eMedinewS15th May 2014, Thursday

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

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Tamoxifen in dietary supplements for athletic performance (March 2014)

Tamoxifen is an antiestrogen. It may be present as an unlabeled ingredient in dietary supplements marketed to enhance athletic performance.

Bodybuilders and other athletes who take exogenous testosterone frequently take tamoxifen (10 to 20 mg/day) to prevent gynecomastia.

In one supplement, EstoSuppress its concentration can be as high as 7.6 mg/day, close to the therapeutic doses (10 to 20 mg/day for painful gynecomastia and male breast cancer).

The drug can lead to venous thromboembolism.

In athletes using androgens and tamoxifen, inadvertent use of additional tamoxifen from dietary supplements could add to the already elevated thromboembolic.


  1. Evans–Brown M, Kimergård A, McVeigh J, et al. Is the breast cancer drug tamoxifen being sold as a bodybuilding dietary supplement? BMJ 2014; 348:g1476.

News Around The Globe

  • Resveratrol – an antioxidant found in red wine, chocolate, and grapes – does not correlate with longevity or lower risk of cancer or cardiovascular disease, reports a prospective study. The study has been published online in JAMA Internal Medicine.
  • Brodalumab, a monoclonal antibody that targets the interleukin (IL)–17 receptor, is effective in moderate–to–severe plaque psoriasis, according to a phase III study. The 75% improvement in the Psoriasis Area Severity Index (PASI 75) at week 12 was achieved by 83.3% of patients receiving a higher dose of brodalumab and by 60.3% given a lower dose, compared with 2.7% of patients given placebo.
  • A new study published in the International Wound Journal has revealed that almost twice as many diabetic foot ulcers subjected to allografting with dehydrated human amnion/chorion membrane completely healed with a weekly application vs. biweekly application, that too without increasing the number and cost of grafts.
  • LASIK surgery is safe and comparatively more effective in patients younger than 25 years than in older patients, reports a retrospective analysis of more than 5000 eyes presented recently at the American Society of Cataract and Refractive Surgery 2014 Symposium.
  • The US Food and Drug Administration (FDA) has approved the first prosthetic arm capable of performing multiple simultaneous powered movements using electrical signals from electromyogram (EMG) electrodes. EMG electrodes in the DEKA Arm System convert electrical signals from the contraction of muscles close to the prosthesis into up to 10 powered movements.

Rabies News (Dr A K Gupta)

Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

Cardiology eMedinewS

  • The Shockless Implant Evaluation (SIMPLE) trial has shown that routine perioperative defibrillation threshold (DFT) testing does not improve the efficacy of delivered shocks or prolong survival in patients receiving an implantable cardioverter defibrillator (ICD). Findings from the study were presented at the Heart Rhythm Society (HRS) 2014 Scientific Sessions.
  • According to a U.S. Preventive Services Task Force (USPSTF) preliminary recommendation, obese and overweight adults with at least one other cardiovascular risk factor should be given intensive behavioral counseling to promote healthy diet and physical activity for heart disease prevention.

Pediatrics eMedinewS

  • Teenagers who spend time with nicotine–dependent parents have increased odds of developing intense smoking patterns. Additionally, the longer the duration of adolescent exposure to parental smoking, the greater is the risk for intergenerational transmission, states an article published online May 12 in Pediatrics.
  • A study presented at the 25th Annual Congress of the European Society for Paediatric Urology (ESPU) has revealed that melt–in–the–mouth desmopressin improved sleep patterns and psychological functioning (including attention problems and memory) in children with nocturnal enuresis.

Dr K K Spiritual Blog

Stress is the reaction of the body and mind to the interpretation of a known situation

You cannot be stressed unless you know the person, place or the situation. The same situation may or may not cause stress unless it is interpreted in such a way that it is uncomfortable to the person, and then it causes stress.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible.

The modality, therefore, is to change your interpretation towards the stressful situation for which one should start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathy is described as cognitive behavior therapy, the origin of which comes from Ayurveda and in Bhagwad Gita where Lord Krishna counsels Arjuna following principles of Cognitive Behavioral Therapy.

In the first chapter, Lord Krishna only listens to Arjuna explaining the importance of listening, listening and listening. The second counseling session or the second chapter is the longest conversation between Arjuna and Krishna and shows the importance of first effective counseling session. From 3rd to 17th chapters, Krishna explains what he has conveyed in chapter 2 and that tells us the importance of reasoning out every doubt that a person under stress has. During this session, Krishna creates both fear as well as consoles Arjuna again indicating the importance of these two factors in counseling. In the last chapter, Krishna revises what he has taught, which is consistent with the last rule of counseling to make sure that the patient has learnt what has been taught to him.

Apart from counseling, the body can be prepared in such a way that stress does not bother one. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise, Dosh–specific diet and using certain Ayurvedic Rasayans, which sterilize the brain functions. Brahmi, an Ayurvedic herb, is one such Rasayan, which boosts the brain.

One should avoid taking allopathic anti–anxiety drugs, unless necessary which, of course, may be required in an acute panic state.

Wellness Blog

Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling — Less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling.

Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling–induced impotence, is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting ten minutes.

Inspirational Story

Dealing with Depression

The dictionary describes depression as a condition of general emotional dejection and withdrawal, sadness greater and more prolonged than that warranted by any objective reason.

The question here is why does one get depressed? Is it the inability to cope with the situation or the high stress levels that come with success or failure? Life is full of twists and turns, some pleasant others not so pleasant or at times dreadful. No one is devoid of problems in their lives. Everyone has their own personal set of problems.

Even the people who have a smile constantly on their face have problems. The only difference is they know how to tackle the problems of their life and smile about the fact that they can overcome those problems, similar to Mother Nature.

Someone compared the changes in Mother Nature with depression so aptly. He said each year nature sheds all its charm and the vibrant colors but then again it blooms to its optimum capacity to smile and teach us the most valuable lesson of life.

Seasonal changes are the main reason for depression in nature. Change is inevitable, be it in nature or in our life, but what are the changes is subjective. They may differ person to person, and so will the approach towards them.

Getting into depression is a normal phenomenon, but letting it over take us completely is not the best thing. There are no specific rules or concepts to deal with it, whatever way one feels is the best way, and one should adopt to tackle it.

Here are some really easy ways to tackle this "blown out of proportion problem".

  1. Lead your life on the basis of fundamental values of what is right and what’s wrong.
  2. Avoid hurting others and yourself too.
  3. It’s easier to change and adapt ourselves to new circumstances, than to expect vice a versa.
  4. Don’t make any decisions when angry or sad.
  5. Fight it. If you can’t, then get help.
  6. Enjoy nature; it’s free.
  7. Spend time with our own self to introspect and retrospect daily.
  8. Yell, scream or punch the bag if you feel like doing it.
  9. Be joyful genuinely and not just put up the mask of happiness.
  10. Last, but not the least, do not underestimate the power of Prayers.

ePress Release

Even children and adolescents can die due to sudden cardiac death

In the United States alone, 2000 individuals younger than 25 years die every year of sudden cardiac death. The number in India is estimated to be 8-10 thousand.

The common causes of sudden death in children aged 3–13 years include congenital heart disease – 21%, hypertrophic heart muscle – 18% and abnormal ECG 25% and mitral valve prolapse – 7%. Chronic blockages as a cause of sudden death are only seen after the age of 25 years.

In children, the warning signs of possible future sudden cardiac death include episodes of chest pain, fatigue, light–headedness and episodes of loss of consciousness, which are seen in upto 50% of children before the actual death episode.

To prevent sudden cardiac death in children, all teachers and school children should learn cardiac first aid, which includes how to revive a child after sudden cardiac death 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.

Dr. Aggarwal said that hands-only CPR 10 can be attempted in children and it differs from adult CPR with the compression being lighter than in the adults. The way to remember is to put pressure, which can only compress the centre of the chest by 1½ – 2".

Dr. Aggarwal revised the CPR 10 mantra as – "To revive a person from sudden cardiac death, 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 by 1 ½" distance continuously with a speed of 10×10 i.e. 100 per minute."

In Hindi, the mantra can be remembered as – "Marne ke dus minute ke andar (jitna jaldi utna behtar), kam se kam agle dus minute tak (jitni der tak utna behtar, 10×10=100 ki gati se, apni chhati peetne ke bajaye mare hue aadmi ki chhati peeto."

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 88972 people since 1stNovember 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 10x10 i.e. 100 per minute."

Zee News – Health Wealth Shows

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


Total CPR since 1st November 2012 – 88972 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

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

press release

Weight loss may improve sexual health of obese diabetes

video of day video of day


IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :


Make Sure

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

eMedinewS Humor

Definitions for Parents

FEEDBACK: The inevitable result when a baby doesn’t appreciate the mashed carrots.

HEARSAY: What toddlers do when anyone mutters a dirty word.

PRENATAL: When your life was still somewhat your own.

PUDDLE: A small body of water that draws other small bodies wearing dry shoes.

STERILIZE: What you do to your first baby’s pacifier by boiling it and to your last baby’s pacifier by blowing on it.

TOP BUNK: Where you should never put a child wearing Superman pajamas.

WHOOPS: An exclamation that translates roughly into "get a washrag."

Quote of the Day

Ability is a poor man’s wealth. John Wooden

Forthcoming events

Coffee with Dr KK

Next CME session with Dr K K will be held on Sunday 18th May, 2014 at 8 am at Moolchand Hospital.

  1. Jaundice Update
  2. Understanding what is transgender
  3. Prevalent common ailments observed in the last two weeks in general practice.

Kindly note that CME will start at 8am sharp.

You can also pass on the message to your colleagues and bring them if they would like to attend.

With regards, Dr Pawan Gupta, Convener, 09813193071


Twitter of the Day

Dr KK Aggarwal: Diabetes is a progressive disease http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Dealing with stress in a better way is the key to breaking the cycle of stress eating. http://bit.ly/WAYHF_DC #WAYHF


eMedi Quiz

Which of the following is not fermented by colonic bacteria?

a) Lignin
b) Pectin
c) Cellulose
d) None of above

Yesterday’s Mind Teaser: A recent fitness walk left you breathless, and you’ve been having trouble sleeping. You’ve also been dealing with an upset stomach and occasional dizziness. These could be symptoms of:

A. Depression.
B. Heart disease.
C. Diabetes.
D. High blood pressure.
E. All of the above.

Answer for yesterday’s Mind Teaser: B. Heart disease

Correct Answers received from: Dr B R Bhatnagar, Sachin Dr Soni, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Avtar Krishan.

Answer for 13th May Mind Teaser: B. No, skin–cancer rates and deaths from the disease are on the upswing.

Correct Answers received from: Sachin Dr Soni, Dr B R Bhatnagar, Dr Bitaan Sen & Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Very useful information. Regards: Dr Kanchan
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