16th October 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

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

Dear Colleague

The 21st MTNL Perfect Health Mela and SAIL Heart and Health Pavilion is being held from 15th to 19th October, 2014 at Talkatora Stadium. It will be a mix of infotainment, exhibitions, competitions and shopping.

Kindly spare some time and visit the mela on any of these days. The mela will be open from 8am to 8pm. There will be full masti on Friday and Saturday with dances, fashion shows and choreography shows etc.

Dr K K Aggarwal

Inaugurate Heart Care Foundation of India’s "21st MTNL Perfect Health Mela 2014"

Mr. Mukul Rohatgi, Mr. Satish Upadhayay and Ms. Meenakshi Lekhi inaugurate Heart Care Foundation of India’s  annual flagship event, the MTNL 21st   Perfect Health Mela and SAIL Heart and Health Pavilion

7th Asia-Pacific Heart Rhythm Scientific Session New Delhi, India

21st MTNL Perfect Health Mela 2014 21st MTNL Perfect Health Mela 2014 21st MTNL Perfect Health Mela 2014

News Around The Globe

  • Humans respond to falls in temperature by switching on genes that generate heat and convert white fat to beige fat, the first step towards the "browning" of adipose tissue. However, this response appears to be weakened in obese people and those with higher levels of inflammation, suggests a new study published online October 9 in the Journal of Endocrinology and Metabolism.
  • The European Medicine Agency (EMA)'s Pharmacovigilance and Risk Assessment Committee has recommended strengthening the restrictions on the use of valproate in women of childbearing age due to the risk for malformations and developmental problems in children exposed to valproate during pregnancy.
  • Patients with Alzheimer's disease (AD) with moderate to severe cognitive impairment have an increase in cerebrospinal fluid (CSF) levels of orexin, a neurotransmitter that plays a fundamental role in the regulation of the sleep-wake cycle, suggests new research published online October 13 in JAMA Neurology.
  • The new European Code Against Cancer outlines 12 things that individuals can do to reduce their risk for cancer. Top of the list is tobacco, followed by healthy body weight, avoiding too much sun and alcohol, including several new recommendations about radon, breast–feeding, and hormone replacement therapy (HRT), and also about vaccinations and organized screening programs.
  • The US Food and Drug Administration (FDA) has cleared for marketing a replaceable urinary prosthesis, called the inFlow Intraurethral Valve-Pump,  for use in women with impaired detrusor contractility (IDC).

Dr KK Spiritual Blog

Understanding Indriyas

As per ancient Indian literature, we have 10 Indriyas, 5 motor and 5 sensory. The motor Indriyas are called Karmendriyas and the sensory indriyas are called Gnanendriyas. The motor indriyas involve the functions of elimination (anus), procreation (genitals), movement (legs), grasping (hands) and speaking (speech). The five sensory indriyas in sequence are smell, taste, seeing, touching and hearing.

The first motor indriya is linked to the first sensory indriya. Therefore, elimination is linked to smelling, procreation to tasting, movement to seeing, grasping to touching and speaking to hearing.

Controlling the senses is the fundamental principle in acquiring spiritual health. Senses in Indian mythology are depicted by horses, which are chanchal and are likely to go out of control. The control over 10 senses is required to become a yogi.

The Ashwamedha Yagna of ancient era of kings basically meant doing a sacrifice so as to be able to control one’s senses.

In internal Ramayana, Lord Dashrath represents a person who has control over his 10 senses. Here ‘Dash’ means ten and ‘Rath’ means horse.

During meditation also, one is taught to sequentially control one’s senses. For example, to be able to meditate, one must first pass urine and stool as in the presence of these urges, one will not be able to meditate. The second is to control one’s sexual desires. It is well known that sexuality and spirituality cannot go hand in hand. In any Shiv Mandir, Nandi, the bull, is always worshipped outside the temple and not inside the temple.

The next step in meditation is control on movements and that is practicing stillness followed by relaxing each every muscle representing control over grasping and then going to an inner journey of inner silence of controlling over the 5th motor indriya i.e. speech. Only after one has learnt to control the mortal indriyas, can one be able to control the 5 sensory indriyas in succession as mentioned above. 

Inspirational Story

The important things in life

A philosophy professor stood before his class with some items on the table in front of him. When the class began, wordlessly he picked up a very large and empty mayonnaise jar and proceeded to fill it with rocks, about 2 inches in diameter.

He then asked the students if the jar was full. They agreed that it was. So the professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles, of course, rolled into the open areas between the rocks.
He then asked the students again if the jar was full. They agreed it was. The professor picked up a box of sand and poured it into the jar. Of course, the sand filled up the remaining open areas of the jar. He then asked once more if the jar was full. The students responded with a unanimous “Yes.”

“Now,” said the professor, “I want you to recognize that this jar represents your life. The rocks are the important things – your family, your partner, your health, your children – things that if everything else was lost and only they remained, your life would still be full. The pebbles are the other things that matter – like your job, your house, your car. The sand is everything else, the small stuff.”

“If you put the sand into the jar first,” he continued, “there is no room for the pebbles or the rocks. The same goes for your life. If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you. Pay attention to the things that are critical to your happiness. Play with your children. Take your partner out dancing. There will always be time to go to work, clean the house, give a dinner party, or fix the disposal.”

“Take care of the rocks first – the things that really matter. Set your priorities. The rest is just sand.”

Rabies News (Dr A K Gupta)

If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.

Cardiology eMedinewS

  • With less than a year of high–level endurance training, ordinary individuals can achieve the kind of left and right ventricular structural changes seen in elite, Olympic-level athletes, though without the increase in cardiac compliance and performance that comes from years of dedication to exercise, suggest researchers in a paper published in Circulation.
  • In patients with type 2 diabetes and hypertension, empagliflozin brings about significant reductions in BP and HbA1c, suggests new research published online in Diabetes Care.

Pediatrics eMedinewS

  • A study of teenagers has revealed that there is no association between physical activity and the development of depressive symptoms later in adolescence. The study is published in JAMA Pediatrics.
  • The use of PCV13, a 13–valent pneumococcal conjugate vaccine, in children has dramatically reduced the incidence of invasive pneumococcal disease in children as well as in adults probably by reducing the transmission between persons, suggests a recent study presented at IDWeek 2014.

Quote of the Day

  • You will become as small as your controlling desire; as great as your dominant aspiration.  James Allen


Hudhud impacts severely and its painful blow to our infant state of A.P., especially the economic hub of A.P.–VIJAG. The cyclone ravages all the greenery(70% of city's trees),20000 electric poles, all cell towers, hundreds of fishing boats,trawlers were devastated leaving the city without any communication link,broken transport. The livelyhood of thousands of fisherman community in jeopardy. vast length and breadth of important roads eroded,acres of agrofields bearing paddy,sugarcane and horticulture crops completely inundated in flood water leaving lacs of farmers in hunger pangs and would be in debt trap. AP state IMA Coordinating with   our local branches in those 3 districts and commissioned 10 teams with needy medicines, utensils, clothes. We have also formed "disater management teams" and would work under respective district health authorities.

  • NHRC Serves Notice to Union Health Secretary on Pentavalent Vaccine: NHRC Sought report from Union Health Secretary on the Pentavalent Vaccine (Odisha Samachar). The apex rights body has directed the Secretary of Health Ministry and Department of Health research to reply in the matter within four weeks. The directives of the commission has came in response to the complaint filed by the Odisha based Human Rights Activist Akhand. Since 2011, the Indian Union Government introduced pentavalent vaccine in a phased manner in Kerala, Karnataka, Pondicherry, Goa, Gujarat, Haryana, Jammu & Kashmir and Delhi. Recently, the Union Government decided to scale-up administration of the pentavalent vaccine throughout the country from this October.

    Pentavalent is a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type b (the bacteria that causes meningitis and pneumonia). The vaccine created a furore after many infants from across the country were reported to have died after the vaccination. The latest RTI reply by Union Ministry of Health and Family Welfare has revealed that the Pentavalent vaccine has been associated with 76 deaths and 227 hospitalizations. The components of this vaccine – the DPT, Hep-B, Hib, etc – are highly controversial for adverse events individually and the combination is proving deadly.
  • The National Pharmaceutical Pricing Authority (NPPA) has imposed a fine of around Rs 300 crore on Swiss multinational drug company Novartis for overcharging consumers on sale of Voveran, its best-selling painkiller medicine.

What to do proactively for preventing Ebola outbreak?

This is how a hospital in US has started preparing

Dear F&MCW Leaders

Froedtert and Medical College of Wisconsin have a strong history of delivering exceptional care with remarkable results, particularly during challenging times.   
This message is how to manage individuals with suspected or confirmed Ebola Virus Disease (EVD).

The following information summarizes our ongoing efforts to support patient and staff safety when caring for patients with suspect or confirmed EVD.


  • The 4th floor Center Intensive Care (CIC) has been environmentally modified and prepared, based on guidelines produced by the CDC and the World Health Organization (WHO), to care for patients with the EVD.

Personal Protective Equipment (PPE) and Infection Control Management

  • We have evaluated and implemented PPE that minimizes exposure to our caregivers, staff, other patients and visitors. A surgical hood covering the head and neck will be stocked in the PPE carts. 
  • The PPE being stocked is 100 percent impervious to fluids.
  • Ebola is not transmitted by an airborne route or permeable to intact skin. A “hazmat,” or Tyvek suit, is not necessary as a routine PPE. The CDC has cautioned that hazmat suits are more difficult to remove and could lead to possible exposures. 
  • Our infection control procedures are guided by and meet current CDC recommendations. We are using the label of heightened special/droplet precautions to identify the expected infection control precautions and PPE use for EVD.


  • Over the last several weeks, we have trained a core group of more than 150 nurses, direct care providers, and ancillary staff to care for our patients.
  • We are training a group of internists and intensivists.
  • We have a section dedicated to PPE and Ebola on the Patient Care Services page of Scout that will be updated regularly. The organization’s policy addressing Infection Prevention & Control for the Care of Patients with Ebola Viral Disease (EVD) is now posted to the Policies section of Scout.  (If navigating from an MCW workstation, the path to the policy is Home / Policies & Procedures / Corporate Policies / Multidisciplinary / Infection Prevention & Control for the Care of Patients with Ebola Viral Disease (EVD) (CPM.0204)).
  • We are working closely with our campus colleagues at Children’s Hospital.
  • We are in constant communication with local, state and federal health officials.

Care of the patient suspected/confirmed EVD

  • A multi-disciplinary planning team is working to ensure that our policies, procedures, training and communication effectively support CDC guidelines. The planning team preparing for the potentiality of an EVD case includes representatives from Infectious Disease and Infection Prevention, Specialty and Primary Care, Community Services, Security, Information Services, Supply Chain, Environmental Services, Facilities, Pharmacy, Lab, Medical Staff, Patient Care Services, Employee Health and Wellness, Family Services, the Emergency Department, Transport, Human Resources, Risk, Food Services,  and Communication. We are also in close contact with our colleagues at Children’s Hospital to ensure that we are all working together in the best interest of our patients, families, and staff.
  • A detailed guideline describing infection prevention and control for the care of patients with Ebola is being developed in collaboration with our campus partners and is nearing completion.

Here are additional actions that will be taken this week:     

  • Froedtert Hospital leaders and staff from infection control, medical staff, nursing and others will be actively participating in a local and statewide preparedness symposium today at the Italian Community Center.  
  • We will begin providing the next level of training by repeatedly conducting drills simulating the expected needs of a patient/family with suspected or confirmed EVD.
  • We will be posting video materials on Scout within the next two weeks showing how to properly put on and take off PPE.

The safety and well-being of our patients, staff, and community is the foundation of our mission. We will continue to communicate frequently, guided by trust, teamwork, and transparency.   We will do everything possible to ensure the health and safety of our patients, families, and staff based on compassion and scientific rigor.
Kathy Bechtel, MSN, RN, NEA-BC
Vice-President Patient Care Services and Chief Nursing Officer
Froedtert Hospital
Lee Biblo, MD
Chief Medical Officer
Froedtert Hospital
Medical College Physicians


emedipicstoday emedipics

Eminent dignitaries – Mr. Mukul Rohatgi, Mr. Satish Upadhayay and Ms. Meenakshi Lekhi – inaugurate Heart Care Foundation of India’s annual flagship event, the MTNL 21stPerfect Health Mela and SAIL Heart and Health Pavilion



Zee News – Health Wealth Shows


press release

To err is human

video of day video of day

Other Blogs

Video Library

MTNL Perfect Health Mela

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

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

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

CPR 10 Success Stories

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

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

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


IJCP Book of Medical Records

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

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


Dr Good and Dr Bad

Situation:A patient on aspirin was to go for non vascular surgery

Dr Bad: Stop aspirin for two days
Dr Good: Stop aspirin for seven days
Lesson: The POISE–2 trial recommends discontinuing aspirin about seven days before noncardiovascular surgery.

Make Sure

Situation:A patient was brought to the ICU in cardiogenic shock.

Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?

Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.

eMedinewS Humor

Final Countdown

A man hasn't been feeling well, so he goes to his doctor for a complete checkup. Afterward, the doctor comes out with the results. 

"I'm afraid I have some very bad news," the doctor says. "You're dying, and you don't have much time left." 

"Oh, that's terrible!" says the man. "Give it to me straight, Doc. How long have I got?"

"Ten," the doctor says sadly.

"Ten?" the man asks. "Ten what? Months? Weeks? What?" 

Twitter of the Day

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

Wellness Blog

Warning signs of worsening heart failure

If you have heart failure, call your doctor if you notice any of these signs:

  • Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up feeling short of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental confusion
  • Loss of appetite

ePress Release

Dignitaries such as Mr. Mukul Rohatgi, Mr. Satish Upadhayay and Ms. Meenakshi Lekhi inaugurate Heart Care Foundation of India’s annual flagship event, the MTNL 21st Perfect Health Mela and SAIL Heart and Health Pavilion

Discuss the implications of the consumer protection act on the medical profession

New Delhi, 15th October 2014 - Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease free nation, today opened the gates to its annual five-day flagship event, the 21st MTNL Perfect Health Mela and SAIL Heart and Health Pavilion being held from Oct 15 – 19, 2014 at the Talkatora Indoor Stadium in New Delhi. Renowned dignitaries such as Mr. Mukul Rohatgi – the Attorney General of India, Mr. Satish Upadhayay – President Delhi BJP and Ms. Meenakshi Lekhi – Member of Parliament inaugurated the event. The key topics discussed during the function included the implications of the Consumer Protection Act on the Indian medical profession, the increasing number of medical negligence cases in the country and the issue of patient compensation.

Started in 1993, the Perfect Health Mela is a mass health awareness module, which caters to people from all age groups and walks of life. Its primary activities include health check up camps, entertainment programs, lifestyle exhibitions, workshops and inter college and school competitions.  This year’s Mela is being organized jointly with NDMC and in association with the UN Information Centre for India and Bhutan, MCD, SAIL and MTNL and its theme is “Swach Bharat, Swasth Bharat”. The key features of the Mela this year include a live telemedicine facility being organized in association with Medanta – the Medicity, heart surgeries for the poor and needy at subsidized rates by the Sameer Malik Heart Care Foundation Fund and a one of its kind SAIL Health Pavilion.

Speaking at the inauguration ceremony, National Awardee, Sr. National Vice President and Secretary General Elect of the IMA and the President of Heart Care Foundation of India, Dr. KK Aggarwal said, “We at Heart Care Foundation of India are extremely delighted to announce the onset of the MTNL 21st Perfect Health Mela and to have such renowned panelists amongst us today. Doctors should not be under Consumer Protection Act as otherwise they would be allowed to advertise and commercialize their services. Also, a large number of hospitalizations can be prevented if everyone in the country follows the ‘Swach Bharat, Swasth Bharat’ mantra in letter and in spirit. By simply observing hygiene in water and environment up to 50% of the diseases can be prevented.  I would like to thank all our supporters and partners for supporting us in this initiative and hope that we can continue making a substantial difference to the Indian healthcare scenario in the future as well.”

Congratulating Heart Care Foundation of India on its initiative, Mr. Ravi Shankar Prasad, Minister of Communication and Information Technology, Government of India, in his message said that effective, transparent and timely communication between doctors and patients can prevent over 90% of the medico–legal complaints. Doctors must insure that they do not just communicate verbally but also give a written opinion in the form of a legible prescription to avoid any errors or miscommunication.

Adding to this, Mr. Mukul Rohatgi, Attorney General of India said, “Doctors should not be afraid of being included in the Consumer Protection Act. A doctor is not supposed to possess the highest degree of skill and knowledge but is supposed to possess and practice only an average degree of skill and knowledge. Simple deviation from practice, medical accidents and error of judgment are not negligence”.

Over 3000 students from across leading schools were seen competing in activities with an underlying healthcare theme in the Harmony Interschool festival.

Noted poet and Padma Shri Awardee Mr Ashok Chakradhar opened the inaugural students walk.

Speaking about Medanta’s association with the Perfect Health Mela Dr. Naresh Trehan, Padma Bhushan Awardee, CMD Medanta - The Medicity said, “It is a privilege to be partnering with this noble and humanitarian cause. We at Medanta- The Medicity will be providing medical consultations, live telemedicine services and subsidized congenital heart surgeries for the poor and needy at the 21st Perfect Health Mela.”
Kiran Mehra - Kerpelman, Director, UN Information Centre for India and Bhutan said, “The UN Information Centre for India and Bhutan (UNIC) represents the UN Secretariat and its Director is the spokesperson of the UN Secretary–General. I interpret UNIC in a new way–as UN-India Connect! There is so much happening in India and I really wanted to be part of it all. Seeing the commitment of the UN agencies and its partners – NGOs, media, academia, think–tanks – to improve the quality of people’s lives and ensure human rights, has been absolutely inspiring. I am so pleased to be able to participate in these inspirational moments.”

Presiding over the function, Mr. Jalaj Srivastava, Chairman NDMC said, “The aim of every citizen of Delhi should be to make Delhi garbage and litter-free. Citizens should consider India Gate as their personal farmhouse, the Metro as their personal limousine and the Yamuna River as their personal swimming pool. Only then will they collectively be able to clean the environment.”

Mr. P.K. Purwar CMD, MTNL said that with the help of telemedicine, it is possible to provide timely advice and a consultation to masses and this is a revolutionary development in India.

Adding to this Mr. C.S. Verma CMD SAIL, said “Prevention of diseases is key in today’s faced paced world. We must take out some time for our health, well-being and happiness and also keep our environment clean. It is our duty to preserve our environment for our future generation like our forefathers did for us.”

Mr. Deepak Jolly Vice President Coke and Mr. Dinesh Kumar Development Comm. Handloom added, “To remain healthy, one must adapt to healthy lifestyle, avoid eating food with high levels of transfat, say no to smoking and alcohol and eat a balanced diet.”

Mr. B.P. Singh, Adviser, DST, who supported the interschool festival Harmony, in his message, said “Children should be taught the importance of health using scientific reasoning so that they not only follow but also understand how a lifestyle can prevent and save lives”.

Others present on the occasion were Dr Anil Goyal President DMA, Nalini and Kamalini, noted Kathak Dancers, Dr H K Chopra President Elect CSI and Dr P K Sharma MOH NDMC

eMedi Quiz

All the following are related to legal responsibility of an insane person except.:

1. Mc Naughten's rule
2. Durham's rule.
3. Curren's rule.
4. Rule of nine.

Yesterday’s Mind Teaser:The Vitamin A supplement administered in prevention of nutritional blindness in children programme contains:

1. 25,000 i.u./ml.
2. 1 lakh i.u./m.l.
3. 3 lakh i.u./m.l.
4. 5 lakh i.u./m.l.

Answer for yesterday’s Mind Teaser:2. 1 lakh i.u./m.l.

Correct answers received from:Najib Khatee, Dr. P. C. Das, Dr Jainendra Upadhyay, Dr.Chandresh Jardosh, Dr Avtar Krishan, Dr Poonam Chablani

Answer for 13th Oct Mind Teaser: 2. Cell membrane.

Correct answers received from: : Dr Avtar Krishan

Send your answer to email

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Giving an opinion on phone has no legal liability

No legal liability will fall upon the doctor as there is no contract between him and the patient. For negligence to be proved there has to be a duty, breach of that duty and resultant damage. In this case there will no breach of duty. Only if the specialist has charged fee for his opinion from the patient (patient can sue) or from the physician (patient and doctor both can sue), he or she is liable. If the fee has been paid by the referring physician, it will be deemed to be paid by the patient.

medicolegal update
  1. Good morning sir, It gives us immense inspiration to be always optimistic and believe in hard work whenever we see the Perfect Health Mela event unfolding. With warm regards, Aruna Tyagi.

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)