eMedinewS14th November 2013, Thursday

Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; 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.facebook.com/Dr KKAggarwal

New Cardiac Prevention Guidelines

The American College of Cardiology (ACC) and American Heart Association (AHA) released four new guidelines dealing with the prevention of cardiovascular disease (CVD) by better assessing risk and by managing cholesterol, lifestyle and weight.

The guideline on managing blood cholesterol diverges from previous guidance by moving away from hard treatment targets for LDL and non–HDL cholesterol, and focusing instead on identifying the appropriate intensity of therapy for a particular patient in order to reduce his or her risk, in combination with a heart–healthy lifestyle.

1. Assessment of Cardiovascular Disease Risk: The new guidelines describes a new equation for estimating a patient’s risk of having an atherosclerotic cardiovascular disease event in the next 10 years based on pooled results from five large cohort studies. The equation considers age, sex, total and HDL cholesterol, systolic blood pressure, blood pressure treatment, diabetes and smoking. The new equation differs from previous ones in that it considers risk of stroke. The authors also concluded that a calculation of longer–term risks –– over the next 30 years or during the lifetime –– may be considered in younger patients ages 20 to 59 who do not have a high short-term risk but have a concerning risk factor burden.

2. Treatment of Blood Cholesterol: The guideline on managing blood cholesterol to reduce atherosclerotic cardiovascular risk diverges from previous guidance by moving away from hard treatment targets for LDL and non–HDL cholesterol. Instead, the focus is on identifying the appropriate intensity of therapy for a particular patient in order to reduce his or her risk in combination with a heart–healthy lifestyle. Although all of the lipid–lowering therapies were considered, the strongest evidence of a favorable risk–benefit ratio existed for statins. Four groups of patients deemed to derive the most benefit from statin therapy: Those with a history of atherosclerotic cardiovascular disease; those with an LDL cholesterol level of 190 mg/dL or more, which includes many patients with familial hypercholesterolemia; patients with diabetes ages 40 to 75 who do not have a history of clinical atherosclerotic cardiovascular disease and have an LDL cholesterol level of 70 to 189 mg/dL and those with a 10–year cardiovascular risk –– assessed using the new equation of 7.5% or higher and an LDL cholesterol level of 70 to 189 mg/dL but no history of cardiovascular disease. High-intensity statin therapy –– which reduces LDL cholesterol by at least 50% –– is indicated in the first two groups. For patients with diabetes, the new risk equation can be used to determine whether high–intensity of moderate-intensity statin therapy (that associated with LDL cholesterol reductions of 30% to 49%) should be used. Moderate-intensity statin therapy should be sufficient in the last group.

3. Lifestyle Management: The importance of healthy dietary patterns is emphasized in the guideline on lifestyle management to reduce atherosclerotic cardiovascular disease risk. There is a strong recommendation to consume a diet rich in fruits, vegetables, whole grains, low–fat dairy, legumes, fish, poultry, and nuts and low in sweets, sugar–sweetened beverages, and red meats –– along the lines of the DASH or Mediterranean diets. There is evidence backing restrictions on saturated fat and trans fat to reduce cholesterol levels, and restrictions on sodium to reduce blood pressure. Physical activity is included as well, with the authors concluding that the evidence supports guidance released by the Department of Health and Human Services in 2008, which recommends 40 minutes of moderate–to–vigorous activity on 3 or 4 days a week.

4. Management of Overweight and Obesity: Maintenance of a healthy weight is the focus. Body mass index should be used as a quick first evaluation, followed by a measurement of waist circumference, to determine risks of cardiovascular disease, diabetes, and death. Even weight loss –– 3% to 5% –– is associated with clinically meaningful benefits. The guideline does not contain a preference for any specific diet to achieve that weight loss, but rather contains a recommendation for clinicians to prescribe diets designed to reduce caloric intake with modifications according to patient preferences and health status. Strong recommendations are made regarding lifestyle interventions to help achieve weight loss, including at least 6 months of counseling regarding diet and exercise. The strongest recommendation was for a comprehensive program that includes on–site, intense interventions delivered by a healthcare professional trained in weight management. The bariatric surgery may be an appropriate option in patients with a BMI of 35 kg/m2 or higher accompanied by obesity–related comorbidities, or with a BMI of 40 kg/m2 or higher regardless of comorbidities. (MedPage)

Top 10 Healthcare Technology Hazards for 2014

1. Alarm Hazards: "Alarm hazards" is a national patient safety goal for 2014 of the Joint Commission. In April 2013, the Joint Commission issued a Sentinel Event Alert after 98 alarm–related events occurred over a three–and–a-half–year period resulting in death for 80 patients and permanent loss of function for 13 others. "Beyond alarm fatigue, patients could be put at risk if an alarm does not activate when it should, if the alarm signal is not successfully communicated to staff or does not include sufficient information about the alarm condition, or if the caregiver who receives the alarm signal is unable to respond or is unfamiliar with the proper response protocol.

2. Infusion Pump Medication Errors: Some medications are life–sustaining–or life–threatening if administered incorrectly.

3. CT Radiation Exposures in Pediatric Patients: The risk can be lessened by using safer diagnostic tests such as traditional X–rays, magnetic resonance imaging, and ultrasound. Repeat testing should be avoided whenever possible, and the lowest possible amount of radiation should be used.

4. Data Integrity Failures in EHRs and Other Health IT Systems: When designed and implemented well, an EHR [electronic health record] or other IT (information technology)–based system will provide complete, current, and accurate information about the patient and the patient's care so that the clinician can make appropriate treatment decisions. The presence of incorrect data can result in patient harm.

5. Occupational Radiation Hazards in Hybrid Operating Rooms: All hybrid operating rooms should have a radiation protection program in place.

6. Inadequate Reprocessing of Endoscopes and Surgical Instruments: Patient cross-contamination is possible leading to the transmission of infectious agents and the spread of diseases such as hepatitis C, HIV, and tuberculosis.

7. Neglecting Change Management for Networked Devices and Systems: One underappreciated consequence of system interoperability is that updates, upgrades, or modifications made to one device or system can have unintended effects on other connected devices or systems.

8. Risks to Pediatric Patients from "Adult" Technologies

9. Robotic Surgery Complications Due to Insufficient Training

10. Retained Devices and Unretrieved Fragments: In October 2013, the Joint Commission issued a Sentinel Event Alert on the unintended retention of foreign objects, noting that 772 such incidents were reported to its Sentinel Event Database from 2005 to 2012, including 16 that resulted in death.

(Source: Health Devices. November 2013 report and Medscape)

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."

VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Do what you do to God

sprritual blog

1. There are two types of people who believe in Dvaita or Advaita philosophy.
2. People who believe in Dvaita philosophy, for them God and human being are different.
3. The people who believe in Advaita philosophy believe that God is within them.
4. In Hinduism, the first group believes in Sanatan Dharma and does Moorti pooja (idol worship) and the second Arya Samaj, which does not believe in Moorti pooja.
5. In both situations, medically the message is one.
6. If God is different than you, then you try to be like Him and if God is in within you, then you are Him.
7. In both situations, we should deal with our body the same way as we deal with God.
8. Anything which is not offered to God should not be offered to our body such as cigarettes, drugs etc or such things should be consumed in less quantity (onion, garlic, radish etc.).
9. We never worship God with hydrogenated oil; we always worship him either with oil or with Desi Ghee. The message is we should not consume trans fats.
10. "Bhagwan ko bhog lagate hain" and we never feed God. The message is, we should eat less.
11. Amongst all Gods, only Lord Shiva is said to consume Bhang and Alcohol that too only in his incarnation of Bhairon, which indicates that both alcohol and bhang can be consumed in some quantity only in special situations meaning that they cannot be consumed without medical supervision.
12. Anything grown under the ground is not offered to God, thus, these items should not be eaten or eaten in moderation.
13. We never offer white salt and white rice to God. They are also bad for human beings.
14. Gur, shakkar, brown rice and puffed rice are offered to God. They can be consumed by human beings.

cardiology news

Nature’s lessons

Why don’t you and your friend get together and play the game?

One of you say the name of any bird, animal, worm or plant and guess what you can learn from it. There usually is something so do not give up too easily. And if you stumped you can always ask the grown up to help you out. Take, for instance, ants. Are they not a model of hard work? How busily and tirelessly they ferret for food all day. They are excellent at team work too. It is wonderful to see six or seven of them haul away a tiny shred of coconut or grain of sugar.

And what about the crow? Most people don’t like crow but I think they are admirable. Do you know that they are nature's garbage disposers? Give them anything, even rotten food, and they will gratefully gobble it up. Another remarkable trait is that when one of them spies food, they generously call out to their fellows, even if it is just a mite, so go ahead and see what our animal friends have to teach us.

News Around The Globe

  • Among 183 consecutively enrolled first responders working at Ground Zero following the 9/11 tragedy who were participating in the WTC–CHEST Program, kidney tests demonstrated a linear trend between level of exposure to particulate matter and measures of poor kidney function. Participants with the highest exposure to particulate matter had an albumin–to–creatinine ratio of 207 µg/mg greater than the low exposure group. The findings were highlighted at ASN Kidney Week 2013. (ASN I the loop)

Non–alcoholic fatty liver disease independently predicts pre diabetes during a 7–year prospective follow–up

Liver International: 2013; 33 (9): 1406–1412.

Background & Aims: Non–alcoholic fatty liver disease (NAFLD) is suspected to confer an increased risk for developing type 2 diabetes (DM). However, only a few prospective studies evaluated NAFLD as a predictor for DM, most did not adjust for the full range of potential cofounders and none used an objectively quantified degree of steatosis. Our aim was to evaluate the independent role of NAFLD in predicting the development of pre–DM in a 7–year prospective follow–up of healthy volunteers.

Methods: A prospective cohort of a subsample of the Israeli National Health Survey evaluated at baseline and after 7 years by identical protocols. Metabolic parameters and ultrasonographic evidence of NAFLD were evaluated in 213 subjects, without known liver disease or history of alcohol abuse. Exclusion criteria were pre–DM at the baseline survey. Steatosis was quantified by ultrasound with the hepato–renal ultrasound index (HRI).

Results: The study included 141 volunteers (mean age 48.78 ± 9.68, 24.82% with NAFLD) without pre–DM/DM at baseline. Both NAFLD on regular US (OR=2.93, 1.02–8.41 95%CI) and HRI (OR=7.87, 1.83–33.82) were independent predictors for the development of pre-DM, adjusting for age, gender, BMI, family history of DM, baseline insulin, adiponectin and glucose. Further adjustment for physical activity and dietary intake did not weaken the association. Furthermore, NAFLD was a stronger predictor for pre-DM than the metabolic syndrome. Subjects with both NAFLD and glucose =89 had 93.3% incidence rate of pre-DM.

Conclusion: Non–alcoholic fatty liver disease is a strong and independent risk factor for pre–DM in the general adult population; thus, NAFLD patients should be classified as a population at risk.


  • According to a new report from the World Health Organization (WHO) A Universal Truth: No Health Without a Workforce, the world needs to train more healthcare workers and fast. The report which was released November 11, estimates that the world will be short 12.9 million healthcare workers by 2035. Today, that figure stands at 7.2 million. The shortage of healthcare workers, if not addressed now, will have serious implications for the health of billions of people across all regions of the world, the WHO says.
  • The gentle art of tai chi, as well as strength and flexibility exercises can help seniors avoid potentially serious falls through conditioning and a gain in self-confidence, according to research presented at the American Public Health Association 141st Annual Meeting.
  • Analysis of data from the E3N-EPIC cohort reveals that a diet high in acidic foods –– meat, fish, and sodas, for instance –– may put some women at greater risk for developing type 2 diabetes, according to a new study reported online in Diabetologia.

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Rabies News (Dr. A K Gupta)

What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Patients who had coronary bypass surgery (CABG) without a bypass machine had a significantly lower risk of acute kidney injury (AKI), but the difference did not translate into a long–term benefit. In a randomized trial, off–pump surgery was associated with a 17% reduction in the relative risk of AKI. A year after surgery, loss of kidney function had occurred in a similar proportion of patients who had surgery with or without a bypass pump.
  • For dialysis patients with hypertension and left ventricular hypertrophy, atenolol may provide better blood pressure control than lisinopril, with fewer cardiovascular risks, according to a new research reported at the Kidney Week. A single–center study comparing the beta-blocker and the angiotensin–converting enzyme (ACE) inhibitor was stopped early this past September when an interim analysis revealed a "clear signal for cardiovascular safety" with lisinopril. While both interventions lowered systolic blood pressure, the beta–blocker atenolol did so to a greater extent.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Learning music at a very young age was linked with neural maturation in the brain regions responsible for language and executive function in adulthood. In a study presented at the Society for Neuroscience meeting, compared with children who started learning to play an instrument at age 7 or older, those who had musical training before age 7 demonstrated increased thickness in the right superior temporal gyrus and precuneus at ages 19 to 21 based on MRI scans. These results indicated strengthened regions related to executive function, language, auditory processing, and self–awareness.
  • Checking fetal heart rhythms with magnetocardiography –– described as the "magnetic analog of ECG" –– may be able to diagnose long QT syndrome and allow intervention before the baby is born. Of 30 at–risk fetuses, 21 were ultimately diagnosed with long QT syndrome, and fetal magnetocardiography (fMCG) accurately identified them with a sensitivity and specificity each 89%. For some of the fetuses, information gleaned from fMCG that was not seen on fetal echocardiography prompted a change in treatment. The study was reported in the Nov. 12 issue of Circulation: Journal of the American Heart Association.
cardiology news

Alcohol: Benefits Vs Risk

  • There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications. People tend to consume more alcohol in winter and near the New Year.
  • Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.
  • The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.
  • For young to middle–aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  • Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.
  • Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  • Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week. (50% for the women).
cardiology news

Total CPR since 1st November 2012 – 71933 trained

Media advocacy through Web Media

Heart failure beware of the winter

Several studies have found a seasonal pattern of deaths from heart attack and sudden death, with more fatal events occurring in the winter than the summer said Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

A similar seasonal variation has been seen in men and women with chronic heart failure.

In a large study from France, deaths from heart failure peaked during the winter months of December and January.

The distribution of monthly deaths differed by up to 35 percent when January was compared to August, which is when deaths were the lowest.

Hospitalizations for HF followed the same seasonal pattern, with a winter-spring predominance.

Approximately one-fifth of the excess in winter admissions has been attributed to respiratory disease.

However, sudden death in patients with heart failure does not follow a circadian rhythm, in contrast to the circadian variation (most deaths between 6 AM and 12 PM) seen in the occurrence of out–of–hospital sudden death or acute heart attack in the general population.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 71933 people since 1st November 2012.

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."

today emedipics

Students from various schools participated in the 20th MTNL Perfect Health Mela

press release

Vitamin D intake associated with reduced risk for Crohn’s disease

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

The blood vessel related to the paraduodenal fossa is:

1. Gonadal vein.
2.Superior mesenteric artery.
3.Portal vein.
4.Inferior mesenteric vein.

Yesterday’s Mind Teaser: The commonest variation in the arteries arising from the arch of aorta is:

1.Absence of brachiocephalic trunk.
2.Left vertebral artery arising from the arch.
3.Left common carotid artery arising from brachiocephalic trunk.
4.Presence of retroesophageal subclavian artery.

Answer for yesterday’s Mind Teaser: 3.Left common carotid artery arising from brachiocephalic trunk.

Correct answers received from: Dr.K.V.Sarma, Dr. V.P. Thakral, Dr. P. C. Das, Dr.K.Raju, Dr Jainendra Upadhyay, Dr.(Maj. Gen.) Anil Bairaria, Tarun Madan, daivadheenam, Dr Prakash Khalap, Dr Avtar Krishan, dr.suresh srinivasan

Answer for 12th November Mind Teaser: 2.Ulnar

Correct answers received from: Muthumperumal Thirumalpillai, Dr B K Agarwal

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Customer: I have a huge problem. A friend has placed a screen saver on my computer, but every time I move the mouse, it disappears.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson: Make sure that all foreigners are diagnosed to be suffering from Traveler’s diarrhea even if there is one single loose motion.

medicolegal update

Happy is the man who can do only one thing; in doing it, he fulfills his destiny. Joseph Joubert

medicolegal update

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: No regrets and no anticipation, just this moment fresh and as is.

Forthcoming events


Venue: Gold Field Institute of Medical Sciences & Research, Ballabgarh, Faridabad
Date: November 14, 2013
Time: 2.00 pm to 4.00 pm

Program Details
Floral welcome
Lighting of lamp & Saraswati vandana (Recorded):
Introduction: Dr Jasveer Singh 
Welcome: Dr (Col) Parduman Singh, Principal GFIMS&R       
Blessings: Dr Shashi Adhlakha, Secretary GFIMS &R 
Felicitation: Padma Shri Dr K K Aggarwal and Dr (Mrs) Veena Aggarwal, Dr Gajinder Goyal
Keynote Address on CPR: Padma Shri & Dr B C Roy National Awardee Dr K K Aggarwal, Eminent cardiologist, Moolchand Medcity, New Delhi
Demonstration of BLS of CPR by already trained persons (Medicos & Non Medicos) under guidance of Dr Nirupama Bansal    
Emergency of Cardiac arrest: Dr Gajinder Goyal, DM Cardiologist
Concluding remarks and Vote of thanks: Dr Jasveer Singh    

medicolegal update
  1. Dear Editor, Hygiene plays an important role in the prevention of systemic as well as ocular diseases. Maintaining hygienic habits is also a must while handling contact lenses - the excellent invisible aid to vision. While there may not be any harm to eyes if you handle your spectacles with dirty hands, but on doing so with contact lenses the dirt may find passage in the eyes along with the contacts and result in discomfort and irritation. Dr. Narendra Kumar.

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medicolegal update

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