eMedinewS24th January 2014, Friday

Dr K K AggarwalPadma 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; Chairman Ethical Committee Delhi Medical Council, 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

Films showing smoking scenes should be certified as adult films

The connection between smoking in films and its influence on adolescent behavior is well established. Smoking is a killer as its connection to cancer, heart attacks, and chronic lung disease is beyond doubt.

Kids start to smoke before they're old enough to think about the risks; after starting they rapidly become addicted to smoking and then regret it later on.

Hollywood and Bollywood play a role by making smoking look really good. As per a US report by Dr James Sargent, MD, co–director cancer control at Norris Cotton Cancer Center by eliminating smoking in movies marketed to youth, an R rating for smoking (in India equivalent to rating as an adult movie) would dramatically reduce exposure and lower adolescent smoking by as much as one-fifth.

As per the study, the movie industry should take smoking as seriously as they take profanity when applying the R rating. R rating for any film showing smoking could substantially reduce smoking onset in U.S. adolescents –– in fact, the effect would be similar if all parents took an active, authoritative stand with their teenage children against smoking.

The study, "Influence of Motion Picture Rating on Adolescent Response to Movie Smoking" published in the journal Pediatrics, Vol. 130, No. 2, August 2012, enrolled a total 6,522 US adolescents in a longitudinal survey conducted at eight–month intervals.

Movie smoking exposure (MSE) was estimated from 532 recent hit movies, categorized into three of the ratings brackets used by the Motion Picture Association of America to rate films by content – G, PG, PG13, and R.

Median MSE from PG–13 movies was approximately three times higher than median MSE from R–rated films but their relation to smoking was essentially the same.

The investigators were able to show that adolescent smoking would be reduced by 18 percent if smoking in PG–13 movies was largely eliminated, all else being equal.

In comparison, making all parents "maximally authoritative" in their parenting with regard to smoking would reduce adolescent smoking by 16 percent, according to Sargent’s findings.

I personally feel that the Indian Central Board of Film certification should consider rating films as "adults" if the same contains smoking scenes. The current practice is only to add a warning when the smoking scene comes.

Smoking in children

  • In India, 36.9% of children initiate smoking before the age of 10 years. Almost 4.2% of students currently smoke cigarettes, with the rate for boys significantly higher than girls, while 11.9 % of students currently use other tobacco products. Cigarette smoking among youth is high in the central, southern, and north–eastern regions of India. Exposure to second hand smoke in public places is also high.
  • A study conducted by Gururaj and colleagues showed point prevalence of tobacco use among 13–15 year olds as 4.9%. One-third of current tobacco users (30.8%) purchased tobacco product in a store and one-fifth used it at home. Nearly half of the never smokers (43%–56.7%) were exposed to tobacco smoke outside home and 83% favored a ban on smoking in public places. Only one-third (31.6%) reported that the reasons of tobacco usage among youth was discussed in formal school settings. (1)
  • A study conducted by Raj Narain and colleagues at Noida, India, in 2011 showed that any kind of tobacco use was found in 537 (11.2%) students, 419 (8.8%) were ‘ever smokers (including current smokers)’, 219 (4.6%) were ‘ever tobacco chewers (including current chewers)’, 179 (3.7%) were ‘exclusive smokers’, and 118 (2.5%) were ‘exclusive tobacco chewers’. The mean age of initiation of these habits was around 12.4 year, mainly from private school students as compared to government school students (P < 0.05). (2)
  • A community–based research, triangulation of qualitative (free list, focus group discussions) and quantitative methods study by Deshmukh and colleagues at rural Wardha, India, revealed that about 68.3% boys and 12.4%girls had consumed any tobacco products in last 30 days. Among the main forms of tobacco, 79.2% consumed kharra and 46.4% consumed gutka. According to respondents, few adolescent boys taste tobacco by 8–10 years of age, while girls do it by 12–13 years. (3)
  • A study conducted by Awasthi and colleagues at Nainital, India, can be statistically summarized as (logistic regression analysis) that students belonging to grade 10 (adjusted odds ratio (OR) = 4.3; 95% class interval (CI): 2–9) and grade nine (adjusted OR = 2.2; 95% CI: 1.3–3) were more likely to use tobacco as compared to grade eight students. Students whose friends used tobacco were more likely to use than those whose friends were non–users (adjusted OR = 3.4; 95% CI: 1.7-6.7). (4)
  • Kapil and colleagues at Delhi in 2007 showed that about 9.8%of the study children had at least once experimented with any form of tobacco in their lifetime. The proportion of children who were "current users" of tobacco products was 5.4% (boys: 4.6%, Girls: 0.8%). (5)


  1. Gururaj G., Girish N. Tobacco use amongst children in Karnataka. Indian J Pediatr 2007;74:1095–8.
  2. Narain R, Sardana S, Gupta S, Sehgal A. Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross–sectional questionnaire based survey. Indian J Med Res 2011;133:300–7.
  3. Dongre AR, Deshmukh PR, Murali N, Garg BS. Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention? Indian J Cancer 2008;45:100–6.
  4. Awasthi S, Jha SK, Rawat CM, Pandey S, Swami SS. Correlates of tobacco use among male adolescents in schools of Haldwani, Nainital. Health and Population: Perspectives and Issues. 2010;33:42–9.
  5. Singh V, Pal HR, Mehta M, Kapil U. Tobacco consumption and awareness of their health hazards amongst lower income group school children in national capital territory of Delhi. Indian Pediatr 2007;44:293–5.

Film certification in the US and India

Motion Picture Association of America Central Board of Film Certification (India)
g–rating G: General Audiences. All Ages Admitted. The picture contains nothing in theme, language, nudity, sex, violence or other matters that would offend parents whose younger children view the motion picture. UUniversal – Unrestricted Public Exhibition throughout India, suitable for all groups Films under this category should not upset children over 4. Any nudity/drug innuendo is cut. Such films may contain mild profanity or crude humour, mild sexual content, educational or family–oriented themes and/or mild violence.
• g–rating PG — Parental Guidance Suggested. Some Material May Not Be Suitable For Children. The picture should be investigated by parents before they let their younger children attend. There is no drug use content in a PG–rated motion picture.

• pg–13–rating PG–13 — Parents Strongly Cautioned.

• Some Material May Be Inappropriate For Children Under 13. A PG–13 rating is a sterner warning by the Rating Board to parents to determine whether their children under age 13 should view the motion picture, as some material might not be suited for them. Any drug use will initially require at least a PG–13 rating. More than brief nudity will require at least a PG–13 rating. There may be depictions of violence in a PG–13 movie, but generally not both realistic and extreme or persistent violence. A motion picture’s single use of one of the harsher sexually–derived words, though only as an expletive, initially requires at least a PG–13 rating. More than one such expletive requires an R rating, as must even one of those words used in a sexual context.
UAParental Guidance – Unrestricted public exhibition but with parental guidance for children under the age of 12. Those aged under 12 years are only admitted if accompanied by an adult. This rating is similar to the MPAA’s PG and PG–13. Such films may contain moderate coarse language or suggestive dialogue, references and use of soft drugs, people wearing minimal clothing (frontal or rear nudity is not permitted), moderate sexual content, mature themes and/or moderate violence (including brief or implied sexual violence).
g–rating R — Restricted. Children Under 17 Require Accompanying Parent or Adult Guardian. The picture contains some adult material. An R–rated motion picture may include adult themes, adult activity, hard language, intense or persistent violence, sexually–oriented nudity, drug abuse or other elements, so that parents are counseled to take this rating very seriously.

nc–17–rating NC–17 — No One 17 and Under Admitted. Most parents would consider patently too adult for their children 17 and under. No children will be admitted. The rating simply signals that the content is appropriate only for an adult audience. An NC–17 rating can be based on violence, sex, aberrational behavior, drug abuse or any other element that most parents would consider too strong and therefore off-limits for viewing by their children
AAdults only – Public exhibition restricted to adults (18 years or over) only. Nobody younger than 18 may rent or buy an A–rated VHS, DVD, Blu–ray Disc, UMD or game, or watch a film in the cinema with this rating. Such films may contain references and use of hard drugs, explicit language or intensely suggestive dialogue, partial nudity (full-frontal or rear nudity is not permitted), strong and crude sexual content, adult/disturbing themes and/or intense/brutal violence (including strong sexual violence).
  SSpecialised Audience – Exhibition to restricted audience such as doctors etc.
Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

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 mantra
VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

The spiritual prescription "I am sorry"

sprritual blog

Two hardest words for a doctor to say: "I’m sorry."

Most defense lawyers counsel doctors not to apologize to patients. Their view is that if you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened or in other words you are pleading guilty. The complainant’s lawyers may use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong. The usual approach is to deny and defend.


• Apologizing after a medical error is the humane thing to do.

• Patients often sue simply because it’s the only way to find out what went wrong.

• Erecting a wall of silence is "enough to make someone very angry. And it’s awfully easy for an angry person to find a lawyer who will listen to them. At that point, it’s too late for sorry.

• Over 35 states in the USA have passed laws prohibiting doctors’ apologies from being used against them in court. (apology laws)

• By promptly disclosing medical errors and offering earnest apologies and fair compensation one can hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Apology the spiritual answer

• The word ‘sorry’ is synonymous with apology.

• To err is human, to admit one’s error is superhuman.

• Sorry should be heartfelt and not ego felt. You should not only say sorry but it should look like that you are sorry.

• Tremendous courage is entailed to face the victim of our wrong doing and apologize.

• It is generally seen that those who are in harmony with their life and consequently with themselves, find it easier to say ‘I’m sorry’. They are the positive, conscientious ones who are at peace only after making amends for their misdeeds.

• The word ‘sorry’ in itself is imbued with so much potential and power. Within a fraction of a second, grave mistakes are diluted, tepid and estranged relations are brought alive, animosity and rancor are dissolved, misunderstandings resolved and tense situations ease out resulting in harmony and rapprochement.

• To forgive and forget is a common spiritual saying

• Remember we all make mistakes and seek forgiveness form GOD every day.

cardiology news

Senior Greeter…

Charley, a new retiree–greeter at Wal–Mart, just couldn’t seem to get to work on time.

Every day he was 5, 10, 15 minutes late. But he was a good worker, really tidy, clean–shaven, sharp–minded and a real credit to the company and obviously demonstrating their "Older Person Friendly" policies.

One day the boss called him into the office for a talk.

"Charley, I have to tell you, I like your work ethic, you do a bang-up job when you finally get here; but your being late so often is quite bothersome."

"Yes, I know boss, and I am working on it."

"Well good, you are a team player. That’s what I like to hear."

"Yes sir, I understand your concern and I’ll try harder."

Seeming puzzled, the manager went on to comment, "It’s odd though you’re coming in late. I know you’re retired from the Armed Forces. What did they say to you there if you showed up in the morning so late and so often?"

The old man looked down at the floor, then smiled.

He chuckled quietly, then said with a grin, "They usually saluted and said, ‘Good morning, Admiral, can I get you a coffee, sir?’

News Around The Globe


Hamdard celebrates the White Coat Ceremony & release of ‘Hamdardians’ (College Magazine of HIMSR)

Hamdard Institute of Medical Sciences and Research (HIMSR) celebrated the White Coat Ceremony on 21st January 2014 at Hamdard Archives & Research Centre, Jamia Hamdard to welcome the first and second year MBBS students to the medical profession. The event was also marked by release of first issue of ‘Hamdardians’, the college magazine of HIMSR and distribution of prizes to meritorious students.

White coat ceremony is a unique tradition to introduce the students to ethics of practice of medicine and to psychologically prepare them to pursue medicine as their professional career.

At the outset Prof. Shridhar Dwivedi, Dean/Principal HIMSR and Associated H.A.H.C. Hospital introduced the Hamdard philosophy of ‘Compassion with Care’ and shared the progress made by HIMSR in a short time after its inception in 2012. Dr. G.N. Qazi, Vice–Chancellor of Jamia Hamdard, presided over the function. He also administered the ‘Medical Oath’ to first and second year MBBS students.

The Chief Guest, Dr. R. Chidambaram, Principal Scientific Advisor to Govt. of India, released the first issue of ‘Hamdardians’.

The Guest of Honour, Prof. M.C.Misra, Director All India Institute of Medical Sciences congratulated the students for choosing medical profession as their career. Dr. Firdous Wani, Registrar Jamia Hamdard proposed the vote of thanks.

  • Antibodies with specificities for various peptides are prevalent in preeclampsia patients and may be useful as diagnostic biomarkers, according to an analysis of plasma samples from 15 women with preeclampsia and 18 women with healthy–outcome pregnancies. The findings are published in Hypertension.
  • The eGFR, along with hypertension, hyperlipidemia, and BMI, may explain the variance of insulin sensitivity seen in elderly men with CKD stages 3 and 4, according to a CJASN study that included 446 patients who were followed for a median of 10 years.
  • Using a self–assessment scoring system to identify patients at risk for melanoma and then performing a skin examination on those patients during a consultation may be better than a standard strategy for preventing skin cancers, according to an article published in the January/February issue of the Annals of Family Medicine.
  • Xigduo (AstraZeneca/Bristol–Myers Squibb), a 2-drug product for the treatment of type 2 diabetes and the first to combine metformin with a sodium–glucose cotransporter–2 (SGLT2) inhibitor, dapagliflozin (Forxiga, AstraZeneca/Bristol-Myers Squibb), has been approved in the European Union. Xigduo will be indicated for adults aged over 18 years with type 2 diabetes as an adjunct to diet and exercise to improve glycemic control in those inadequately controlled on their current metformin-based treatment regimen; or in combination with other glucose–lowering medicinal products, including insulin, in patients inadequately controlled with metformin and these medicinal products; or for those who are currently receiving dapagliflozin and metformin as separate tablets. The product is intended as a twice–daily treatment and is available in 2 strengths: 5–mg dapagliflozin/850–mg metformin and 5-mg/1000-mg film-coated tablets.
  • A study in the journal Pain has for the first time shown a relationship between pain sensitivity and the amount of grey matter in certain regions of the brain.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

Can a person receiving/completed antirabies immunization, either pre–exposure or post–exposure, donate blood?

A person receiving/completed antirabies immunization can donate blood. However, the recipient does not benefit from the transfer of rabies–neutralizing antibodies due to hemodilution.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • A Mediterranean diet may not only reduce the risk of stroke and MI in high-risk patients, but for the first time, a randomized trial suggests that this diet may be linked with a lower risk of peripheral artery disease (PAD). In close to five years of follow-up, compared with high–risk patients who followed a low–fat diet (controls), those who followed a Mediterranean diet supplemented with extra nuts had half the risk of developing symptomatic PAD, and those who followed a Mediterranean diet supplemented with extra–virgin olive oil had a one–third risk of this outcome. These findings from a nonprespecified exploratory analysis of patients in the Prevención con Dieta Mediterránea (PREDIMED) trial are published in a research letter in the January 22/29, 2014 issue of the Journal of the American Medical Association.
  • A screening approach that selectively uses laboratory-based cholesterol testing to assess cardiovascular risk is able to identify patients at risk for cardiovascular disease to a similar extent as a widely used risk model. The multistage primary cardiovascular disease screening approach, in which only patients first identified as at intermediate risk of cardiovascular events are sent to the laboratory to measure cholesterol levels, performed as well as the Framingham Risk Score (FRS), which utilizes laboratory testing in all patients to assess cholesterol levels, in terms of discriminating risk of cardiovascular disease. Published online January 14, 2014 in Circulation: Cardiovascular Quality and Outcomes, the researchers used a multistage screening strategy that calculated an individual's risk of fatal or nonfatal cardiovascular outcomes using multiple non–laboratory–based risk markers. These included age, sex, smoking status, history of diabetes, blood–pressure treatment, systolic blood pressure, and body–mass index (BMI). From here, patients were classified as high, intermediate, or low risk for cardiovascular disease.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • A randomized study of almost 200 children between the ages of 7 and 12 years in the United Kingdom showed that 50% of those in the full guided group recovered from their clinically diagnosed anxiety disorder after treatment vs 39% of those in the brief guided group suggesting that parent–delivered cognitive–behavioral therapy (CBT) guided by therapists is effective in treating child anxiety disorders. The full guided group was also 85% more likely to recover than those assigned to a treatment wait list. The study was published in the December issue of the British Journal of Psychiatry.
cardiology news

Most uncontrolled asthmatics think they are controlled

Two–thirds of patients with uncontrolled asthma think their disease is well under control,

Asthmatics on proper medicines can not only lead a normal life but also reduce their future complications. Drugs include those medicines that keep the disease at bay as well as those that are used when a flare–up occurs. Uncontrolled asthmatics will invariably end up with right heart complications due to persistent lack of oxygenation in the blood.

Most asthmatics fail to perceive their level of disease control and with an uncontrolled state they often feel that their asthma is under control.

Dr. Eric van Ganse, of University of Lyon, France, in a study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, nearly 69 percent considered themselves to be completely or well controlled.

Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

In severe asthma, low blood oxygen levels might impair a person’s ability to assess their own breathing difficulty.

Another reason is that the notion of asthma control seems poorly understood by asthmatic patients. Also, mild to moderate asthma limits the activities of a person and they over a period of time take that as their normal limits.

cardiology news

Total CPR since 1st November 2012 – 84500 trained

Media advocacy through Web Media

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press release

Rise in blood pressure during mental stress is a strong predictor of plaque progression

Rise in blood pressure during mental stress is a strong predictor of plaque (early blockages in heart) progression, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association.

Therefore, mental stress test should be done in every patient with neck artery plaques and if positive, these patients should be put on plaque stabilizing drugs. If the plaque is stabilized, one can reduce the chances of heart attack and paralysis.

Presence of plaque in the neck artery in an asymptomatic person is highly indicative of a future heart attack or paralysis. Plaque can be measured by using high resolution ultrasound in any echocardiography laboratory. Plaques grow along the neck artery 2.4 times more than their thickness.

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 84500 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."

emedipicstoday emedipics

Hamdard celebrates the White Coat Ceremony & release of ‘Hamdardians’ (College Magazine of HIMSR)

press release

Longer CPR efforts may improve survival chances

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

An increased incidence of cholangiocarcinoma is seen in all of the following, except:

1. Hydatid cyst of liver.
2. Polycystic disease of liver.
3. Sclerosing cholangitis.
4. Liver flukes.

Yesterday’s Mind Teaser: Central nervous system manifestations in chronic renal failure are a result of all of the following, except:

1. Hyperosmolarity.
2. Hypocalcemia.
3. Acidosis.
4. Hyponatremia.

Answer for yesterday’s Mind Teaser: 1. Hyperosmolarity.

Correct answers received from: daivadheenam, Dr. SUSHMA Chawla, Dr.Jayashree Sen & Dr.Bitaan Sen, Arvind Gajjar, Raju Kuppusamy, Deepali Chatterjee, Dr.K.V.Sarma, Dr Pankaj Agarwal, Sangeetha Raja, Dr Jainendra Upadhyay, Dr.(Maj. Gen.) Anil Bairaria, Muthumperumal Thirumalpillai, Dr.Chandresh Jardosh, Dr.K.V.Sarma, Dr Pankaj Agarwal

Answer for 22nd January Mind Teaser: 1. Hydatid cyst of liver.

Correct answers received from: Muthumperumal Thirumalpillai, Dr.Chandresh Jardosh, DR. BIPIN Vyas, Dr Pankaj Agarwal

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update
medicolegal update

Jogging Shoes

Deciding to take up jogging, the middle-aged man was astounded by the wide selection of jogging shoes available at the local sports shoe store.

While trying on a basic pair of jogging shoe, he noticed a minor feature and asked the clerk about it.

"What’s this little pocket thing here on the side for?"

"Oh, that’s to carry spare change so you can call your wife to come pick you up when you’ve jogged too far."

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient of pulmonary Koch’s on ATT complains of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

medicolegal update

Growth begins when we begin to accept our own weakness. Jean Vanier

medicolegal update

Dr KK Aggarwal: High BP in Pregnancy Increases Risk for Future Atherosclerosis http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Awareness exists at the core of all material objects from atoms to galaxies http://bit.ly/15QdVeB #Health

medicolegal update
  1. Dear Sir, Thanks for the nice information. Regards: Dr Kamal.

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