eMedinewS 14th August 2013, Wednesday

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; 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

In coma the patient is listening

The Indian Upanishads have been saying that one can hear even while in coma and so one should not talk bad or ill in front of a comatose patient and now another western study has proved this.

Researchers led by Lorina Naci, PhD, and Adrian Owen, PhD, of Western University in London, Ontario have established a primitive type of communication with two nonresponsive patients using fMRI to measure their attention to certain words, serving as responses to questions. The study is published in online in JAMA Neurology.

The technique in future may be useful in establishing basic communication with patients who appear unresponsive to bedside examinations and cannot respond with existing neuroimaging methods.

Brain activity measured by fMRI in one patient with minimal consciousness and one in a persistent vegetative state demonstrated not only that they heard words spoken to them, but also could use their attention to the words to give "Yes" or "No" answers to questions about their names and location.

The second patient, who had been in a persistent vegetative state for 12 years after a head injury, was able to "answer" in the negative when asked if he was in a supermarket, but affirmatively when asked if he was in a hospital. The patient also gave correct answers to yes-no questions about his name.

These "answers" were in the form of increased activity in brain regions that had previously been activated during a training period in which patients were instructed either to count occurrences of the words "Yes" or "No" when spoken to them or to ignore them.

With functional magnetic resonance imaging it is possible that behaviorally nonresponsive patients can use selective auditory attention to convey their ability to follow commands and communicate.

Earlier studies

  • Some apparently comatose patients retain some cognitive ability despite being unable to move or speak.
  • In one study, fMRI showed distinctive patterns of brain activity when patients were told to imagine certain images.
  • Former Israeli Prime Minister Ariel Sharon, in a vegetative state for 6 years following a stroke, was found to show a unique pattern of brain activity in response to the voice of his son.

(Source MedPage) …Read More

Vitamin may have no role in hypertension

Supplementation with high doses of oral vitamin D3 every 3 months did not have a significant effect on blood pressure in older patients with isolated systolic hypertension as per a small randomized trial reported online in JAMA Internal Medicine. At both 3 months and 1 year, there were no differences in office blood pressure between the supplementation and placebo groups. And there were no effects seen on nearly all of the secondary outcomes, with the exception of parathyroid hormone levels, which dropped by 3.8 ng/mL with supplementation relative to placebo. …Read More

Antihypertensive and cardioprotective effects of pumpkin seed oil

  • Pumpkin seed oil is a natural product commonly used in folk medicine for treatment of prostatic hypertrophy.
  • The pumpkin seed oil exhibits an antihypertensive and cardioprotective effects through a mechanism that may involve generation of NO. (El-Mosallamy AE, Sleem AA, Abdel–Salam OM, et al. J Med Food. 2012 Feb;15(2):180–9).
  • Telfairia occidentalis (fluted pumpkin) is one of the commonly consumed leafy vegetables in Nigeria. In a study on rats supplemented diets containing 3% and 6%, T. occidentalis decreased plasma and PMF cholesterol levels by 20% and 30% and by 30% and 45%, respectively. (Adaramoye OA, Achem J, Akintayo OO, et al. Hypolipidemic effect of Telfairia occidentalis (fluted pumpkin) in rats fed a cholesterol–rich diet. J Med Food 2007 Jun;10(2):330–6).
  • Natural products like pumpkin–seed oil (PSO) may modify the potency of the calcium antagonist felodipine (FEL) or angiotensin-converting enzyme inhibitor (ACE–inhibitor), captopril (CPT) in modulating the biochemical derangement in blood, heart and kidney as well as blood pressure and heart rate of spontaneously hypertensive rats. (Zuhair HA, Abd El–Fattah AA, El–Sayed MI. Pumpkin-seed oil modulates the effect of felodipine and captopril in spontaneously hypertensive rats. Pharmacol Res. 2000 May;41(5):555-63)

Read More

Low blood testosterone linked with poor outcomes in dialysis

Higher serum testosterone levels are linked with significantly reduced risk of death, with a 42% reduced risk per 10-ng/dL increase as per a study of 623 men initiating dialysis. In the study patients were followed for a median of 20 months. Higher levels of testosterone were also associated with significantly higher health-related quality of life scores. The findings are published in the American Journal of Kidney Diseases.

Dr Sanjay Gupta changes stance on medical marijuana

In an op-ed written for the CNN website, Dr. Sanjay Gupta apologizes for his anti-marijuana stance and says that he now endorses the medicinal use of the drug, which “doesn’t have a high potential for abuse” and has “very legitimate medical applications.”

Pio is back, update

  1. THE GAZETTE OF INDIA EXTRAORDINARY: Pioglitazone and all formulations containing Pioglitazone for human use is allowed to be manufactured for sale, sale and distribution subject to the condition that the manufacturers shall mention the following on their package insert and promotional literature of the drug;
    1. The drug should not be used as first line therapy for diabetes,
    2. The manufacturer should clearly mention following box warning in bold red letters.

Advice for healthcare professional:

  • Patient with active bladder cancer or with a history of bladder cancer and those with uninvestigated haematuria should not receive pioglitazone.
  • Prescribers should review the safety and efficacy of pioglitazone in individuals after 3-6 months of treatment to ensure that only patient who are deriving benefit continue to be treated. Pioglitazone should be stopped in patients who do not respond adequately to treatment (e.g. reduction in glycosylated haemoglobin, HbA1C.
  • Before starting pioglitazone, the following known risk factors for development of bladder cancer should be assessed in individuals: age, current or past history of smoking, exposure to some occupation or chemotherapy agents such as cyclophosphamide, or previous irradiation of the pelvic region.
  • Use in elderly patients should be considered carefully before and during treatment because the risk of bladder cancer increases with age. Elderly patients should start on the lowest possible dose and be regularly monitored because of the risks of bladder cancer and heart failure associated with pioglitazone. (F.NO. 4-01/2011-DC/Piogl, ARUN K. PANDA, Jt. Secy)

2. MINISTRY OF HEALTH AND FAMILY WELFARE, Department of Health and Family Welfare, NOTIFICATION, New Delhi, the 31st July 2013

G.S.R. 520(E)-Whereas the Central Government was satisfied that the use of the drug Pioglitazone and all drug formulations containing Pioglitazone was likely to involve risk to human beings and whereas safer alternatives to the said drug are available;

Whereas the Central Government was satisfied that it was necessary and expedient to regulate by way of suspension, the manufacture for sale, sale and distribution of the said drug in the country in public interest, and accordingly in exercise of the powers conferred by section 26A of the Drug and Cosmetic Act, 1940 (23 of 1940) the Central Government suspended the manufacture for sale, sale and distribution of Pioglitazone and all formulations containing Pioglitazone for human use through the notification number G.S.R. 379 (E) dated 18TH June 2013;

Whereas, the Drug Technical Advisory Board has examined the issue of suspension of manufacture and sale of the said drug on 19th July, 2013 and has recommended that the suspension of the drug should be revoked and allowed to be marketed subject to certain conditions the manufacturers shall mention on their package insert and promotional literature of the drug;

Now, therefore, on the basis of the recommendations of the Drugs Technical Advisory Board, the Central Government hereby revokes the notification G.S.R. 379(E) DATED 18TH June 2013 subject to the following condition as recommended by the Drugs Technical Advisory Board.…Read More

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 10x10 i.e. 100 per minute."

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

Ringtone – CPR 10 Mantra English

sprritual blog Quantum Physics and Soul Consciousness

Quantum Consciousness is based on the concept that all things are interrelated and can affect each other at speeds greater than the speed of light.

Observer effect: There is no phenomenon until it is observed (an observer is required to interact with an object in order for events to occur). This effect is known as the ‘Observer Effect’. It means that before anything can manifest in the physical universe it must first be observed. An observation therefore cannot occur without the pre-existence of some sort of consciousness to do the observing. The Observer Effect clearly implies that the physical Universe is the direct result of ‘consciousness’.

This notion has a striking resemblance to perennial esoteric theory which asserts that all phenomena are the result of the consciousness of a single over lighting Creative Principle or the Mind of God.

Everything – matter, us and the universe – is simply a result of wave structure in space. Chandogya Upanishad talks about this void in details. (Chapter XII — the Birth of the Gross from the Subtle)

There is a delicious irony in all this. Contemporary Western scientific theory postulates that human consciousness is solely a result of the workings of a physical brain, yet if the observer effect is correct, the physical matter comprising a brain cannot come into existence until it is the subject of observation by some pre–existing consciousness.

Rumi has a famous poem on this subject "we came whirling out of nothingness scattering stars like dust, the stars made a circle and in the middle we dance. The wheel of heaven, with all its pomp and splendour, circles around God like a mill."

The illusion of continuity: The whole universe looks like it is made up of matter but actually is nothing but void with Brahman as the base. Also everything which looks like a continuity actually has discontinuity. A running movie has no continuity; it is only a rapid sequential screening of still frames. The earth looks stationary but actually is a moving structure. Each and every cell in the body looks stationary but actually has a spinning base. Thoughts have no continuity; the space between the thoughts is the reality.

In this discontinuity (between the thoughts) lies the consciousness with infinite possibilities and capability of instantaneous interconnectedness, synchronicity, uncertainty and quantum leap.

EPR effect: In 1935, three physicists, Albert Einstein, Boris Podolsky, and Nathan Rosen said that non local interactions between objects had to exist. They challenged the existing theory of relativity and quantum mechanics; this is called Einstein–Podolosky–Rosen (EPR) paradox. Many experiments have shown that a non local correlation between objects indeed occurs once these objects have interacted. There is now evidence that EPR correlation occurs between human brains.

Non– local correlation (nonlocal behavior" or colloquially as "quantum weirdness") means everything is connected with everything else irrespective of distance and time. This connection is instantaneous. It has no communication mode. The phenomenon cannot be explained by routine physics as nothing can travel faster than the speed of light.

Every particle in every star and galaxy that we can see "knows" about the existence of every other particle. (Gribbin,1984).

Quantum leap: Now here, now there in between nowhere. A quantum leap is a leap from A to B, without passing through any of the points between A and B.

Heisenberg principle of uncertainty: It is not possible to simultaneously determine the position and momentum of a particle. Moreover, the better the position is known, the less well the momentum is known (and vice versa). A consequence of the Qunatum Mechanical nature of the world is that the particles can appear in places where they have no right to be. (Source one of the talks of Deepak Chopra)) ….Read More

cardiology news

Everyone Can Play

At a fundraising dinner for an American school that serves learning disabled children, the father of one of the students delivered a speech that would never be forgotten by all who attended. After extolling the school and its dedicated staff, he offered a question:

"When not interfered with by outside influences, everything nature does is done with perfection. Yet my son, Shay, cannot learn things as other children do. He cannot understand things as other children do. Where is the natural order of things in my son?" The audience was stilled by the query.

The father continued. "I believe that when a child like Shay, physically and mentally handicapped comes into the world, an opportunity to realize true human nature presents itself, and it comes, in the way other people treat that child."

Then he told the following story:

Shay and his father had walked past a park where some boys Shay knew were playing baseball. Shay asked,"Do you think they'll let me play?" Shay’s father knew that most of the boys would not want someone like Shay on their team, but the father also understood that if his son were allowed to play, it would give him a much-needed sense of belonging and some confidence to be accepted by others in spite of his handicaps.

Shay's father approached one of the boys on the field and asked if Shay could play, not expecting much. The boy looked around for guidance and said, "We’re losing by six runs and the game is in the eighth inning. I guess he can be on our team and we'll try to put him in to bat in the ninth inning."

Shay struggled over to the team’s bench put on a team shirt with a broad smile and his Father had a small tear in his eye and warmth in his heart. The boys saw the father's joy at his son being accepted. In the bottom of the eighth inning, Shay’s team scored a few runs but was still behind by three. In the top of the ninth inning, Shay put on a glove and played in the right field.

Even though no hits came his way, he was obviously ecstatic just to be in the game and on the field, grinning from ear to ear as his father waved to him from the stands. In the bottom of the ninth inning, Shay's team scored again. Now, with two outs and the bases loaded, the potential winning run was on base and Shay was scheduled to be next at bat.

At this juncture, do they let Shay bat and give away their chance to win the game? Surprisingly, Shay was given the bat. Everyone knew that a hit was all but impossible because Shay didn't even know how to hold the bat properly, much less connect with the ball.

However, as Shay stepped up to the plate, the pitcher, recognizing the other team putting winning aside for this moment in Shay’s life, moved in a few steps to lob the ball in softly so Shay could at least be able to make contact. The first pitch came and Shay swung clumsily and missed. The pitcher again took a few steps forward to toss the ball softly towards Shay. As the pitch came in, Shay swung at the ball and hit a slow ground ball right back to the pitcher. The game would now be over, but the pitcher picked up the soft grounder and could have easily thrown the ball to the first baseman. Shay would have been out and that would have been the end of the game.

Instead, the pitcher threw the ball right over the head of the first baseman, out of reach of all team mates. Everyone from the stands and both teams started yelling, "Shay, run to first! Run to first!" Never in his life had Shay ever ran that far but made it to first base. He scampered down the baseline, wide-eyed and startled.

Everyone yelled, "Run to second, run to second!" Catching his breath, Shay awkwardly ran towards second, gleaming and struggling to make it to second base. By the time Shay rounded towards second base, the right fielder had the ball, the smallest guy on their team, who had a chance to be the hero for his team for the first time. He could have thrown the ball to the second–baseman for the tag, but he understood the pitcher’s intentions and he too intentionally threw the ball high and far over the third–baseman’s head. Shay ran toward third base deliriously as the runners ahead of him circled the bases toward home.

All were screaming, "Shay, Shay, Shay, all the Way Shay" Shay reached third base, the opposing shortstop ran to help him and turned him in the direction of third base, and shouted, "Run to third! Shay, run to third" As Shay rounded third, the boys from both teams and those watching were on their feet were screaming, "Shay, run home! Shay ran to home, stepped on the plate, and was cheered as the hero who hit the "grand slam" and won the game for his team.

That day, said the father softly with tears now rolling down his face, the boys from both teams helped bring a piece of true love and humanity into this world. Shay didn’t make it to another summer and died that winter, having never forgotten being the hero and making his father so happy and coming home and seeing his mother tearfully embrace her little hero of the day! Read More

News Around The Globe

  • 9th International Convention 2013
    To celebrate the excellence of esteemed fraternity of insurance professionals a grand ‘9th International Convention 2013’ is organized by Indian Institute of Excellence & Consultancy Pvt. Ltd. (IIOE) in Mumbai. Dr KK Aggarwal has been invited as a GUEST SPEAKER at the inaugural function.
  • The FDA has approved dolutegravir (Tivicay), a once–daily medication for the treatment of HIV.

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Rabies News (Dr. A K Gupta)

Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.

cardiology news
  • A new research has found that higher levels of parathyroid hormone (PTH) are associated with heart disease in older patients even when they're within the normal range. In a cross-sectional population study, older patients in the highest quintile of normal serum PTH levels had a significantly higher risk of cardiovascular disease compared with those in the lowest quintile. Men with high–normal PTH levels had more calcification of the abdominal aorta. The study is reported online in the Journal of Clinical Endocrinology and Metabolism. (Source: Medpage Today)

  • In a study, published online August 7, 2013 in the Journal of the American College of Cardiology, Dr Richard Page (University of Wisconsin School of Medicine and Public Health, Madison) and colleagues report that Cardiac arrests are more likely to occur at nontraditional exercise facilities than at traditional gyms, suggesting that a broader placement of automated external defibrillators (AEDs) could help improve resuscitation from sudden cardiac arrest. In the study, the annualized site incidence of sudden cardiac arrest at health clubs and traditional gyms was 0.024 arrests per site. A higher rate of cardiac arrest was observed at indoor tennis facilities, ice arenas, and bowling alleys than at traditional exercise facilities, with one arrest every 11, 13, and 27 years/site, respectively. (Source: Medscape)

Valvular Heart Disease News

In elderly adults: Mitral valve repair, if possible, is the surgical treatment of choice for mitral regurgitation. It preserves all of the functional components of the native valve, avoids the use of a prosthesis with its attendant complications, and overall is associated with lower rates of morbidity and mortality than mitral valve replacement.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • Children admitted to intensive care for bronchiolitis did significantly worse if they also had low sodium levels. In a retrospective analysis, children with hyponatremia were more likely to die, to be on a ventilator longer, and to spend more time in the intensive care unit. While they were not more likely than children with normal sodium to need mechanical ventilation, they were more than twice as likely to need noninvasive breathing support. Ricky Luu, MD, of Children’s Hospital Colorado in Aurora, and colleagues have reported their findings in the Journal of Pediatrics. (Source: Medpage Today)

  • Preterm babies were more likely than term babies to have a smaller right ventricle and enlarged right ventricular mass, according to Paul Lesson, PhD, of the John Radcliffe Hospital in Oxford, and colleagues. Compared with babies who were born at term, preterm birth was associated with small right ventricle (end diastolic volume 79.8 mL/m2 versus 88.5 mL/m2, P<0.001) and large right ventricular mass (24.5 g/m2 versus 20.3 g/m2, P<0.001). These differences were also associated with altered function later in life, with preterm babies having a significantly lower right ventricular ejection fraction than term babies in young adulthood (24.5 g/m2 versus 20.4 g/m2, P=0.001). (Source: Medpage Today)
cardiology news

Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many Christian patients from Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

cardiology news

The effect of viewing violence depends upon the amount, the context in which it is seen, and the social message that accompanies the presentation. Televised violence differs from real violence in ways that affect its impact on children and adolescents. Media violence often is perceived as socially acceptable and without consequence.

cardiology news

10th August: Second CPR 10 Training Programme for South Delhi Police Personnel

8th August: DMA Dharna against one year mendatory Rural Posting at Jantar Mantar


CPR 10 Camp – E Book Balwant Rai Mehta School, G K – 2, New Delhi

Total CPR since 1st November 2012 – 59668 trained

10th August: CPR 10 at Moolchand (29)

10th August: CPR Police Training Camp Part 2 (135)

Second CPR 10 Training Programme for South Delhi Police Personnel, 10th August 2013 11th August: CPR 10 at Moolchand (70)

CPR VIP Sensitization

CPR Classes 59668

Video Chats and uploads

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News JULY

Media advocacy through Print Media

sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping

Media advocacy through Web Media

The world’s deadliest virus in China today 12th aug


Longer the waist line shorter the brain size 11th August


Birth defects linked to mother’s use of cold medicines

A study published in July issue of American Journal of Epidemiology has shown that women who use oral or nasal decongestants during first three months of pregnancy have more chances of giving birth to a child with cognitive defects, said Padma Shri & Dr. BC Roy National Awardee, President, Heart Care Foundation of India, Dr K K Aggarwal.

In the past, use of phenylephrine in the first three months of pregnancy is linked with congenital heart disease with endocardial cushion effect.

Another link has been shown with the use of phenylpropanolamine with pyloric stenosis.

The current recommendation is that in the first three months of pregnancy, oral or intranasal decongestants should not be used. That means for any common cold and cough in the first three months of pregnancy should not be taken lightly and over–the–counter drugs should not be used.

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 59668 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

Conducting Second CPR 10 Training Programme for South Delhi Police Personnel, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India

press release

Calcium pills may raise risk of heart attack

today video of the dayOne more life saved from CPR 10

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

Smart Phones Benefits and Hazards

eMedi Quiz

Read this…………………

Nurse Wayne is aware that which finding would be least suggestive of necrotizing enterocolitis (NEC) in an infant?

a. Hepatomegaly
b. Distended abdomen
c. Gastric retention
d. Blood in the stool

Yesterday’s Mind Teaser: When developing a postoperative plan of care for an infant scheduled for cleft lip repair, Nurse Elaine should assign highest priority to which intervention?

a. Comforting the child as quickly as possible
b. Maintaining the child in a prone position
c. Restraining the child’s arms at all times, using elbow restraints
d. Avoiding disturbing any crusts that form on the suture line

Answer for yesterday’s Mind Teaser: a. Comforting the child as quickly as possible

Correct answers received from: Dr P J Khalap, deepti jain, Dr B K Agarwal, DR ARPAN GANDHI, Dr K P Chandra, Dr. P. C. Das, Dr. V.P. Thakral, daivadheenam, Anil Bairaria, Dr pankaj Agarwal, Dr.K.Raju, Dr.K.V.Sarma, Dr Jainendra Upadhyay, DR AVTAR KRISHAN, Dr Kanta Jain, nprabakar, Dr.Rohini Dhillon.

Answer for 12th August Mind Teaser: a. A sunken fontanel

Correct answers received from: dr p j khalap, Rameshwar prasad

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!
Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

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.

medicolegal update

Don’t be pushed by your problems. Be led by your dreams. Calvin & Hobbes

medicolegal update

Dr KK Aggarwal: The world’s deadliest virus in China today http://bit.ly/16wknsh #Health

Dr Deepak Chopra: In my stillness I am the eternal possibility. In my movement I am the cosmos.

medicolegal update

Dear Sir, you are doing a great work through eMedinewS. Please continue to patronage your services for holistic health care services to the suffering masses who at times also need spiritual and psychosocial counseling to alleviate their sufferings. Your inspirational stories are very impressive n educative. Please keep the flag of eMedinewS flying high. With regards: Abhay Singh Deora.

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medicolegal update

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