eMedinewS2nd May 2014,Friday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

WHO releases the first global report on antimicrobial resistance

The WHO released a first global report of its kind on antibiotic resistance yesterday. The report provides the most complete global picture of current status of surveillance and antimicrobial resistance, in particular antibacterial resistance to date, with data from 114 countries.

The report titled "Antimicrobial resistance: global report on surveillance" includes surveillance findings from around the world on antimicrobial resistance. It yet again emphasizes that antibiotic resistance is very much an issue today and is no longer a threat for the future. It is a major public health issue today and can affect anyone of any age in any country. Though the number/organisms may vary from region to region, antimicrobial resistance is emerging in all parts of the world. The consequences are disproportionately worse for the developing countries.

The report has focused mainly on antibiotic resistance in seven different bacteria, which cause bloodstream infections (sepsis), diarrhea, pneumonia, urinary tract infections and gonorrhea. Hospitals from all parts of the world are reporting untreatable or nearly untreatable infections. Ten countries have reported gonorrhea that is untreated by any antibiotic.

The impact of antimicrobial resistance is tremendous. It means extra hospitalizations; there may be chronic consequences of untreated infections and most importantly it affects our ability to treat infections especially in the vulnerable population groups such as those with cancer, diabetes, chronic renal failure, preterm babies, and malnourished children among others.

According to Dr Keiji Fukuda, WHO’s Assistant Director–General for Health Security, the picture is a grim one, but is not entirely a hopeless one. There are ways through which antimicrobial resistance can be tackled such as better use of vaccines, infection control measures (handwashing), better hygiene and reducing non health use of antibiotics.

A key finding of the report was that there are significant gaps in surveillance, and a lack of standards for methodology, data sharing and coordination. It is a call for global action and intensify efforts to create awareness about antimicrobial resistance in the community. Better tracking and monitoring systems need to be put in place in every country.

Dr Keiji Fukuda said, "Without urgent, coordinated action by many stakeholders, the world is headed for a post–antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill."

Key findings from the report

  • Resistance to the treatment of last resort for life–threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae–carbapenem antibiotics–has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.
  • Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli–fluoroquinolones–is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.
  • Treatment failure to the last resort of treatment for gonorrhea–third generation cephalosporins–has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhea around the world every day.
  • Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin–resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non–resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

(Source: WHO Press Briefing)

News Around The Globe

  • The US Food and Drug Administration (FDA) has recently approved the anticholinergic umeclidinium 62.5 μg delivered through an inhaler as a once–daily maintenance treatment for patients with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema.
  • The World Health Organization’s extensively used Fracture Risk Assessment Tool (FRAX) significantly underestimates the risk for fragility fractures, reports a study published online April 29 in the Journal of Clinical Endocrinology and Metabolism.
  • A new autopsy study has shown that positron emission tomography (PET) using florbetaben can reliably exclude the presence of amyloid in the brain of patients with dementia. The study authors noted a high negative predictive value of a negative florbetaben scan, showing a close association between uptake of the tracer and amyloid deposition in the brains of patients.
  • A study presented at the National Kidney Foundation’s 2014 Spring Clinical Meeting has stated that proteinuria remains undetected and untreated in many patients. Researchers noted that on routine urinalysis, 40% patients had proteinuria while only 37% of them were being treated for it. One–third of the patients had hypertension, but only 43% were taking an antiproteinuric, antihypertensive drug.
  • A study presented at the American Academy of Neurology (AAN) 66th Annual Meeting has stated that adding sex hormone estriol to glatiramer acetate, a drug indicated for the treatment of relapsing–remitting multiple sclerosis (RRMS), leads to greater reduction in the 1–year relapse rate. The combination is safe and well tolerated.

Rabies News (Dr A K Gupta)

What are most dangerous sites of bites/exposure in man?

Theoretically, the richly innervated areas like head, neck, face, hands and genitals are the most dangerous sites of bite in man. But practically, it is often the wounds on legs, which are ignored/neglected, that cause rabies.

Cardiology eMedinewS

  • A study published online April 30 in the Journal of the American College of Cardiology has shown that obese individuals without any evidence of metabolic syndrome had increased likelihood of having evidence of subclinical atherosclerosis when compared with metabolically healthy individuals who were at normal weight.
  • Two large US cohort studies have provided retrospective evidence that increasing fiber consumption can increase survival after MI. Data review from two large cohort studies revealed that a post–MI increase in fiber intake was associated with a reduced risk of death after age–adjusted analyses.

Pediatrics eMedinewS

  • A study presented at the National Kidney Foundation’s 2014 Spring Clinical Meeting in Las Vegas has revealed that a significant number of severely obese kids have abnormal kidney function. Researchers noted that 17% had microalbuminuria, 3% had glomerular filtration rate (GFR) <60, and 7% had GFR >150.
  • A study published in the April issue of JAMA has revealed that lorazepam has similar efficacy and safety as diazepam for pediatric status epilepticus. Cessation of status epilepticus for 10 minutes without recurrence within 30 minutes occurred in 72.1% patients in the diazepam group and 72.9% patients in the lorazepam group.

Dr K K Spiritual Blog

Today is Akshaya Tritiya

  1. Akshay Tritiya, also called Akshaya Teej or Akha Teej is one day which is never "absent" from the lunar calendar.
  2. It is one of the most pious festivals in Hinduism. It marks the beginning of ‘Treta Yuga’.
  3. Akshaya means imperishable. Japa, worship, purification of body, donations etc. done on this day remain imperishable.
  4. All auspicious initiatives can be taken on this day without asking the priest.
  5. The Day is worshipped as an auspicious day in Jainism because it is said to have established the very first "ahar charya" a methodology to prepare and serve food to Jain monks. Shreyansha Kumara offered Tirthankara Rishabhadeva sugarcane juice after one year of fast.
  6. The day has great significance for taking holy dip in the Ganga River. The holy dip makes a person free from all sins and troubles (Best day for self confession).
  7. Sun baths during the month of Vaisakh also indicate the need for sun bath to remove vitamin D deficiency from the body.
  8. The day is also marked with the opening of doors of Badrinarayanji (Best time to start new ventures: Vishnu symbolizes doing ventures).
  9. It is believed that if you do charity on this day you will be blessed. The devotees should offer mishri and wet gram pulses.
  10. One should donate water with sesame and Kusha grass to forefathers (For treating attachment disorders).
  11. One should also install free drinking water or sharbat centers (pyau) on this day (Denotes need for safe water in the summer).
  12. This festival is charity–oriented (Anything which in excess can harm should be donated).
  13. One should also donate Sattu with sugar or Jaggery.
  14. One must consume Sattu on Akshaya Tritiya (Sattu is the fast food of summer with cooling properties; it’s a high energy drink).
  15. Fast should be broken with sugarcane juice (Sugarcane is the best summer drink provided it is hygienically prepared).
  16. Akshay Tritiya is also traditionally celebrated as the birthday of the Hindu sage Parashurama, the sixth incarnation of the god Vishnu, who represents the quality to fight injustice.
  17. The gold industry proliferates on the day and people like to buy gold on this day.
  18. It is also worshipped as a combined day of Kubera and Goddess Lakshmi and works on the principle "what was lost will come back to you."

Wellness Blog

Elderly should beware of the commonly prescribed group of drugs

Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs – used to treat acid reflux, Parkinson’s disease and urinary incontinence –– may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anti–cholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

In older adults taking a moderately acting anticholinergic medication, or two or more mildly acting anticholinergic medications, their function is similar to that of someone 3 to 4 years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine.

About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.

Inspirational Story

Don’t hope, decide!

While waiting to pick up a friend at the airport in Portland, Oregon, I had one of those life–changing experiences that you hear other people talk about — the kind that sneaks up on you unexpectedly. This one occurred a mere two feet away from me.

Straining to locate my friend among the passengers deplaning through the jet way, I noticed a man coming toward me carrying two light bags. He stopped right next to me to greet his family.

First he motioned to his youngest son (maybe six years old) as he laid down his bags. They gave each other a long, loving hug. As they separated enough to look in each other’s face, I heard the father say, "It’s so good to see you, son. I missed you so much!" His son smiled somewhat shyly, averted his eyes and replied softly, "Me, too, Dad!"

Then the man stood up, gazed in the eyes of his oldest son (maybe nine or ten) and while cupping his son’s face in his hands said, "You’re already quite the young man. I love you very much, Zach!" They too hugged a most loving, tender hug.

While this was happening, a baby girl (perhaps one or one–and–a–half) was squirming excitedly in her mother’s arms, never once taking her little eyes off the wonderful sight of her returning father. The man said, "Hi, baby girl!" as he gently took the child from her mother. He quickly kissed her face all over and then held her close to his chest while rocking her from side to side. The little girl instantly relaxed and simply laid her head on his shoulder, motionless in pure contentment.

After several moments, he handed his daughter to his oldest son and declared, "I’ve saved the best for last!" and proceeded to give his wife the longest, most passionate kiss I ever remember seeing. He gazed into her eyes for several seconds and then silently mouthed. "I love you so much!" They stared at each other’s eyes, beaming big smiles at one another, while holding both hands.

For an instant they reminded me of newlyweds, but I knew by the age of their kids that they couldn’t possibly be. I puzzled about it for a moment then realized how totally engrossed I was in the wonderful display of unconditional love not more than an arm’s length away from me. I suddenly felt uncomfortable, as if I was invading something sacred, but was amazed to hear my own voice nervously ask, “Wow! How long have you two been married?

"Been together fourteen years total, married twelve of those." he replied, without breaking his gaze from his lovely wife’s face. "Well then, how long have you been away?" I asked. The man finally turned and looked at me, still beaming his joyous smile. "Two whole days!"

Two days? I was stunned. By the intensity of the greeting, I had assumed he’d been gone for at least several weeks – if not months. I know my expression betrayed me. I said almost offhandedly, hoping to end my intrusion with some semblance of grace (and to get back to searching for my friend), "I hope my marriage is still that passionate after twelve years!" The man suddenly stopped smiling.

He looked me straight in the eye, and with forcefulness that burned right into my soul, he told me something that left me a different person. He told me, "Don’t hope, friend… decide!" Then he flashed me his wonderful smile again, shook my hand and said, "God bless!"

ePress Release

Summer Diarrhea Treatment

One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. They need no antibiotics. The only treatment is oral rehydration solution, 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.

One loose motion is equivalent to loss of one glass of fluid. Explaining this, Dr. Aggarwal said that if a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

For upto 12 loose motions a patient can be managed as an out patient but if the loose motions are more than 12 he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions one should maintain that he or she passes urine every 6–8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.

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 88972 people since 1stNovember 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."

Zee News – Health Wealth Shows

Cancer Prevention
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Fluid Intake


Total CPR since 1st November 2012 – 88972 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
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

World Earth Day Celebration at DAV Public School, RK Puram, New Delhi.

press release

Treating vitamin D deficiency in the country

video of day video of day


IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

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 :


Make Sure

Situation: A 36–year–old truck driver had severe allergic rhinitis and came for treatment.
Reaction: Oh my God, why was he not prescribed azelastine nasal spray?
Lesson: Make sure to avoid oral antihistamines in persons who perform tasks like driving as they may cause sedation and drowsiness; instead prescribe azelastine nasal spray which is effective and non–sedating.

eMedinewS Humor

While he was talking to me, his nurse came in and said,
"Doctor, there is a man here who thinks he’s invisible."
The doctor said, "Tell him I can’t see him."

Quote of the Day

"When you are in the light, everybody follow you. When you are in dark, even your shadow does NOT follow you."


Twitter of the Day

Dr KK Aggarwal: Equipment–related failures common in Operation Theater http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: I maintain that the cosmic religious feeling is the strongest noblest motive for scientific research–Einstein #CosmicConsciousness


Forth Comming Event

A symposium on "Importance of Alternate Medicine and Healings in this Era" & "Build India Awards 2014" 4th May 2014, 6:30PM Onwards Gulmohar Hall India Habitat Centre, Lodhi Road New Delhi 7:15PM: Lamp Lighting Ceremony by Chief Guests:

  • Sri Ravindra Bhandari, Convener Bharat Nirman,
  • Homoeopathy King DR. S.P.S. Bakshi,
  • Padma Shri Dr. K.K.Aggarwal
  • Organic Lady Dr. Vandana Shiva (Promoter Navdanya)
  • Reiki Healer Dr. N.K. Sharma
  • Sri A.K.Singh (ZM North Zone LIC)

eMedi Quiz

An early systolic murmur may be caused by all of the following except:

1. Small ventricular septal defect.
2. Papillary muscle dysfunction.
3. Tricuspid regurgitation.
4. Aortic stenosis.

Yesterday’s Mind Teaser: Prevalence of skin infections in HIV infection is approximately

d .extremely rare

Answer for yesterday’s Mind Teaser: c.90–100%

Correct answers received from: Dr P C Das, Dr KV Sarma, Daivadheenam Jella, Dr Navasnk, Abhay Naik, Dr B K Agarwal, Dr Bitaan Sen & Dr Jayashree Sen.

Answer for 30th April Mind Teaser: 4. Glycosylation.

Correct answers received from: Dr P C Das, Dr Bitaan Sen & Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

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medical querymedical query

medicolegal update

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medicolegal update
  1. Dear Sir, Very Informative news. Regards: Dr Kirti
cardiology news

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