13th October 2014, Monday

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

The 5 As of Treating Tobacco Use Dependence

Guidelines for Treating Tobacco Use Dependence recommend the 5 As.

  • Ask your patient about their tobacco use status at every visit.
  • Advise your patient to quit. Make it clear, strong, and personal.
  • Assess their willingness to quit.
  • Assist in your patient's quit attempt. Order a smoking cessation referral, Prescribe medications.
  • Arrange follow-up. See them again after their quit date or readdress their tobacco dependence the next time you see them.

Welcome Dr Mohan Nair

Dr Mohan Nair

A renowned Cardiologist and Chairman of the Department of Cardiac Sciences at Saket City Hospital, Dr Mohan Nair will be a columnist with us for the next two weeks. He is Chairman of the Organizing Committee of the 7th Asia Pacific Heart Rhythm Society’s (APHRS) Scientific Sessions, being organized simultaneously at the Taj Palace Hotel and ITC Maurya in New Delhi from October 29th to November 1st, 2014. The highlights of the conference will be published in eMedinewS.

Dr. Nair has over 30 years of experience in the field with his core competencies in Interventional Cardiology and Electrophysiology. Before joining Saket City Hospital, he held several significant positions at Max Super Specialty Hospital; Fortis Healthcare, GB Pant Hospital; and Maulana Azad Medical College.

Over the years, Dr. Nair has performed over 5000 Electrophysiology procedures and 3500 radiofrequency catheter ablations and over 10,000 angioplasties. This makes him one of the top 10 Interventional cardiologists in India and one of the leading electro physiologists of South Asia. He has published more than 100 publications in top international journals like Circulation, American Heart Journal and American Journal of Cardiology. He has given several orations, invited lectures and has many presentations at national and international fora. Dr Nair has also initiated educational and academic activities in Cardiology with special respect to Electrophysiology and Angioplasty, in various healthcare institutions in India, Europe, Pakistan, China, UAE and Sri Lanka and helped them in introducing advanced cardiac program in their centres.

News Around The Globe

  • Mirogabalin has shown promise as a potential treatment for diabetic peripheral neuropathic pain in a dose-ranging, proof-of-concept study in comparison with both placebo and pregabalin. The study was published online in Diabetes Care.
  • Sleep disturbance is associated with pain and depression in osteoarthritis of the knee, and baseline sleep disturbances predict increased disability and depression over time, even without increases in pain, suggested a new study published online October 6 in Arthritis Care & Research.
  • In a report presented recently at the European Society for Medical Oncology Congress 2014, experts have pointed out that in the management of metastatic colorectal cancer, it is time to go beyond KRAS testing and do expanded RAS testing.
  • A new study indicates that both regular and decaf coffee lower liver enzyme levels, suggesting the benefits are not linked to caffeine content. The findings are published in Hepatology.
  • Several regimens that exclude efavirenz have similar efficacy in the initial treatment of HIV, suggest the results from a phase 3 AIDS Clinical Trials Group randomized controlled trial published online October 6 in the Annals of Internal Medicine. The results expand the treatment options for people who cannot take the drug.

Dr KK Spiritual Blog

Spirituality The Key To Health

To stay healthy, one needs to eat right, get plenty of exercise and rest, and avoid bad habits such as smoking. But, now it is said that “what you believe in” can have a big impact on health and longevity.

There have been a lot of studies that show how patients with strong spirituality can improve their health from a variety of chronic conditions, like hypertension, heart disease, recover from surgery and more.

Research indicates there are real health benefits from spirituality:

  1. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  2. Positive thinking produces nearly a 30 percent drop in perception of pain.
  3. Spirituality and the practice of religion have recently been associated with a slower progression of Alzheimer's disease.
  4. Those who regularly attend organized religious activities may live longer than those who don't. Regular participation lowers mortality rate by about 12 percent a year.
  5. People undergoing cardiac rehabilitation are more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  6. Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  7. Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body's stress response.
  8. Spirituality can affect immune-system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  9. Prayer heals the heart.
  10. Positive talking and thinking in the ICU produces better results.

Spirituality is what brings you peace and safety. It can be achieved through praying to God or Goddess, nature, a beautiful sunset, a meditation, pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

Inspirational Story

Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.

The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said “you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one.”

You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.

Rabies News (Dr A K Gupta)

Can “major surgery” be done after the dog bite?

There is no contraindication for any surgery along with anti-rabies vaccination and a full course of anti-rabies immunization should be given, irrespective of the surgery or other procedures.

Cardiology eMedinewS

  • The US Food and Drug Administration has approved a new microbubble contrast agent for echocardiography: Lumason (Bracco Diagnostics) sulfur-hexafluoride lipid microspheres. Lumason's safety and efficacy were explored and defined in three trials among patients with suspected heart disease but hard-to-interpret standard echocardiograms.
  • A new review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has stated that there is no consistent evidence that the use of testosterone in men with hypogonadism increases the risk for cardiovascular problems. The committee has determined that the benefits of testosterone continue to outweigh its risks but stresses that testosterone-containing medicines should be used only where lack of testosterone has been confirmed by signs and symptoms as well as laboratory tests.

Pediatrics eMedinewS

  • A new study published in PLos One shows that by the age of five, children become wary of information provided by people who make overly confident claims. During the study, the four-year-olds were as likely to believe a confident liar as a hesitant truth-teller, but as they neared the age of five, they were more likely to believe the previously accurate but hesitant individual. Thus, a year can make a big difference in terms of a child's evolution in the critical consumption of information.
  • Hospitalized children go home sooner and are less likely to be readmitted when the hospital has an antibiotic stewardship program that's dedicated to controlling antibiotic prescriptions and treatment, suggested a study presented at IDWeek 2014.

Quote of the Day

  • The best and most beautiful things in the world cannot be seen or even touched - they must be felt with the heart. Helen Keller


According to the health minister, three new Bills to regulate health research and facilitate clinical practices in areas like surrogacy and new systems of medicine have been finalised. These are: The Biomedical and Health Research Regulation Bill, 2014 – to regulate ethical aspects of health research; The Assisted Reproductive Technology (Regulation) Bill, 2014 which will oversee medical, legal and social issues linked to surrogacy; and, The Recognition of New Systems of Medicine Bill, 2014 to determine the distinctive characteristics of alternative systems of medicine.

WMA Asks Physicians To Roll Up Their Sleeves For Influenza Vaccination: The second phase of the WMA’s campaign, supported by the International Federation of Pharmaceutical Manufacturers and Associations, was launched today at the WMA’s annual General Assembly in Durban, South Africa. Dr. Mukesh Haikerwal, Chair of the WMA, told more than 200 physician leaders attending the meeting that they should become role models by incorporating better immunization practices into their clinical routine. He said: ‘Between five and ten per cent of adults and up to 30 per cent of children worldwide will contract seasonal influenza annually and there are about five million severe cases and 500,000 deaths each year. Annual vaccinations are critical for high-risk groups, such as the very young, the elderly, pregnant women, and those with underlying non-communicable diseases such as diabetes, heart disease, and chronic obstructive pulmonary disease.

  • The campaign seeks to harness the power of digital communication and social media to get the message across to physicians all over the world. Based on findings that health professionals are the most trusted source of information on health issues, their role in promoting increased vaccination coverage is critical, particularly for high risk groups and people living with NCDs. In the USA, the personal recommendation by a healthcare professional, particularly a family doctor or nurse, has been shown to be the single greatest factor most likely to encourage vaccination. Through the campaign, the WMA is encouraging physicians to make a small thing (getting the flu vaccine) a big deal by protecting themselves and those they care for, and by asking others to follow their lead.
  • New guidelines about the practice of cosmetic treatment have been agreed by the World Medical Association: Meeting in Durban, South Africa, delegates at the WMA's annual Assembly adopted a statement expressing concern that in many countries aesthetic procedures are not adequately regulated, particularly when it involves children. They agreed new guidelines, primarily for physicians, warning that many treatments involve risks and may potentially harm the health of the patient.

The guidelines say: ‘Body image affects a person's self-esteem and mental health and is an integral part of a person's overall health and well-being. However, media images of “perfect bodies” have become the norm, causing some people, to develop unrealistic and unhealthy body images.'

Dr. Xavier Deau, President of the WMA, said: ‘This type of treatment has become increasingly common in recent years as people become more preoccupied with their physical appearance. We are talking about treatment or surgery not for an injury or a deformity, but for non-therapeutic reasons, with the sole purpose of changing the physical appearance of an individual. And we are particularly concerned that children are vulnerable, as their bodies are often not fully developed.'

The guidelines say that minors may need or benefit from plastic medical treatment but that pure aesthetic procedures should not be performed on them. The statement says: ‘If, in exceptional cases, aesthetic treatment is performed on a minor, it should only be done with special care and consideration and only if the aim of the treatment is to avoid negative attention rather than gain positive attention'. Dr. Deau said: ‘We have also said that advertising and marketing of aesthetic treatments should never be targeted at minors.'

The guidelines also state that these treatments are performed by practitioners with widely differing clinical and educational backgrounds and that they must only be performed by practitioners with sufficient knowledge, skills and experience. Therefore all practitioners providing aesthetic treatments must be registered with or licensed by the appropriate regulatory authority. Ideally, the practitioner should also be authorized by this authority to provide these specific aesthetic treatments.

WMA Recommendations on EBOLA:

The WMA commends those countries that have committed resources for the urgent establishment of new treatment and isolation centres in the most heavily burdened countries and regions.  The WMA calls upon all nations to commit enhanced support for combatting the EVD epidemic.

2. The WMA calls on the international community, acting through the United Nations and its agencies as well as aid agencies, to immediately provide the necessary supplies of PPE to protect health care workers and ancillary staff and reduce the risk of cross infection.  This must include adequate supplies of gloves, masks and gowns, and distribution must include treatment centres at all levels.

3. The WMA calls on all those managing the epidemic, including local and national governments and agencies such as WHO, to commit to adequate training in infection control measures, including PPE for all staff and caregivers who might come into contact with infective materials.

4. The WMA honours those working in these exceptional circumstances, and strongly recommends that national governments and international agencies work with health care providers on the ground and offer stakeholders training and support to reduce the risks that they face in treating patients and in seeking to control the epidemic.

5. The WMA calls on national and local governments to increase public communication about basic infection control practices.

6. The WMA calls upon WHO to facilitate research into the timeliness and effectiveness of international interventions, so that planning and interventions in future health emergencies can be better informed.

7. The WMA strongly urges all countries, especially those not yet affected, to educate health care providers about the current case definition in addition to strengthening infection control methodologies and contact tracing in order to prevent transmission within their countries.

8. The WMA calls for NMAs to contact their national governments to act as described in this document

Wellness Blog

Eating high fiber diet

  • There are two types of fibers. One is soluble and the other is insoluble.
  • Soluble fiber includes those that are made up of carbohydrates and are soluble in water. Examples are oats, barley and legumes.
  • Insoluble fiber comes from plant cells and does not dissolve in water. Examples are wheat, ragi and other grains.
  • Traditionally, fiber is insoluble fiber.
  • Dietary fiber is a combination of soluble and insoluble fiber.
  • The recommended amount of dietary fiber is 20-35 gm in a day.
  • Eating a high-fiber diet both can prevent constipation, reduce cholesterol, and help in reversing obesity and heart diseases in children and adults.
  • A high-fiber diet should be a balanced diet with food from all food groups.
  • The common sources of fiber are whole grain produce and cereals, legumes, fruits and vegetables.
  • Prunes and peas are natural laxatives.
  • Raw vegetables such as carrot, garlic or cherry tomatoes are rich in fiber.
  • Salads with dark green lettuce provide high fiber content.
  • Eating whole wheat bread or with added fiber is a rich source of fiber.
  • Prefer brown rice over white rice.
  • You can eat whole wheat carbohydrates, bran muffins, bran cereals or oat meals.
  • Avoid eating refined white flour, cereals and other starches.
  • If juices are to be taken, one should take 4-6 ozs.
  • Fruits are better than juices
  • Try to develop a taste for bran by starting with 2-4 table spoons every day.
  • Mix a high fiber cereal with a regular cereal.
  • Isabgol is a fiber supplement.

ePress Release

Over 50, focus only on upper blood pressure

For patients over 50, doctors only need to monitor the upper systolic blood pressure, and can ignore the lower diastolic blood pressure reading, 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.

Systolic blood pressure – the top number in a blood pressure reading – is the pressure exerted at the beginning of the heart's pumping cycle, while diastolic pressure records the lowest pressure during the resting cycle of the heart. Both pressures are routinely measured when recording the blood pressure.

As per a report published in the journal The Lancet, there is such an emphasis on diastolic pressure that the patients are not getting their systolic blood pressures adequately controlled. The fact is that people over the age of 50 probably do not even need to measure diastolic pressure, it is only the systolic blood pressure that should be the focus.

Generally, systolic blood pressure continues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time when cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent. Rising systolic pressure is the most significant factor in causing stroke and heart disease.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, a continued emphasis on both systolic and diastolic blood pressures is needed. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too.

For people 50 or older, systolic pressure is high if it is 140 mmHg or above.

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!!!!"

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at N P CO-ED Sr Sec School, Laxmi Bai Nagar on 28th August 2014



Zee News – Health Wealth Shows


press release

FDA panel recommends first drug for HIV prevention

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Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

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 – 96458 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 45–year–old came with first onset diabetes.
Dr Bad: Start pioglitazone.
Dr Good: Start metformin.
Lesson: Metformin is considered the first choice for oral treatment of type 2 diabetes in the absence of contraindications (Diabetes Care 2009;32:193).

Make Sure

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.

Twitter of the Day

Dr KK Aggarwal: ECGECG not reliable marker for predicting heart disease
Dr Deepak Chopra: Harness the power of intention

eMedi Quiz

A 2-month-old baby with acute icteric viral hepatitis like illness slips into encephalopathy after 48 hours. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is most likely to be:

1. HBsAg positive only.
2. HbsAg and HBeAg positive.
3. HBsAg and HBe antibody positive.
4. HBV DNA positive.

Yesterday’s Mind Teaser: A hybrid teledermatology is

a. Combination of store and forward and mobile teledermatology
b. Combination of store and forward and video conference
c. Combination of online discussion group and author based second opinion teledermatology
d. Combination of online discussion group and video conference

Answer for yesterday’s Mind Teaser: b. Combination of store and forward and video conference

Correct answers received from: Dr Jainendra Upadhyay, Dr.K.Raju, Dr. Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Poonam Chablani

Answer for 11th Oct Mind Teaser: C. Store-and-forward teledermatology

Correct answers received from: Dr Poonam Chablani

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)

Can doctor–couple dispense drugs without license?

Dr P Kamalasanan, a private medical practitioner from Kollam in Kerala was punished last month for dispensing drugs without a license. Additional Sessions Judge, Kollam on August 7 sentenced Dr Kamalasanan of one–day "imprisonment" and also fined him Rs 1.20 lakh on the charges of running a pharmacy without a license from his clinic. Appearing before the court, Dr Kamalasanan reportedly served the sentence by remaining there till the rising of the court.

View1: Under the rules, only a single–doctor clinic is exempted from the process of obtaining a license before dispensing drugs and any clinic run with the help of more than one doctor falls under the category of hospital, for which it is mandatory to obtain a license to dispense medicines.

View 2: The Drugs & Cosmetics Act, 1940 & Rules, is very clear that private clinics, the place where professional activities of registered medical practitioners take place, are exempted from the drug licence. Private clinics are fully protected from harassment of drug controllers.

Clause–5 of Schedule–K of the Drugs and Cosmetics Rules allows a single doctor to stock, prescribe or dispense medicines without having a license; it does mandate a clinic run by more than one doctor to obtain a license.

A doctor cannot dispense medicines on the prescription given by another doctor; neither can a visiting doctor dispense medicines from that clinic. Item 5. Drugs supplied by a registered medical practitioner to his own patient or any drug specified in Schedule C supplied by a registered medical practitioner at the request of another such practitioner if it is specially prepared with reference to the condition and for the use of an individual patient provided the registered medical practitioner is not (a) keeping an open shop or (b) selling across the counter or (c) engaged in the importation, manufacture, distribution or sale of drugs in India to a degree which render him liable to the provisions of Chapter IV of the Act and the rules there under." (Excerpts from news in IMT)

medicolegal update
  1. Dear Sir, Very informative news. Regards: Dr Shravan

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)