eMedinewS30th August 2013, Friday

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; 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

Cardiac Autonomic Dysfunction Predicts Outcomes in Diabetes

Among patients with stable CAD and type 2 diabetes, measures of autonomic function––such as heart–rate recovery after exercise––may help predict the risk of short–term adverse cardiovascular events as per a study.

A second study reports that autonomic dysfunction is strongly linked with a greater risk of severe hypoglycemia in patients with type 2 diabetes.

The best way to avoid it is to have intensive glucose control with hemoglobin A1cs that are definitely below 7.5 and ideally below 7. On the other hand, if you have (HbA1c) levels above 8, certainly above 9, you have a very high likelihood of having the problem (within) 10 or more years.

The two studies were published online August 19, 2013 in Diabetes Care.


  • The patients performed a test on an exercise bicycle, which allowed the researchers to determine their heart–rate recovery, defined as the drop in heart rate from the rate at maximal exercise to the rate one minute after stopping the exercise.
  • Blunted heart–rate recovery after exercise: defined as a drop in heart rate of less than 21 beats per minute––had a 1.69–fold greater risk having a cardiovascular event than their peers.
  • Holter: Blunted heart-rate turbulence (<3.4 ms/R–R interval) had a 2.08–fold increased risk of an event
  • Low heart–rate variability (<110 ms) had a 1.96–fold greater risk of having a cardiovascular event.
  • Heart–rate variability at three times: during a Valsalva maneuver, deep breathing, and going from lying down to standing.

….Read More

In mild strokes, ultra–early treatment may eliminate risk of disability

1. Patients with mild–to–moderate strokes who received care within 90 minutes of stroke symptoms were less likely to have permanent disability.

2. Early treatment also helped those with minor strokes, but the likelihood of disability is already very low in these patients.

In the case of mild or moderate strokes, getting treatment ultra–fast – within 90 minutes of experiencing symptoms – greatly reduces the risk of suffering disability, according to a new study reported in the American Heart Association’s journal Stroke.

According to guidelines, clot–busting drugs may be given to treat stroke up to 4.5 hours after the onset of symptoms.

The study found that survivors with mild to moderate strokes who were given the clot–busting drugs in the first 90 minutes of the recommended time window had little or no disability three months later compared to those who were treated between 90 and 270 minutes.

The study included more than 6,800 stroke patients at 10 stroke centers in Europe over 14 years. They were treated intravenously with Alteplase, a clot–busting drug that is given IV in the vein.

Early treatment also helped those with minor strokes, but the likelihood of disability is already very low in these patients.

Those with severe stroke did not benefit as much from the ultra–early treatment because they had severe artery blockage.

FAST is an easy way to remember the sudden signs of stroke.

F: Face drooping, A – Arm weakness, S– Speech difficulty and T–Time (Act fast)

….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 10x10 i.e. 100 per minute."

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

Ringtone – CPR 10 Mantra English

sprritual blog Why Lakshmana could not kill Ravana?

We need to understand Ramayana in the language of Internal Ramayana taking place in the body everyday in which Rama represents consciousness, Sita the body and Lakshmana, the determined mind with an aim.

Ravana is synonymous with ego, which the determined mind (Lakshmana) cannot kill. Only the consciousness can kill the ego.

Consciousness gets activated only in parasympathetic mode, which in turn takes over only when the person has control over the breathing.

Control over breathing in mythology means your friendship with Hanumana which represents the Prana Vayu.

….Read More

cardiology news

Tips to Fight Depression

During the phase of depression sometimes we become pessimist and our negative thoughts make it hard to attain back the peaceful state. As we are already depressed due to tough circumstances, these negative thoughts add fuel to fire and steal our peace of mind making it really hard to concentrate even on routine things. So what should be done to fight the depression and negativity? Below are the tips to be considered:

  1. Try not to think about problems and rough circumstances again and again; instead focus on the solution. Think what needs to be done to fix the issues.
  2. Change your environment. Take a break from your routine life and visit some relative or explore some new city/country.
  3. Stay away from negative people. Remember, if someone is negative, he/she is spreading negative germs. Keep yourself germ–free.
  4. Read newspaper or a good book on daily basis.
  5. Go to market and buy yourself something you like. Feel good about it.
  6. Surround yourself among happy people. Spend quality time with joyful and colorful friends.
  7. Adopt some good hobby and spend time on it e.g. gardening, blogging, book reading etc.
  8. Visit an Orphan house and spend time with children. Help them financially if possible. Give gifts. This act gives real inner happiness.
  9. Think about the positive events of your life. About your childhood, education, fun trip, a friend’s wedding etc.
  10. Go to a religious place and spend time in prayers to get peace of mind

...Read More

News Around The Globe

Dr G Samaram was felicitated and presented an Award for his Outstanding Services for promoting the cause of Sexual Health in India on 24th August, 2013 in the 29th National Conference of Sexology held at Hyderabad.

The official visit of Sweden Medical Students to India

Message: Medical students, Sofia & Emilia from Sweden visiting Medical Students Association of India at New Delhi. MSAI arranged a visit to the local slum near ITO as the students wanted to see the education and healthcare accessibility at the slums.

  • Victims of road accidents and their next of kin have a right under law to claim compensation, the Bombay high court has ruled. Twenty–three years after a Yavatmal–based bank officer lost his life in a road accident involving an MSRTC bus, Justice A P Bhangale ordered the state transport undertaking to pay Rs 6.51 lakh, along with interest, to his wife and three children. The judge threw out the MSRTC’s contention that the deceased bank officer, Mukundrao Dongre (38), could not be categorized as a third party eligible for compensation under the third–party risk insurance rule.
  • Cytomegalovirus (CMV) retinitis, a late–onset opportunistic infection that leads to visual loss, affects more than one in seven HIV patients in Asia. According to Dr. Nathan Ford from the World Health Organization and colleagues, this high prevalence may be due to delays in seeking treatment and the lack of facilities for eye screening. Declining immunity in HIV results in reactivation of CMV and slow necrotizing damage to the retina with visual loss. (Source: Medscape)
  • Hepatitis C treatment with a two–drug, interferon–free regimen was effective at maintaining a sustained virologic response in patients deemed unlikely to respond to treatment. A new study says that a 24–week regimen of sofosbuvir in tandem with weight–based or low–dose ribavirin was associated with a sustained virologic response to treatment of 68% and 48%, respectively, in those with a "high prevalence of unfavorable traditional predictors of treatment response. Shyamasundaran Kottilil, MD, PhD, of the National Institute of Allergy and Infectious Diseases in Bethesda, Md., and colleagues have reported their study in Journal of the American Medical Association. (Source: Medpage Today)
  • In a case–control study, patients who were obese but metabolically healthy had lower levels of several inflammatory markers, including C–reactive protein (CRP), TNF–alpha, and IL–6, Catherine Phillips, BSc, PhD, of University College Cork in Ireland, and colleagues reported online in the Journal of Clinical Endocrinology and Metabolism. According to the authors, people with favorable inflammatory profiles also tended to have healthy metabolic profiles regardless of their body mass index. (Source: Medpage Today)
  • Patients with rheumatoid arthritis (RA) receiving monotherapy with etanercept (Enbrel) did not fare as well overall as those also taking methotrexate in a new reasearch. Among 205 patients randomized to the combination or monotherapy for an additional 6 months after an initial 6 months of combination treatment, the difference in disease activity scores was 0.4, but the non-inferiority margin was 0.6. However, in patients who had achieved a state of low disease activity during the first 6 months, changes on disease activity scores were similar at 12 months for the combination and monotherapy groups, at 0.57 and 0.7. (Source: Medpage Today)
  • A case report published online in the Journal of Clinical Investigation provides the "first convincing evidence" for a direct donor contribution to a kidney recipient’s skin squamous cell carcinoma. Skin tumor cells with the donor genotype were found in the kidney recipient. Anne Janin, MD, PhD, of the University Caen Basse Normandie in Caen, France, and colleagues found that the patient "harbored a TP53 mutation on codon 175," which is associated with an increased risk of invasive skin squamous cell carcinoma (SCC) in kidney transplant recipients, according to the brief report. (Source: Medpage Today)

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Rabies News (Dr. A K Gupta)

Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titre level but this is rarely practicable due to scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:

(1) 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history
(2) 40% of dogs’ vaccinated only one time lost most of their immunity 4–6 months later.
(3) Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.

cardiology news

Older patients who did not have heart disease had a significantly lower risk of myocardial infarction and stroke when treated with statins

Although the drugs had no effect on all–cause or cardiovascular mortality, according to a meta–analysis. The risk of MI was 40% lower in statin users compared with nonusers, and stroke incidence was 24% lower. The beneficial effects did not translate into a lower mortality risk, which was virtually identical between statin users and nonusers, Pasquale Perrone–Filardi, MD, PhD, of Federico II University in Naples, Italy, and co-authors reported online in the Journal of the American College of Cardiology. (Medpage)

Valvular Heart Disease News

Although a variety of microorganisms can cause infective endocarditis, streptococci and staphylococci species are the most common pathogens associated with infective endocarditis in children

(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

Children with Down syndrome found a high rate of missing salivary glands, according to a study from Israel. Also, children with Down syndrome have different saliva composition than normal children. Dr Marwan Odeh of Western Galilee Hospital Nahariya and colleagues reported their findings in an August 1 online paper in Archives of Disease in Childhood. On ultrasound exam, all controls in the study had intact, normal parotid and submandibular salivary glands, whereas in four children with Down syndrome (26.7%), one or more salivary glands were absent. The submandibular gland was unilaterally absent in three children and bilaterally absent in one child. (Source: Medscape)

cardiology news

Eating fast food can cause liver damage

Eating at least two fast foods meals every day and restricting levels of physical activity to no more than 5,000 steps a day can lead to signs of liver damage or gain weight as per a Swedish study by Dr. Fredrik H. Nystrom of University Hospital of Linkoping, Sweden and colleagues published in the journal Gut

At the end of 4 weeks, the fast food eaters had put on an average of 6.5 kgs (14.3 pounds). After just one week on the fast food diet, blood tests showed sharp increases in a liver enzyme called serum glutamic pyruvic transaminase or SGPT. SGPT levels were more than quadrupled over the 4–week study period. Increased SGPT levels are used to diagnose liver disease before symptoms develop. In 11 fast food eaters, SGPT rose to levels suggestive of liver damage. The SGPT increases were linked to weight gain and higher sugar and carbohydrate intake.

cardiology news

CMAAO India Conference will be held from September 12 to 14, 2013 at Hotel Shangri La.

CMAAO represents Confederation of Medical Associations in Asian and Oceania. The theme for the conference on 12th and 13th will be "Be Human Stop Child Abuse" and on 14th will be "Lifestyle disorders".

cardiology news

CPR Classes: Persons trained (1200)

21st August: CPR 10 at Ramjas School, R K Puram – 1200

Total CPR since 1st November 2012 – 62966 trained

14th August: CPR 10 at Modern School, Noida (2000)

CPR Classes 62966

Media advocacy through Print Media

sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping

Media advocacy through Web Media

Sudden Cardiac Death 24th August


When could Constipation be a Serious Problem?

While most instances of constipation may not be serious, some cases of infrequent or difficult bowel movements need evaluation by a doctor 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.

Heart Care Foundation of India offers this list of warning signs:

  1. You’re constipated for the first time
  2. Constipation occurs for you very frequently.
  3. You’ve been treating constipation at home with more fiber, fluids and exercise for at least three weeks, but with no improvement.
  4. You have abdominal pain.
  5. You have bloody stools.
  6. You have unexplained weight loss.

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 62980 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 CPR 10 Training Camp was organized by Heart Care Foundation of India to train the students of Ramjas School, R K Puram

press release

Dr KK Aggarwal on Embolization shows success in benign prostatic hyperplasia

today video of the dayDr KK Aggarwal on Costly Treatment

Dr KK Aggarwal on Sleeping Disorder

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

When caring for children who are sick, who have sustained traumas, or who are suffering from nutritional inadequacies, Nurse Ron should know the correct hemoglobin (Hb) values for children. Which of the following ranges would be inaccurate?

a. Neonates: 10.6 to 16.5 g/dl
b. 3 months: 10.6 to 16.5 g/dl
c. 3 years: 9.4 to 15.5 g/dl
d. 10 years: 10.7 to 15.5 g/dl

Yesterday’s Mind Teaser: Dr. Smith suspects tracheoesophageal fistula in a 1-day-old neonate. Which nursing intervention is most appropriate for this child?

a. Avoiding suctioning unless cyanosis occurs
b. Elevating the neonate’s head and giving nothing by mouth
c. Elevating the neonate’s head for 1 hour after feedings
d. Giving the neonate only glucose water for the first 24 hours

Answer for yesterday’s Mind Teaser: b. Elevating the neonate’s head and giving nothing by mouth

Correct answers received from: Dr Prakash Khalap, daivadheenam, Raju Kuppusamy, drlaxmankumar, Prabha Sanghi, Anil Sarin, DR MONICA GANDHI, DR ARPAN GANDHI, Dr. P. C. Das , Narahari Kandakatla, Dr. V.P. Thakral, DR.BITAAN SEN & DR.JAYASHREE SEN, Dr. Thakor Hitendrsinh G, Dr Pankaj Agarwal,Dr Jainendra Upadhyay , Dr Chandresh Jardosh, DR AVTAR KRISHAN, Dr Kanta Jain, Dr B K Agarwal, Narahari Kandakatla

Answer for 28th August Mind Teaser: d. HIB, DTP, HepB; and IPV

Correct answers received from: Dr B K Agarwal, Dr.NAGESWARA RAO PATNALA, DR.BITAAN SEN & DR.JAYASHREE SEN, Dr.Rohini Dhillon. Narahari Kandakatla

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Teacher: Ellen, give me a sentence starting with "I".
Ellen: I is…
Teacher: No, Ellen. Always say, I am.
Ellen: All right. I am the ninth letter of the alphabet.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

medicolegal update

A plant blooms daily after shedding the flowers of yesterday, so let our happiness bloom daily shedding the sorrows of yesterday.

medicolegal update

Dear Sir, Very inspirative and spiritual message of Lord Krishna. Regards: Dr Tapan

Forthcoming Events

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

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medicolegal update

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