eMedinewS3rd March 2014,Monday

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.twitter.com/DrKKAggarwal
www.facebook.com/Dr KKAggarwal

INDIA LIVE 2014

What can a Quasi–judicial Body not decide?

An authority is described as Quasi-judicial because it has some of the attributes or trappings of a ‘Court’ but not all. A true judicial decision presupposes an existing dispute between two or more parties and then involves four requisites:

  1. The presentation (not necessarily orally) of their case by the parties to the dispute.
  2. If the dispute between them is a question of fact, the ascertainment of the fact by means of evidence adduced by the parties to the dispute and often with the assistance or argument by or on behalf of the parties of the evidence.
  3. If the dispute between them is a question of law, the submission of legal argument by the parties; and
  4. A decision which disposes of the whole matter by a finding upon the facts in dispute and an application of the law to the facts so found, including, where required, a ruling upon any disputed question of law.

    A Quasi–judicial decision, on other hand, involves requisites (1) and (2), does not necessarily involve (3) and never involves (4). The place of (4) is in fact taken by administrative action
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
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Significance of Lighting a Lamp in Any Worship?

sprritual blog

Prayer

Deepajyothi parabrahma
Deepa Jyotir Janaardanah
Deepo harati paapaani
Sandhyaa deepa namostute ||

I prostrate to the dawn/dusk lamp; whose light is the Knowledge Principle (the Supreme Lord), which removes the darkness of ignorance & by which all can be achieved in life.

Light symbolizes knowledge, and darkness, ignorance. Knowledge removes ignorance just as light removes darkness. The purpose of any ritual is to remove internal darkness and attain some knowledge.

Vedic literature recommends lighting of lamp daily as a part of pooja ritual. Some do it once at dawn, others twice a day – at dawn and dusk and remaining continuously (akh anda deepa). No auspicious function can commence without lighting of the lamp and the same is to be maintained right through the occasion.

Knowledge is a lasting inner wealth by which all outer achievement can be accomplished.
By lighting the lamp we bow down to knowledge as the greatest of all forms of wealth. Knowledge about the self is the greatest wealth. It goes around achieving inner happiness by burning the negativity of mind full of lust and ego.

The traditional oil lamp defines this spiritual significance. The oil or ghee symbolizes our vasanas (lust) and negative tendencies (the wick & the ego). When lit by spiritual knowledge, the vasanas get slowly exhausted and the ego too finally perishes. The flame of a lamp always burns upwards signifying that the only those knowledge should be acquired that take us towards higher ideals.

cardiology news

The Little Wave

The story is about a little wave, bobbing along in the ocean, having a grand old time. He’s enjoying the wind and the fresh air –until he notices the other waves in front of him, crashing against the shore. "My God, this terrible", the wave says. "Look what’s going to happen to me!"

Then along comes another wave. It sees the first wave, looking grim, and it says to him: "Why do you look so sad?" The first wave says: "You don’t understand! We’re all going to crash! All of us waves are going to be nothing! Isn’t it terrible?"

The second wave says: "No, you don’t understand. You’re not a wave; you’re part of the ocean."

News Around The Globe

INDIA LIVE 2014
"Revolutionise Interventional Cardiology in the Region",
Taj Palace Hotel, 28th February to 2nd March 2014

VUS-Guided Stent Placement Improves Outcomes vs Angiography

Dr. Neeraj Pandit, Senior Cardiologist, Associate Prof RML Hospital, New Delhi

The use of intravascular ultrasound (IVUS) to guide stent placement in percutaneous coronary intervention (PCI) leads to better clinical outcomes than use of angiography guidance, according to a meta-analysis of 3 randomized trials and 12 observational studies published between 2005 and 2013 totaling 24,849 patients (n = 11,793 IVUS-guided and n = 13,056 angiography-guided). Compared with angiography, IVUS–guided PCI was associated with a reduction in the risk of MACE, all–cause mortality, MI, TVR, and stent thrombosis. The advantage of IVUS–guided DES implantation appears related to lower incidence of MI or risk of death rather than a decreased rate of angiographic restenosis or repeat revascularization. Specifically, the data suggest that the benefit of IVUS in the DES era might be "the capability to identify factors associated with periprocedural complications, such as side branch occlusion, stent edge dissections and hematoma, stent under expansion, and incomplete stent apposition."

Exercise Testing in Asymptomatic Severe Aortic Stenosis

Dr. B.B Chanana

HOD, Maharaja Agrasen Hospital, New Delhi

The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these patients. However, the optimal timing for surgery remains controversial due to the lack of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification, and randomized studies on patient management. Exercise stress testing with or without imaging is strictly contraindicated in symptomatic patients with severe aortic stenosis.

Exercise stress test is now recommended by current guidelines in asymptomatic patients and may provide incremental prognostic value. Indeed, the development of symptoms during exercise or an abnormal blood pressure response are associated with poor outcome and should be considered as an indication for surgery, as suggested by the most recently updated European Society of Cardiology 2012 guidelines.

Exercise stress echocardiography may also improve the risk stratification and identify asymptomatic patients at higher risk of a cardiac event. When the test is combined with imaging, echocardiography during exercise should be recommended rather than post-exercise echocardiography. During exercise, an increase >18 to 20 mm Hg in mean pressure gradient, absence of improvement in left ventricular ejection fraction (i.e., absence of contractile reserve), and/or a systolic pulmonary arterial pressure>60 mm Hg (i.e., exercise pulmonary hypertension) are suggestive signs of advanced stages of the disease and impaired prognosis. Hence, exercise stress test may identify resting asymptomatic patients who develop exercise abnormalities and in whom surgery is recommended according to current guidelines.

Exercise stress echocardiography may further unmask a subset of asymptomatic patients (i.e., without exercise stress test abnormalities) who are at high risk of reduced cardiac event free survival. In these patients, early surgery could be beneficial, whereas regular follow–up seems more appropriate in patients without echocardiographic abnormalities during exercise.

Unprotected LMCA Stenting: Follow up Surveillance Angiography

Dr. Rajeev Bhagwat
HOD, Nanavati Hospital, Mumbai

  • Stents in the coronary arteries are more demanding than those in other parts of the body.
  • Blood compatibility has been added to the requirements for biological performance.
  • Durable polymer stents in the coronary circulation elicit a more severe reaction than subcutaneous implants.
  • In durable polymer-based stents, an early thrombotic occlusion was observed in some studies;18% incidence of subacute closure was noted by withholding anticoagulant with Palmaz&–Schatz stent.
  • Physicians now prefer biodegradable polymers. They become BMS after couple of months; dual antiplatelet therapy can be limited for such patients.

Dedicated bifurcation stenting is the way to go

Dr Nimit C Shah, Consultant Interventional cardiologist, MBBS, MRCP (UK), MD (UK),CCT in Cardiology (OXford, UK) Interventional fellowship (Dorset Heart Centre, UK).

  • Outcomes associated with bifurcation lesions are less favorable
  • Existing evidence suggests that in general a two–stent strategy is associated with lower rates of procedural success, increased (MACE) , (TLR), (TVR), a procedural MI, ST and ISR.
  • Three-dimensional geometry of a coronary bifurcation is complex
  • Clear disparity between the Y–shape of a bifurcation and the cylindrical shape of a stent
  • Huge variation in anatomy: vessel size differences, vessel angulations, plaque distribution etc.
  • Dedicated bifurcation stents are an interventionalist’s dream especially in complex anatomy as they
  • Simplify procedure
  • Improve procedural success
  • Improve late outcomes
  • Large clinical trials are complete or underway for some devices
  • Progress is being made

We have got data on an Early UK experience of the AXXESSTM dedicated bifurcation stent Our data of 69 lesions suggest that the AXXESSTM dedicated bifurcation stent can be safely used and successfully delivered to treat bifurcation lesions with high peri–procedural success rates supported by positive 5 year data from Diverge study

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

What is the mode of action of IDRV?

The deposition of approved modern rabies vaccine (or antigen) in the layers of dermis of skin stimulates the immunoreceptive Langerhan cells present within the dermis. Subsequently the antigen is carried by antigen presenting cells via the lymphatic drainage to the regional lymph nodes and later to the reticuloendothelial system eliciting a prompt and highly protective antibody response. Immunity is believed to depend mainly upon the CD 4+ T– cell dependent neutralizing antibody response to the G protein. In addition, cell–mediated immunity has long been reported as an important part of the defense against rabies. Cells presenting the fragments of G protein are the targets of cytotoxic T– cells and the N–protein induced T helper cells. The immune response induced by IDRV is adequate and protective against rabies.

cardiology news

Nine modifiable risk factors for heart attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors: include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, and one should daily consume of fruits and vegetables and do regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one–half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

All hypertensive patients should keep their sugar lower than 90mg%

Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage, 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 results of the anglo–Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT–BPLA) study has shown that the major predictor of new–onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg%. The risk increases by 5.8 times for each 18mg% rise above 90 mg%.

Other risk factors are higher weight, higher blood pressure and higher triglyceride levels. Apart those high BP patients taking the drugs atenolol (beta blocker drug) regimen with or without a diuretic are also at risk.

On the other hand high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use, and age older than 55 years had protection from developing 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 86664 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

Padma Shri Awardee Dr. K K Aggarwal receives the DST National Award for Outstanding Efforts in Science & Technology Communication

press release

AHA – ACS update

vedio of day

today video of the dayPadma Shri & Dr B C Roy National Awardee,Dr KK Aggarwal on Tackling tension headaches

Hands only CPR 10 Utsav, 15th December 2013

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

eMedi Quiz

The parameters of sensitivity and specificity are used for assessing:

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

Yesterday’s Mind Teaser: The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1.Fluorescence spectroscopy.
2.Electron microscopy.
3.Nuclear magnetic resonance.
4.X–ray diffraction .

Answer for yesterday’s Mind Teaser:4.X–ray diffraction

Correct answers received from: Dr B K Agarwal, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Jainendra Upadhyay,Dr Chandresh Jardosh,DR Avtar Krishan, Daivadheenam Jella,Dr.Bitaan Sen & Dr.Jayashree Sen,

Answer for 28th February Mind Teaser: 3.Gelfiltration chromatography.

Correct answers received from: Daivadheenam Jella, Dr.Bitaan Sen & Dr.Jayashree Sen

Send your answer to ijcp12@gmail.com

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centralbank
medicolegal update

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medical querymedical query

medicolegal update
medicolegal update

Coffee Dilemma

A man and his wife were having an argument about who should brew the coffee each morning.

The wife said, "You should do it, because you get up first, and then we don’t have to wait as long to get our coffee".

The husband said, " You are in charge of the cooking around here and you should do it, because that is your job, and I can just wait for my coffee."

Wife replies, "No you should do it, and besides it is in the Bible that the man should do the coffee."

Husband replies, " I can’t believe that, show me."

So she fetched the Bible, and opened the New Testament and shows him at the top of several pages, that it indeed says:

"HEBREWS"

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: : A patient of pulmonary Koch’s taking ATT complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure to prescribe B–complex vitamins (especially vitamin B6) in patients talking ATT to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system

medicolegal update

Greatness is so often a courteous synonym for great success – Philip Guedalla

medicolegal update

Dr KK Aggarwal: ECG not reliable marker for predicting heart disease http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: When you express your creativity in the world, you honor your own needs and serve the needs of humanity http://bit.ly/WAHF_Am #WAYHF

Forthcoming events

Date: Saturday 2PM-Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

medicolegal update
  1. Dear Sir, Thanks for the information: Regards: Dr Kartik

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

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