16th December 2014, Tuesday

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

Women Beware Of Heart Disease

More women die of cardiovascular disease than from the next four causes of death combined, including all forms of cancer. More than 80 percent of cardiac events in women can be prevented by modifying diet, exercise and abstinence from smoking. Dr Aggarwal said that the following may be the warning signals of heart attack:

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of the chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Breaking out in a cold sweat, nausea or lightheadedness.

As with men, the most common heart attack symptom in women too is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

In presence of any of the above one should not wait for more than five minutes and get to a hospital right away.


Proceedings of 66th Annual Conference of Cardiological Society of India (4-7th December, Hyderabad)

Value based cardiac imaging (Dr Daniel S Berman, USA)

  • Technology/assessments will improve across modalities and clinical settings.
  • The challenge is that these technologies by themselves do not improve diagnostics.
  • Applications providing value will dominate. Their value
    • Depends upon use in appropriate clinical setting
    • Requires linkage to therapeutic/behavioral change
    • Evidence will be required
  • Imaging for prevention used in CAC screening; CAC is a marker of CAD. It provides incremental prognostic value vs other variables like Framingham risk score.
  • Coronary CTA has a sensitivity and specificity of 95% and 90% respectively; unlikely to miss high risk disease. The negative predictive value is very high.
  • Coronary arterial 18F–sodium fluoride uptake has the potential to identify vulnerable plaque.

The road to effective primary prevention (Dr K Srinath Reddy, Delhi)

  • CVDs are leaders in disease burden including premature mortality.
  • A small decrease in risk factor levels when achieved across the whole population results in a larger reduction in CVD events.
  • In persons at high risk of adverse events in the next 10 years, drug therapy is the most cost effective approach.
  • Combination of population based prevention and high risk individual management approaches yield the best results.
  • The road seems to be attainable if we take early and concerted action. So we talk of behavioral goals and health system changes.
  • If we try to reduce tobacco by 50%, we are likely to achieve our goal by 2025. There is global evidence including from low middle income countries that taxation on tobacco is effective.

Ulnar artery cannulation: Tips and Tricks (Dr RK Gokhroo, Ajmer)

  • Ulnar artery cannulation is as comfortable as radial artery cannulation.
  • With experience, it’s not snakes and ladders, but only ladders all the way: Learning curve of ulnar artery cannulation did not differ much when compared to radial artery
  • Ulnar’s VInTEx SCore (Volume of pulse; INability to palpate ulnar artery comfortably; Tortuosity; EXperience of operator<50 for radial/ulnar artery cannulation; Sex category: Female; Calcified vessel) of ≤3 is simple bed side score for predicting success of ulnar artery cannulation.
  • Bless radial for future: Always consider ulnar artery first if ulnar’s VInTEC score favors.
  • Rest Assured!: PTCA via ulnar route is as comfortable and as successful as radial route.

News Around The Globe

  • Liver fibrosis develops early after hepatitis C virus (HCV) seroconversion and progresses quickly to cirrhosis in many patients, suggest new findings published online in JAMA Internal Medicine.
  • For severe emphysema, lung volume reduction treatment with the RePneu coil seems safe in the long-term, but there is a gradual lessening of clinical benefit over time for some patients, suggests the first long–term follow–up study published online in Respirology.
  • New correlative findings from the previously reported CALGB 40603 trial suggest that bevacizumab works in breast cancer, specifically in subtypes of triple–negative breast cancer (TNBC), which is particularly difficult to treat. The data were presented at the San Antonio Breast Cancer Symposium (SABCS) 2014.
  • Physicians should avoid polysomnography (PSG) in patients with chronic insomnia unless symptoms suggest a comorbid sleep disorder, advises the American Academy of Sleep Medicine (AASM) in its new "Choosing Wisely" list. The complete list can be found at www.aasmnet.org.
  • Rituximab treatment is associated with improved disease activity in most patients with eosinophilic granulomatosis with polyangiitis (EGPA), suggests a new retrospective study published online in Annals of the Rheumatic Diseases.

Dr KK Spiritual Blog

Negative Thoughts Are Absence Of Positive Thoughts

Darkness cannot be removed physically; it can only be removed by switching light or going into sunlight or lighting fire. Similarly negative thoughts are absence of positive thoughts.

In Bhagavad Gita also it has been said that the period of Uttarayana with longer days, the first half at full moon, in the presence of light or agni, one acquires more positive thoughts as compared in Dakshinayana before Amavasya or no moon or in absence of light.

Bhagavad Gita also says that whatever you think the whole life, you think at the time of death and if the time at the time of death you have positive thoughts, you are likely to get Moksha. That may be the reason why in Hindu mythology it is said that just before the death, we should light a diya or chant in front of agni (fire) so that dying person’s thoughts become positive.

In computer language, it is explained that when you open a file repeatedly, it becomes a priority file and comes in search engine on priority as compared to other files.

Inspirational Story

The Bird Feeder

Last fall I hung outside my window a bird feeder. Now not knowing the first thing about wild birds, I assumed that as soon as I hung this bird feeder outside, a multitude of beautiful birds would be swooping to my new addition. Days, weeks and months went by; NO BIRDS.

I asked so many people what to do? What was I doing wrong? "Nothing" most of them replied. "Just wait." So I waited and waited and waited trying everything possible, to attract these birds. I cleaned off the deck, I changed the feed, I washed the feeders, I even made the cat go out the other door! But nothing seemed to work. So......I waited, "with patience and hope."

Two (2) months later, on a Saturday afternoon, I FROZE! What to my eyes had appeared on the bird feeder but the most beautiful bird I have ever seen in my life! All of a sudden HUNDREDS UPON HUNDREDS OF BIRDS WERE APPEARING FROM EVERYWHERE!

What a beautiful lesson I learned from this little creature. "Patience and hope" and "things" will attract the beautiful things in life. I never realized how much patience I really do have and how much I do rely upon "hope" to sort out the questions in my heart.

 So I keep hoping and waiting, waiting and hoping. I will try to use this "little lesson" with so many other things in my life. I guess "patience is a virtue" after all.

Rabies News (Dr A K Gupta)

What are the factors responsible for rabies transmission in man from rabid animals?

  • Rabies is most commonly transmitted to humans via the bite of a rabies–infected animal.
  • Humans usually contract rabies through bite wounds from rabid animals (bite exposure) because the rabies virus is highly concentrated in the saliva of infected animals.
  • The amount of virus reaching the lesion is also a factor in transmission; for example, when a bite has to penetrate clothing, the saliva may be retained in the fabric and be prevented from entering the wound.
  • It can also be transmitted through non–bite exposure, although this rarely occurs. Airborne infections, such as inhaling an aerosol of infected animal brain tissue in virus laboratories, or of contaminated air in bat–inhabited caves, have been reported.
  • Iatrogenic rabies cases have occurred in patients who received cornea, kidney, liver, or blood vessel graft transplantation from donors who had undiagnosed rabies.
  • To date, the only medically verified cases of human–to–human rabies transmission are the cases infected through organ transplantation from undiagnosed rabies patients

Potential non–bite modes of transmission include contamination of a pre–existing wound, contact of mucous membrane or respiratory tract with the saliva of an infected animal, exposure to aerosolized rabies virus in the laboratory (or from bats), or via organ transplantation from an infected donor.

Cardiology eMedinewS

  • An early intervention strategy in patients with non–ST–segment–elevation ACS (NSTE–ACS) results in significant cost savings compared with a delayed intervention strategy for both high–and low–risk patients, suggests a Canadian analysis. The study was published online in the Canadian Journal of Cardiology.
  • A new research has identified novel lipid–derived molecules associated with future coronary heart disease events. The approach, called metabolomics, has identified two lipid metabolites, lysophosphatidylcholine and sphingomyelin that reduced the risk of developing coronary heart disease, while monoglyceride was associated with increased risk of coronary heart disease. The report is published in the journal PLOS Genetics.

Pediatrics eMedinewS

  • Children younger than two years who were born prematurely are at increased risk of being hospitalized if they develop influenza, suggests a new systematic review and meta-analysis published online in Lancet Respiratory Medicine.
  • For treatment of juvenile recurrent parotitis (JRP), ductal corticosteroid infusion (DCI) appears to work equally well as sialendoscopy with DCI, suggests a new retrospective study published online in JAMA Otolaryngology–Head & Neck Surgery.

Quote of the Day

All human power is a compound of  time and patience.   ~ Honor de Balzac


emedipicstoday emedipics

Health Check Up and CPR 10 Camp at GB S School, Khan Pur, New Delhi, on 27th November 2014

video of day
press release

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

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 – 101090 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 diabetic patient was found unconscious.
Dr Bad: He has suffered a stroke.
Dr Good: First rule out hypoglycemia.
Lesson: In diabetics, sudden loss of consciousness is hypoglycemia unless proved otherwise.

Make Sure

Situation: A patient with pygenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given when the meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

eMedinewS Humor

Lil’ Johnny was sitting in front of a party store, with him he had a German Shepherd dog. A man came up and asked Johnny: "Does your dog bite?" Johnny said: "No." So the man went to pet the dog and he bit the man’s arm. The man said: "I thought you said your dog don’t bite." "He doesn’t, said Johnny, but this isn’t my dog."

Twitter of the Day

Dr KK Aggarwal: Walk atleast 80min the a day brisk walk atleast 80 min a week
Dr Deepak Chopra: The light of awareness going out through us creates our experience, both mental & perceptual. Where awareness goes energy flows

Wellness Blog

B12 Deficiency Can Present With Recent Memory Loss

If you are forgetting things instead of worrying that you are going towards dementia get your vitamin B 12 levels done.

Animal products (meat and dairy products) provide the only dietary source of B12 (Cbl) for humans. Strict vegans avoid all animal products, and are at risk of developing nutritional Cbl deficiency. The usual western diet contains 5 to 7 micrograms of cobalamin per day, while the minimum daily requirement is 6 to 9 micrograms per day. Total body stores of Cbl are 2 to 5 milligrams and one–half of which is in the liver. It takes years to develop vitamin B12 deficiency after absorption of dietary B12 ceases.

There is a link between infection with Helicobacter pylori (as seen in peptic ulcer) and low serum B12 levels.  Mild and usually subclinical cobalamin deficiency can also occur in 24% of the elderly.  10 to 30 percent of patients taking metforminj (diabetics, obesity, polycystic ovarian disease) have impaired Cbl absorption and lower B12 levels, which can be reversed with supplemental oral calcium.  Prolonged use of omeprazole (given for acidity) can result in Cbl deficiency. Women who are only moderate vegetarians may become Cbl deficient during pregnancy and lactation; their infants may also be Cbl deficient.

ePress Release

Deep frying of potato can cause cancer but soaking potatos in water before frying can nullify these effects

A study has shown that soaking potatoes in water before frying cuts down on the formation of the suspected carcinogen acrylamide, 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.

Acrylamide is created when starch-rich foods are cooked at high temperatures, (120 C) such as frying, baking, grilling, broiling or roasting. Raw or even boiled potatoes test negative for the chemical. Boiling and microwaving appear less likely to form acrylamide as the coking does not involve very high temperatures. Longer cooking times increase the amount of acrylamide produced when the temperature is high enough. Potato chips and French fries contain high levels of acrylamide compared to other foods, with lower levels also present in bread and cereals.

Acrylamide, is harmful to health and may cause cancer in animals.

In a study published in Journal of the Science of Food and Agriculture it has been found that simply soaking potatoes before frying can significantly reduce the formation of acrylamide. The researchers tried three different approaches. They washed raw French fries, soaked them for 30 minutes, and soaked them for two hours. This reduced acrylamide levels by up to 23 percent, 38 percent and 48 percent, respectively, but only if the fries were cooked to a light color. It's not clear whether the same reductions could be achieved if French fries are cooked to a deep, dark brown.

The cooking and re-cooking of fried foods in the same fry pan or broiler is the main cause. Even the thoroughly washed iron skillet can continue to contain submerged carcinogens collected from previous use. Most restaurants uses the same rancid cooking oil for days or even weeks and even reusing it after washing the pot.

Traditional ayurveda has been advocating against deep frying and has been advocating low temperature cooking for centuries.

However occasional consumption of these products is not likely to be a health concern. Apart from foods, cigarette smoking is the other source of acrylamide.

eMedi Quiz

A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1.Pain sensation on the ipsilateral side.
2.Proprioception on the contralateral side.
3.Pain sensation on the contralateral side.
4.Propriception on the ispilateral side

Yesterday’s Mind Teaser: A 64 Year old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end–tidal carbon-dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1.Fat embolism.
4.Myocradial infarction.

Answer for yesterday’s Mind Teaser: 2.Hypovolemia.

Correct answers received from: Raju Kuppusamy, Dr Rakesh Sharma Nohar, Dr Avtar Krishan.

Answer for 14th December Mind Teaser: 3.Atracurium.

Correct answers received from: Srinivas Subudhi, Veeranna Gowda, Dr Poonam Chablani, Dr Rakesh Sharma, Dr Avtar Krishan, Tukaram Pagad, Dr Bitaan Sen & Dr Jayashree Sen, R Krishnamoorthy, Dr Sushma Chawla, Dr Jainendra Upadhyay, Raju Kuppusamy.

Send your answer to email

medicolegal update

(Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS)

Q. What is the Native American Graves Protection and Repatriation Act 1990?

Doctors and scientists have long sought to understand life in early civilizations through the excavation of burial grounds and exhumation of human remains. In the United States the attempt to understand early cultures led to the exhumation of the remains of Native Americans, many of which ended up in the nation’s museums and archaeology labs. In an attempt to prevent the desecration of Native American graves, the Native American Graves Protection and Repatriation Act was introduced in Congress in July 1990 and subsequently passed into law.

  • The bill states that any human remains and objects found on federal or tribal lands after the date of enactment are to be considered owned or controlled by lineal descendants, the tribe on whose land it was found, the tribe having the closest cultural affiliation, or the tribe which aboriginals occupied the area. Anyone who discovers items covered by the bill must cease his or her activity, notify the federal land manager responsible and the appropriate tribe, and make a reasonable effort to protect the items.
  • Anyone who violates the provisions of the bill may be fined, imprisoned not more than one year, or both. The penalty may increase to five years for a second violation.
  • The act further states that all federal agencies and museums receiving federal funds that have control over any of the items covered in the bill are to, within five years, inventory and identify the items, notify the affected tribes, and make arrangements to return such items if the appropriate tribe made a request. If an item was acquired with the consent of the tribe or if the item was part of a scientific study which was expected to be of major benefit to the country, the request for repatriation (i.e., return) could be denied.
medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

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