical facts are not descriptions of fundamental reality but descriptions of modes of human observation using a human nervous system


eMedi Quiz

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.

Yesterday’s Mind Teaser: The conversion of an optically pure isomer (enantiomer) into a mixture of equal amounts of both dextro and levo forms is called as:


Answer for yesterday’s Mind Teaser: 3.Racemization.

Correct answers received from: Jayant gaikwad, Dr.Bitaan Sen & Dr.Jayashree Sen, dr.pawan mehta, Dr. Pawan Mehta, Dr. Pawan Mehta, Dr.Chandresh Jardosh, Dr.Chandresh Jardosh

Answer for 10th May Mind Teaser: 4. Protein folding.

Correct answers received from: Dr.Chandresh Jardosh

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, thanks for the updated news. Regards: Dr Kaveri
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