September 13   2015, Sunday
Elderly should Beware of Commonly Prescribed Group of Drugs
Dr KK Aggarwal Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anti-cholinergic drugs used to treat acid reflux, Parkinson's disease and urinary incontinence may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include the blood pressure medication, nifedipine; the stomach antacid, ranitidine and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and donepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.
Padma Shri Awardee Dr. KK Aggarwal becomes the first doctor ever to receive the Vishva Hindi Samman Receives the award from Home Minister Shri Rajnath Singh at the 10th Vishva Hindi Samelan hosted by the Ministry of External Affairs, Government of India in Bhopal

High intake of fish could reduce the risk of depression, suggests a meta-analysis published in the Journal of Epidemiology & Community Health.

Pulmonary Medicine

For patients with moderate chronic obstructive pulmonary disease (COPD) and a history of or risk for cardiovascular disease, the combination of an inhaled corticosteroid and a long-acting beta-2 agonist provides no mortality benefit, suggests a new study presented at the European Respiratory Society (ERS) International Congress 2015.

In testicular cancer, almost 50% comes from DNA, i.e., inherited, suggests a new study published in the journal Scientific Reports.


New research has shown for the first time that the part of the brain used for learning, memory and mental health - the hippocampus - is smaller in people with unhealthy diets. The findings were published in the journal BMC Medicine.


More than a third of patients with chronic pain may have attention-deficit disorder (ADD), suggested a small pilot study presented during PAINWeek 2015.
Cardiology eMedinewS
  • New research, presented at the European Society of Cardiology (ESC) 2015 Congress, revealed that the drug still commonly referred to as LCZ696 (valsartan/sacubitril) appears similar to a common ACE inhibitor in not increasing renal dysfunction in patients with reduced-LVEF heart failure (HFrEF).
  • According to data from the large, international ROPAC (Registry on Pregnancy and Cardiac disease) registry, the mortality risk for pregnant women with moderate or severe aortic stenosis is close to zero in contemporary practice. However, according to Dr. Stefan Orwat of University Hospital in Muenster, Germany more than one-third of women with severe aortic stenosis will require hospitalization for cardiac reasons during their pregnancy, with heart failure the number-one cause for admission.
Pediatrics eMedinewS
Allergy and Immunology

Infants in households with furry pets were found to share some of the animals' gut bacteria, possibly explaining why early animal exposure may protect against some allergies, suggests a small, preliminary study published online in the Journal of Allergy and Clinical Immunology.


Inferior turbinoplasty is safe and effective for treating nasal obstruction in children, but most patients continue to take medication for their symptoms, reported a new 10-year retrospective review published online in JAMA Otolaryngology - Head & Neck Surgery.
Pulmonary Embolism
Hemodynamically unstable Pulmonary embolism

Hemodynamically unstable pulmonary embolism (PE) is defined as a systolic blood pressure <90 mmHg or a drop in systolic blood pressure of ≥40 mmHg from baseline for >15 minutes. Patients with hemodynamically unstable PE are more likely to die from obstructive shock in the first two hours of presentation, and the risk remains elevated for up to 72 hours after presentation.
Dr KK Spiritual Blog
Leverage your strengths
  1. Know your strengths
  2. According to a British study, only about one-third of people have a useful understanding of their strengths.
  3. If something comes easily, you may take it for granted and not identify it as a strength.
  4. If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  5. Strengths which most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
  6. Strengths are so important that they're worth cultivating and applying in your daily life, even if they don't come naturally to you
Wellness Blog
Why is My Nose Bleeding?

Nosebleed is a common problem, occurring in up to 60 percent of the general population and is often because of a respiratory illness or dry conditions. Nasal drying is common in the hot summer months because of the extreme temperature and dry air due to use of air conditioners. Here are some typical reasons for nosebleeds:
  • Nasal allergies
  • Blowing your nose too hard or trying to remove something from inside the nose
  • A result of “popping” the ear
  • Nasal exposure to chemicals
  • Frequent sneezing or having an upper respiratory infection
  • Use of nasal spray or a blood-thinning drug, such as aspirin
  • Inhaling air that is extremely dry or cold
  • Having recent surgery on the nose or elsewhere on the face
  • Breaking the nose or a similar injury
  • Uncontrolled blood pressure
Bleeding can be controlled by direct pressure i.e. compression of the nostrils rasping the alae distally so all mucosal surfaces are opposed. Direct pressure should be applied continuously for at least five minutes, and for up to 20 minutes. The patient should be encouraged not to check for active bleeding. Patients who are properly instructed may control their bleeding while the evaluation gets underway.

Other maneuvers include bending forward at the waist while sitting up (to avoid swallowing blood), placing a plug of cotton wool or gauze into the bleeding nostril (sometimes coated with antibiotic ointment), expectorating out blood that accumulates in the pharynx and a cold compress applied to the bridge of the nose.

These maneuvers also should be taught to high-risk patients for use at home. Many ENT specialists recommend initial treatment with two puffs of oxymetazoline to hasten hemostasis.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Modern ERA Convent Sr. Sec. School
Make Sure
Situation: A terminally ill patient who developed bed sores is prescribed only systemic antibiotics.
Reaction: Also change the position of the patient frequently and keep the skin clean and dry.
Lesson: Make sure that a patient with bed sore is also advised good nursing care and maintenance of skin hygiene, along with topical antibiotics.
Dr Good 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.

(Copyright IJCP)
eMedinewS Humor
Civil Servant

Three boys are in the schoolyard bragging of how great their fathers are. The first one says, "Well, my father runs the fastest. He can fire an arrow, and start to run, I tell you, he gets there before the arrow".

The second one says, "Ha! You think that's fast! My father is a hunter. He can shoot his gun and be there before the bullet".

The third one listens to the other two and shakes his head. He then says, "You two know nothing about fast. My father is a civil servant. He stops working at 4:30 and he is home by 3:45!!"
HCFI Videos
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
Video of the Day
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 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
eIMA News
  1. Instead of taking a conventional lunch break, experts suggest that a respite earlier in the workday replenishes more resources — energy, concentration and motivation. The study also suggests that frequent short breaks are better than longer breaks and people who take 'better breaks' experience good health and increased job satisfaction. (TOI)
  2. Michael Trenell, PhD, of Newcastle University in the UK and coauthors suggest that high-intensity intermittent exercise training (HIIT) improved cardiac structure and function in patients with type 2 diabetes (T2DM), suggesting that such exercise could reverse the cardiac dysfunction associated with diabetes.
  3. The Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) today issued a health advisory urging all clinicians and facilities to double-down on properly cleaning, disinfecting, and sterilizing reusable medical devices. The joint advisory cited a recent rash of infection control lapses that have forced healthcare organizations to test patients for bloodborne pathogens such as hepatitis B virus and HIV.
  4. Dynamic leg muscle power is an independent determinant of pain and quality of life in knee osteoarthritis (OA), and it appears to outperform muscle strength as a measure of muscle performance, according to researchers from Tufts University and Tufts Medical Center, Boston.
  5. In the Systolic Blood Pressure Intervention Trial (SPRINT), investigators report that treating high-risk hypertensive adults 50 years of age and older to a target of 120 mm Hg significantly reduced cardiovascular events by 30% and reduced all-cause mortality by nearly 25% when compared with patients treated to a target of 140 mm Hg.
We are starting a new column from today ‘Bioethical Issues in Medical Practice’ by Dr Smita N. Deshpande, Head, Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, PGIMER-Dr. Ram Manohar Lohia Hospital, New Delhi, that will focus on the various ethical dilemmas that doctors come across in their day to day practice. We hope that all our readers will participate enthusiastically in this interactive column.

Here is a brief introduction to this new column.

Bioethics is the study of the ethical and moral implications of medical research and medical practice. The UNESCO Declaration on Bioethics, to which India is a signatory, was adopted on 19th October, 2005 at the UNESCO General Conference with the aim of teaching-training medical healthcare personnel in ethical issues around patient care and biomedical research. The Indian medical curriculum does not adequately address ethical issues in daily practice. Ethical issues in medical practice are being adversely targeted all over the world, India being no exception.

With a view to addressing this lacuna, the Central India Unit of the Asia Pacific Bioethics Network of the UNESCO Chair Haifa based at Dept. of Psychiatry, PGIMER-Dr. RML Hospital, in partnership with the Indian Medical Association (IMA) is beginning this column to increase awareness about bioethical issue impacting medical practice among our members.

This column will highlight ethical dilemmas as well as pose queries and puzzles on ethical issues we face in clinical practice. Often, ethical issues may need to be resolved keeping cultural practices and beliefs in mind. Many such dilemmas may not have a black and white answer. But they need to be resolved sensitively yet ethically. You are most welcome to contribute by sending in ethical dilemmas that you may have faced, as healthcare providers, and how you resolved those issues.
Blood pressure, diabetes, smoking among biggest killers in India: Study
Sushmi Dey, TNN | Sep 12, 2015, 05.11 AM IST

NEW DELHI: High blood pressure, high blood sugar, smoking and pollution are causing more deaths in India than under nutrition and other tropical diseases, according to a latest study by Lancet, as reported in the Times of India. It observed a significant increase in deaths over the past decade due to diseases associated with these health risk factors.

Between 1990 and 2013, deaths due to high blood pressure and cholesterol in India have more than doubled, whereas that from outdoor pollution have increased by more than 60% during the period. Deaths from alcohol have also increased by 97%, data collected through analysis of 79 risk factors showed.

The study, assessing the global disease burden, was conducted by an international consortium of researchers led by the University of Washington and included representatives from the Public Health Foundation of India (PHFI).

In 1990, childhood under nutrition was the topmost health risk causing around nearly 8.97 lakh deaths in India. However, the study shows it is no longer among the top ten health risk factors in the country. On the contrary, high blood pressure, which caused over 76 lakh deaths in 1990, was the most serious threat to the health of people with deaths increasing by 106% in 2013. According to the study, high blood pressure, high blood sugar and indoor pollution together contributed to 3.3 million premature deaths in India in 2013.

The other major contributors to health loss in India are unsafe water sources and tobacco consumption. Though the contribution of child and maternal under nutrition to health loss have dropped significantly since 1990, these are still substantial contributors to health loss in India, the study said. "It is remarkable that the contribution of metabolic risk factors such as high blood pressure, blood sugar and cholesterol, and that of poor diet and alcohol use, to health loss has doubled in India over the past quarter of a century," said study co-author Lalit Dandona, who is also a professor at PHFI.

Experts said findings from the study provide useful pointers for where policy emphasis is needed to improve health in India.
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Inspirational Story
The Tale of Two Pebbles

Many years ago in a small Indian village, a farmer had the misfortune of owing a large sum of money to a village moneylender. The moneylender, who was old and ugly, fancied the farmer’s beautiful daughter. So he proposed a bargain. He said he would forgo the farmer’s debt if he could marry his daughter.

Both the farmer and his daughter were horrified by the proposal. So the cunning money-lender suggested that they let providence decide the matter. He told them that he would put a black pebble and a white pebble into an empty money bag. Then the girl would have to pick one pebble from the bag.

If she picked the black pebble, she would become his wife and her father’s debt would be forgiven. If she picked the white pebble she need not marry him and her father’s debt would still be forgiven. If she refused to pick a pebble, her father would be thrown into jail.

They were standing on a pebble strewn path in the farmer’s field. As they talked, the moneylender bent over to pick up two pebbles. As he picked them up, the sharp-eyed girl noticed that he had picked up two black pebbles and put them into the bag. He then asked the girl to pick a pebble from the bag.

Now, imagine that you were standing in the field. What would you have done if you were the girl? If you had to advise her, what would you have told her? Take a moment to ponder this. What would you recommend that the girl do? The girl put her hand into the moneybag and drew out a pebble. Without looking at it, she fumbled and let it fall onto the pebble-strewn path where it immediately became lost among all the other pebbles.

“Oh, how clumsy of me!” she said. “But never mind, if you look into the bag for the one that is left, you will be able to tell which pebble I picked.” The moneylender dared not admit his dishonesty. The girl changed what seemed an impossible situation into an extremely advantageous one.

Most problems do have a solution, sometimes we just need to think in a different way.
eIMA Quiz
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

Yesterday’s Mind Teaser: Which of the following is a basic teledermatology tool?

a. Videoconference
b. Hybrid teledermatology
c. Store-and-forward teledermatology
d. Mobile teledermatology

Answer for Yesterday’s Mind Teaser: c. Store-and-forward teledermatology

Correct answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr K Raju, VISWANATHA SARMA, Dr B R Bhatnagar, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 11th September Mind Teaser: c. Elevate the scrotum using a soft support

Correct Answers received from: Dr BR Bhatnagar, Dr Poonam Chablani, Raju Kuppusamy, Dr Shangarpawar, Dr Ridu Kumar Sharma, Dr Avtar Krishan, Daivadheenam Jella.
Quote of the Day
Success is no accident. It is hard work, perseverance, learning, studying, sacrifice and most of all, love of what you are doing or learning to do. Pelé
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Dear Sir, Very Informative News. Regards: Dr Kanak
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Rabies News (Dr A K Gupta)
Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier.
Press Release
Padma Shri Awardee Dr. KK Aggarwal becomes the first doctor ever to receive the Vishva Hindi Samman

Receives the award from Home Minister Shri Rajnath Singh at the 10th Vishva Hindi Samelan hosted by the Ministry of External Affairs, Government of India in Bhopal

Recognizing an outstanding contribution in the field of modern scientific, medical writing, the Ministry of External Affairs – Government of India today conferred Dr. KK Aggarwal the Vishva Hindi Samman. The award was given to Dr. Aggarwal at the ongoing 10th Vishva Hindi Samelan in Bhopal for his book Alloveda. Presenting the award was none other than Home Minister – Shri Rajnath Singh.

Others present on the dais included Dr. Harshvardhan - Minister of Science & Technology and Earth Sciences, Govt of India,Shri Shivraj Chouhan -Chief Minister of MP, Shri Mohan Lal Khattar – Chief Minister of Haryana, Shri Raman Singh – Chief Minister of Chhattisgarh, Smt – Mridula Singha – Governor of Goa, Shri Keshari Nath Tripathi – Governor of West Bengal, General VK Singh – Minister of State for External, Shri Anil Wadhwa – Secretary East MEA, Smt Leela Devi – Minister of Social Security Mauritius and Shri Anil Mahav Dave – MP, Shri Alok Sanjar - MP

A consultant cardiologist, President of Heart Care Foundation of India and the Honorary Secretary General of the Indian Medical Association, Dr. KK Aggarwal has worked extensively towards explaining Vedic medicine in a scientific manner. He has also played an active role in streamlining the procedure of handling medical negligence cases and creating guidelines that all doctors must follow through his books and writings. He is also the MD of the IJCP Group of Medical Communications through which he has contributed immensely in the field of medical scientific writing. Dr. Aggarwal also works tirelessly for the upliftment of the lower sections of the society with the basic belief that every person irrespective of their gender, caste or social standing deserves proper medical care.

Dr. Aggarwal is the recipient of three other National awards namely the Padma Shri, Dr. B C Roy National Award, and National Science Communication Award. He is also a Limca book of World Record holder for the maximum people trained in the life-saving technique of Hands only CPR.

Commenting on the occasion, Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General Indian Medical Association and the President of the Heart Care Foundation of India said, “I am honored to receive such a prestigious award from the Ministry of External Affairs, Govt. of India. Vedic Scientific knowledge incorporates science behind rituals, religion, and festivals. As per the Vedic philosophy incorporating parasympathetic breathing and exercises in one’s everyday life can reduce the disease duration, requirement of modern medicine drugs and help prevent most lifestyle disorders."

Alloveda is a book that Dr. Aggarwal has authored on Vedic knowledge in Allopathic language. The book in Hindi, explains how Vedic knowledge can be synergistically used in modern practice. For example chanting of vowels produces interleukin 2 and chanting of nasal consonants produces delta activity in the EEG and hence all sounds with a mix of a vowel and a nasal consonant will produce mental and physical relaxation. Dr. Aggarwal also explains Adwait Ramayana in modern science language linking Mind Body and Soul concept. Hein his book emphasizes the role of parasympathetic lifestyle and breathing. Any activity, which can bring one from a sympathetic to parasympathetic mode, can help healing.

Vedic medicine is not about drugs but procedures and activities linked to mind body and soul detoxification. It talks about relaxation, meditation, parasympathetic exercises and how to detoxify the mind by practicing mindfulness exercises and cultivating positive thoughts.

This year a total of 40 awards were given by at the VishveHindi Samelan. 20 Awards were conferred to people of International eminence and 20 to the eminent people from India.