eMedinewS17th April 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

Supreme Court Recognizes Transgender as the Third Legal Gender

In a landmark judgment delivered on April 15, 2014, the Supreme Court for the first time recognized eunuchs or transgenders as the third legal gender. Earlier, they were forced to write male or female against their gender as reported in the TOI.

Management of transgender patients requires great care and sensitivity. Now a third category of gender would now need to be added to patient charts or forms in hospitals, or clinics making it more comfortable for transgender patients. This translates into more inclusive health care and gives them access to comprehensive and safe health care without gender discrimination or rejection.

What does the term transgender mean? Transgenderism is the discrepancy between one’s own experience of gender identity and the physical body. There is a wide range of severity of transgenderism. The most extreme form is transsexualism, the condition in which a person with apparently normal somatic sexual differentiation of one gender is convinced that he or she is actually a member of the opposite sex.

The initial assessment of a patient for transsexualism is based on psychodiagnostic instruments and is generally done by a mental health professional. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM–5)1 and International Classification of Diseases 10 (ICD–10) have issued guidelines for the diagnosis of these disorders.

The Standards of Care defined by the World Professional Association for Transgender Health (WPATH) serve as guidelines to clinicians to meet the healthcare needs of transgender people. 2

The current ICD criteria for transsexualism include3:

  • The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatments.
  • The presence of the transsexual identity persistently for at least two years.
  • The absence of another mental disorder or a genetic, intersex, or chromosomal abnormality.

The diagnosis of transsexualism must first be made before considering hormone and surgical reassignment therapy.3 It is also essential to identify any comorbid psychiatric diagnosis that may require treatment before considering hormone therapy.

While India now recognizes the transgender community as a third gender, the ruling only applies to transgender people and not gays, lesbians or bisexuals. In December, the Supreme Court reversed a 2009 court order that decriminalized homosexuality, reinstating a ban on gay sex.


  1. American Psychiatric Association. Gender dysphoria. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.451.
  2. WPATH. Standards of Care. http://www.wpath.org/publications_standards.cfm (Accessed on January 08, 2013).
  3. Hembree WC, Cohen–Kettenis P, Delemarre–van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94:3132.

News Around The Globe

  • A review published in the April 15 issue of the Annals of Internal Medicine has stated that extracorporeal shockwave therapy (ESWT) has the potential to decrease pain and improve function in patients with chronic calcific shoulder tendinitis and could be a good alternative to conventional therapies. The review included 28 randomized controlled trials and noted that high–energy ESWT decreased shoulder pain, improved function, and resolved calcifications; however, low–energy ESWT improved only function.
  • A study presented at the European Association for the Study of the Liver (EASL) International Liver Congress 2014 has revealed that obeticholic acid could represent a novel treatment for primary biliary cirrhosis. The study included 216 patients with primary biliary cirrhosis who could not tolerate or had not responded well to UDCA, the only drug currently approved to treat primary biliary cirrhosis. In the intention–to–treat analysis, the primary end point (alkaline phosphatase (ALP) <1.67 times the upper limit of normal (ULN)) was met by 47% patients in the obeticholic acid 10 mg group and by 10% in the placebo group. Additionally, about 46% patients met the primary end point in the titration group (5mg to 10 mg). The mean decrease in ALP level from baseline was better in the 10 mg group than in the placebo group (39% vs 5%), and was better in the titration group too (33% vs 5%).
  • Six–year results of the Barrow Ruptured Aneurysm Trial (BRAT) presented at the American Association of Neurological Surgeons (AANS) 82nd Annual Meeting have stated that microsurgical clip occlusion is no better than endovascular coil embolization in preventing disabilities in most patients with subarachnoid hemorrhage resulting from cerebral aneurysms. However, at 6 years, 96% of the clipped patients had their aneurysms completely obliterated, compared with only 48% of the coiled patients. Additionally, only 4% of the clipped patients needed retreatments vs. 13% of the coiled patients. Both the differences were statistically significant. Clipping could therefore be a better option for ruptured aneurysm patients.
  • The Food and Drug Administration (FDA) has recently approved albiglutide, a once–weekly injectable glucagon–like peptide 1 (GLP–1) receptor agonist to treat type 2 diabetes. The drug is indicated as monotherapy or in combination therapy with metformin, glimepiride, pioglitazone, or insulin. Of note, it is not indicated for patients with type 1 diabetes or diabetic ketoacidosis or as first–line therapy for patients who are unmanageable with diet and exercise.
  • A novel study presented at the World Ophthalmology Congress 2014 highlighted the use of Sensimed’s Triggerfish contact lens sensor to analyze fluctuations in intraocular pressure patterns over 24 hours. Researchers stated that this could help distinguish between a healthy eye and one with glaucoma. The contact lens sensors had a 78% probability of discriminating a healthy eye from one with glaucoma, with 74% sensitivity and 78% specificity.

Rabies News (Dr A K Gupta)

What are the initial (prodromal) symptoms of rabies?

  • Pain or paresthesia at the site of the bite is well–known as a diagnostically useful prodromal symptom occurring in one–third to two–thirds of cases. In Thailand, however, a specific type of paresthesia–itching–was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesia may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in 3 of the 4 patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.

Cardiology eMedinewS

  • Patients undergoing therapy with an anticoagulant for deep vein thrombosis (DVT) or pulmonary embolism (PE) who also take a nonsteroidal anti–inflammatory drug (NSAID) or aspirin for pain or headache, even for a few days, have increased odds of developing a major bleed, reports a new study published online April 14 in JAMA Internal Medicine. Researchers examined bleeding risk in the EINSTEIN–DVT and EINSTEIN–PE trials wherein patients were randomized to rivaroxaban or enoxaparin/vitamin–K antagonist (VKA). There were 6.5 major bleeds/100 patient–years in those taking NSAIDs vs. 2 events in non–NSAID users with anticoagulants and 4.8 major bleeds/100 patient–years in those taking aspirin vs. 2.2 events in those not taking aspirin with anticoagulants.
  • A novel research has revealed that childhood programs initiated as early as at the preschool level to provide social and cognitive stimulation led to fewer risks for cardiovascular disease in the participants in their mid–30s as compared to those who did not attend the program. The preschool intervention brought about statistically significant differences for the men in the treatment group, showing less hypertension, less vitamin D deficiency, and no metabolic syndrome.

Pediatrics eMedinewS

  • Children and young adults with epilepsy may be at heightened risk of injury than their healthy counterparts, reports a recent study published April 14 in Pediatrics. It appears that young patients with epilepsy may be 18% more likely to suffer fractures, 50% more prone to burns and more than twice as likely to poison themselves, especially with medicines.
  • The FDA has approved Merck’s Grastek tablet for grass pollen allergy, making it the second sublingual oral immunotherapy (SLIT) agent to gain that status following Greer’s Oralair. Grastek contains a single pollen extract of Timothy grass, which is cross-reactive with multiple other grass species. It is approved for adults up to age 65 and children as young as 5 years old.

Dr K K Spiritual Blog

Why is Ganesha worshipped in every pooja?

Every Hindu ritual traditionally begins with a prayer to Lord Ganesh. The wedding ceremony too begins with a pooja of Lord Ganesha invoking him to bless the couple and to ensure that the ceremony goes off well.

Ganesha, the son of Shiva and Parvati, is the harmonious Aacharan or characteristic disposition of man. Remembered and ritually worshipped before starting a new venture, the entity of Ganesha has in store the facets of a complete man.

Ganesha’s head that of an elephant, represents wisdom, intelligence and a healthy mind capable of making sound decisions. Think before you speak, implies Ganesha’s head.

The big ears of this elephant deity signify the lending of a patient ear to the echo produced by others’ deeds and speech. It is said that half the dispute is resolved by patiently lending an ear to the words of the other. It also denotes that one must patiently listen to all sides before reaching a decision.

Ganesha’s extremely small mouth characteristically represents the need for a limited dialogue and the vanity of talking too much.

Overexpression through words results in unsought–for problems which could have been avoided.

Ganesha’s small eyes highlight the need for a focused outlook in life. Such an outlook not only re–defines and foresees the right goals, but also relieves one from the stress–manifested episodes in life.

The long trunk identifies with the power of discrimination. Ganesha’s long nose has the strength to uproot a tree and the competency of picking up a pin from the ground. Such should be the approach of an individual who should be capable of perceiving the good and bad for one’s own self, and then have the strength to overcome these against all odds.

The tusks and the small teeth of Ganesha tell us to maintain a balance between loss (broken tooth) and gains (whole tooth) in the life. Man ought to maintain his mental state so that ups and downs do not deter him from his honest endeavors.

The ample stomach of Ganapati Deva advocates the need for retaining information. Acquiring knowledge, utilizing it and retaining it for years to come, is the crux of ‘big–belly commandment’.

The Char–Bhuja Dhari Ganesha, further represents strength by virtue of his four hands in which the Lord entraps his attachments, desires and greed. Two of the arms of Ganesha, which hold a rope, symbolize control over the attachments. The laddoo or sweet in one shows command over desires and earthly delusions.

The mouse sitting near the feet of Ganesha represents greed and gluttony upon which the Almighty rides, exhibiting control over evils.

Ganesha’s physical traits are an assembly of the characteristics most desired in an individual of substance.

Wellness Blog

Blood pressure measurement may detect proneness to heart attack

The ankle–brachial index (ABI), a simple, non–invasive 10–minute test should be incorporated into a routine physical exam for diagnosing peripheral arterial disease in the middle aged and the elderly, especially those with heart attack risk factors like smokers, diabetics and the ones with high BP or cholesterol levels.

With the patient in a supine position, the doctor takes blood pressure readings from both arms; he then takes blood pressure readings from both ankles with a sphygmomanometer and Doppler device. ABI value is calculated by dividing the higher systolic pressure in each leg by the higher systolic brachial pressure.

ABI scores should be interpreted as follows:

  • Greater than 0.90: Normal
  • 0.71 – 0.90: Mild obstruction
  • 0.41 – 0.70: Moderate obstruction
  • Less than 0.40: Severe obstruction
  • More than 1.30: Calcification of the vessels

Presence of peripheral arterial disease may indicate associated blockages in the heart and proneness to heart attack or paralysis.

Inspirational Story

Weakness or Strength?

Sometimes our biggest weakness can become our biggest strength. Take, for example, the story of one 10–year–old boy who decided to study Judo despite the fact that he had lost his left arm in a devastating car accident.

The boy began lessons with an old Japanese Judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move.

"Sensei," the boy finally said, "Shouldn’t I be learning more moves?" "This is the only move you know, but this is the only move you’ll ever need to know," the sensei replied.

Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals.

This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time–out. He was about to stop the match when the sensei intervened.

"No," the sensei insisted, "Let him continue."

Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.

On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind.

"Sensei, how did I win the tournament with only one move?"

"You won for two reasons," the sensei answered. "First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grip your left arm."

The boy’s biggest weakness had become his biggest strength.

ePress Release

5–10% of heart attacks occur in Indian men and women younger than 40 years

The prevalence of coronary artery disease (CAD) in India has more than doubled in the past two decades, 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. CAD occurs when the arteries that supply blood to the heart muscle harden and narrow.

India topped the world with 1,531,534 cardiovascular disease-related deaths in 2002, and based on WHO report, 2009, CAD currently occupies the first place in cause of death.

It is estimated that 9.2 million productive years of life were lost in India in 2000, with an expected increase to 17.9 million years in 2030.

Salient features of the CAD epidemic in India

  • Incidence of CAD in young Indians is about 12–16%, which is higher than any other ethnic group
  • Age–standardized estimates for Disability–adjusted life lost due to CAD per 1,000 population in India are three times higher than in developed countries
  • About 5–10% of heart attacks occur in Indian men and women younger than 40 years
  • Median age of first heart attack in Indians is 53 years
  • 1,55,88,000 DALYs (WHO, 2009)

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

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VIP’s on CPR 10 Mantra Video

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

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A free health checkup camp was organized by Heart Care Foundation of India at Bal Bharti Public School

press release

New Drug for ED

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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 rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.

eMedinewS Humor

A Texas millionaire

A Texas millionaire had fallen ill. The doctors consulted did not seem to understand what ailed him. The millionaire let it be known that any doctor who could heal him could have whatever he desired.

A country doctor was finally able to cure him, and as the doctor was leaving after a week’s stay, the Texan said, "Doc! I am a man of my word. You name it, and if it is humanly possible I'll get it for you."

"Well," said the doctor, "I love to play golf, so if I could have a matching set of golf clubs, that would be fine." With that the physician left.

The doctor didn’t hear from the Texan millionaire for some months. Then, one day, he got a phone call from the millionaire.

"Doc, I bet you thought that I had gone back on my word. I have your matching set of golf clubs. The reason it took so long is that two of them didn’t have swimming pools, and I didn’t think they were good enough for ya. So I had pools installed and they’re all ready for you now!"

Quote of the Day

Be always at war with your vices, at peace with your neighbors, and let each new year find you a better man. Benjamin Franklin


Twitter of the Day

Dr KK Aggarwal: ECG not reliable marker for predicting heart disease http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Knowing that everyone is doing their best from their level of consciousness. http://bit.ly/DC_Ananda #ananda


Forthcoming events

Date: Saturday 2PM–Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – reg mno, rawat.vandana89@gmail.com
SMS – BK Sapna reg mno1, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed


Our Contributors

Dr Veena Aggarwal, Dr Chanchal Pal, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Monica Vasudev, Dr Navin Dang, Dr Pawan Gupta, Dr Parveen Bhatia, Dr Prachi Garg, Rajat Bhatnagar, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

eMedi Quiz

A patient has been allegedly bitten by cobra snake. The venom in such a bite would be:

1. Musculotoxic.
2. Vasculotoxic.
3. Cardiotoxic.
4. Neurotoxic.

Yesterday’s Mind Teaser: Mummification refers to:

1. Hardening of muscles after death.
2. Colliquative putrefaction.
3. Saponification of subcutaneous fat.
4. Dessication of a dead body.

Answer for yesterday’s Mind Teaser: 4. Dessication of a dead body.

Correct answers received from: Dr.K.V.Sarma, Arvind Gajjar, Anil Tandon, Dr. Raghavendra jayesh, Prabha Sanghi, Dr. P. C. Das, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Chandresh Jardosh, Daivadheenam Jella, Dr Avtar Krishan, Arvind Diwaker, Dr Jayant Shah, Dr.Bitaan Sen & Dr.Jayashree Sen.

Answer for 14th April Mind Teaser: 1. Pemphigus vulgaris.

Correct answers received from: Dr Prakash Khalap, Arvind Diwaker.

Send your answer to ijcp12@gmail.com

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  1. Dear Sir, Very informative news. Regards: Dr Kanchan
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