eMedinewS 16th August 2013, Friday

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

Only three diseases so far have been eradicated from India after independence

After we got azadi from Britishers, a type of stress based disease India has been able to eradicate only three diseases.

1. 1979: Azadi from small pox: After vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979. 

2. 2007: Azadi from Guinea Worm: Guinea worm disease for at least three consecutive years to be certified as Guinea worm-free by the World Health Organization, for India in 2007.

3. 2012: Azadi from Polio: India completes two years without any case of polio on 13 January 2013, an unprecedented progress for a country, which in 2009 accounted for nearly half the world's polio cases.

WHO struck off India off the list of polio endemic countries on 25 February 2012, after India completed one year without any case of polio. India has not reported any case after a two-year old girl was paralyzed by polio in Howrah district of West Bengal on 13 January 2011.

India's success leaves only three countries in the world considered polio-endemic - meaning they have never stopped indigenous wild poliovirus transmission- Afghanistan, Nigeria and Pakistan.  

Eradication is the reduction of an infectious disease's prevalence in the global host population to zero.

Global azadi from diseases attempts.

Eight attempts have been made to date to eradicate infectious diseases globally - two successful programs targeting smallpox and rinderpest, three ongoing programs targeting poliomyelitis, yaws and dracunculiasis, and three aborted programs targeting hookworm, malaria, and yellow fever. 

Five more infectious diseases have been identified as of April 2008 as potentially eradicable with current technology by the Carter Center International Task Force for Disease Eradication-measles, mumps, rubella, lymphatic filariasis and cysticercosis....

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 Spiritual Prescription: Who am I? Know Your Soul Profile

"I am not my physical body, as I know, once my body dies, nobody wants to touch it." (Adi Shankaracharya in the Bhaja Govindam)

"I am not my mind as I know whenever I am in trouble; the mind asks the heart for help" (Deepak Chopra in the Seven Spiritual Laws of Success).

"I am my consciousness which is residing in the core of my heart" (Svetasvatara Upanishad 5.8).

"This consciousness is nothing but a web of energized information situated in the void" (Chandogya Upanishad Chapter XII — the Birth of the Gross from the Subtle)

"The consciousness is timeless, has no beginning, no end, weapons cannot cut it, air cannot dry it, water cannot wet it and fire cannot burn it" (Bhagavad Gita 2.23, 24).

Each one of us has a physical profile (as defined by our height, complexion, collar number, waist size, etc.) and has a mental or ego profile. A few examples of ego profile: my bank balance, car, job designation, locality of residence, size of house, contacts, power, clothes, etc.

Similarly each one of us also has a soul profile. We should give sometime to ourselves for knowing our soul profile and revisit it at least once in a week.

According to Deepak Chopra, to know the soul profile one should ask seven questions to his or her consciousness while sitting in a meditative pose or in state of relaxation. The answer to each question should be either in three words or three phrases.

1. What is my purpose of life?
2. What is my contribution going to be for my friends and family?
3. Three instances in my life when I had my peak experiences.
4. Names of three people who inspire me the most.
5. Three qualities which I admire in others the most.
6. Three of my unique talents.
7. Three qualities I best express in my relationship.

These twenty–one answers will characterize your soul profile or will be your passport for every action you perform in your life.

In day–to–day's life, one should act from the soul profile and not from the ego profile. Soul profile cannot be manipulated while the ego profile can be.

There are only three ways of improving one's soul profile and these are:

• The choices one makes should be soul–profile oriented and not ego–profile oriented. Whenever there is an opportunity for an action, ask the head for choices, then ask the heart to choose one, and finally order the hand to take action. A soul–based action is the one which is based on the truth, is necessary, and which makes the person and the people around him or her, both happy.

• Total clarity of vision of "What do I want" and also "What I don't want".

• Learn to enter into discontinuity of thought processes using "beej mantra" or doing primordial sound meditation 20 minutes in the morning and 20 minutes in the evening.

These can also be equated to the eight limbs of Yoga Sutras of Patanjali, where the "choices I make" represents Yama and Niyama, "what do I want" represents Dharma and the "entering into discontinuity" represents Dhyana and Samadhi. ….Read More

cardiology news

The American Dream

An American businessman was standing at the pier of a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large yellow fin tuna. The American complimented the Mexican on the quality of his fish.

"How long did it take you to catch them?" the American asked. "Only a little while" the Mexican replied. "Why don’t you stay out longer and catch more fish?" the American then asked. "I have enough to support my family’s immediate needs" the Mexican said. "But" the American then asked, "What do you do with the rest of your time?"

The Mexican fisherman said: "I sleep late, fish a little, play with my children, take a siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos. I have a full and busy life, senor."

The American scoffed: "I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds you could buy a bigger boat and, with the proceeds from the bigger boat, you could buy several boats. Eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman, you would sell directly to the consumers, eventually opening your own can factory. You would control the product, processing and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually NYC where you will run your expanding enterprise."

The Mexican fisherman asked: "But senor, how long will this all take?" To which the American replied: "15-20 years." "But what then, senor?"

The American laughed and said: "That’s the best part. When the time is right, you would announce an IPO – an Initial Public Offering – and sell your company stock to the public and become very rich. You would make millions." "Millions, senor? Then what?"

The American said slowly: "Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take a siesta with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos..."

News Around The Globe

  • 9th International Convention 2013
    To celebrate the excellence of our 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.

  • A mobile–bearing, bone–sparing cervical spinal disc device for single–level replacement has been approved by the FDA. The Mobi–C Cervical Disc device, the first such replacement disc to win FDA approval is an attractive treatment alternative to anterior cervical discectomy fusion according to the manufacturer. The approval was based on a trial comparing the discectomy procedure with disk replacement using the Mobi–C device. After 2 years, LDR said, outcomes showed that the device was not inferior to the discectomy surgery. Overall treatment success rates were slightly higher with the device (73.7% versus 65.3%) and secondary surgeries at the index level for the device were less frequent (1.2% versus 6.2%). (Source: Medpage Today)

  • The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has recommended a new indication for ustekinumab (Stelara, Janssen–Cilag International). The committee has endorsed the use of ustekinumab, alone or in combination with methotrexate, for the treatment of active psoriatic arthritis in adult patients when the response to previous nonbiological disease-modifying antirheumatic drug therapy has been inadequate. (Source: Medscape)

  • Natural killer (NK) cells, particularly those that express the NKp30 receptor, play an important role in the pathogenesis of primary Sjogren’s syndrome (pSS) according to a study published July 24 in Science Translational Medicine. This has opened up new avenues for treatment. (Source: Medscape)

  • Mycophenolate mofetil is effective as a steroid-sparing agent in pyoderma gangrenosum, according to findings reported online July 15 in the Journal of the American Academy of Dermatology. The efficacy and safety of MMF was examined by Dr. Jane Li and Dr. Robert Kelly from St. Vincent's Hospital Melbourne in Fitzroy, Australia by reviewing the charts of 26 patients with pyoderma gangrenosum, the largest series of such patients to date. (Source: Medscape)

  • Omalizumab (Xolair), a monoclonal antibody used for allergic asthma, may be helpful for nonallergic cases as well, as per a proof–of–concept study reported in the August issue of Chest. Marc Humbert, MD, PhD, of Hôpital de Bicêtre, France, and colleagues observed that in severe, refractory nonatopic asthma, the drug effectively turned down immunoglobulin E receptor levels in inflammatory immune cells and also reduced the degree of airway obstruction, with a 9.9% improvement in forced expiratory volume in 1 second (FEV1) over baseline. (Source: Medpage Today)

  • Biomarker Picks Up Alzheimer's Early: Low levels of mitochondrial DNA in cerebrospinal fluid appear to signal the onset of Alzheimer's disease at least 10 years before clinical symptoms and may also cause the disease.

  • Early Surgery Best for This Mitral Valve Leak : Early surgical repair of severe mitral valve regurgitation from flail leaflets improved long-term outcomes compared with waiting until symptoms or other surgical indications appeared.

  • Among Medicare beneficiaries with heart failure, cardiac resynchronization therapy (CRT) had the greatest impact in those with left bundle-branch block and a longer QRS duration, consistent with clinical trial data. Patients with both features had significantly lower rates of mortality and all-cause, cardiovascular, and heart failure rehospitalization compared with patients with left bundle-branch block and a shorter QRS duration, and those with no left bundle-branch block regardless of QRS duration, according to Pamela Peterson, MD, MSPH, of the Denver Health Medical Center, and colleagues. The significance of the differences remained after adjustment for demographics and clinical factors, the researchers reported in the Aug. 14 issue of the Journal of the American Medical Association.

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Rabies News (Dr. A K Gupta)

Management if anaphylactic reaction occurs:

• Adrenaline: The dose is 0.5 ml of 0.1% solution (1 in 1000, 1mg/ml) for adults and 0.01ml/kg body weight for children, injected intramuscularly (IM).

• Inj Hydrocortisone: 100 mg stat and 6 hourly I/V.
• Inj Chlorphinaramine I/V.
• Inj Ranitidine I/V.

If patient is sensitive to ERIG, HRIG should be used. Patient who has had prior exposure of anti-sera (e.g. Anti–tetanus serum, anti–diphtheria serum) should receive subcutaneous dose of Inj adrenaline (the requirement will be half dose of that required for treatment for anaphylaxis).

cardiology news
  • When imaging centers adopted advanced scanning technology tools, the median radiation dose from coronary computed tomography angiography (CTA) dropped by 31%, without any significant loss in acceptable image quality, a new study published online August 7, 2013 in Circulation: Cardiovascular Imaging has reported. After 15 centers in Michigan that participated in the Advanced Cardiovascular Imaging Consortium (ACIC) adopted new CT–scanner hardware and software technology, the median effective radiation dose dropped from 9.5 mSV to 6.6 mSv. (Source: Medscape)
  • According to a new study published online August 6 in Diabetes Care by Tina Costacou, PhD, and colleagues from the department of epidemiology, University of Pittsburgh, Pennsylvania, a greater potential capacity to respond to oxidative stress may mitigate the future development of coronary artery disease (CAD) in patients with type 1 diabetes. These new data suggest that individual risk may be better evaluated by simultaneously assessing factors representing risk and those representing protection from or resistance to that risk. (Source: Medscape)

Valvular Heart Disease News

In patients ≥62 years of age with MAC, 6 percent have mitral obstruction.

(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
  • Nine risk factors account for most cases of young-onset dementia (YOD) diagnosed before age 65 years, suggest results of a study of Swedish men. Peter Nordström, PhD, from Umeå University, Sweden, and colleagues observe that these risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention. The strongest risk factor for YOD was alcohol intoxication. The study was published online August 12 in JAMA Internal Medicine. (Source: Medscape)
  • According to Michael Long, the lead author of a new study has said that children who exercise at school don’t make up for the extra effort by being less active at home and suggests that activity in schools should be increased. The study used accelerometers to track kids’ activity levels. The Centers for Disease Control and Prevention recommend that kids get at least one hour of physical exercise during the day, but less than a third of high school students meet that goal.(Source: Medscape)
cardiology news

Binge Eating: New Epidemic of the Society

Binge eating disorder is a newly recognized condition. People with binge eating disorder frequently eat large amounts of food while feeling a loss of control over their eating.

This disorder is different from binge-purge syndrome (bulimia nervosa) because people with binge eating disorder usually do not purge afterward by vomiting or using laxatives. But most people with serious binge eating problems have:

  • Frequent episodes of eating what others would consider an abnormally large amount of food.
  • Frequent feelings of being unable to control what or how much is being eaten.
  • Several of these behaviors or feelings:
    • Eating much more rapidly than usual.
    • Eating until uncomfortably full.
    • Eating large amounts of food, even when not physically hungry.
    • Eating alone out of embarrassment at the quantity of food being eaten.
    • Feelings of disgust, depression, or guilt after overeating.
    • The binges occur at least twice a week for 6 months.

The major complications of binge eating disorder are the diseases that accompany obesity. These include diabetes, high blood pressure, high cholesterol levels, gall bladder disease, heart disease and certain types of cancer.

Out–of–control binge eating is the biggest eating disorder of today, more common than anorexia and bulimia combined and contributing to a rise in obesity. Binge eating afflicts 3.5 percent of women and 2 percent of men at some point in their lives.

Binge eating disorder is a little more common in women than in men; three women for every two men have it.

Cognitive–behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.

Large amounts of food high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse. Proteins supplement may reduce the craving.

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Compulsive overeaters tend to crave foods high in carbohydrates, sugars and salt.

cardiology news

Children and adolescents in the United States spend an average of 6.5 hours per day watching television, playing video games, or using computers. Children’s television (particularly cartoons), movies, music videos, and video games are potential sources of violent content.

cardiology news

Total CPR since 1st November 2012 – 61668 trained

14th August: CPR 10 at Modern School, Noida (2000)

CPR Classes 61668

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

Birth defects linked to mother’s use of cold medicines. 14 August


ACE inhibitors can reduce dementia progression 13Th Aug


Equipment-related failures common in Operation Theater

As per a study published in BMJ Quality and Safety July Edition, equipment related errors are responsible for 20% of all errors that occur in the operating room.
Commenting on the subject, Padma Shri & Dr. BC Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India said that lack of equipments availability accounted for 38% of all failures and direct malfunctioning of the equipment accounted for 34%.

Many cases of equipment failure have also been reported in Indian circumstances though most of them go unnoticed. It is not unusual for the patient under anesthesia to wait for procurement of a particular device or non-availability of the right size of the interventional device.

In the study, 21% of all errors were serious errors with equipment problem, communication failure and technical fault amounting to 21% and 13% of major failures respectively.

Assessing a checklist specifically including an equipment check, the error can be reduced by up to 60%.

In the US, such an error would lead to a malpractice suit and in India it will be considered either as a deficiency of service or a medical accident as the case may be.

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 61668 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

Heart Care Foundation of India Organizes a CPR 10 Training camp at Balwant Rai Mehta School, Greater Kailash, Part 2, New Delhi on 2nd August 2013.

press release

Do not give citalopram more than 40mg

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…………………

Percutaneous intervention for unprotected left main stenosis is what level of recommendation in the current ACC/AHA guidelines?

a. I
b. IIa
c. IIb
d. III

Yesterday’s Mind Teaser: A recent large database study of bivalirudin and vascular closure devices for interventional procedures has shown reduced bleeding with.......

a. Bivalirudin use
b. Vascular closure device use
c. Both used together
d. All of the above

Answer for yesterday’s Mind Teaser: d. All of the above

Correct answers received from: DR.BITAAN SEN & DR.JAYASHREE SEN, Dr.K.V.Sarma, DR AYYAVOO ERODE, Dr Santha Kumari, DR ARPAN GANDHI, Dr Chandresh Jardosh, DR AVTAR KRISHAN, Dr kanta Jain,

Answer for 14th August Mind Teaser: a. Hepatomegaly

Correct answers received from: DR P K SAHU, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr PJ khalap

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

A guy is walking up to a doctor’s office when a nun comes running out screaming and crying.

The guy walks in and says, "Doc, what’s with the nun?"

The doctor says, "Oh, I just told her she’s pregnant."

The guy says, "The nun’s pregnant?"

The doctor says, "No. But it certainly cured her hiccups!"

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

If you have zest and enthusiasm you attract zest and enthusiasm. Life does give back in kind. Norman Vincent Peale

medicolegal update

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever http://bit.ly/1666DSO  #Health

Dr Deepak Chopra: What are the benefits of meditation? http://tinyurl.com/kbwj6oo #askdeepak

medicolegal update

KK, your message and wonderful description of Indian flag was terrific; I read it and I will use the information today at 2 places where I will be speaking including at Raj Bhavan. Very timely for me--your column. Thanks KK, you are an incredible man. Dr. Venkata Ram

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