eMedinewS 18th July 2013, Thrusday

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; Chairman Ethical Committee Delhi Medical Council; 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

Dance Bar Girls

There has been a recent controversy about the dance bar girls in Maharashtra. While the Supreme Court has upheld the High Court’s decision to allow them to function, Government is still adamant and finding ways to continue banning them. One of the view is that these girls are responsible for increased crime rate, extra-marital affairs and teen-age crime.

Going back to ancient Indian literature, we do find three types of women: (i) ordinary woman; (ii) commercial sex workers; and (iii) Apsaras or celestial nymphs.

As per Kama Sutra, a perfect woman is supposed to have 64 arts. Out of them there are certain arts which make woman super-woman and these are art of dancing, art of music, art of gambling, art of gaming and the art of sexuality.

The women who have expertise in these arts were differentiate from ordinary women and were called Apsaras, whose job was to entertain other people and international guests. They were different from commercial sex workers as they would not sell their virginity for money.

In today words, dance bar girls, cheer girls in IPL and the dancer in Lucknow Kothas can be compared to them. The classical examples are the role played by Rekha in the film Umrao Jan and Meena Kumari in the film Pakija. Their job was to entertain and they were not available for sexual exploitation.

I personally feel that Apsaras are there and they should be allowed to be there as long as one can strictly follow that they do not end up with sexual exploitation. ....Read More

Bihar children death after eating mid-day meal update.

Food poisoning epidemic keep occurring now and then and it is unfortunate that children or people die every year because of these instances which can occur in school mid-day meal, marriage functions, religious functions, etc.

Possible ways of food poisoning, one is, pre-formed toxin in the food like staph and bacillus cereus. Both poisoning occur when someone eat partially cooked food including rice and vegetables. When the partially cooked food is kept at room temperature overnight toxins can form from the bacteria. The key point is food should not be kept for more than 2 hours at room temperature at no cost. Even if this food is reheated and served it can still cause poisoning as most of the toxins are heat stable. In mid-day school meal or in marriage functions, this is very likely that the food is served at 11 am. The food either might have been prepared in night before or early in the morning and then it stays at a room temperature for hours together.

Another is poisoning because of insecticides and pesticides. The classical toxic oil syndrome, a name given to spain epidemic in 1981, which killed over 600 people was linked to either adulterated coiza oil which had been intended for industrial rather than food use.

In the same epidemic some people linked the poisoning because of organophosphorus compound which is often used as an insecticide.

In the present epidemic till the final report comes possibility of all three will remain. Preformed toxin usually cannot cause deaths in such a large number. Canned food can cause such epidemic because of botulism. But is unlikely in the present epidemic.

The basic precautions are:

  1. Food should be properly cooked for the right time and at the right temperature.
  2. Food should be properly hot when eaten.
  3. Vegetables should be properly washed in running water for 15 minutes.
  4. Egg and meat should be properly and fully cooked.
  5. Half cooked rice can be dangerous.
  6. Water should be boiled before used.
  7. All liquids should be boiled.
  8. Eating fruits which can be pealed by hand are safe.

....Read More

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 An empty mind is the devil’s house

It is an old saying that “Khali dimag shaitan ka ghar”.

Empty mind means when you are doing nothing and Shaitan means negative thoughts. In terms of Vedic Sciences, negative thoughts mean absence of positive thoughts and they are often equated to darkness which is absence of light.

Positive thoughts always need efforts and exertions while negative thoughts are spontaneous and without exertion.
It is recommended that one should think differently and positive otherwise there will be spontaneous appearance of negative thoughts.

Darkness is spontaneous and naturally present and to bring light one has to make efforts by switching on the light or the nature has to ask the Sun to come and give the light. ....Read More

cardiology news

Testing for Gossip

In ancient Greece, Socrates was reputed to hold knowledge in high esteem. One day an acquaintance met the great philosopher and said, "Do you know what I just heard about your friend?"

"Hold on a minute", Socrates replied. "Before telling me anything I'd like you to pass a little test. It's called the Triple Filter Test." "Triple filter?"

"That's right", Socrates continued. "Before you talk to me about my friend, it might be a good idea to take a moment and filter what you're going to say. That's why I call it the triple filter test. The first filter is Truth. Have you made absolutely sure that what you are about to tell me is true?"

"No, “the man said, "Actually I just heard about it and ..."

"All right", said Socrates. "So you don't really know if it's true or not. Now let's try the second filter, the filter of Goodness. Is what you are about to tell me about my friend something good?"

"No, on the contrary." "So", Socrates continued, "you want to tell me something bad about him, but you're not certain it's true. You may still pass the test though, because there's one filter left: the filter of Usefulness. Is what you want to tell me about my friend going to be useful to me?"

"No, not really."

"Well", concluded Socrates, "if what you want to tell me is neither true nor good nor even useful, why tell it to me at all?" ...Read More

News Around The Globe

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  • The biggest achievement of my career to date has been the publication of my article online in the January 2013 issue of The American Journal of Cardiovascular Disease.(3) In this publication, I described my findings; namely, that atherosclerosis in modern human beings is based on the biochemistry, composition and structure of three of the five phospholipids in the cell membrane of the coronary arteries. My findings indicate fried foods, powdered egg yolk, excess vegetable oils, partially hydrogenated vegetable oils and cigarette smoke as the greatest culprits in heart disease. Fried foods and powdered food substitutes are dietary sources of oxysterols, which alter the phospholipid membranes of our arteries in ways that increase the deposition of calcium, a key hallmark of atherosclerosis. Consumption of excess polyunsaturated fats stimulates the formation of oxysterols within the human body. Cigarette smoke and trans fats from partially hydrogenated vegetable oils interfere with fatty acid metabolism, leading to the interruption of blood flow, a major contributor to heart attacks and sudden death. In my opinion, many of these factors have been largely ignored by the medical establishment, which has focused instead on using drugs to lower cholesterol levels. I hope my recent publication in The American Journal of Cardiovascular Disease changes this and provides the answer for proper dietary advice. (Hannah Wilson)
  • Adults with coeliac disease seem to be at potentially increased risk of early atherosclerosis as suggested by vascular impairment and unfavorable biochemical risk pattern. Chronic inflammation might play a determining role. Gluten abstinence with mucosal normalization reverts to normal the observed alterations. (Aliment Pharmacol Ther. 2013;38(2):162-169.)
  • For patients with diabetes, the use of the angiotensin-receptor blockers (ARBs) telmisartan (Micardis, Boehringer Ingelheim) and valsartan are both associated with a significantly lower risk of macrovascular disease compared with irbesartan, a large, retrospective study suggests (1). In the analysis, the use of telmisartan and valsartan lowered the risk of hospital admission for MI, stroke, or heart failure by 15% and 14%, respectively. (CMAJ 2013; DOI: 10.1503/cmaj/121771.)
  • Patients with prosthetic valve endocarditis (PVE) continue to have a high mortality risk that early surgical intervention does not reduce, results of a large multinational trial showed. An unadjusted analysis controlling only for treatment selection suggested a large benefit from early surgery. A fully adjusted analysis, however, showed no benefit of surgery versus medical therapy for in-hospital (HR 0.90) or 1-year mortality (HR 1.04), according to Tahaniyat Lalani, MD, of Naval Medical Center Portsmouth in Virginia, and co-authors.
  • Hindustan Times today has carried a news that medical colleges in Punjab propose to raise MBBS fee for Govt seats from 1,50,000 per year to 10,50,000 per year which is nearly a 7 fold increase. This is the crux of the problem. Medical education today is fast becoming an exclusive preserve of the rich or of those who benefit from policies of social justice. There is no proposal to fund the non affording student with guaranteed job and repayment of fee from salary or any other such proposal to offset the effect of such an exorbitant hike. After paying 50 lakh tuition fee (MBBS) plus let us assume 10 lakh hostel and other expenses over 5 years the student still has to do (free) rural service to be eligible for PG entrance where again fee will be proportionately hiked. Assuming spending another 60 lakh tuition fee for PG, the parental "investment" of 1,20,00,000 will yield a princely 50000 - 70000 Rs per month after approximately 10 years. Welcome to the world of Med-Edu-nomics. (Dr Neeraj Nagpal)

Infertility News (Dr Kaberi Banerjee, IVF expert, New Delhi)

What happens after the egg retrieval procedure?

Two days after the egg retrieval, the fertilized egg divides to become a 2– to 4–cell embryo. By the third day, a normally developing embryo will contain approximately 6 to 10 cells. By the fifth day, a fluid cavity forms in the embryo, and the placenta and fetal tissues begin to separate. An embryo at this stage is called a blastocyst. Embryos may be transferred to the uterus at any time between 1 and 6 days after the egg retrieval. If successful development continues in the uterus, the embryo hatches from the surrounding zona pellucida and implants into the lining of the uterus approximately 6 to 10 days after the egg retrieval.

Rabies News (Dr. A K Gupta)

What is the cause of death in a rabid animal?

Death in rabid animal is due to progressive paralysis.

cardiology news

Six-step plan may cut HF readmissions

Hundreds of millions of dollars could be saved if hospitals implemented six strategies aimed at reducing heart failure readmissions, a large national sample of hospitals revealed.

Individually, the six strategies had a modest but still significant size effect ranging from 0.34 to 0.18 percentage points change in risk-standardized 30-day readmission rate (RSRR), wrote Elizabeth Bradley, PhD, of Yale University, and colleagues in the study published online in Circulation: Cardiovascular Quality and Outcomes.

Combo Tx helps in inpatient cardiac arrest

For patients with in-hospital cardiac arrest requiring vasopressors, adding vasopressin and steroids to epinephrine improved outcomes compared with epinephrine alone, a randomized trial showed.

Patients in the combination group were more likely to have a return to spontaneous circulation lasting at least 20 minutes (83.9% versus 65.9%, odds ratio 2.98, 95% CI 1.39-6.40), according to Spyros Mentzelopoulos, MD, of Evaggelismos General Hospital in Athens, Greece, and colleagues.

They also were more likely to be discharged with a favorable neurological status (13.9% versus 5.1%, OR 3.28, 95% CI 1.17-9.20), the researchers reported in the July 17 issue of the Journal of the American Medical Association.

Valvular Heart Disease News

Valvular heart disease is common in patients undergoing maintenance dialysis. Predisposing factors include secondary hyperparathyroidism, an elevated calcium-phosphorus product, vascular calcification, hypercalcemia, uremic milieu and hyperphosphatemia.

(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

Kids' heart-lung bypass need tied to vitamin D

A dramatic decline in vitamin D levels among children undergoing congenital heart surgery was associated with the use of the cardiopulmonary bypass machine, a prospective observational study found. The "abrupt" change in 25(OH)D coincided with the initiation of the cardiopulmonary bypass machine, they wrote in the study published online in the journal Anesthesiology. (Source: Medpage Today)

Potential early biomarkers for autism identified

Excessive cerebral spinal fluid and enlarged brain size in infancy may signal increased risk for autism, paving the way for early intervention. Researchers at the MIND Institute at University of California, Davis, found that children who were later diagnosed with autism spectrum disorder (ASD) had elevated extra-axial fluid and enlarged brains at 6 to 9 months of age. The findings were published online July 10 in Brain. (Source: Medscape)

cardiology news

Food poisoning with rice dishes

Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit

  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic-type food poisoning associated with B. cereus
  • The organism is frequently present in uncooked rice, and heat-resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin-mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one-third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice-based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight. ...Read More
cardiology news

Psychological conditions associated with intimate partner violence include:

  • Depression
  • Suicidality
  • Anxiety and panic disorder
  • Eating disorder
  • Substance use
  • Post traumatic stress disorder
  • Dissociative disorders
cardiology news
  1. 9th July: HCFI Executive Meeting


CPR 10 Training Camp, EPFO, 30th May 2013

CPR 10 Camp - Police Training Center Najafgarh


CPR Classes: Persons trained (52)

CPR VIP Sensitization

Total CPR since 1st November 2012 – 54572 trained

6th July: Zoonosis Conference: 52

Video Chats and uploads

Symposium on Prayer, Faith, Meditation and healing Part 9

Symposium on Prayer, Faith, Meditation and healing Part 8

Symposium on Prayer, Faith, Meditation and healing Part 7

Symposium on Prayer, Faith, Meditation and healing Part 6

Symposium on Prayer, Faith, Meditation and healing Part 5

Symposium on Prayer, Faith, Meditation and healing Part 3

Symposium on Prayer, Faith, Meditation and healing Part 2

Symposium on Prayer, Faith, Meditation and healing Part 1

CPR 10 training was given to 1001 students learnt CPR at Bal Bharti Public School, Dwarka

Seven Steps to Patient Safety

What patient expect on doctor – A survey

MTNL Perfect Health Mela to focus on Disaster Management & Doctor patient relationship

Dr AK Aggarwal Speaks on Workshop on Patient Safety

Dr RN Makroo on Blood Safety

Prof (Dr) Usha Gupta on Medication Safety

Dr N V Kamath DHS on Patient Care

Differentiate different types of Fever

One can differentiate different types of fever clinically said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela & National Vice President-Elect IMA.

Following are the tips

  1. If a patient comes with fever with chills and rigors, think of Malaria in north and filarial in Vidarbha region in India.
  2. In Malaria, Chills are more common in the afternoon and in Filaria chills are in the evening.
  3. Fever with joint pains on extension is due to Chikungunya (flexion improves the pain)
  4. Think of dengue if there is fever with itching, rash and periorbital pain.
  5. In presence of fever with single chills, think of pneumonia.
  6. Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children
  7. Fever with red angry-looking throat: Think of streptococcal sore throat
  8. Fever with red epiglottis: Think of Hemophilus infection
  9. Fever with cough and or nasal discharge: Think of common flu
  10. Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  11. Fever with toxic look, persistent fever: Look for typhoid
  12. Fever with no or low rise in pulse: Look for typhoid
  13. Fever with urinary symptoms (burning, frequency): Rule out urinary infection
  14. Fever with high TLC (White count) and liver pain: Rule out liver abscess
  15. Fever with loose motions, watery, no blood, no mucous: Rule out acute gastroenteritis
  16. After the fever is over, jaundice appears: Its viral hepatitis
  17. After the fever is over one feels very weak: Rule our dengue hemorrhagic fever.

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 54572 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 10x10 i.e. 100 per minute.” ...Read More

today emedipics

Doctor Day Celebration

On the occasion of Doctors Day, a CME was organized by IMANDB, eMedinewS and Heart Care Foundation of India on 29th June 2013 at IIC, New Delhi

press release

White rice linked to diabetes in Asians

today video of the dayDr KK Aggarwal on Monsoon Take Care

Dr KK Aggarwal on Danger of Epidemics (Uttarakhand Disaster)

CPR Utsav 6th April 11543 Male Female Trained in 1 day

eMedi Quiz

Read this…………………

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, nurse Ernie detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit?

a. A sunken fontanel
b. Decreased pulse rate
c. Increased blood pressure
d. Low urine specific gravity

Yesterday’s Mind Teaser: Nurse Rose is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents?

a. The cast will be removed in 6 weeks
b. A new cast is needed every 1 to 2 weeks
c. A short leg cast is applied when the baby is ready to walk
d. The cast will be removed when the baby begins to crawl

Answer for yesterday’s Mind Teaser: b. A new cast is needed every 1 to 2 weeks

Correct answers received from: Tukaram Pagad, DR ABBAS VAKIL, Dr P J Khalap, DR P K SAHU, Dr Arpan Gandhi, daivadheenam jella, Dr. Thakor Hitendrsinh G, Dr. V.P. Thakral, Dr.(Maj. Gen.) Anil Bairaria, DR AVTAR KRISHAN, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, rajeev ardey, DR SANTHAKUMARI, Dr.K.Raju, Muthumperumal Thirumalpillai, DR Chandresh Jardosh, Dr B K Agarwal, Narahari Kandakatla,

Answer for 15th July Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr. Thakor Hitendrsinh G, DR Chandresh Jardosh

Send your answer to ijcp12@gmail.com

eMedi Apps

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Chairman Legal Cell Indian Academy of Echocardiography; Chairman Ethical Committee Delhi Medical Council; Editor eMedinewS and President Heart Care Foundation of India)

What is physician assisted suicide?

Ans. Physician assisted suicide refers to a physician’s act of providing a drug, a prescription, information or other intervention to a patient with the understanding that the patient intends to use them to commit suicide. It is legal in Netherlands, Belgium and Switzerland. In United States, Oregon legalized it in 1997 and the practice was legalized in Washington in March, 2009. Read More

medicolegal update

Getting Rid of the Problem

A farmhand is driving around the farm, checking the fences. After a few minutes he radios his boss and says, "Boss, I've got a problem. I hit a pig on the road and he's stuck in the bull-bars of my truck. He's still wriggling. What should I do?"

"In the back of your truck there's a shotgun. Shoot the pig in the head and when it stops wriggling you can pull it out and throw it in a bush." The farm worker says okay and signs off. About 10 minutes later he radios back. "Boss I did what you said, I shot the pig and dragged it out and threw it in a bush."

"So what's the problem now?" his Boss snapped.

"The blue light on his motorcycle is still flashing!" Read More

medicolegal update
medicolegal update

Situation: A patient came with mild hypertension
Dr. Bad: Start with only hydrochlorothiazide.
Dr. Good: Monotherapy can be started with any of the drugs
Lesson: Among hypertensive patients without an indication for a specific drug, drugs that have been used for monotherapy are a low-dose thiazide diuretic, long-acting angiotensin converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARBs), or a long-acting dihydropyridine calcium channel blocker. Given the preference for an ACE inhibitor/ARB plus a dihydropyridine calcium channel blocker in patients requiring combination therapy, use one of these drug classes as initial therapy so that the other can be added, if necessary. Read More

medicolegal update

Situation: A hypertensive with obstructive sleep apnea (OSA) was not responding to CPAP?
Reaction: Oh my God! Why was an antihypertensive drug not started?
Lesson: Make sure that all hypertensives with OSA are given anti-HT drugs in addition to CPAP (Continuous positive airway pressure therapy). In a randomized crossover trial of 23 patients with OSA and systemic hypertension, an anti–hypertensive medication (valsartan 160 mg per day) lowered the mean 24–hour blood pressure significantly more than CPAP therapy alone (Am J Respir Crit Care Med 2010;182:954).

medicolegal update

Just don't give up trying to do what you really want to do. Where there is love and inspiration, I don't think you can go wrong. Ella Fitzgerald

medicolegal update

Dr KK Aggarwal: High fat diet prostate cancer prone
http://bit.ly/1aBeL42 #Health

Dr Deepak Chopra: "Are You Paying Attention: Mind Full or Mindful?" My article was written for @SFGate http://tinyurl.com/q3sfaq4

medicolegal update

Dear KK, this is the ideal format for eMedinewS great keep moving forward. Dr.R.Mani Chennai

Forthcoming Events

2nd annual Ped Neuro Conclave

Sunday, 25th August 2013.
This is an annual event hosted jointly by Fortis Escorts Hospital and IAP Jaipur. This conference is held every year and is attended by more than 200 delegates, which include Neurologists, Pediatricians, GPs and resident doctors from all over Rajasthan. Senior faculty from different institutes all over India and abroad participates and shares their knowledge and experience with the audience.

The eminent faculty includes
Dr. Pratibha Singhi, Head Pediatric Neurology, PGI – Chandigarh
Dr R K Sabharwal, Head Pediatric Neurology, Sir Ganga Ram Hospital, New Delhi
Dr. Vineet Bhushan Gupta, Sr Consultant Pediatric Neurologist, Apollo Hospital, New Delhi;
Dr Deepak Gupta, Sr Consultant Paediatric Psychiatrist, Sir Ganga Ram Hospital, New Delhi.
Venue: Jaipur Marriott Hotel
Date: Sunday, 25 August 2013 (0900-1700)
Organizing Secretary: Dr Sharad Sharma, MD (PGI), MRCPCH (UK), Fellow Pediatric Neurology (London)
Senior Consultant Pediatric Neurology, Fortis Hospital, Jaipur, Rajasthan

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medicolegal update

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