eMedinewS4th January 2014, Saturday

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 Colleague Watch my show on Zee News @ Health Wealth: Can Alcohol be Prescribed as Medicine
@ Health Wealth: All about Paralysis

Predicting sudden cardiac death

  • Normally people can walk a distance of 400–700 meters in 6 minutes.
  • People who can walk 500 meters in 6 minutes can safely go for Amarnath Yatra.
  • A 6 minute walking distance of less than 300 meter is simple and useful predictors of sudden cardiac death in patient with mild to moderate heart failure.
  • Patient with ILD who can cover less than 200 meters during 6 minute walk test are 4 times more likely to die than those who can walk greater distance.
  • People who can cover a distance of 200–300 meters need further evaluation.
  • A fall of SpO2 of more than 4% ending below 93% suggests significant desaturation.
  • An improvement of more than 70 meters or 10% in distance walk can make all the difference.
  • An improvement of 30 meters in any distance walked is the minimally important difference in any treatment.
  • Sudden cardiac death is linked to 15% of total urban mortality
  • Risk factors for sudden cardiac death include abnormal lipid level, high blood pressure, cigarette smoking physical inactivity, diabetic, obesity, family history of pre–mature heart disease or heart attack.
  • Binge alcoholism can cause sudden cardiac death (6 or more drinks per day or five drinks in one session)
  • Risk of SCA is transiently increased during for up to 30 minutes after strenuous exercise (1/1.5 million of episode of exercise)
  • If you are at low risk for having a heart problem, you do not need a regular treadmill test.

Lifestyle tricks

  • Set goals: For example to add one fruit serving in my meal every day
  • Measure progress: Count distance traveled in 6 minutes every day. An improvement of 30 meters in distance walked is significant.
  • Make goals that are achievable. For example, don’t set a goal of a daily 5 mile run if you’re out of shape.
  • Make realistic goals: Quitting smoking or losing weight without a doctor’s help may not be realistic but an additional fruit serving a day is a small, manageable step toward better health.
  • Set time commitments: Pick a date and time to start.

Full speech of Delhi CM Arvind Kejriwal in Assembly

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

Direct all your energy towards the should and nor the ego

sprritual blog

The epic Mahabharata can also be understood as a science of inner Mahabharata happening in everybody’s mind.

Lord Krishna here symbolizes with consciousness and the five Pandavas with five positive qualities of a person and they are – righteousness (Yudhishthir), being in focus (Arjuna), power to fight injustice (Bheem), helping others (Sahdev) and learning to be neutral in difficult situations (Nakul). Panchali indicates 5 senses which can only be controlled when these five forces are together.

Dhratrashtra symbolizes with ignorance, Duhshasan with negative ruling quality ( dusht while ruling) and Duryodhana (dusht in yudh) with one who is not balanced in war. To kill the negativity in the mind, one has to take conscious based decisions. Every action, if directed towards the consciousness or the soul, is the right action. To kill the 100 Kauravas (the 100 negative tendencies a person can have) controlled by Duryodhan and Duhshasan along with Shakuni (the negative power of cunningness), one has to redirect one’s positive qualities towards the consciousness and take right decisions.

The five Pandavas (positive qualities) made soul (Lord Krishna) as their point of reference (Sarthi) and won over the evils (Kauravas).

Bhishma Pitamah, Karana and Draunacharya, all had winning powers individually but they all gave support to the negative thoughts and made Duryodhana as their point of reference and ultimately had to die.

The message is very clear – if one directs his or her positive powers towards ego as the reference point in long run, they will be of no use and, in fact, will be responsible for one’s destruction.

In Ramayana, Ravana was a great scholar but he directed all his energies and powers towards his ego and ended up in misery.

One should cultivate, therefore, positive mental attitude, positive thoughts instead of directing them towards desire, attachment or ego and should direct them to soul/consciousness for a positive outcome.

cardiology news

Sometimes your biggest weakness can become your biggest strength.

Take, for example, the story of one 10–year–old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move.

"Sensei," the boy finally asked, "Shouldn’t I be learning more moves? This is the only move I know"

"But this is the only move you’ll ever need to know," the sensei replied.

Not quite understanding, but believing in his teacher, the boy kept training. Several months later, the sensei took the boy to his first tournament.

Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time–out. He was about to stop the match when the sensei intervened.

"No," the sensei insisted, "Let him continue." Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion. On the way home, the boy and sensei reviewed every move in each and every match.

Then the boy summoned the courage to ask what was really on his mind. "Sensei, how did I win the tournament with only one move?" "You won for two reasons," the sensei answered.

"First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm."

The boy’s biggest weakness had become his biggest strength.

News Around The Globe


This is what happens in civil hospital to a male resident doctor

This is what happens despite Prevention of violence against Medicare Establishment and Personal Acts. (Source Dr Neeraj Nagpal)

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

  • ESRD at ICU admission: In a retrospective analysis of data from 12,938 patients admitted to a 50–bed surgical ICU in 2004 through 2008, patients with ESRD at admission had a higher ICU mortality rate (23.1% versus 5.5%) and a higher hospital mortality rate (31.2% versus 10.0%) than patients without ESRD. (Critical Care)
  • Words capture emotional experience: Survey results published in HealthCare: The Journal of Delivery Science and Innovation reveal 35 emotion words related to health care experiences that have consistent meanings for patients, family members, and medical professionals. Positive emotion words included compassion, confident, empowered, and safe, among others. Examples of negative emotion words included afraid, frustrated, ignored, and insecure.
    • Vitamin E slows decline in Alzheimer’s: According to a study in the Journal of the American Medical Association, older veterans with mild to moderate Alzheimer’s disease who took daily supplements of 2,000 IU of vitamin E (alpha tocopherol) in a randomized trial showed less progression of functional impairment, researchers said.
    • Depression linked to low zinc levels in blood: A meta–analysis in the journal Biological Psychiatry reports that people who are depressed have lower concentrations of zinc in their peripheral blood compared with nondepressed individuals.
    • Tests of low–risk HPV types fail to detect later cancer risk: According to 2 large studies, testing for low–risk human papillomavirus (HPV) types should be excluded from cervical cancer screening because such tests fail to predict risk of developing cervical intraepithelial neoplasia (CIN) grade 3 or worse, as well as expose women to potential harm; also, they have no proven benefit for patients. Both reports were published in the journal Obstetrics & Gynecology.

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Rabies News (Dr. A K Gupta)

What is the role of monoclonal antibodies in Rabies?

Monoclonal antibodies against rabies virus have been widely used in the diagnosis and immunological analysis of rabies. Human monoclonal antibodies to rabies virus G protein are also expected to be used as a replacement for rabies immunoglobulin (RIG) in the post–exposure treatment of rabies. In 1978, Wiktor reported the preparation of rabies virus monoclonal antibodies. Since then, rabies virus monoclonal antibody (mAb) technology has been more and more widely used in basic research and diagnosis of rabies.

cardiology news

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

  • Meaningful, long–term weight loss is possible: The 8–year weight–loss results from the Look AHEAD: Action for Health in Diabetes study of overweight or obese patients with type 2 diabetes suggest it is possible to lose and keep weight off with a program of intensive lifestyle counseling. The findings are published online January 2 in Obesity. In Look AHEAD, at 1 year, 68.0% of participants who received intensive lifestyle counseling vs 13.3% of participants who received usual care lost at least 5% of their initial body weight. At 8 years, these percentages were 50.3% vs 35.7%, respectively.
  • Positive EP test helps ID Post–MI patients for ICDs: Post–myocardial infarction (MI) patients with severe left ventricular dysfunction who have a negative electrophysiologic study (EPS) showing no inducible ventricular tachycardia (VT) can do without the protection of an implantable cardioverter defibrillator (ICD), according to a new study in the journal Circulation. The patients in the series, all with a left ventricular ejection fraction (LVEF) lower than 30% or LVEF lower than 35% with heart failure, had low long-term rates of arrhythmia or death if VT could not be induced during electrophysiology testing.
cardiology news

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

  • High serum creatinine in very preterm infants: In a retrospective study of 1461 preterm infants, creatinine values greater than 1.6, 1.1, and 1.0 mg/dL respectively at 24 to 27, 28 to 29, and 30 to 32 weeks of gestation were associated with more than an 8–fold increased risk of neonatal mortality before and after adjustment for risk factors. (Plos One)
  • Oral immunotherapy for peanut allergy: In a pilot study, oral immunotherapy was found to protect some peanut–allergic patients even after therapy is discontinued. Twelve of 24 patients showed ongoing desensitization to peanuts four weeks after stopping immunotherapy, and none reported allergic reactions when contacted at a median of 40 months afterward. (Journal of Allergy and Clinical Immunology)
cardiology news

First Aid in Burns

  1. Patients with severe thermal burns are at significant risk of death and major morbidity.
  2. Look for evidence of respiratory distress and smoke inhalation injury, a common cause of death in the acute burn victim.
  3. Laryngeal edema can develop suddenly and unexpectedly.
  4. Burn depth and size determine fluid resuscitation and the need for transfer.
  5. Vascular collapse from burn shock is a critical component.
  6. Rapid, aggressive fluid resuscitation to reconstitute intravascular volume and maintain end–organ perfusion is crucial.
  7. The fluid requirement during the initial 24 hours of treatment is 4 mL/kg of body weight for each percent of TBSA burned, given IV. Superficial burns are excluded from this calculation. One–half of the calculated fluid need is given in the first eight hours, and the remaining half is given over the subsequent 16 hours.
  8. Monitor urine output is important
  9. Hourly urine output should be maintained at 0.5 mL/kg in adults.
  10. Carbon monoxide and cyanide – Burn patients may be exposed to carbon monoxide, requiring immediate treatment with high–flow oxygen.
  11. Cool and clean wounds, but avoid inducing hypothermia.
  12. Remove any jewelry and any hot or burned clothing and obvious debris not densely adherent to the skin.
  13. Irrigation with cool water may be used.
  14. Topical antibiotics are applied to all non superficial burns.
  15. Give opioids (morphine) to treat pain and give tetanus prophylaxis.
cardiology news

Total CPR since 1st November 2012 – 84073 trained

Media advocacy through Web Media

web media webmedia webmedia
press release

Negative stress may lead to heart disease

Marital disharmony and job dissatisfaction are the two main mental risk factors for the causation of heart attack. Many studies in the past have linked that there is a strong correlation between a nagging wife and early heart attacks in men. Similarly, literature has shown that work related stress is related to early onset of high blood pressure, diabetes, stroke and heart attacks said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & National Vice President IMA.

A study from University College, London has shown that chronically stressed workers have a 68% of higher risk of developing heart disease especially in people under the age of 50.

Whether it is stress related chemical changes or stress related behavior linked to heart disease, is yet to be answered. Stress related lifestyle involves eating unhealthy food, smoking, drinking and skipping exercises.

Chemical changes related to chronic stress are increased levels of cortisol, epinephrine and norepinephrine.

Amongst stress, negative stress is more dangerous than positive stress and amongst negative stress it is jealousy, anger and cynicism which are associated with heart attack.

The answer lies in managing stress by acting on a personal situation and not reacting to it. In children the same type of stress, especially during exam days, can end up with anxiety, insomnia and suicidal attempts.

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 Teachers learned CPR–10

press release

Statins may worsen asthma

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

A hemodynamically stable nulliparous patient with ectopic preganancy has adnexal mass of 2.5 × 3 cms and Beta hCG titre of 1500 miu/ml. What modality of treatment is suitable for her:

1. Conservative management.
2. Medical Management.
3. Laparoscopic Surgery.
4. Laparotomy.

Yesterday’s Mind Teaser: A 55–year–old lady presenting to outpatient department (OPD) with postmenopausal bleeding for 3 months has a 1×1 cm nodule on the anterior lip of cervix. The most appropriate investigation to be done subsequently is:

1. Pap smear
2. Punch biopsy
3. Endocervical curettage
4. Colposcopy

Answer for yesterday’s Mind Teaser: 2. Punch biopsy

Correct answers received from: Narahari Kandakatla, DR.A.K.GAJJAR, Dr.K.V.Sarma, Dr.K.Raju, Dr. Vishal D Wahane, daivadheenam, Dr Chandresh Jardosh, Dr.Bitaan Sen & Dr.Jayashree Sen,dranish jain, DR AVTAR KRISHAN, DR. BIPIN Vyas, Dr Gopal Shinde, Shravan Kumar, Manjit Mohi

Answer for 2nd January Mind Teaser: 4. IgM.

Correct answers received from: Muthumperumal Thirumalpillai,

Send your answer to ijcp12@gmail.com

medicolegal update

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

Q. Can MD Pharmacology get a licence to run a medical store?

Ans. The licence can be given only after the requirements laid down by the licencing authority are fulfilled in accordance with the Drugs and Cosmetics Act, 1940, and the Rules, 1945. A degree in pharmacology is not a requirement.
––M C Gupta

medicolegal update
medicolegal update

Priceless definitions

Something other people have, similar to my character lines.

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

medicolegal update

Shame occurs when you haven’t been able to get away with the ‘who’ you want people to think you are. Carl Whitake

medicolegal update

Dr KK Aggarwal: ECG not reliable marker for predicting heart disease http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Happiness can be woven into every aspect of life once you make new choices http://bit.ly/15QdVeB #Health

medicolegal update
  1. .Dear Sir, Very informative news. Regards: Dr Karan

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