1st November 2014, Saturday

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

Tackling Vitamin B12 Deficiency

Vitamin B12 deficiency can be prevented if you are strict vegetarian. 3.2% of adults over age of 50 have a serious low B12 levels and up to 20% may have a borderline deficiency. The common causes of B12 deficiency are being on a vegetarian diet and after a weight loss surgery. Plants do not make Vitamin B12. It is only present in animal food.


  1. Strange sensations, numbness or tingling in the hands, legs or feet.
  2. Difficulty in walking (staggering, balance problem)
  3. Anemia
  4. A swollen inflamed tongue.
  5. Difficulty thinking and reasoning (cognitive difficulties) or memory loss.
  6. Yellowed skin (jaundice)
  7. Paranoia or Hallucinations
  8. Weakness
  9. Fatigue

Ask your Doctor about having your B12 level check if you:

  • Are over 50 years old
  • Take a proton–pump inhibitor or H2 blocker drugs for acidity
  • Take metformin (a diabetes drug)
  • Are a strict vegetarian
  • Had weight loss surgery or have a condition that interferes with absorption of food.


7th APHRS Scientific Session comes to India

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News Around The Globe

A chemical signature of Aspergillus fumigatus infection can be detected in patients' breath, according to a study published online October 23 in Clinical Infectious Diseases.

  • Isolation of the most severely ill patients with Ebola within the first few days of symptoms may be the key to ending the epidemic. A new mathematical model of the Ebola epidemic in Liberia reveals that a shift in the focus of public health efforts from case isolation and hygienic burial of the dead to the isolation of infected individuals before they progress into critical condition and the late phase of illness may slow disease transmission. (October 28 in the Annals of Internal Medicine.)
  • Swedish researchers have found that a high intake of milk may be associated with higher mortality and fracture risks in women and higher mortality risk in men, but they caution against basing any dietary recommendations on their findings, which were published online October 28 in BMJ.
  • Following a Mediterranean diet, monitoring high blood pressure at home, and increasing efforts to ban smoking in public places top the list of new recommendations for reducing stroke risk from the American Heart Association/American Stroke Association. Revised stroke prevention guidelines also expand the list of acceptable oral anticoagulant options for patients with nonvalvular atrial fibrillation beyond warfarin to include dabigatran, apixaban, and rivaroxaban.
    • Weight loss following laparoscopic Roux-en-Y gastric-bypass (RYGB) surgery is almost double that following adjustable gastric banding (AGB), suggested a large comparative study published online October 29 in JAMA Surgery.
    • Brodalumab appears safe and effective for treating moderate to severe psoriasis, points a new 120-week open-label extension study of a phase 2 trial. The study is published online in the Journal of the American Academy of Dermatology.

IMA News

Fetus treated for defect in heart: The rare surgical procedure was successfully performed a week after a similar attempt had ended in failure. A wire and a tiny balloon were then used to expand the blocked aortic valve to relieve the block. Just two days after the surgery, Sirisha, a resident of Injapur village, Ranga Reddy district, was discharged and later re-admitted for reassessment..." Foetal procedure is a latest technique used in treating birth defects in foetuses. And in Sirisha’s case, it was done in her 27 week of pregnancy,” said chief paediatric cardiologist at the hospital K. Nageshwar Rao said.

  • Vitamin A intake was inversely associated with gastric cancer risk, according to a meta-analysis including 31 studies in Clinical Nutrition.
  • Could prophylactic metronidazole prevent Clostridium difficile (C. difficile) infection? A retrospective analysis in Clinical Gastroenterology and Hepatology looked at high-risk patients.
  • How many colonoscopies does it take for a trainee to become competent? Researchers in the U.K. quantified the answer in Gut.
  • October 26 was World Obesity Day, but it's nothing to celebrate: non-alcoholic fatty liver disease is a frequent co-traveler with the extra weight.
  • The American College of Gastroenterology annual meeting in Philadelphia: o need for fresh donor stool: freeze-dried fecal samples were effective and convenient for recurring C. difficile infections, according to a small study; Rifaximin significantly improved symptoms in diarrhea-predominant irritable bowel syndrome(IBS-D), reported researchers. The FDA will decide whether to approve the antimicrobial's use for IBS in February 2015.

Dr KK Spiritual Blog

Why most temples are located in far away places?

Most temples represent God or the spirit the deity located in the temple or mandir situated in an area at the outskirts of the city. A spiritual atmosphere is devoid of pollution and anything which promotes rajsik or tamsik behavior. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. The inner journey of being in touch with one’s consciousness requires detachment from worldly pleasures and the withdrawal of the five senses of the body.

To be in touch with one’s consciousness one needs to bypass the disturbed state of consciousness controlled by emotion, memories and desires, through mind, intellect and ego.

This bypass usually requires a prolonged period of persistence and undertaking the inward journey devoid of external stimuli. The parikrama, which means "the path surrounding something", incorporating many long walks helps to detoxify the mind and thus shifts the consciousness from a disturbed state to an undisturbed, calm state.

A long walk not only has physical benefits but one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The person is often required to walk bare foot on natural ground, inhale pure air and concentrate and listen to the sounds of the nature, birds and trees. This proximity of nature helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode described by lowering of blood pressure and pulse rate and rise in skin resistance.

The final happiness invariably comes from within us at the time of final darshan when a person invariably closes his eyes and experiences God within his heart.

Most temples today are being constructed in residential colonies and provide a holy atmosphere to people right at their doorstep. However, this does not have the same spiritual significance and benefits as a temple located at the outskirts of a city.

There is no way a person can go to a temple in the vicinity of his house and detoxify his mind as this can hardly be achieved in minutes unless you are a siddha yogi, and if you are one, you need not go to a temple as the temple is within you.

In Vedic texts, it has been clearly mentioned that to acquire powers and inner happiness, rishi, munis were also required to do tapasya for months and years together.

This tells us that spiritual well–being is acquired over an extended period of time as the process of detoxification is a long drawn process. Cars and other vehicles should not be allowed near temples as the basic motive is to have a pollution–free atmosphere and to give time and space for the mind to detoxify.

Inspirational Story

Redeem the Time

Let us detach ourselves from things trifling and insignificant, and give ourselves up to the study of things worthy our nature and capacity. We all value our possessions, and much more ought we to estimate our time.

How many words and actions are capable of being taken by two handles, are patient of two interpretations, a good interpretation and a bad one? We are unmerciful when without necessity we are judges of evil thoughts, when we suspect meanness, littleness, untruthfulness, not to speak of worse surmising, in others.

Make yourselves nests of pleasant thoughts, bright fancies, and faithful sayings: treasure-houses of precious and restful thoughts, which care cannot disturb nor poverty take away from you-houses built without hands for your souls to live in.

Every noble act of devotion to truth, every pure life unstained with evil, every word of pity, every instance of forgiving, and goodness, helps us to a better faith in that divine and eternal goodness which has no variableness or shadow of turning.

Injustice to you is not an awful thing like injustice in you.

Rabies News (Dr A K Gupta)

Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier.

Cardiology eMedinewS

  • A US Food and Drug Administration (FDA) advisory panel voted in favor of a novel anticoagulant for the treatment of patients with atrial fibrillation (AF). The Cardiovascular and Renal Drugs Advisory Committee voted 9 to 1 in favor of approving edoxaban, a factor Xa inhibitor, for the prevention of stroke and non–central-nervous-system (CNS) systemic embolism in patients with nonvalvular AF.
  • Two newly identified genetic variants that influence the LDL-cholesterol response to statin therapy have been identified in a large analysis. Two single nucleotide polymorphisms (SNPs) at SORT1/CELSR2/PSRC1 appear to be associated with an enhanced LDL-cholesterol–lowering response with statin therapy, while a SNP at SLCO1B1 was associated with a smaller LDL-cholesterol reduction in response to statin treatment. The report is published October 28 in Nature Communications.

Pediatrics eMedinewS

  • A new study has shown that "Integrated Play Groups," or IPGs, appear effective in teaching children with autism the skills they need to interact with their peers and engage in symbolic play such as pretending. The study is published in the Journal of Autism and Developmental Disorders.
  • Teens whose parents use guilt or withholding have trouble working out disagreements well into adulthood, suggests a new study published online in Child Development.

Quote of the Day

  • Shame occurs when you haven’t been able to get away with the ‘who’ you want people to think you are. Carl Whitake

Wellness Blog

Treatment of Fatty Liver

  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

ePress Release

One of the largest International conferences on Heart Rhythm disorders in the World – the 7th APHRS Scientific Session comes to India

Over 1500 physicians and cardiologists attend the four-day conference organized jointly by the Asia Pacific Heart Rhythm Society (APHRS) and Indian Heart Rhythm Society (IHRS)

The APHRS Scientific Session, one of the largest gatherings of Cardiac Electrophysiologists in the world is being held in the capital city of India for the first time ever. The four-day conference-taking place from Oct 29th – Nov 1st simultaneously at Hotel Taj Palace and ITC Maurya, is the largest medical conference ever organized in the country in terms of the International faculty participation from different continents such as the Asia Pacific, USA and Europe.

The 7th APHRS Scientific Session is a global conclave aimed at upholding excellence and advancement in the diagnosis and treatment of patients with heart rhythm disorders. The highlight of this year’s conference are the 200 scientific sessions being conducted by 250 core leading National and International faculty on topics such as ECGs, Sudden Cardiac Death, Atrial Fibrillation, Heart Failure and Arrhythmia. A special focus is also being given to technological development in the field of heart rhythm disorders. New technologies like Leadless Pacemakers and Subcutaneous ICD’s are being showcased during the scientific sessions and special training sessions for young cardiologists, nurses and technicians are being organized.

Speaking at the conference, Dr Mohan Nair, Chairman Organizing Committee, 7th Asia APHRS Scientific Session and Chairman Cardiology, Saket City Hospital said, “It is indeed a proud moment to have an International conference of such stature and scale being organized in India. With the increasing incidence of heart rhythm disorders in the country, it is extremely important that we make full use of the advancements in technology in the fields of arrhythmia and electro cardiology and educate the community about new and innovative treatment options available globally. The 7th APHRS Scientific Session provides platform to physicians, researchers and other partakers to come together and contribute in enhancing international academic exchange and development. I thank all our partners and look forward to many such opportunities in the future”.

Adding to this, Dr Young-Hoon Kim, President APHRS said, “Started in 2008, APHRS takes place every year in different countries of the Asia Pacific Region. The goal behind scheduling these conferences in different countries is to provide an exchange of information related to not only arrhythmia and electro cardiology but also to put forward an apt platform for the exposure to the local culture which is rewardingly educational and deeply enriching. I am thrilled to be in India for the conference and amongst some of the leading global experts in the field”.

In the past APHRS has been organized in countries such as Hong Kong, Singapore, China, Korea, Japan, and Taiwan. Next year’s conference will take place in Melbourne, Australia during the month of November 2015.

Giving a global perspective, Dr Richard Fogel, President, Heart Rhythm Society said, “I am extremely happy to be here in India today for the 7th APHRS Scientific Session. The treatment of arrhythmic disorders differs not just within different North American countries but also globally, making a platform such as this extremely beneficial and important. Technological advancement has now revolutionized treatment of heart rhythm disorders. For instance putting a three lead pacemaker is now an established non-drug therapy for end stage heart failure”.

Commenting on the medical advancements in the treatment of heart rhythm disorders, Dr Kalyanam Shiv Kumar, Director, Cardiac Arrhythmia Center and Professor, Department of Medicine Radiology, UCLA USA, said, “It is now possible to catheter ablate most of the cardiac irregular heart rhythms safely and effectively. With the help of ultra-modern technologies a majority of heart attacks due to heart rhythm disorders can be avoided”.

Adding to this, Dr Jonathan Kalman, Professor at The Royal Melbourne Hospital in Melbourne, said, “Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance and a major cause of stroke and death. Over recent decades, the incidence of AF has increased dramatically, positioning AF as one of the epidemics of the new millennium. Conferences like the APHRS Scientific Session like are extremely important platforms to discuss advancements in the field and provide adequate training to heart rhythm physicians to address this modern epidemic”

A public awareness program on sudden cardiac arrest was also launched at the venue. To know more please visit www.aphrsindia.com

eMedi Quiz

The parameters of sensitivity and specificity are used for assessing:

1.Criterion validity.
2.Construct validity.
3.Discriminant validity.
4.Content validity.

Yesterday’s Mind Teaser: The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1.Fluorescence spectroscopy.
2.Electron microscopy.
3.Nuclear magnetic resonance.
4.X-ray diffraction.

Answer for yesterday’s Mind Teaser: 4.X-ray diffraction.

Correct answers received from: Dr K V Sarma, Dr Palanivelrajan, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Tukaram Pagad.

Answer for 29th Oct Mind Teaser: 3.Gelfiltration chromatography.

Correct answers received from: Najib Khatee, Dr Avtar Krishan, Dr Poonam Chablani.

Send your answer to email

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21st Perfect Health Mela 15th October 2014



press release

Strenuous exercise may increase risk of cardiac disorder

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Video Library

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

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VIP’s on CPR 10 Mantra Video

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


IJCP Book of Medical Records

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

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


Dr Good and Dr Bad

Situation: A patient on aspirin was to go for non vascular surgery
Dr Good: Stop aspirin for seven days
Dr Bad: Stop aspirin fir two days
Lesson: Based on POISE-2, we recommend discontinuing aspirin about seven days before noncardiovascular surgery.

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

eMedinewS Humor

That Darned Cat

A man absolutely hated his wife's cat and decided to get rid of him one day by driving him 20 blocks from his home and leaving him at the park. As he was getting home, the cat was walking up the driveway.

The next day he decided to drive the cat 40 blocks away. He put the beast out and headed home. Driving back up his driveway, there was the cat!

He kept taking the cat further and further and the cat would always beat him home. At last he decided to drive a few miles away, turn right, then left, past the bridge, then right again and another right until he reached what he thought was a safe distance from his home and left the cat there.

Hours later the man calls home to his wife: "Jen, is the cat there?"

"Yes", the wife answers, "why do you ask?"

Frustrated, the man answered, "Put that darned cat on the phone. I'm lost and need directions!"

Twitter of the Day

Dr KK Aggarwal: Equipment-related failures common in Operation Theater
Dr Deepak Chopra: Knowing God consists of many experiences acquired over a lifetime, a slow-motion epiphany

medicolegal update

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

Giving an opinion on phone has no legal liability

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

medicolegal update
  1. Dear Sir. I endorse your views about Dengue. Our blood banks are actively helping Clinical friends on these lines that unnecessary transfusion of Platelets should be avoided. Your timely advice will go a long way to check irrational use. Thanks and regards. Dr. N. K. Bhatia

eMedinewS Special

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