eMedinewS28th October 2013, Monday

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; 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

11 Sutras

  1. Fever with chills and rigors unless proved otherwise is malaria, urinary tract infection or filaria.
  2. Malarial chills are usually in the afternoon and filarial chills are usually in the evening.
  3. Malaria fever patients invariably will be non-toxic in between fever attacks, while typhoid patients will be toxic.
  4. Fever with single episode of chills unless proved otherwise is pneumococcal pneumonia.
  5. Abrupt high grade fever with pain in eye movement is dengue.
  6. Fever with pain in joints, which improves with flexion is Chikungunya.
  7. In viral hepatitis, jaundice will always appear after fever subsides. If patient has fever and jaundice together, look for other causes.
  8. In SLE fever, patients will always have negative CRP. Positive CRP, look for associated TB.
  9. Evening rise of fever lasting more than 6 weeks invariably is TB. These patients may have mild derangement of SGOT and SGPT.
  10. In dengue fever, SGOT will be more than SGPT by day 3.
  11. In dengue, capillary leakage syndrome starts only after fever subsides.

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."

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

Why different reactions to the same feeling?

sprritual blog

If your son commits a mistake and sleeps with a girl, your approach is protective. You will never ask the son to leave the house. Similarly, if your daughter commits the same mistake, then also you never take action or take her out with all legal rights. In both the situations, you approach is protective.

But your approach is destructive if the same thing happens with your wife or husband. Husband will not tolerate their wife having an affair with some one else.

cardiology news

The last cab ride

Twenty years ago, I drove a cab for a living. One time I arrived in the middle of the night for a pick up at a building that was dark except for a single light in a ground floor window.

Under these circumstances, many drivers would just honk once or twice, wait a minute, then drive away. But I had seen too many impoverished people who depended on taxis as their only means of transportation. Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself. So I walked to the door and knocked.

"Just a minute," answered a frail, elderly voice. I could hear something being dragged across the floor. After a long pause, the door opened. A small woman in her 80’s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase.

The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

"Would you carry my bag out to the car?" she said. I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness. "It’s nothing," I told her. "I just try to treat my passengers the way I would want my mother treated." "Oh, you’re such a good boy," she said. When we got in the cab, she gave me an address, then asked, "Could you drive through downtown?" "It’s not the shortest way," I answered quickly. "Oh, I don’t mind," she said. "I’m in no hurry. I’m on my way to a hospice." I looked in the rear view mirror. Her eyes were glistening.

"I don’t have any family left," she continued. "The doctor says I don’t have very long." I quietly reached over and shut off the meter. "What route would you like me to take?" I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing. As the first hint of sun was creasing the horizon, she suddenly said, "I’m tired. Let’s go now." We drove in silence to the address she had given me.

It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

"How much do I owe you?" she asked, reaching into her purse. "Nothing," I said. "You have to make a living," she answered. "There are other passengers." Almost without thinking, I bent and gave her a hug. She held onto me tightly. "You gave an old woman a little moment of joy," she said. "Thank you."

I squeezed her hand, then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn’t pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away? On a quick review, I don’t think that I have done anything more important in my life. We’re conditioned to think that our lives revolve around great moments. But great moments often catch us unaware—beautifully wrapped in what others may consider a small one.

News Around The Globe


  • The US FDA has approved Juvéderm Voluma XC (Allergan) to correct age-related volume deficits in the midface in adults aged 21 years and older.Juvéderm Voluma XC is a viscous gel composed of cross-linked hyaluronic acid suspended in phosphate-buffered saline with 0.3% lidocaine. It is the first dermal filler approved in the United States specifically for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the midface.
  • Hyperthyroidism may increase the activity of brown fat, the fat that is more metabolically active to begin with. In a small study, patients with hyperthyroidism had glucose uptake into their brown adipose tissue (BAT) that was three times higher than normal controls (2.7 vs 0.9 mcmol/100g/min, P=0.0013), Pirjo Nuutila, MD, PhD, of the University of Turku in Finland, and colleagues reported online in the Journal of Clinical Endocrinology and Metabolism.
  • The US FDA has approved of flutemetamol F18 injection (Vizamyl, GE Healthcare), a radioactive diagnostic tracer for use with positron emission tomography (PET) of the brain in adults being evaluated for Alzheimer’s disease (AD) and dementia. This is the second brain imaging drug to get FDA approval. The first, florbetapir F18 injection (Amyvid, Eli Lilly and Company), was approved last year.
  • The US FDA has approved the first single-entity extended-release formulation of hydrocodone bitartrate (Zohydro ER, Zogenix Inc) for the management of pain severe enough to require daily around-the-clock long-term treatment and for which alternative options are inadequate. Zohydro ER, a Schedule II controlled substance under the Controlled Substances Act, is the first FDA-approved single-entity (not combined with an analgesic such as acetaminophen) and extended-release hydrocodone product.
  • Researchers have identified a bacterial toxin that they believe may be a trigger for multiple sclerosis (MS). Their study, published in the October issue of PLoS ONE, is the first to identify the culprit bacterium, Clostridium perfringens type B, in humans, and to single out the toxin it produces — known as epsilon toxin — as a probable MS trigger.
  • Medical graduates will have to take two tests before they can pursue post-graduation, if a new proposal of the Medical Council of India (MCI) gets the nod, reports the TOI, Oct 26, 2013.In a recent meeting, the MCI proposed that the entrance exam for the post-graduate course, which assesses the theoretical knowledge gained during graduation, should be held immediately after the final MBBS exam and before the beginning of internship. Graduates will be expected to take the licentiate test, which will test them on practical understanding of medicine, after their internship. At present, the PG entrance exam is held after internship and there is no licentiate test. The decision to advance the PG entrance exam stems from numerous complaints that MBBS students don't take their internship seriously but instead get busy preparing for PG entrance tests. The last year of the five-and-a-half year MBBS course is set aside for internship

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Rabies News (Dr. A K Gupta)

What is the criterion for "protection" after immunization?

The rabies virus neutralizing antibody (RVNA) titer of =0.5 IU/ml of serum in the vaccinated person is considered protective.

The facility for this test is available at NCDC, Delhi, CRI, Kasauli, Pasteur institute, Coonnor, NIV, Pune and NIMHANS, Bangalore.

cardiology news

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

  • The US FDA has approved the MitraClip (Abbott Vascular) for patients with symptomatic degenerative mitral regurgitation deemed high risk for mitral valve surgery. The approval is for patients considered high risk for surgery, a question that left FDA advisory panel members grappling with the use of retrospective analyses and registry data to gain insight into this high-surgical-risk patient population.
  • Treatment with oral direct thrombin inhibitors, including dabigatran etexilate (Pradaxa, Boehringer Ingelheim), appears to raise the risk of MI, according to a pair of meta-analyses published recently in the American Journal of Cardiology. The findings likely explain the small elevated MI risk associated with dabigatran in the RE-LY trial, refute suggestions that it reflected a protective effect from the warfarin comparator, and extend the risk to all oral direct thrombin inhibitors, conclude the authors, led by Dr Ramin Artang (University of Nebraska Medical Center, Omaha).
cardiology news

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

  • Spanking can negatively influence a child’s behavior, but a new research suggests that it can also impair cognitive development. A cohort study of nearly 2000 children showed that those who were spanked even a little at the age of 5 years by their mothers had significantly more externalizing behaviors, such as aggression and rule breaking, at the age of 9 years than those who did not experience maternal spanking. And this association remained significant after controlling for a long list of risk factors. In addition, those who experienced high levels of paternal spanking at the age of 5 years had significantly lower scores on a test assessing receptive vocabulary at the age of 9.
  • The CDC Advisory Committee on Immunization Practices (ACIP) has recommended the meningococcal conjugate vaccine MenACWY-CRM (Menveo, Novartis Vaccines) for use in infants and young toddlers who are at increased risk for meningococcal disease. That group includes children aged 2 through 23 months with complement deficiencies or asplenia, those living in areas experiencing outbreaks, and those traveling to or living in areas with high rates of meningococcal disease, including sub-Saharan Africa or Mecca. The recommended schedule is administration at ages 2, 4, 6, and 12 months. Children who remain at increased risk for meningococcal disease should have booster doses 3 years after the primary vaccination series and every 5 years thereafter.
cardiology news

20 minutes of sunlight and a glass of milk can keep osteoporosis at bay

Osteoporosis and vitamin D deficiencies are the two new epidemics of the society.

Drinking less milk, avoiding sunlight exposure and omitting the traditional aerobic indoor games are few reasons for these new epidemics. Most young professionals now remain confined to their offices or workplace, with practically no exposure to sunlight. This is especially true for the medical residents.

Here are a few tips for preventing osteoporosis and strengthening the bones.

  1. One should stop smoking as it increases bone loss.
  2. Eat a calcium-rich diet: The aim should be to get 1,500 mg of calcium a day in postmenopausal woman or a man over age 65. Good dietary sources of calcium include dairy products, tofu and other soy products, orange juice fortified with calcium, canned salmon with the bones, and cooked spinach. The alternative is to take calcium supplements.
  3. Get enough vitamin D: Vitamin D levels are influenced by how much sunlight one gets. Levels tend to decrease in older adults, especially in winter and in people who are unable to leave their home. One should consider taking a supplement to make sure one gets the recommended daily amount.
  4. Get exposure to sunlight of at least 20 minutes per day. The exposure should be for duration of 20 minutes every day for a month in a year.
  5. Get enough protein in diet: An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds. However, too much protein with too little calcium can be harmful.
  6. Weight-bearing exercise: Activities such as walking, jogging and climbing stairs with your feet and legs supporting your weight. They work directly on the bones of the legs, hips and lower spine to slow mineral loss.
  7. Weightlifting exercises: These exercises, also called resistance training or strength training. They strengthen muscles and bones in the arms, chest and upper spine. They can work directly on the bones to slow loss of minerals.
  8. Get adequate vitamin K: This vitamin may be helpful in enhancing bone strength. Green leafy vegetables are the best sources of vitamin K. If one is taking a blood thinner, he or she should check with the doctor.
  9. Avoid excessive alcohol: Women should limit alcohol consumption to less than one ounce a day and men should limit it to less than two ounces.
  10. Limit cola drinks: People who have high cola intake often have lower bone density.
cardiology news

Total CPR since 1st November 2012 – 69833 trained

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Heart Care Foundation of India Announces the First National Healthcare Promotion Awards

Aimed at recognizing exceptional work in the social health sector in India.

The Heart Care Foundation of India 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,  today announced the National Healthcare Promotion awards. These awards aim at recognizing exceptional work in the social health sector in the country and are divided into three categories – “The Eminent Statesman of the Year”, “Eminent Guardians of the Year” and “Eminent Person of the year”.

The Guest of Honor at the award ceremony which took place at the ongoing Perfect Health Mela was Ustaad Shamsher Mehndi. Another eminent personality who were present on the occasion were Mrs Rashmi Singh, Executive Director, Rashtriya Mahila Kosh, Women and Child Development, Govt. of India; Ms. Uma Sharma, Padma Bhushan and noted Kathak dancer, Ms Roshni Thakur, noted Poetess, Ms Neena Singh and Dr Ekta Chadha.

The first National Healthcare Promotion Award “Eminent Statesman of the Year” was received by the Former Chief Election Commissioner of India Dr. S Y Quraishi.

The awards under the category “Eminent Guardians of the Year”, were received by Dr. Mathew Cherian  Chief Executive  Helpage India; Dr. Dindeshwar Pathak Founder Sulabh International; Dr. S P Agarwal,  Secretary General Indian Red cross Society, Lt Gen D Raghunath  and Raja Saboo Former President Rotary international.

The National Healthcare Promotion Awards will be given on an annual basis. From next year, an Award Committee will be chaired by Dr. S Y Quraishi.  The categories of the awards will be Eminent Statesman of the Year (1), Eminent Gus ardian of the year (5) and Eminent Person of the year (9).

Dr. S Y Quraishi said that the awardees will form a think tank who will meet once in three months and will work for the welfare of the society.

Speaking at the occasion, Padmashri & Dr. BC Roy National Awardee and the President Heart Care Foundation of India, Dr. KK Aggarwal said “Heart Care Foundation of India is committed to raising health awareness in the country and it gives me great pleasure to announce the first National Healthcare Promotion Awards. We are happy that the we have on our panel, individuals who have done exceptional work in raising health awareness in the country and hope that together we can help make India a healthier nation”.

In a key note address Mrs. Krishna Tirath, Union Minister for Women and Child Development spoke about her concern about the declining child sex to ratio in India.  She appealed to the doctors to educate the public about the various laws in the country catering to the prevention of sexual offences in children and.   She said all doctors must learn and report sexual abuses in children. 

Dr. S Y Quraishi said “CSR activities should not be only for the large PSUs but also for small commercial groups. He said that up to 2% of the turnover or the profit should be devoted for social upliftment of the society”.

Other eminent doctors present were Dr Anil Goyal, Dr GK Mani, Dr Manju Mani, Dr N K Bhatia, Dr I M Chugh, Dr P Ranjan, Dr Sanjay Gupta and Dr Aditya.

All religion seminar  organized on life after death.

The seminar was moderated by Dr. KK Aggarwal and Dr. AK Merchant from Bahai faith. The spiritual gurus in a joint statement resolved that basic purpose of life is to acquire inner happiness. All dharma gurus also gave a statement – irrespective of religion one should learn cardiopulmonary resuscitation and save a dying person.

Spiritual GURS who participate included Father Dr. M.D. Thomas Christian perspective, Prof. M.H. Qureshi Muslim perspective, Dr. (Mrs.) Shernaz Cama Zoroastrianism perspective, Swami Shantatmananda Secretary Rama Krishna Mission Hindu perspective, Dr. Mohinder Singh, Honorary Directory Bhai Veer Singh Sahitya Sadan Sikh perspective, Dr. A.K. Merchant Bahai faith perspective and  Dharmacharya Shatum Seth  Buddhist perspective.

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 69833 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.”

today emedipics

Heart Care Foundation of India Announces the First National Healthcare Promotion Awards The first National Healthcare Promotion Award “Eminent Statesman of the Year” was received by the Former Chief Election Commissioner of India Dr. S Y Quraishi.

press release

Obesity reduces life expectancy

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

Nurse hazel receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

a. Liver disease
b. Myocardial damage
c. Hypertension
d. Cancer

Yesterday’s Mind Teaser: Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of:

a. Diuretics
b. Antihypertensive
c. Steroids
d. Anticonvulsants

Answer for yesterday’s Mind Teaser: c. Steroids

Correct answers received from: DR P K SAHU, Narahari Kandakatla, Vasdev Bhagia, Dr.K.Raju, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, .DR.A.K.GAJJAR, Dr valluri ramarao. DR AYYAVOO ERODE, Dr Arpan Gandhi, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, DR AVTAR KRISHAN, Dr B K Agarwal, Dr pooja khullar

Answer for 26th October Mind Teaser: E. Four to five cups of fruit and vegetables.

Correct answers received from: Narahari Kandakatla, DR AVTAR KRISHAN

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

An army major called his wife to tell her that he would be late home because dirty magazines had been found in the barracks, and the soldiers responsible were facing serious disciplinary action.

"The punishment sounds a little harsh," she said. "After all, most of the soldiers have pictures of women on the walls of their quarters."

"No, honey," he explained patiently. "Dirty magazines means the clips from their rifles had not been cleaned properly!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A terminally ill patient, who developed bed sores, is prescribed only systemic antibiotics.

Reaction:Please change the position of the patient frequently and keep the skin clean and dry.

Lesson: Make sure Make sure that good nursing care and maintenance of skin hygiene is advised first to patients with bed sores, along with topical antibiotics.

medicolegal update

We give up leisure in order that we may have leisure, just as we go to war in order that we may have peace. Aristotle

medicolegal update

Dr KK Aggarwal: Dr KK Aggarwal Birthday 5th September: http://youtu.be/D5m0FZmI6Ac?a via @YouTube

Dr Deepak Chopra: Based on the central doctrine of materialism consciousness shouldn't exist. You are conscious now http://tinyurl.com/kok8s7t

medicolegal update

Dear Sir, Very Informative newsletter. Regards: Dr Tapan

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