eMedinewS4th July 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

Hypertension Update

  1. Failure of renal denervation in resistant hypertension: Although several unblinded studies suggested that renal denervation could substantially lower blood pressure in patients with resistant hypertension, a blinded randomized trial (SYMPLICITY–HTN–3) failed to demonstrate benefit (1).
  2. Due to the lack of benefit, a larger ongoing international trial (SYMPLICITY–HTN–4) was stopped early.
  3. Revascularization in high–risk patients with renal artery stenosis: Randomized trials of renal artery revascularization in patients with renal artery stenosis did not include many patients with high–risk factors such as flash pulmonary edema, resistant hypertension, and progressive kidney disease. In a prospective cohort study, 467 patients with renal artery stenosis, treated according to patient and physician preferences with either revascularization or medical therapy alone, were followed for a median of 3.8 years (2). Revascularization was independently associated with a lower risk of death in patients who presented with flash pulmonary edema (58 versus 76 percent) and in patients who presented with both resistant hypertension and progressive kidney function decline (9 versus 65 percent).
  4. JNC–8 guidelines: JNC–8, the major change compared with the older JNC–7 guidelines is a higher blood pressure goal for older adults (60 years and older) and for patients with diabetes mellitus or chronic kidney disease. (3)
  5. CORAL trial of stenting in renal artery stenosis: In a randomized trial comparing revascularization plus medical therapy with medical therapy alone in 947 patients with atherosclerotic renal artery stenosis and either poorly controlled hypertension or a decreased estimated glomerular filtration rate (eGFR <60mL/min/1.73m2), revascularization had no effect at 3.6 years on the primary outcome (a composite of cardiovascular or renal death, stroke, myocardial infarction, hospitalization for heart failure, a reduction in eGFR by more than 30 percent, or end–stage renal disease) or any individual component of the primary outcome (4).
  6. BP goal and progression of renal disease in patients with proteinuric CKD: One meta–analysis, combined seven goal blood pressure trials including 5308 patients with CKD that were followed for at least 1.6 years (5). Compared with standard blood pressure lowering, more aggressive blood pressure lowering significantly reduced the risk of renal events (defined as end–stage renal disease, a doubling of serum creatinine, or 50 percent reduction in glomerular filtration rate) among those with proteinuric CKD (38.5 versus 40.5 percent). 6. Blood pressure lowering and cardiovascular events in patients with non–proteinuric CKD: A meta-analysis examined the cardiovascular outcomes and mortality of 30,295 patients with an estimated glomerular filtration rate <60 mL/min/1.73m2 from 26 randomized hypertension trials; 93 percent of patients were non–proteinuric (6). Compared with placebo, both ACE inhibitors (3.2 percent absolute decrease) and calcium channel antagonists (2.1 percent absolute decrease) reduced the composite of stroke, myocardial infarction, heart failure, and mortality. In drug versus drug trials, the incidence of these events was similar comparing angiotensin inhibitors with diuretics or beta–blockers (18 versus 19 percent) or with calcium channel antagonists (23 versus 24 percent).


  1. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370:1393.
  2. Ritchie J, Green D, Chrysochou C, et al. High–risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 2014; 63:186.
  3. James PA, Oparil S, Carter BL, et al. 2014 evidence–based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507.
  4. Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal–artery stenosis. N Engl J Med 2014; 370:13.
  5. Lv J, Ehteshami P, Sarnak MJ, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta–analysis. CMAJ 2013; 185:949.
  6. Blood Pressure Lowering Treatment Trialists’ Collaboration, Ninomiya T, Perkovic V, et al. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta–analysis of randomised controlled trials. BMJ 2013; 347:f5680.
    (Source Uptodate)

News Around The Globe

  • Insulin–pump therapy appears to be effective for patients with type 2 diabetes in whom multiple daily injections do not provide adequate glycemic control, reports a new study published online July 3 in the Lancet.
  • A new multi–institutional study has reported that the earlier damage control laparotomy patients are taken back to the operating room, the more likely primary fascial closure will succeed. Best results may be noted if the reoperation takes place within 24 hours of the initial surgery. The research was done by the Open Abdomen Study Group of the American Association for the Surgery of Trauma and published online in Surgery.
  • Researchers from Duke–NUS Graduate Medical School Singapore have pointed that shortness of sleep speeds up the aging of the brain in older people. According to their study, published in Sleep, every hour of reduced sleep duration led to an incremental annual expansion of the brain ventricles and an annual incremental decline in global cognitive performance.
  • The U.S. Food and Drug Administration has approved OZURDEX as a new treatment option for diabetic macular edema (DME) in adult patients who have an artificial lens implant (pseudophakic) or who are scheduled for cataract surgery (phakic).
  • A new study in the journal Neurology suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate Parkinson’s disease. In the study, vigorous walks 3 days a week improved just about everything in patients with mild to moderate Parkinson’s disease.

Rabies News (Dr A K Gupta)

What are the signs of rabies in dogs/cats?

  • Any change in normal behavior suggesting either undue aggression or depression.
  • Running aimlessly and attacking others without provocation.
  • Becomes too drowsy and withdraws to a corner.
  • Change in voice/bark.
  • Excessive salivation.
  • Refusal to feed or eating objects like stone, paper, wood, metal pieces etc.

Cardiology eMedinewS

  • A proof–of–concept study revealed that shortly after eating the equivalent of a small bar of dark, but not milk, chocolate, patients with moderate to severe peripheral arterial disease (PAD) could walk slightly farther and longer on a treadmill before stopping due to pain. The study is published July 2 in the Journal of the American Heart Association.
  • Among patients with type 2 diabetes taking insulin, those who achieve good glycemic control were less likely to have a major adverse cardiac event (MACE) in the medium term than those who failed to achieve this, reports a new "real–world" study, presented recently at the American Diabetes Association (ADA) 2014 Scientific Sessions.

Pediatrics eMedinewS

  • A new study published online in the Journal of Child and Adolescent Psychopharmacology has revealed that psychostimulant use in children and adolescents is associated with two–fold increased risk for a cardiovascular event compared with nonuse of the drugs. The risk is even higher when the drugs are used for the treatment of attention–deficit/hyperactivity disorder (ADHD).
  • Telemedicine screening for retinopathy of prematurity (ROP) is valid when conducted by trained nonphysicians, reports a study by the eROP Cooperative Group, published online in JAMA Ophthalmology. Image readers could correctly identify 90% of infants who needed an evaluation. Among those infants who went on to treatment, 98% were detected.

Dr K K Spiritual Blog

The lips of truth shall be recognized for ever, a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is ever lasting and always ends up in internal happiness and self realization & in long run always gives you happiness and an all-win situation. On the contrary a lying tongue will only give you a momentarily pleasure but will lead to or create some difficulty later in life.

Spoken words cannot come back just as in the case of a released arrow from the bow. Once lost, one cannot get back his youth, virginity, or respect. Similarly, spoken bad words cannot be taken back and once spoken will create negative waves in the other persons (on whom they were spoken) mind which will persist as repressed thoughts or memory in the people’s mind for ever. Such bad memories will keep on coming back in the person’s mind causing damage to the personal relationships.

A spoken word is a karmic expression. For every karmic action there is an opposite and equal reaction. For every negative karmic expression one has to pay the debt either now or in future. The law of karma says that every debt has to be paid. It is always better to avoid negative language both in spoken words as well as in the mind. The yoga sutras of Patanjali describe thinking, speaking or doing anything wrong as having the same karmic significance. We should not only purify our self in actions and spoken words but also in the mind. If a person keeps negative thoughts in the mind sooner or later the same will be reflected to the outside world.

The momentary pleasure which one gets by "lying" has no spiritual significance as it only satisfies your ego sense or makes you attached to any of the five senses. The transient pleasure experienced by the body stimulates a chain of reactions, consisting of action, memory and desire leading to action again, which will only intensify the greed & attachments.

In the Mahabharata, Lord Krishna has given only two examples, which work as an exception to such a situation. Any truth which harms others may not be spoken and any lie which does not harm anyone but benefit a few may be spoken.

Truth is the opposite of doubt & it is always better to clear all the doubts from the mind as any repressed doubts can end up into causation of heart attack, paralysis and cancer.

Truth also means taking conscious based decisions as the consciousness will never lie. While taking any decision one should always ask oneself— Is it the truth? Is it necessary? And will it bring happiness to me and the people around?

Lord Krishna is also described as "SATCHITANAND" which only indicates the qualities like truthfulness, conscious based decisions and internal happiness. The practice of truthfulness has to be practical over a period of time and made a part and parcel of your daily life. To start with a person may have bad experiences but in the long run truthfulness will always win.

Wellness Blog

Work–related Stress can kill

Job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest stress–induced biological changes may play a more direct role than previously thought.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability – a sign of a poorly–functioning weak heart and higher than normal levels of cortisol, a "stress" hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart.

Inspirational Story


The cockroach theory for self development

At a restaurant, a cockroach suddenly flew from somewhere and sat on a lady.

She started screaming out of fear.

With a panic stricken face and trembling voice, she started jumping, with both her hands desperately trying to get rid of the cockroach.

Her reaction was contagious, as everyone in her group also got panicky.

The lady finally managed to push the cockroach away but …it landed on another lady in the group.

Now, it was the turn of the other lady in the group to continue the drama.

The waiter rushed forward to their rescue.

In the relay of throwing, the cockroach next fell upon the waiter.

The waiter stood firm, composed himself and observed the behavior of the cockroach on his shirt.

When he was confident enough, he grabbed it with his fingers and threw it out of the restaurant.

Sipping my coffee and watching the amusement, the antenna of my mind picked up a few thoughts and started wondering, was the cockroach responsible for their histrionic behavior?

If so, then why was the waiter not disturbed?

He handled it near to perfection, without any chaos.

It is not the cockroach, but the inability of the ladies to handle the disturbance caused by the cockroach that disturbed the ladies.

I realized that, it is not the shouting of my father or my boss or my wife that disturbs me, but it’s MY inability to handle the disturbances caused by their shouting that disturbs me.
It's not the traffic jams on the road that disturbs me, but MY inability to handle the disturbance caused by the traffic jam that disturbs me.

More than the problem, it’s MY reaction to the problem that creates chaos in my life.

Lessons learnt from the story:

I understood, I should not react in life.

I should always respond.

The women reacted, whereas the waiter responded.

Reactions are always instinctive whereas responses are always well thought of, just and right to save a situation from going out of hands, to avoid cracks in relationship, to avoid taking decisions in anger, anxiety, stress or hurry. A beautiful way to understand…………………LIFE

ePress Release

Most uncontrolled asthmatics think they are controlled

Two–thirds of patients with uncontrolled asthma think their disease is well under control, 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. Asthmatics on proper medicines can not only lead a normal life but also reduce their future complications. Drugs include those medicines that keep the disease at bay as well as those that are used when a flare–up occurs. Uncontrolled asthmatics will invariably end up with right heart complications due to persistent lack of oxygenation in the blood. Most asthmatics fail to perceive their level of disease control and with an uncontrolled state they often feel that their asthma is under control.

Dr. Eric van Ganse, of University of Lyon, France, in a study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, nearly 69 percent considered themselves to be completely or well controlled. Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

In severe asthma, low blood oxygen levels might impair a person’s ability to assess their own breathing difficulty. Another reason is that the notion of asthma control seems poorly understood by asthmatic patients. Also, mild to moderate asthma limits the activities of a person and they over a period of time take that as their normal limits.

eMedi Quiz

Ofleck phenomenon is seen in:

a. Joint psoriasis
b. Mucosal psoriasis
c. Nail psoriasis
d. Pustular psoriasis

Yesterday’s Mind Teaser: Patient empowered teledermatology is well documented with which of the following teledermatology conditions?

a. Acne
b. Psoriasis
c. Leg ulcer
d. All of above

Answer for yesterday’s Mind Teaser: d. all of above

Correct answers received from: : Dr K V Sarma, Dr Jayant Gaikwad, Dr Ajay Gandhi.

Answer for 2nd July Mind Teaser: 3.Atracurium.

Correct answers received from: Jayant Gaikwad, Dr P C Das, Dr Swati Surana, Dr K V Sarma, Arvind Diwaker, Dr Jainendra Upadhyay, Pritam Nandkumar Haval, Dr Jayashree Sen, Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

eMedinewS Humor

10 Guinness’ in 10 Minutes

An American walks into an Irish pub and says, "I’ll give anyone $100 if they can drink 10 Guinness’s in 10 minutes."
Most people just ignore the absurd bet and go back to their conversations. One guy even leaves the bar.
A little while later that guy comes back and asks the American, "Is that bet still on?"
"Sure," he says.
So the bartender lines 10 Guinness’ up on the bar the Irishman drinks them all in less than 10 minutes.
As the American hands over the money he asks, "Where did you go when you just left?"
The Irishman answers, "I went next door to the other pub to see if I could do it."

Quote of the Day

Whether you believe you can do a thing or believe you can’t, you are right. Henry Ford



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 – 94595 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

Health Check Up and CPR 10 Camp at NP Co-Ed Sr. Sec. School, Havlock Square-2nd July 2014

press release

Vitamin D intake associated with reduced risk for Crohn’s disease

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 patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

Twitter of the Day

Dr KK Aggarwal:Travel more than doubles risk of blood clots http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: You alone are the judge of your worth and your goal is to discover infinite worth in yourself, no matter what anyone else thinks

Forth Comming Event


Call for Free Registration

4th annual conference Zoonosis 2014
Sunday 6th July 10am–2 pm followed by Lunch

Venue; Indian Medical Association HQs, IMA House, ITO New Delhi

Objective: To discuss about prevention of diseases communicable
from animals to human.

Who can take part: Medical Practitioners,Veterinary Practitioners, Animal Owners/Breeders, NGOworking with animal care etc.

Experts will be from Veterinary/Medical sectors

All participants will be given certificate of participation.

Organizers: Heart Care Foundation
of India, Millennium India Education
Foundation,CAR (Ministry of Agriculture Govt.of India,

Register at :
or Call: Vandana 9891673085/Dr Kakroo 9810301261

Zoonosis 2014 9-1 PM

6 July 2014 Zoonosis 2014

Speakers Zoonotic disease in India
Dr Jyoti Misri Pr Scientist ICAR Govt of India

Inaugural address
Dr M L Madan Fmr DDG ICAR

Dr KK Aggarwal (To Moderate)

Bovine Tuberculosis and Brucellosis
Dr R Somvanshi HOD Vety Pathology IVRI Bareilly UP

Dr Rishendra Verma Jt Dir.Centre for Animal Disease Research and Diagnosis IVRI Bareilly UP

Equine Encepahalitis
Dr. Baldev Gulati Pr.Scientist National Centre for Research in Equines,Hissar Haryana

Cysticarcosis, Neurocysticercosis
Dr R Somvanshi HOD Vety Pathology IVRI Bareilly UP

Rabies, Cat Scratch Disease
Dr. Ashok Bhardwaj Asstt.Prof. SKAUST Jammu

Swine Flu, Japanese Encepahlitis
Dr.P K Uppal Fmr FAO Expert on Flu
Dr. Baldev Gulati Pr.Scientist National Centre for Research in Equines, Hissar Haryana

Bird Flu
Dr.P K Uppal Fmr FAO Expert on Flu

Mycotic Diseases

Dr.P P Gupta Fmr Dir.Research Punjab Agri Univ.

Food Borne Diseases Salmonellosis, tapeworms, teniasis

Dr.Lal Krishna
Fmr Animal Husbandry Commissioner Govt.of India.

Anthrax, Rota Virus, Carona Virus

Dr. A K Bhatia Professor & Head, Biotechnology Dept.GLA Univ. Mathura

Dr.M P Yadav Fmr Director IVRI Bareilly UP

Dr.C Bhattacharya Vety Public Health Spl. Delhi

Emerging Threats : JD,Crone's Disease,Nepha Virus,etc.

Dr.Shoorvir Singh Pr Scientist National centre for Res in Goats Makhdoom Agra


medicolegal update

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

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