2nd November 2014, Sunday

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

Cinnamon in Nonalcoholic Fatty Liver Disease

Cinnamon (dalchini) helps improve lipid profiles and improve nonalcoholic fatty liver disease (NAFLD), according to a new Iranian trial reports Medscape. The report found that 12 weeks consumption of 1.5 grams cinnamon per day plus a balanced diet improves insulin resistance and NAFLD characteristics. The study by Dr. Azita Hekmatdoost is published online December 9 in the journal Nutrition Research.

Cinnamon has anti–oxidant and insulin–sensitizer properties.

In the study, 50 patients were randomized to two 750 mg capsules of cinnamon or placebo daily for 12 weeks. All patients were given advice on a balanced diet and physical activity. In both groups, LDL cholesterol dropped significantly but there was no significant change in serum HDL cholesterol levels. After 12 weeks, LDL levels were 55.8 mg/dL in the treatment group and 90.3 mg/dL in the placebo group (p=0.032).

In the active treatment group there were also significant decreases in the HOMA (Homeostatic Model Assessment) index, fasting blood glucose, total cholesterol, triglyceride, SGOT and SGPT levels. This was also true of gamma GT and hs–CRP.

News Around The Globe

  • A Maine judge has rejected the state's desire to keep a nurse in quarantine over Ebola fears. Instead, Judge Charles LaVerdiere ruled that Kaci Hickox, RN, should continue twice-daily direct active monitoring of her temperature and symptoms and coordinate any travel with state authorities so the monitoring can continue.
  • Rifaximin, a gut-targeted antibiotic for diarrhea-predominant irritable bowel syndrome, can be safely and effectively used to retreat patients who have relapsed after already being treated with the drug, report investigators. These are the findings from the TARGET 3 trial presented at the American College of Gastroenterology 2014 Annual Scientific Meeting.
  • The results of a new US study show that only 58% of individuals with type 2 diabetes were started on metformin as their first oral glucose-lowering medication, despite the fact that this drug is widely recommended as the initial therapy of choice in numerous diabetes guidelines. The research is published October 27 in JAMA Internal Medicine
  • A novel, noninvasive neurostimulator targeting the vagus nerve improves on treatment of chronic cluster headaches over the current standard of care, according to a new study. "Patients who used this device for 6 minutes, two times per day had the number of cluster headache attached reduced by 40% per week," said lead author Eric J. Liebler, vice president of scientific, medical and governmental affairs for ElectroCore, LLC, based in Basking Ridge, New Jersey.
  • Men who lose chromosome Y in blood cells are more likely to get cancer and to die younger, suggests a new study presented at the American Society of Human Genetics 2014 Annual Meeting.

National IMA news

Does an MBBS doctor have any privileges ?

The New Medical Termination of Pregnancy Amendment Draft Bill allows Ayurvedacharyas, Homeopaths and Nurses to conduct MTP. As per news reports it is based on a study by Population Council done in 2012 which showed that trained nurses and Ayurved physicians provide medical abortion as safely as MBBS doctors. What concerns me is that Medical Termination of Pregnancy Act 1971 was in place in 2012 and it does not allow anyone other than an MBBS doctor registered under the Act to conduct and abortions. How then were abortions conducted by Ayurved doctors and nurses during the study conducted by Population Council ?

Political agendas are given scientific reasoning by pliable persons of intellect. I hope the Indian Medical Association HQs is seized with the matter. As the umbrella organization of all allopathic doctors it is the duty of the leaders to nip this transgression in the bud. As an MBBS doctor I feel a second class citizen already since my Government considers subjugating my interests as its official policy.

MLAG is seeking legal opinion on this issue and the larger issue as to "What if any are privileges of an MBBS doctor ?" Why is MCI stringent in allowing colleges awarding MBBS degree. Why standards of getting into MBBS as well as passing MBBS should not be lowered to match those of Central Council of Indian Medicine for BAMS and BHMS degree colleges. The question arises since it is the Government's persistent agenda to equate BAMS, BUMS, BHMS doctors with MBBS doctors. Why then should there not be only one degree say BAMS and close all MBBS colleges. Those wishing to study modern medicine should seek education in western countries.

Dr Neeraj Nagpal

Dr KK Spiritual Blog

Debts in Mythology

It is said that there are three debts which everybody has to pay in his or her lifetime. In Vedic language, they are called Dev Rin, Pitra Rin and Rishi Rin.

In medical language the body consists of soul, physical body, mind, intellect and ego. The soul is given to us by God or Devtas (Dev Rin), the physical body by our parents (Pitra Rin) and the mind, intellect and ego by our Gurus (Rishi Rin).

In terms of computer language, if I see my body as a computer, then my body as a computer is made by my parents; operating software and my inner internet represent the soul or consciousness given by the Devtas and the application software i.e. Word, Excel and Power point which we learn over a period of time are given to us by our Gurus. Therefore, we have to pay all these three debts while we are still alive.

Inspirational Story

Our Lives Are Better Left To Chance…

My family and I recently attended a Sweet 15. In the Hispanic culture, it is more traditionally know as a Quinceanera. I wanted to share with you some special moments that I witnessed that day.

I saw a moment during the church service, a mother's true love for her daughter. Mom stood up and shared some special thoughts of what she described as her strong-willed daughter. As she began to speak, her voice began to shake. She spoke with pure conviction of the bond they shared with one another. Everyone in the church began to feel the true love they had for one another. If mom had only kept talking, I believe all the parents, especially the moms in attendance would have been in tears.

There was another moment, one that made me believe of a daddy's love for his little girl. This took place at the reception. You need to first paint a picture in your mind of how special it must be for a father to dance his last dance, if you will, with his little girl.

The young girl looked especially beautiful that day, almost magical in her long white dress. Her cheeks looked like roses and her blue eyes like flowers. The curls in her hair bounced as she walked in the room. You could see her sparkle as she walked along to the middle of the dance floor. She looked like Cinderella and daddy like Prince Charmin standing there holding her hand.

"The Dance" by Garth Brooks began to play and the magic unfolded as they held each other and began to dance. As the dad held his young daughter, they looked like they were dancing on air. Her dress swayed from side to side as he held her tight. How special this must have felt to be in her daddy's arms that night.

The song finally came to an end and it was time for daddy to let go…but he couldn't. He stood there big and strong, as his body began to shake, and then broke down as he began to cry. It was a very special moment. Here was this giant of a man, towering over his young child, but yet with the innocence of a baby he fought hard to hold back his tears. He held his little girl by her arms as he leaned over and gave her a big kiss on her forehead. He embraced her as he wiped the tears streaming down his face.

As I stood there watching all this happen, I felt a big lump in my throat and I quickly began to share his pain. It made me sad but yet, at the same time, it made me happy. This is what it was all about. Daddy had always been there for his little girl.

As Garth Brooks sang his last note, I could feel dad "looking back on the times he shared" just like the song was saying. Daddy kissed her again and then his little girl turned and walked away.

Hug you children every day and tell them you love them. Time stands still for no one. One day you'll be looking back and your memories will seem nothing more than a dream.

Rabies News (Dr A K Gupta)

What are the initial (prodromal) symptoms of rabies?

  • Pain or paresthesiae at the site of the bite is well–known as a diagnostically useful prodromal symptom occurring in one–third to two–thirds of cases.
  • In Thailand, however, a specific type of paresthesiae – itching – was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesiae may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in three of the four patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.

Cardiology eMedinewS

  • In patients undergoing noncardiac surgery after previous percutaneous coronary intervention (PCI) and stent implantation, the use of aspirin appears to be unrelated to the occurrence of a major cardiac adverse event, suggests a new study presented at the American Society of Anesthesiologists 2014 Annual Meeting.
  • New American Heart Association (AHA)/American Stroke Association (ASA) guideline on primary stroke prevention includes recommendations for new oral anticoagulants in patients with atrial fibrillation (AF), home blood pressure monitoring in patients with hypertension, smoking cessation, nonestrogen oral contraceptives for women experiencing migraine with aura, and the healthy Mediterranean diet for all patients. The updated guideline was published online October 28 in Stroke.

Pediatrics eMedinewS

  • A child’s later-life intelligence may not be influenced by parenting; instead it may be more dependent on genetics, suggests new research published in the journal Intelligence.
  • In children with poorly controlled asthma, once-daily tiotropium delivered with the Respimat inhaler may improve lung function when added to inhaled corticosteroids, with no apparent change in adverse effects, suggests new research presented at CHEST 2014: American College of Chest Physicians Meeting.

Quote of the Day

  • Insanity: doing the same thing over and over again and expecting different results. Albert Einstein

Wellness Blog

Snorers at risk of sudden death

The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

ePress Release

Dengue patients don’t die of platelet deficiency

According to international guidelines, unless the platelet count is below 10,000 or there is spontaneous active bleeding, no platelet transfusion is required, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association

The cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure, he added. At the first instance of plasma leakage from intravascular compartment to extravascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual.

Dr. Aggarwal has created a ‘Formula of 20’ for family doctors to understand the severity of dengue.

  • Rise in pulse by 20
  • Fall in upper blood pressure by 20 mmHg
  • Pulse pressure is lower than 20
  • Hematocrit increased by 20%
  • Platelet count is less than 20,000
  • More than 20 petechiae in the tourniquet test

eMedi Quiz

An increase in which of the following parameters will shift the O2 dissociation curve to the left?

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of hemoglobin.

Yesterday’s Mind Teaser: The parameters of sensitivity and specificity are used for assessing:

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

Answer for yesterday’s Mind Teaser: 1.Criterion validity.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan.

Answer for 29th Oct Mind Teaser: 4.X-ray diffraction.

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

Send your answer to email

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21st Perfect Health Mela 15th October 2014



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To err is human

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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
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IJCP Book of Medical Records

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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 came with tubercular pericarditis
Dr Good: Start steroids
Dr Bad: No steroids are needed
Lesson: The current recommendation is to use corticosteroids for patients with constrictive tuberculous pericarditis and for those felt to be at high risk of developing the condition i.e., large effusion, high level of pericardial fluid inflammatory cells, or early signs of constriction.

Make Sure

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

eMedinewS Humor

The reluctant spender

After being away on business, Tim thought it would be nice to bring his wife a little gift. "How about some perfume?" he asked the cosmetics clerk. She showed him a Rs 50.00 bottle. "That’s a bit much," said Tim, so she returned with a smaller bottle for Rs 30.00.

"That’s still quite a bit," Tim complained. Growing annoyed, the clerk brought out a tiny Rs 15.00 bottle.

"What I mean," said Tim, "is I’d like to see something really cheap."

So the clerk handed him a mirror.

Twitter of the Day

Dr KK Aggarwal: Do not eat more than 5 grams of salt in a day
Dr Deepak Chopra: God isn’t selfish. He doesn’t want anything from you. God doesn’t reject. Whatever you are is fine with him

medicolegal update

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

Giving wrong advice on email is liable for negligence

If the doctor has charged his/her full fees for the email consultation from the patient or a referring physician regarding a patient, he/she will be liable as if he or she has seen the patient. When giving a written opinion through email one can take the following precautions and write:

  • “Expert opinion provide¬d as a professional courtesy only”
  • “Nominal fee charged is only to cover the secretarial / incidental expenses involved and does not count towards a consideration or contract”
  • “This is only an opinion based on the information provided to me. It is not a final opinion which cannot be given without seeing the patient physically.
  • “This is not a final opinion and you may use this opinion at your own responsibility and discretion”
  • “As it is an opinion given without seeing the patient I take no legal responsibility for the opinion given”.
medicolegal update
  1. Dear Sir, Very informative newspaper. Regards: Dr RS Sharma

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)