eMedinewS28th September 2013, Saturday

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

Hand, mouth, foot disease update

  • Person can remain infective for one week
  • No antibiotics are required
  • Can occur in adults
  • Rash is itchy as against dengue non itchy rash
  • Painful sores in mouth make swallowing difficult

….Read More

Harvard commonly held myths about end–of–life issues

Myth: More care is always better.

Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It’s important to know what interventions are truly important. It’s often impossible to know that in advance. That’s where the advice of a healthcare team is invaluable.

Myth: Refusing life support invalidates your life insurance, because you are committing suicide.

Truth: Refusing life support does not mean that you are committing suicide. Instead, the underlying medical problem is considered to be the cause of death.

Myth: If medical treatment is started, it cannot be stopped.

Truth: Not starting a medical treatment and stopping a treatment are the same in the eyes of the law. So you or your health care agent can approve a treatment for a trial period that you think may be helpful without fear that you can’t change your mind later. However, be aware that stopping treatment can be more emotionally difficult than not starting it in the first place.

Myth: If you refuse life–extending treatments, you’re refusing all treatments.

Truth: No matter what treatments you refuse, you should still expect to receive any other care you need or want — especially the pain and symptom management sometimes called intensive comfort care.

Myth: Stopping or refusing artificial nutrition and hydration causes pain for someone who is dying.

Truth: Unlike keeping food or water from a healthy person, for someone who is dying, declining artificial nutrition or intravenous hydration does not cause pain. ….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 10×10 i.e. 100 per minute."

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

Ringtone – CPR 10 Mantra English

What is the importance of silence?

sprritual blog

The true silence is the silence between the thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. The process of achieving silence is what meditation is.

Observing silence is another way of getting benefits of meditation. Many yogis in the past have recommended and observed silence now and then. Mahatma Gandhi used to spend one day of each week in silence. He believed that abstaining from speaking brought him inner peace and happiness. On all such days he communicated with others only by writing on paper.

Hindu principles also talk about a correlation between mauna (silence) and shanti (harmony). Mauna Ekadashi is a ritual followed traditionally in our country. On this day the person is not supposed to speak at all and observes complete silence all through the day and night. It gives immense peace to the mind and strength to the body. In Jainism this ritual has a lot of importance. Nimith was a great saint in Jainism who long ago asked all Jains to observe this vrata. Some people recommend that on every ekadashi one should observe silence if not the whole day but for few hours in a day.

Deepak Chopra in his book 7 Laws of Spiritual Success talks in great detail about the importance of observing silence in day today life. He recommends everyone should observe silence for 20 minutes everyday. Silence helps redirecting our imagination towards self from the outer atmosphere. Even Swami Sivananda in his teachings recommends observation of mauna daily for 2 hours. For ekadashi, take milk and fruits every day, study one chapter of Bhagwad Gita daily, do regular charity and donate one-tenth of your income in the welfare of the society.

Ekadashi is the 11th day of Hindu lunar fortnight. It is the day of celebration occurring twice a month, meant for meditation and increasing soul consciousness. Vinoba Bhave was a great sage of our country who is known for his Bhoodaan movement. He was a great advocator and practical preacher of mauna vrata.

Mauna means silence and vrata means vow hence mauna vrata means a vow of silence. Mauna was practiced by saints to end enmity and recoup their enmity. Prolonged silence as the form of silence is observed by the rishi munis involved for prolonged periods of silence. Silence is a source of all that exists. Silence is where consciousness dwells. There is no religious tradition which does not talk about silence. It breaks the outward communication and forces a dialogue towards inner communication. This is one reason why all prayers, meditation and worship or any other practice whether we attune our mind to the spiritual consciousness within are done in silence. After the death of a person it is a practice to observe silence for two minutes. The immediate benefit is that it saves a tremendous amount of energy.

Silence is cessation of both sensory and mental activity. It is like having a still mind and listening to the inner mind. Behind this screen of our internal dialogue is the silence of spirit. Meditation is the combination of observing silence and the art of observation. ….Read More

cardiology news

Run your own RACE and wish others WELL

I was jogging one day and I noticed a person in front of me, about 1/4 of mile. I could tell he was running a little slower than me and I thought, good, I shall try to catch him. I had about a mile to go my path before I needed to turn off. So I started running faster and faster. Every block, I was gaining on him just a little bit. After just a few minutes I was only about 100 yards behind him, so I really picked up the pace and push myself. You would have thought I was running in the last leg of London Olympic competition. I was determined to catch him. Finally, I did it! I caught and passed him by. On the inside I felt so good.

"I beat him" of course, he didn’t even know we were racing. After I passed him, I realized I had been so focused on competing against him that I had missed my turn. I had gone nearly six blocks past it. I had to turn around and go all back. Isn’t that what happens in life when we focus on competing with co–workers, neighbors, friends, family, trying to outdo them or trying to prove that we are more successful or more important? We spend our time and energy running after them and we miss out on our own paths to our God given destinies.

The problem with unhealthy competition is that it’s a never ending cycle. There will always be somebody ahead of you, someone with better job, nicer car, more money in the bank, more education, better behaved children, etc. But realize that "You can be the best that you can be, you are not competing with no one." Some people are insecure because they pay too much attention 2 what others are doing, where others are going, wearing & driving.

Take what God has given you, the height, weight & personality. Dress well & wear it proudly! You’ll be blessed by it. Stay focused and live a healthy life. There’s no competition in DESTINY, run your own RACE and wish others WELL!!

News Around The Globe

5th Dil Ka Darbar

Date: Sunday, 29th September 2013, Venue: Constitution club of India, Rafi Marg, Time: 8 AM to 6 PM

Programme: A non stop question answer–session between all top cardiologists of the NCR region and the public.

The focus of the discussions will be prevention of heart diseases in women and young men. Special discussion will be held on Sex and Heart Diseases. Practical training will also be given to people on Hands–only Cardiopulmonary Resuscitation. Another focus of the discussion will be the launch of the Project Dhadkan (Palpitations) and Project Murmur (Congenital and valvular heart diseases in children).

Entry free…

20th MTNL Perfect Health Mela Programme Brouchure

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  • Social deprivation, a composite of poverty, lack of access to healthcare facilities, lack of education, and other factors was found to put type 1 diabetes patients at a greater risk of death over 10 years than similar patients with higher social status in a study presented at the European Association for the Study of Diabetes. In a study that included 1,038 patients with type 1 diabetes, 61% of those who died were socially deprived, with scores in the highest quintile of the Index of Multiple Deprivation (IMD). Those patients who died during the 10–year time frame of the study had a mean IMD score of 32.3 compared with a mean IMD score of 23.6 for those patients still alive.
  • Absence of macro albuminuria in a diabetic patient does not a guarantee that the patient is free of advanced chronic kidney disease. Presenting results of the Prevalence of Renal Impairment in Diabetes (PRIDE) study at the annual meeting of the European Association for the Study of Diabetes, Lars Weiss, MD, PhD, associate professor of nephrology at Karlstad Central Hospital in Sweden, said "We only found that 5% of our patients with stage 3–5 kidney disease had macro albuminuria. Yet 20% of our patients had reduced renal function." The presence of albuminuria was measured by urinary albumin–creatinine ratio. They suggest that all patients with a history of diabetes should be tested for glomerular filtration rate (GFR) even if they do not show macro albuminuria in their urine tests.
  • Some 14% of Parkinson’s disease patients seen in routine practice reported double vision, with most saying they had never discussed it before with their physicians. Questioning of 257 consecutive patients with Parkinson’s disease revealed that 35 (14.2%) reported symptoms of diplopia, both in structured interviews and in a self–report questionnaire. Diplopia was also significantly correlated with a variety of other non-motor symptoms of Parkinson’s disease. Anna Sauerbier of King’s College London and colleagues presented their findings at the World Congress of Neurology.
  • The European Commission has approved golimumab (Simponi, Janssen Biologics) for moderate to severe active ulcerative colitis (UC) in adults who fail to respond to conventional therapies or who are intolerant to or have medical contraindications for such therapies, which include corticosteroids and 6–mercaptopurine or azathioprine. Golimumab, a monoclonal antibody, inhibits tumor necrosis factor (TNF)–alpha. It is the first and only subcutaneous anti–TNF–alpha treatment administered every 4 weeks as maintenance therapy for UC. For adults weighing less than 80 kg, the golimumab dose regimen is 200 mg initially, followed by 100 mg at week 2 and then 50 mg every 4 weeks thereafter. For adults weighing 80 kg or more, the initial regimen is 200 mg, followed by 100 mg at week 2 and then 100 mg every 4 weeks thereafter.
  • Results from the Insulin Resistance Atherosclerosis Study (IRAS) show that high serum calcium levels, but not necessarily calcium intake, are associated with an increased risk of developing type 2 diabetes. Calcium concentration was also observed to act independently of glucose, insulin secretion, and insulin resistance. Dr Carlos Lorenzo from the University of Texas Health Science Center, San Antonio, presented the results at the European Association for the Study of Diabetes (EASD) 2013 Meeting.
  • As high as 74% of residents of Hyderabad in their 30s and early 40s stood a high risk of developing heart disease as against Mumbai’s 72% and Delhi’s 71%, according to Saffolalife Study 2013, one of India’s biggest studies conducted over a period of 3 years as reported in TOI, Sep 27, 2013. The study involved 1.86 lakh respondents across 12 cities of India The study findings were released ahead of the World Heart Day to be observed this Sunday shows Hyderabadis love to binge on fatty and processed food, skirting the healthy high fiber diet recommended by doctors to avoid heart disease. Hyderabad, Kolkata and Ahmedabad are leading the country in terms of cardiovascular disease risk. Intake of vegetables, salads and fruits was found to be the least in Ahmedabad, closely followed by Hyderabad and Chennai.

Rabies News (Dr. A K Gupta)

What are the common adverse reactions to HRIG?

In rare cases the following adverse reactions may occur:

  • Allergic reactions including fall in blood pressure, dyspnea, cutaneous reactions and, in isolated cases reaching as far as anaphylactic shock, even when the patient has shown no hypersensitivity to previous administration of immunoglobulins.
  • Generalized reactions such as chills, fever, headache, malaise, nausea, vomiting, arthralgia and moderate back pain
  • Cardiovascular reactions particularly if HRIG is inadvertently injected intravenously.

Local reactions such as local pain, tenderness or swelling at the injection site can be observed in rare cases.

cardiology news
  • The investigational drug serelaxin has been found improved renal plasma flow in patients with chronic heart failure in a small randomized trial presented at the annual meeting of the Heart Failure Society of America. Renal plasma flow increased from baseline by 29% over 8–24 hours in the serelaxin group versus 14% in the placebo group (P=0.038), according to Adriaan A. Voors, MD, PhD, of the University Medical Center Groningen in Groningen, The Netherlands, and colleagues. Serelaxin also increased renal plasma flow over 0–24 hours (31% versus 13% for placebo, P=0.004) and over 24–28 hours (35% versus 16%).
  • The US FDA has granted two separate orphan–drug designations for riociguat (Adempas, Bayer Healthcare): for the treatment of pulmonary arterial hypertension (PAH) and the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Riociguat is a vasodilator that restores the nitric–oxide–soluble guanylate cyclase–cyclic guanosine monophosphate (NO–sGC–cGMP) pathway by directly stimulating sGC independent of NO and sensitizing sGC to low levels of NO.

Valvular Heart Disease News

Patient with large vegetations are at high risk of complications.

(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
  • Older children with muscular dystrophy (MD) are at a greater risk of heart failure–related hospitalizations and death; risk was11.6% in those 16–20 years old, 7.2% in those 11–15 years old and 1.2% in children 10 years or younger. The death rate for those with MD and heart failure was 12.7% versus 2.9% for those without heart failure, according to Joseph W. Rossano, MD, medical director of Pediatric Heart Transplant and Heart Failure at the Children’s Hospital of Philadelphia, and colleagues at the annual meeting of the Heart Failure Society of America. When controlled for age, year, and comorbidities, they found that heart failure was an independent risk factor for death., they reported here
  • The American Academy of Family Physicians has come out in opposition to free samples of high–energy drinks to children and agreed to work with the FDA to establish definitions for energy drinks. The new policy positions were approved Tuesday by the AAFP’s policymaking Congress of Delegates. The body stopped short of recommending adoption of a full ban on the sale of energy drinks to children under age 16, which was originally proposed by the academy’s New York chapter.
cardiology news

5 Steps For a Pain—Free Back

1. Stay fit

Stretching and strengthening both your back and abdominal muscles is important. A stretching and strengthening regimen should target the back, abdominal and buttock muscles.

Bicycling (either stationary or regular), swimming, and walking lead the list of low–risk, high–benefit activities for most people’s backs. All are low – or minimal–impact exercises that strengthen muscles which support the back. None involve awkward or stressful actions that are detrimental to back muscles.

Sports and activities such as football, tennis, gymnastics, wrestling, weight lifting, rowing (crew), running, aerobic dance, and ballet involve a relatively high risk for back injury because of the extension, lifting, or impacts involved. Other unnatural motions that could induce pain include back arching (during gymnastics and diving), twisting (while hitting a golf ball, swinging at a baseball, or bowling), vertical jolting (while riding a horse), and stretching your legs strenuously (when hiking or when balancing a sailboat during a race).

2. Maintain a healthy weight

The heavier you are, the greater the load your spine must carry. To make matters worse, if the bulk of your weight comes in the form of abdominal fat, rather than muscle, your center of gravity can shift forward — a condition that puts added pressure on your back.

3. Kick the habit

Nicotine in cigarettes contributes to low back pain in two ways. First, nicotine hampers the flow of blood to the vertebrae and disks. This impairs their function and may trigger a bout of back pain. Second, smokers tend to lose bone faster than nonsmokers, putting them at greater risk for osteoporosis, another common cause of back pain.

4. Lighten your load

A survey by the American Academy of Orthopaedic Surgeons found that nearly 60% of the doctors responding had treated school–age patients complaining of back and shoulder pain caused by heavy backpacks.

1. Use both of the pack’s straps instead of slinging one strap over a shoulder.
2. Carry only the essentials
3. Lighten your load whenever possible.
4. Opt for backpacks that have different–sized compartments to help distribute weight evenly.
5. Look for wide, padded straps and a padded back.
6. When carrying a heavy load, put the heaviest items as close as possible to the center of the back
7. Use the hip strap for support.
8. For very heavy loads, use a backpack with wheels.
9. Bend from your knees when picking up your pack.

5. Develop back–healthy habits

1. While standing to perform ordinary tasks like ironing or folding laundry, keep one foot on a small step stool.
2. Don’t remain sitting or standing in the same position for too long. Stretch, shift your position, or take a short walk when you can.
3. When bending from the waist, always use your hands to support yourself.
4. When sitting, keep your knees a bit higher than your hips and bend them at a 90–degree angle. Sit with your feet comfortably on the floor. If your feet don’t reach the floor, put a book or a small stool under them.
5. Because vacuuming can take a toll on your back, tackle rooms in chunks, spending no more than five to 10 minutes at a time doing this task.

(Source: HealthBeat)

cardiology news

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When Constipation May be a Serious Problem 30th August


TB more dangerous than FLU 29th August


Diabetes is a progressive disease

Diabetes is a progressive disease, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Dr Aggarwal said that an analysis from the United Kingdom Prospective Diabetes Study (UKPDS) found that 50 percent of patients originally controlled with a single drug required the addition of a second drug after three years; by nine years 75% of patients need multiple therapies to achieve the target hemoglobin A1C (HbA1c) value, which is the average blood sugar of the last three months. After a successful initial response to oral therapy, patients fail to maintain target A1C levels (<7%) at a rate of 5-10% per year. That means that all diabetic patients will, start with one drug and will invariably end up with three, with or without the addition of insulin within 10 years.

A1c should be done every three months until it is <7% and then at least every 6 months and should be preferred over the fasting sugar levels. It represents the average blood sugar of the last three months and the value should be kept lower than 7%.

Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes for blood glucose concentrations is to rise gradually with time.

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients and insulin may be indicated for initial treatment for some.

In the absence of contraindications, metformin is usually the initial therapy for most patients with type 2 diabetes.

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 63400 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."

today emedipics

A press conference was organized by the Heart Care Foundation of India as a curtain raiser to the 5th Dil Ka Darbar to be held on Sunday, 29th September at Constitution Club of India.

press release

Vegetable and fruits lower chances of getting some cancers

today video of the dayDr KK Aggarwal Birthday 5th September

Cultural Evening at IMA

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

Do women have more headaches than men?

A. No, they get equal numbers.
B. Yes, but not that many more.
C. Yes, and the headaches are more severe.
D. Yes, but men tend to get more painful kinds that last longer.
E. None of the above.

Yesterday’s Mind Teaser: What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Answer for yesterday’s Mind Teaser: C. About 30 percent of your daily calories.

Correct answers received from: Dr.K.Raju, Prabha Sanghi, Dr. SUSHMA Chawla, Dr ajay Gandhi, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, DR Chandresh Jardosh, DR.BITAAN SEN & DR JAYASHREE SEN, DR AYYAVOO ERODE, dr.deepali chatterjee, DR AVTAR KRISHAN, Dr pooja khullar, Dr Kanta jain, Dr Abbas Vakil, dr santhi thiyagarajan,

Answer for 26th September Mind Teaser: d) Trigeminal neuralgia.

Correct answers received from: dr.deepali chatterjee, Dr Kanta jain, Dr B K Agarwal, anju saumya, Dr.A.K.GAJJAR, Dr Prakash Khalap

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

A group of expectant fathers sat nervously in the hall. A nurse beckoned to one of them and said, "Congratulations, you have a son!"

Another man dropped his magazine, jumped up and said, "Hey, what’s the idea? I got here two hours before he did!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

medicolegal update

When the character of a man is not clear to you, look at his friends. Japanese Proverb

medicolegal update
medicolegal update

Dear Sir, Nice updates. Regards: Dr Saran

Forthcoming Events

29thSeptember–Dil Ka Darbar at Constitution Club of India,New Delhi

20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India

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