eMedinewS4th April 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

Free and Subsidized treatment to Hemophilic Patients in Delhi’s Three Hospitals

By the intervention of the Delhi High Court, now hemophilic BPL patients will get free and subsidized treatment for life, if they are not able to afford the cost of the treatment. Justice M.M. Singh of Delhi High Court disposed of the petition on April 1st 2014, filed on behalf of one patient suffering from hemophila.

On 26th March, 2014, this Court directed Government of NCT of Delhi to place on record the Scheme under which hemophilia patients were being given free treatment. The Delhi Government was also directed to explain as to why petitioner’s case did not fall within the parameters of the aforesaid Hemophilia Scheme.

As per the submissions by the Principal Secretary, Health and Family Welfare, Government of NCT of Delhi "In pursuance of directions of the Hon’ble High Court and meetings held by the Committee, the following course of action has been decided upon in so far as Govt. of NCT of Delhi is concerned:"

1. Facility to provide anti–hemophilic factor (AHF) for hemophilia patients shall be provided in three hospitals of this Government namely, Lok Nayak, DDU and GTB hospitals. Dr. Naresh Gupta, Professor of Medicine & Head, Clinical Hematology, MAMC will be the Coordinator/Nodal Officer. Medical Superintendents of Lok Nayak, DDU Hospitals will also designate a nodal officer for this purpose.

Treatment in these three hospitals would be given along the following lines:

  1. All BPL families will be supplied AHF free of cost.
  2. Free treatment will be given to all Hemophilia patients who came to designated hospitals i.e. LNH, GTB and DDU in an emergency.
  3. In respect of APL patients with minimum three years domicile in Delhi, the following graded payment system will be adopted.
    1. Family income upto Rs. 2 lakhs per annum-20% of cost of AHF (concerned MS would be competent to relax 20% charge in exceptional cases for reasons to be recorded in writing).
    2. Family income between Rs.2–5 lakhs per annum–50% of cost of AHF.
    3. Family income above Rs.5 lakhs per annum–full cost of AHF.

Patients would be required to provide documentary evidence regarding family income (BPL card, pay slip, income certificate from Executive Magistrate, income tax statement etc.), patients would have to produce voter I–card, extract of electoral roll, passport, etc.

Delhi High Court Views: In view of the aforesaid letter, this Court is of the view that all hemophilia patients irrespective of the medication that they require have to be given treatment in accordance with the said letter. Reference: Manmohan, J: (Oral). Amit Ahuja vs. Union Of India & Ors., W.P.(C) 1507/2014 & CM Appl. 3144/2014, Date of Decision: 1st April, 2014, Available at: http://lobis.nic.in/dhc/MMH/judgement/01–04–2014/MMH01042014CW15072014.pdf

(Source: From excerpts written by Dr. Mukesh Yadav)

News Around The Globe

  • A recent research published online in the Journal of Clinical Endocrinology & Metabolism has revealed that considerable amount of neglect or abuse during childhood adversely affects the levels of hormones leptin and irisin, thereby suggesting a link between adversity in early years and metabolic disorders later in life. Higher levels of C–reactive protein and lower adiponectin levels were also found in the high–adversity group.
  • A study published in the journal Surgery analyzed 76 consecutive patients with BMI >30 kg/m2 and 76 non–obese patients and noted that obese patients undergoing laparoscopic colectomy for cancer fared as well as the non–obese subjects in both perioperative and long–term oncologic outcomes. The operative duration for the obese patients was on average 182 minutes vs. 157 minutes for the non–obese group. There were no significant differences in rates of long–term complications and the overall survival rates at five years were 85.6% for obese patients and 89.3% for non–obese subjects.
  • A new study conducted by researchers from Netherlands has reported that fetoscopic laser coagulation of the entire vascular equator has the potential to reduce fetal morbidity in twin–to–twin transfusion in comparison to selective coagulation. The study authors investigated whether using the Solomon technique could improve outcomes and noted that the primary outcome — a composite of incidence of twin anemia polycythemia sequence, recurrence of twin–to–twin transfusion syndrome, perinatal mortality or severe neonatal morbidity — occurred in 34% of the fetuses treated with the Solomon technique vs. 49% of the standard–treatment group.
  • A research paper published online March 25 in Translational Psychiatry has put forward phenomenal findings by researchers at the University of Michigan. The researchers have used skin fibroblasts from patients with bipolar disorder (BD) to create the very first stem cell lines specific to the disorder. Melvin McInnis, the principal investigator of the Prechter Bipolar Research Fund and its programs, said that this research could help in achieving personalized medicine both for the understanding of pathophysiology of the disorder and to ascertain what interventions will be effective.
  • A recent study published in JAMA Internal Medicine reports that antihypertensive medications not only lower the blood pressure but may also result in falls in elderly patients. In comparison with individuals who were not taking antihypertensive medications, those taking antihypertensives had a 30–40% increased risk of falls resulting in a serious fall–related injury. Furthermore, the risk for a serious fall-related injury doubled in those who had a history of falls.

Medicine news

Obesity primes the colon for cancer, according to NIH study

Obesity, rather than diet, causes changes in the colon that may lead to colorectal cancer, according to a study in mice by the National Institutes of Health. The finding bolsters the recommendation that calorie control and frequent exercise are not only key to a healthy lifestyle, but a strategy to lower the risk for colon cancer, the second leading cause of cancer–related death in the United State

6 cases of new tick–borne Heartland virus, CDC reports

The Centers for Disease Control and Prevention has advised to consider Heartland virus testing for patients who have otherwise unexplained fever, leukopenia, and thrombocytopenia and who have tested negative for Ehrlichia and Anaplasma infection or have not responded to doxycycline therapy. Heartland is a newly identified phlebovirus transmitted by the Lone Star tick (Amblyomma americanum). CDC defines Heartland virus infection: fever ≥100.4°F, white blood cell count, <4500, Platelet count, <150,000/mm3 without a more likely clinical explanation.

One–third of children tested in Texas have borderline or high cholesterol

One in three children undergoing routine lipid screening in primary–care pediatric clinics have cholesterol levels considered high or borderline high, according to a new analysis. Regarding LDL–cholesterol levels, 46% of children have borderline–high or elevated levels and 44% have HDL–cholesterol levels considered low or borderline low as per Dr Thomas Seery (Texas Children’s Hospital, Houston). 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommends that children undergo lipid screening for nonfasting non–HDL–cholesterol levels or a fasting lipid panel between the ages of nine and 11 years followed by another full lipid screening test between 18 and 21 years of age.

Aspirin flops for postop MI prevention

Low–dose clonidine given to patients undergoing noncardiac surgery did not reduce the rate of death or nonfatal myocardial infarction at 30 days; but, it did increase the risk of hypotension and nonfatal cardiac arrest. Aspirin given before surgery and throughout the early postsurgical period to patients undergoing noncardiac surgery had no significant effect on the rate of death or nonfatal myocardial infarction at 30 days but increased the risk of major bleeding. Neither aspirin nor clonidine helped prevent heart attacks as a complication of non–cardiac surgery, a randomized trial showed. (Perioperative Ischemic Evaluation 2 (POISE–2) trial in New England Journal of Medicine)

Rabies News (Dr A K Gupta)

Does kissing a rabies patient call for anti-rabies vaccination?

Kissing a rabies patient may transmit disease because there may be contact with rabies patient’s saliva. Full post–exposure immunization must be given either by intramuscular (IM) or intradermal (ID) route.

If there are ulcers in the mouth of the exposed person, then rabies immunoglobulins (RIG) must be given by IM route.

Cardiology eMedinewS

  • A much debated presentation at the American College of Cardiology 2014 Scientific Sessions has reported that the rate of major adverse cardiac events (MACE) is significantly lower in the heparin–treated patients at 28 days in comparison to bivalirudin. The single–center randomized trial also reported no differences in bleeding complications in the two groups. It was noted that at four weeks, the primary efficacy end point (MACE, defined as all–cause mortality, cerebrovascular accident, reinfarction, or unplanned target lesion revascularization (TLR)) had occurred in 8.7% of bivalirudin-treated patients and in 5.7% of heparin–treated patients.
  • One–year data from the Transcatheter Valve Therapy (TVT) Registry has reported that 56% of patients undergoing transcatheter aortic–valve replacement (TAVR) therapy are still alive and have not been readmitted to the hospital for any cause. The overall mortality at one year was just above 26%. Additionally, the rate of stroke at one year was 3.6%; a rate that is significantly lower than that in previous trials. The study results were presented at the American College of Cardiology 2014 Scientific Sessions.

Pediatrics eMedinewS

  • According to a new study published in JAMA Pediatrics, the performance of kids in school, their relationships with peers and their weight are all related with how their parents monitor their television and video game habits. The study included 1,323 third– to fifth–grade students and reported that parents regulating the screen time kids watch, restricting what they watch and talking about the shows was linked to more sleep, better school performance and less aggression among kids.
  • Siblings of children with vesicoureteral reflux (VUR) have a significantly higher risk for reflux than the general pediatric population, reports a study published recently in Pediatrics. Researchers analyzed data from 275 families with VUR; among 424 siblings screened, about 45% were found to have VUR while another 128 siblings were diagnosed with VUR after a urinary tract infection. VUR in siblings was high–grade in about 46%.

Dr K K Spiritual Blog

The 3 C’s: Don’t Criticize, Condemn, or Complain!

  • Don’t Criticize, always look for positive in a person or a situation. There is always something positive in every situation.
  • Don’t Condemn a situation (and a person) howsoever small it may be.
  • Don’t Complain, unless it is a must.

You will not do any of the 3 Cs if you are laughing. By avoiding the 3Cs we avoid a lot of arguments that would usually naturally occur when you criticize, condemn or complain. If we criticize, condemn, complain, show resentment, or gossip about others, it comes back to "us." If we praise, support, encourage and forgive others, this too comes back to us.

Wellness Blog

Cancer survival rates can increase the anxiety

One of the first questions many people ask when first diagnosed with cancer is their prognosis. They want to know whether their cancer is relatively easy or more difficult to cure. The doctor cannot predict the future, but often he/she gives the estimates based on the experiences of other people with the same cancer. Survival statistics can be confusing and frightening. Survival rates cannot tell about the situation specifically. The statistics may be impersonal and not very helpful.

Cancer survival rates or survival statistics indicate the percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use a five–year survival rate. For instance, the five–year survival rate for prostate cancer is 99 percent. That means that of all men diagnosed with prostate cancer, 99 of every 100 lived for five years after diagnosis. Conversely, one out of every 100 will die of prostate cancer within five years. Cancer survival rates are based on research that comes from information gathered on hundreds or thousands of people with cancer. An overall survival rate includes people of all ages and health conditions diagnosed with the cancer, including those diagnosed very early and those diagnosed very late. Only the treating doctor may be able to give more specific statistics based on the stage of cancer. For instance, 49 percent, or about half, of people diagnosed with early–stage lung cancer live for at least five years after diagnosis. The five–year survival rate for people diagnosed with lung cancer that has spread (metastasized) to other areas of the body is 2 percent. Overall and relative survival rates don’t specify whether cancer survivors are still undergoing treatment at five years or if they’ve become cancer free (achieved remission). The five year survival rates for all men is 47.3–66%% and for all women is 55.8–63%

Other terms

  • Disease–free survival rate: This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies.
  • Progression–free survival rate: This is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but their cancer hasn’t disappeared completely.

Inspirational Story

Mom’s Last Laugh

Consumed by my loss, I didn’t notice the hardness of the pew where I sat. I was at the funeral of my dearest friend — my mother. She finally had lost her long battle with cancer. The hurt was so intense; I found it hard to breathe at times.

Always supportive, mother clapped loudest at my school plays, held a box of tissues while listening to my first heartbreak, comforted me at my father’s death, encouraged me in college, and prayed for me my entire life.

When mother’s illness was diagnosed, my sister had a new baby and my brother had recently married his childhood sweetheart, so it fell on me, the 27–year–old middle child without entanglements, to take care of her. I counted it an honor.

"What now, Lord?" I asked sitting in church. My life stretched out before me as an empty abyss. My brother sat stoically with his face toward the cross while clutching his wife’s hand.

My sister sat slumped against her husband’s shoulder, his arms around her as she cradled their child. All so deeply grieving, no one noticed I sat alone. My place had been with our mother, preparing her meals, helping her walk, taking her to the doctor, seeing to her medication, reading the Bible together. Now she was with the Lord. My work was finished and I was alone.

I heard a door open and slam shut at the back of the church. Quick footsteps hurried along the carpeted floor. An exasperated young man looked around briefly and then sat next to me. He folded his hands and placed them on his lap. His eyes were brimming with tears. He began to sniffle. "I’m late," he explained, though no explanation was necessary. After several eulogies, he leaned over and commented, “Why do they keep calling Mary by the name of ‘Margaret’?"

"Oh" "Because that was her name, Margaret. Never Mary. No one called her ‘Mary,’ I whispered. I wondered why this person couldn’t have sat on the other side of the church. He interrupted my grieving with his tears and fidgeting. Who was this stranger anyway?

"No, that isn’t correct," he insisted, as several people glanced over at us whispering, "Her name is Mary, Mary Peters." "That isn’t who this is, I replied." "Isn’t this the Lutheran church?" "No, the Lutheran church is across the street." "Oh." "I believe you’re at the wrong funeral, Sir."

The solemnest of the occasion mixed with the realization of the man’s mistake bubbled up inside me and came out as laughter. I cupped my hands over my face, hoping it would be interpreted as sobs.

The creaking pew gave me away. Sharp looks from other mourners only made the situation seem more hilarious. I peeked at the bewildered, misguided man seated beside me. He was laughing too, as he glanced around, deciding it was too late for an uneventful exit.

I imagined mother laughing. At the final "Amen," we darted out a door and into the parking lot.

"I do believe we’ll be the talk of the town," he smiled. He said his name was Rick and since he had missed his aunt’s funeral, asked me out for a cup of coffee. That afternoon began a lifelong journey for me with this man who attended the wrong funeral, but was in the right place.

A year after our meeting, we were married at a country church where he was the assistant pastor. This time we both arrived at the same church, right on time. In my time of sorrow, God gave me laughter. In place of loneliness, God gave me love. This past June, we celebrated our twenty–second wedding anniversary. Whenever anyone asks us how we met, Rick tells them, "Her mother and my Aunt Mary introduced us, and it’s truly a match made in heaven."

ePress Release

Diabetes mainly linked to obesity

Type 2 diabetes mellitus is strongly associated with obesity 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.

More than 80 percent of cases of type 2 diabetes can be attributed to obesity.

  1. There is a curvilinear relationship between BMI and the risk of type 2 diabetes.
  2. Lowest risk is associated with a BMI below 22 kg/m2
  3. At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.
  4. Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.
  5. The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.
  6. Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.
  7. Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.
  8. Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.
  9. Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contribute to high lipid levels and high blood pressure.

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
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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

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VIP’s on CPR 10 Mantra Video

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

emedipicstoday emedipics

A free heart checkup camp was organised by Heart Care Foundation of India at Mandi House, Doordarshan Kendra where over 500 people were examined.

press release

Monitoring LFT in a patient on statins

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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 patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

eMedinewS Humor

A doctor of psychology was doing his normal morning rounds, and he entered a patient’s room to find his patient sitting on the floor, sawing at a piece of wood with the side of his hand.

Meanwhile, another patient was in the room, hanging from the ceiling by his feet.

The doctor asked his patient what he was doing, sitting on the floor.

The patient replied in an irritated fashion, "Can’t you see I’m sawing this piece of wood in half?"

The doctor inquired, "And what is the fellow hanging from the ceiling doing?"

"Oh. He’s my friend, but he’s a little crazy. He thinks he’s a light bulb."

The doctor asks, "If he’s your friend, don’t you think you should get him down from there before he hurts himself?"

"What? And I work in the dark!?!"

Quote of the Day

If you can’t excel with talent, triumph with effort. Dave Weinbaum


Twitter of the Day

Dr KK Aggarwal: Do not misuse Navratri diet By Dr k k Aggarwal http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Emotional intelligence begins when you feel what you feel without labels or evaluation.


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 – reg mno, rawat.vandana89@gmail.com
SMS – BK Sapna reg mno1, bksapna@hotmail.com

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


Our Contributors

Dr Veena Aggarwal, Dr Chanchal Pal, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Monica Vasudev, Dr Navin Dang, Dr Pawan Gupta, Dr Parveen Bhatia, Dr Prachi Garg, Rajat Bhatnagar, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

eMedi Quiz

Injury to radial nerve in lower part of spiral groove:

1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Yesterday’s Mind Teaser: The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

1. Transitional
2. Stratified squamous
3. Stratified cuboidal.
4. Stratified columnar.

Answer for yesterday’s Mind Teaser: 1. Transitional

Correct answers received from: Dr P C Das, Dr K V Sarma, Dr Raghavendra Jayesh, Dr K Raju, Dr Pankaj Agarwal,
Dr Jainendra Upadhyay, Anil Tandon, Dr Avtar Krishan, Daivadheenam Jella, Dr B K Agarwal.

Answer for 2nd April Mind Teaser: 3.Lateral rectus and abducent nerve.

Correct answers received from: Archna Parwani.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Very informative newspaper. Regards: Dr Kartik
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