eMedinewS2nd January 2014, Thursday

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

Dear Colleagues

In the year 2013 knowingly or unknowingly, if I have hurt your conscious with my actions, speech, thoughts or writings, please forgive me.


Quite often we annoy people unknowingly and that keeps on disturbing the relationship between two souls. Over the years, I have learnt and am still learning ways of non–violent communication, which means no gossip, no criticism, no complaints and no condemnation.

I define gossip as talking about someone in his or her absence and which is not based on facts and is without any source or reference.

Farooq Sheikh sudden death in Dubai

Sudden cardiac death of any cine star can create waves of fear in the mind of anyone. In the last one week, I have received at least 20 inquiries related to how to predict and prevent sudden cardiac death.

My formula is very simple. If your blood sugar, blood cholesterol and blood pressure are normal; if you can climb two flights of stairs or walk 2 km or perform exercise in the bed with your partner without any discomfort in the chest or breathlessness, you are not going to die suddenly of a cardiac arrest in the next 10 years. This is a rough formula which can be used to give clearance to people to join competitive games, join a gym, go to Amarnath Yatra or get married in middle age.

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

Win relationships and not arguments

sprritual blog

It is a well known saying that when you are arguing with a wrong boss, you may win the argument but you may invariably lose the relationship and not the argument.

Lord Krishna taught us when to say ‘sorry’ even if you are not at fault. Never hurt the ego of a person who is under influence of alcohol or a boss when he is angry.

cardiology news

Competing with others

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 to what others are doing, where others are going, wearing & driving.

Take what God has given you, the height, weight & personality. We all enjoy with our own destinies.

News Around The Globe


CPR 10 success stories

1. Hands–only CPR 10 English

2. Handsonly CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful handsonly CPR 10

6. Elderly man saved by Anuja

  • New organ donation message boosts registration: A clinical trial conducted in the UK tested a series of messages to which people were directed after renewing their vehicle tax or registering for a driving license. During the 5-week trial, more than 1 million people viewed one of the messages. The most successful read: "If you needed an organ transplant, would you have one? If so, please help others." The results suggest that the message could lead to 96,000 extra registrations in one year.
  • Buttonhole cannulation in routine clinical practice? In a CJASN analysis of clinical outcomes in 90 home hemodialysis patients, buttonhole (blunt needle) cannulation of vascular arteriovenous fistulae was associated with higher rates of infectious events, increased staff support requirements, and no reduction in surgical fistula interventions compared with traditional rope ladder (sharp needle) cannulation.
  • Smoking and consumption of animal products linked to cancer: Following have correlations with various cancers: lung cancer incidence rates (direct correlation with 12 types of cancer), energy derived from animal products (direct correlation with 12 types of cancer, inverse with 2), latitude (direct correlation with 6 types, inverse correlation with 3) and per capita GDP (5 types). Life expectancy and sweeteners directly correlated with 3 cancers, animal fat with 2, and alcohol with 1. The findings are published in Nutrition.
  • Testosterone level affects flu shot response: Men with high testosterone and a certain gene cluster may not experience an antibody response after a flu shot. Men with higher levels of serum testosterone had a mean 81% lower antibody response to the flu shot compared with women, while men with lower levels of testosterone had only a 13% lower response. The findings are published online in the Proceedings of the National Academy of Sciences.
  • USPSTF recommendations for lung cancer screening: The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low–dose computed tomography (LDCT) for adults between the ages of 55 to 80 years who have a 30 pack–year smoking history and who currently smoke or have quit within the last 15 years. Screening should be discontinued once a person has not smoked for 15 years or has developed a health condition that will substantially limit life expectancy or the ability or willingness to undergo curative lung surgery. The guidelines are published December 31 in the Annals of Internal Medicine.

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Rabies News (Dr. A K Gupta)

Can RIG be given locally to a healed wound?

Yes. If anti–rabies vaccination has not been started, then RIG can be given locally without disturbing the scab.

cardiology news

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

  • Dr. Asim Cheema, an interventional cardiologist at St. Michael’s Hospital in Toronto has advised aspiring transradial interventionists under the guidance of an experienced practitioner; perform simple cases in lower–risk patients and progress to more difficult cases as expertise builds. It’s best to start with a solid foundation in transfemoral PCI, and begin using the radial approach in stable patients who have single vessel disease and are presenting for angiography or some other elective procedure, he said at the18th World Congress on Heart Disease. In the transition from transfemoral to transradial PCI, one should not hesitate to "switch to femoral access in case of unusual anatomy, technical difficulties.
  • An investigational tissue–engineered vascular graft has enduring potential for vascular access for hemodialysis in patients with end–stage renal disease, based on early clinical results. The results from the first–in–man, ongoing phase I clinical experience with the Humacyte graft, which to date has been implanted to provide vascular access for hemodialysis in 28 patients, with 6–month patency as the primary study endpoint were presented at the American Heart Association scientific sessions. The overall 6–month patency was 100%, with no infections, no sign of an immune response, and no aneurysms or other indication of structural degeneration.
cardiology news

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

  • Children with higher–frequency hearing loss due to tympanic membrane (TM) perforation are unlikely to have significant recovery in this range after type I tympanoplasty, according to a study in JAMA Otolaryngology –– Head & Neck Surgery.
  • According to a research from UK, in infants with less than 29 weeks of gestation, postnatal head growth in the first 28 days can be improved by adding macronutrients to standard parenteral nutrition (PN). The findings are published in the journal Pediatrics. Infants of this gestation should start parenteral nutrition as soon after birth as possible. Delayed nutrition means postnatal head growth failure is almost inevitable. Postnatal head growth and brain weight are closely associated, and poor head growth is associated with poorer neurodevelopment.
cardiology news

It is fruit juice which increases the risk of diabetes and not the fruits

A research published in the British Medical Journal has shown that eating blueberries, apples and grapes may be linked to a reduced risk and type 2 diabetes. However, increased consumption of fruit juice was linked to a higher risk.

It is a typical Ayurvedic teaching that one should eat fruits and not take fruit juice unless one is sick when digestion is weak. It is a myth that eating grapes can cause diabetes.

The well–known saying that eating an apple a day keeps the doctor away is true from this study especially green apples, which are known to be more health–friendly then the red apples.

The answer is simple… anything which is natural cannot be harmful. Fruits are natural but juices are not.

cardiology news

Total CPR since 1st November 2012 – 84073 trained

Media advocacy through Web Media

web media webmedia webmedia
press release

Naproxen the best long-term painkiller for heart patient

In heart patients or in patients who are at high risk for heart attack and who require high dose of painkiller, one should not use ibuprofen or diclofenac. The safest painkiller for heart patients is Naproxen, said Padma Shri and Dr. B. C. Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India.

Most non–steroidal anti–inflammatory drugs increase the risk of heart attack. High dose of diclofenac increases chances of no fatal heart attack, no fatal paralysis and vascular death by 40%. High dose of Naproxen has no effect on vascular motility.

In high–risk patients, use of high–dose long–term ibuprofen or diclofenac can lead to 8 extra events per thousand patients used per year including two fatal events.

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 84073 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

Suraj Bhan D.A.V. Public School students learned CPR–10

press release

Lifestyle change can reduce aging

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

The earliest immunoglobulin to be synthesized by the fetus is:

1. IgA.
2. IgG.
3. IgE.
4. IgM.

Yesterday’s Mind Teaser: The following are true regarding Lyme’s disease, except:

1. It is transmitted by ixodes tick.
2. Erythema chronicum migrans may be a clinical feature.
3. Borrelia recurrentis is the etiological agent.
4. Rodents act as natural hosts.

Answer for yesterday’s Mind Teaser: 3. Borrelia recurrentis is the etiological agent.

Correct answers received from: Dr A K Gajjar, Dr PC Das, Dr Jainendra Upadhyay,
Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Daivadheenam, Muthumperumal Thirumalpillai.

Answer for 31st December Mind Teaser: 2. Herpes simplex virus

Correct answers received from: Dr K Raju, Dr Prakash Khalap.

Send your answer to ijcp12@gmail.com

medicolegal update

(Ex)Prof. M C Gupta, (Advocate & Medico–legal Consultant)

Q. What are the present status, strengths and weaknesses of Medicare Protection Act?



After the Andhra Pradesh Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and damage to property) Act, 2008, was passed, 17 more states have passed similar Acts, the latest being Goa in 2013. Some of these are: Delhi, Haryana, Madhya Pradesh, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Tripura and West Bengal.


Most of the above state Acts are very similar in nature. Their provisions are quite stringent. Some of these are described below (in relation to the Tamil Nadu Act).

Section 2(2) ––"(2) "medicare service person" in relation to a medicare service institution shall include,—

(a) registered medical practitioners (including a person having provisional registration);
(b) registered nurses;
(c) medical students;
(d) nursing students;
(e) para medical workers;
employed and working in such medicare service institutions;”

Section 2 (3):

"(3) "property" means any property, movable or immovable or medical equipment or medical machinery owned by or in possession of, or under the control of, any medicare service person or medicare service institution;"

(It may be noted that the above definition of property would also include hospital records/medical case sheet etc. which may be damaged or snatched away by the miscreants. Such records constitute movable property of the hospital/clinic.)

Section 2 (4):

(4) "violence" means activities of causing, any harm, injury or endangering the life or intimidation, obstruction or hindrance to any medicare service person while discharging his duty in the medicare service institution or causing damage or loss to the property.

It may be noted that the above definition of violence would also include an act "causing damage or loss to the property" including hospital records/medical case sheet etc. Please note that the term violence includes even "intimidation, obstruction or hindrance to any medicare service person". The acts of violence can lead to non–bailable arrest and the stringent minimum three years jail as per sections 3 and 4. given below:

Sections 3 and 4:

"3. Any person either by himself or as a member or as a leader of a group of persons or organization, commits or attempts to commit or abets or incites the commission of any act of violence shall be punished with imprisonment for a term which shall not be less than three years but which may extend to ten years and with fine.

4. Any offence committed under section 3, shall be cognizable and non bailable."

Section 5:

The Act has a provision of compensation for loss of property without specifying any limit as per section 5, given below:

"5. (1) In addition to the punishment specified in section 3, the person shall be liable to pay compensation for the damage or loss caused to the property, as determined by the court.

(2) If the person has not paid the compensation under sub–section (1), the said sum shall be recovered under the provisions of the Tamil Nadu Revenue Recovery Act, 1864 as if it were an arrear of land revenue."


The main weakness is not in the Act but in its implementation. Very often it happens that when a complaint of violence in a hospital is made to the police, the FIR is not registered under the Medicare Protection Act. The medical profession needs to be vigilant to ensure that the provisions of the state Medicare Protection Act are invoked when the police register an FIR. The best strategy is to write in the police complaint itself that necessary action may be taken under the state Medicare Protection Act. If there is no such an Act in the state, the state IMA must pressure the government to pass such an Act/ordinance.

Even though the Acts at present are useful and effective, the following modifications (mentioned with reference to the Tamil Nadu Act) are suggested:

1—Modification of the second part of the preamble to include injury to the body of such persons and to the reputation of such persons or institutions.

2—Modification of the definition of the term "Medicare Service Institution" by substituting the definition of the term "clinical establishment" in the CEA, 2010.

3— Modification of the definition of the term "violence" in section 2(4) to include violence while going to such institution for performing duty or returning from such institution after performing such duty. (This would include incidences like the recent attack in Punjab on the well –known cardiologist Dr. Wander who was returning after examining a patient in the hospital).

4—Quantifying fine in section 3 as minimum Rs. 10,000/– and maximum Rs.

5 lakh. 5—Modifying section 5(1) to include injury to body and damage to reputation.

medicolegal update
medicolegal update

Embarrassing Traffic Stop

A police car pulled me over near the high school where I teach. As the officer asked for my license and registration, my students began to drive past. Some honked their horns, others hooted, and still others stopped to admonish me for speeding.

Finally the officer asked me if I was a teacher at the school, and I told him I was.

"I think you’ve paid your debt to society," he said with a smile, and left without giving me a ticket.

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

medicolegal update

Beautiful things are not always good, but good things are always beautiful!

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 Dr. Aggarwal, It’s the best New Year guidance I have come across till date. I will try to incorporate it in my daily life to get closer to my goals. Once again thanks for your continuous Endeavor to enlighten our lives. Astha Gupta

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