24th November 2014, Monday

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

Elective noncardiac surgery after acute stroke

In a nationwide cohort study from Denmark, which examined all patients aged 20 years or older undergoing elective noncardiac surgeries, a history of stroke was associated with risk of major adverse cardiovascular events (ischemic stroke, acute myocardial infarction, and cardiovascular mortality), post surgery, especially if time period between stroke and surgery was less than 9 months. The associated risk appeared stable after 9 months, but it was still high vs patients with negative history of stroke.1

Intravenous alteplase in acute stroke

According to a meta-analysis of individual patient data from randomized trials, administration of intravenous alteplase within 4.5 hours of onset of stroke, significantly improved the overall odds of a good stroke outcomes, with earlier treatment associated with bigger proportional benefit. The study evaluated individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. 2

Detection of atrial fibrillation after cryptogenic stroke

  • ECG monitoring with an insertable cardiac monitor (ICM) was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. In the CRYSTAL AF trial, at 6 months, detection of atrial fibrillation was higher in patients with ICM vs control group; 8.9% vs 1.4%, respectively. At one year, atrial fibrillation was detected in 12.4% of patients in the ICM group vs 2.0% of patients in the control group. The trial included patients aged 40 years or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring after ischemic stroke.3
  • Noninvasive ambulatory ECG monitoring of patients who had a cryptogenic stroke or TIA and no evidence of AF on routine monitoring for 30 days significantly improved the detection of atrial fibrillation and almost increased rate of anticoagulant treatment by 2-folds. In the EMBRACE trial, atrial fibrillation lasting =30 sec was detected in 16.1% patients in the intervention group vs 3.2% in the control group. The trial included patients aged 55 years or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months.4


  1. Jørgensen ME, Torp-Pedersen C, Gislason GH, et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312(3):269-77.
  2. Emberson J, Lees KR, Lyden P, et al; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014 Aug 5. Epub ahead of print.
  3. Sanna T, Diener HC, Passman RS; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014;370(26):2478-86.
  4. Gladstone DJ, Spring M, Dorian P, et al; EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014;370(26):2467-77.

News Around The Globe

  • CT with substantial dose reductions can accurately identify ureteral stones in emergency department patients, suggests new research published in Annals of Emergency Medicine.
  • Women who breastfeed for four months or more experience a decrease in the volume and thickness of bone mineral density (BMD) in cortical bone, as well as trabecular thickness at the ultra-distal tibia, suggests a Swedish study published online in the Journal of Clinical Endocrinology and Metabolism.
  • A new set of "guiding principles" for the care of people with diabetes and those who are at risk for it has been issued by the federally funded National Diabetes Education Program (NDEP), cosponsored by the National Institutes of Health and Centers for Disease Control and Prevention. “Guiding Principles for the Care of People With or at Risk for Diabetes” serves as a "quick-read" reference providing guidance for clinicians.
  • Catheter-tip cultures do not appear to be helpful for identifying central line-associated blood stream infections (CLABSI), suggests new research published online in Clinical Infectious Diseases.
  • Being overweight or obese is associated with poorer brain health in cognitively healthy adults in their 60s, suggests new data from the long-running Australian PATH Through Life Study. The findings were presented at the Society for Neuroscience 2014 Annual Meeting.

66th Annual Conference of Cardiological Society of India (CSI) -2014


Dr KK Spiritual Blog

Mindfulness meditation

Sit on a straight-backed chair or cross-legged on the floor.

Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.

Once you've narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas.

Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.

Inspirational Story

The Eagle and the Chickens

During the office coffee break a couple of days back I was looking at the highway from the 34th Floor of my office and noticed hundreds of cars passing at a high speed every minute. I pondered that each of these passengers is in different mood right now. Someone belonging to Country-A might be sad because of some tragic incident, someone from country-B is stressed due to his/her financial issues, someone might be happy because his/her mother/spouse is coming to him/her and so on. However, for most of these people the current state will not be the same by tomorrow. The person who is in crisis today may become happy by tomorrow. The one who is happy today might be more delightful and the one who is stuck in a situation today might get out of it by tomorrow.

That means, overall, millions of stories are taking birth on earth each day and millions of stories are dying.

From my 3-5 minutes thought process I learnt a very nice lesson that no matter how bad is the situation, the time will pass. So next time I am in stress, I would visualize the highway and think that I am not alone in this situation. I would think that if millions of people are passing through such stages and recovering why should I take stress on my heart. Just like all those drivers, I must keep driving in the right lane and I shall reach my destination. The definition of right lane might be different for different kind of scenarios but the basic concept is same that when you have issues, you must meet the issues with courage, greet them with wow approach, treat them with wisdom and defeat them with strategy.

You may want to read my articles on how to face tragic moments by clicking here and here. Further studies on Effective Decision Making, Depression management might help you recover from your stressful circumstances.

Rabies News (Dr A K Gupta)

What is the importance of pre-exposure vaccination?

Pre-exposure vaccination simplifies post-exposure vaccination because after bite, those who have received full pre-exposure vaccination require only two doses of vaccine at Days 0 & 3. RIG is not required (WHO 2007).

Cardiology eMedinewS

  • Bypass surgery may be the preferred option for coronary revascularization in patients with diabetes, especially when long-term survival is anticipated, suggests a systematic review and meta-analysis published November 18 in the Annals of Internal Medicine.
  • Results of a new trial presented at the American Heart Association (AHA) 2014 Scientific Sessions suggest that supplemental oxygen therapy in patients with ST-elevation MI (STEMI) may actually be harmful for patients who are not hypoxic.

Pediatrics eMedinewS

  • The consumption of a diet high in fructose throughout adolescence can worsen depressive- and anxiety-like behavior and alter how the brain responds to stress, suggests new research presented at Neuroscience 2014.
  • Infant exposure to peanut traces in house dust may double the risk for peanut allergy, suggests new research published online November 18 in the Journal of Allergy and Clinical Immunology.

Quote of the Day

  • Whatever we plant in our subconscious mind and nourish with repetition and emotion will one day become a reality. Earl Nightingale

Wellness Blog

Supplements may cut LDL in older women

Postmenopausal women taking calcium and vitamin D supplements had improved lipid profiles compared with those taking placebo as per a new study.

In an analysis of data from the Women's Health Initiative, the level of LDL cholesterol was lower by an average of 4.46 mg/dL in the women on active treatment reported Peter F. Schnatz, DO, of Reading Hospital in Pennsylvania in the journal menopause.

In addition, higher concentrations of 25-hydroxyvitamin D3 (25[OH]D3) were associated with higher levels of HDL cholesterol and lower levels of LDL cholesterol and triglycerides.

eMedinewS Humor

A Friendly Honest Neighbour

A man received the following text from his neighbor:

I am so sorry Bob. I've been riddled with guilt and I have to confess.

I have been tapping your wife, day and night when you're not around.

In fact, more than you.

I'm not getting it at home, but that's no excuse.

I can no longer live with the guilt and I hope you will accept my sincerest apology with my promise that it won't happen again.

Bob, anguished and betrayed, went into his bedroom, grabbed his gun, and without a word, shot his wife and killed her.

A few moments later, a second text came in:

Damn autocorrect. I meant "wifi", not "wife".

ePress Release

Heart Care Foundation of India and Indian Medical Association now part of NCD Alliance

New Delhi India: Heart care Foundation of India and Indian Medical Association have joined the NCD Alliance, said Padma Shri Awardee Dr K K Aggarwal President Heart Care Foundation of India and incoming Honorary Secretary General IMA.

The NCD Alliance was founded by four international NGO federations representing the four main NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease. These involved International Diabetes Federation, World Heart Federation, and the Union for International Cancer Control.

Together with other major international NGO partners, the NCD Alliance unites a network of over 2,000 civil society organizations in more than 170 countries. The mission of the NCD Alliance is to combat the NCD epidemic by putting health at the centre of all policies.

The NCD Alliance uses targeted advocacy and outreach to ensure that NCDs are recognized as a major cause of poverty, a barrier to economic development, and a global emergency.

Other member associations from India are Disease Management Association of India; India800 Foundation, Breastfeeding Promotion Network of India, Indian Centre for Alcohol Studies, Indian Alcohol Policy Alliance and Indian Medical Association.

NCD Global Facts

  • Non-communicable diseases (NCDs) are the world’s number one killer, bringing hardship to rich and poor nations alike.
  • NCDs make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs).
  • Worldwide, NCDs account for 60% (35 million) of global deaths.
  • The largest burden - 80% (28 million) - occurs in LMICs, making NCDs a major cause of poverty and an urgent development issue. They will be the leading global cause of disability by 2030.
  • NCDs in LMICs also put G20 nations at risk since we all benefit from healthy individuals and stable populations around the globe. 8 million people below the age of 60 die each year in LMICs from preventable causes, which include tobacco use, unhealthy diets, alcohol consumption, and physical inactivity. Lack of access to affordable medicines and health care services are also major causes of these preventable deaths.
  • Globally, the NCD burden will increase by 17% in the next ten years, and in the African region by 27%. The highest absolute number of deaths will be in the Western Pacific and South-East Asia regions.
  • This rapidly changing health and disease profile has serious implications for poverty reduction and economic development. NCDs strangle macro-economic development and keep the bottom billion locked up in chronic poverty. NCDs have a severe impact on individuals, communities and countries. The magnitude and rapid spread of NCDs means we are all headed for a sick future unless we take action now. Low-income countries still grappling with heavy burdens of infectious disease risk being overwhelmed by this wave of largely preventable NCDs.
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21st Perfect Health Mela 18th October 2014



press release

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

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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 with heart failure came for cardiac evaluation.
Dr. Bad: Get Echo done.
Dr. Good: Go for Tissue Doppler Echo
Lesson: A patient with heart failure must go for Tissue Doppler Echo for evaluation of diastolic functions.

Make Sure

Situation: A patient on ACE inhibitor developed angioedema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).


Twitter of the Day

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://tl.gd/n_1rvf2jc
Dr Deepak Chopra: Who is the most powerful person in your life? What are the characteristics of a powerful person? http://tinyurl.com/mts7jor

eMedi Quiz

Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

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.Raju, Dr Pankaj Agarwal, Dr Avtar Krishan, Dr Rakesh Sharma, Dr Poonam Chablani

Answer for 21st November Mind Teaser: 1. Pemphigus vulgaris.

Correct answers received from: Dr.K.Raju

Send your answer to email

medicolegal update
  1. Dear sir very nice information about Ebola virus. Thank you. Dr. Nirmal Jit Singh

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

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