5th January 2015, Monday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

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

Stress may increase smoking habits

Stress increases the risk of heart attack by pushing people toward bad habits.

A British study published in the Journal of the American College of Cardiology suggests that people with psychological stress had a 50 percent increased risk of a cardiovascular disease event over the follow–up period.

The reasons were higher smoking rates and low exercise levels of individuals who were stressed.

In the study over a seven year follow–up period, incidence of cardiovascular events –– heart attacks, stroke, bypass surgery and the like –– was 50 percent higher among the people with a high level of depression and anxiety when compared to happier people. Smoking and lack of physical activity explained about 63 percent of the increase, with smoking alone responsible for 41 percent.

Alcohol intake explained less than 2 percent of the increase, with high blood pressure assigned 13 percent of the blame.

All such patients should be treated with combined physiological approaches with intensive lifestyle changes to reduce modifiable risk


F.No. 18-6/2011-DC
Directorate of General of Health Services
Central Drug Standard Control Organization
FDA Bhawan, Kotla Road, New Delhi
(O/o DCG (I)
Dated: 23.09.2011

All State Drug Controllers

Subject: Regarding Limiting of Acetaminophen (paracetamol) in Prescription Combination products and giving Box Warning about its Liver Toxicity- recommendation of DTAB in its 59th meeting held on 24.06.2014.


The proposal of limiting of Acetaminophen (Paracetamol) in prescription combination product and giving B ox Warning about its liver toxicity was considered by the DTAB in its 59th meeting held on 24th June, 2011 at New Delhi under the Chairmanship of Directorate General f Health Services

The proposal was based on USFDA News Release dated 13.01.2011. it has directed the manufactures of prescription combination products in USA containing Acetaminophen to limit the amount of Acetaminophen to no more than 325mg in each tablet or capsule. In addition to this, a box warning highlighting the potential for severe liver injury and a warning of potential for allergic reaction (e.g. swelling of face, mouth and throat, difficulty breathing, itching or rash) to be added to the label of all prescription drugs products that contain Acetaminophen USFDA has taken this action to make prescription combination pain medications containing Acetaminophen safer for patients use

It was further mentioned in the News Release that there is no immediate danger to patients who take these combination pain medications and they should continue to take them as directed by their health care providers. The risk of liver injury primary occurs when patients take multiple products containing acetaminophen at one time and exceed the current maximum dose of 4,000 milligrams within a 24-hour period. The elimination of higher dose prescription combination Acetaminophen products will be phased in over 3 years and should not create a shortage of pain medication.

The DTAB after deliberations agreed that as the Paracetamol is known to have liver toxicity and in the light of the decision taken by US FDA India should also limit the content of Paracetamol to not more than 325mg per tablet or capsule in the combination products in a phased manner in three years.

Manufactures marketing fixed dose combinations of paracetamol may also be requested to limit the content of Paracetamol in such combinations to 325mg and a box warning be printed on the label of such FDCs indicating that taking more than daily dose may cause serious liver damage or allergic reactions (e.g. swelling of the face, mouth and throat, difficulty in breathing, itching or rash).

It is therefore requested that the State Licensing Authorities under your jurisdiction should be asked not grant fresh licenses or renewals of the combinations products paracetamol containing more than 325mg per tablet or capsule. The manufactures marketing combination products having more than 325 mg of paracetamol should be asked to limit the Paracetamol contents to 325 mg only in a period of three years.

The manufactures of Paracetamol combination products may also be requested to provide a box warning on the label of such FDCs indicating that taking more than daily dose may cause serious liver damage or allergic reactions (e.g. swelling of the face, mouth and throat, difficulty in breathing, itching or rash).
Action taken in the matter may please be communicated to the undersigned.

Yours Faithfully

(Dr. Surinder Singh)
Drugs Controller General (India)

Copy forwarded for information and necessary follow up to the Zonal/ sub zonal officers of CDSCO.

National Health Policy Debate

  • Section 5 on Human Resources for Health
  • Section 10 on Knowledge for Health.
  • Para on AYUSH professionals, talks about "mandatory bridge course" to attain "competencies of mid-level care provider with respect to allopathic remedies"; and continuing education in their respective systems (page 34)
  • Para In the context of strengthening tertiary care services talks about "strengthening 58 medical colleges in the first three phases, upgrading 58 district hospitals to become medical colleges and building up close to 15 more new AIIMS" (page 35)
  • Para deals with faculty shortage and human resource issues in tertiary care medical college hospitals and centres of excellence (page 35)
  • Para deals with financing issues in HPE including private sector (page 36)
  • Para 5.2 contemplates a comprehensive policy framework in human resources for health (page 37)
  • Para 5.3 tries to address the shortage of doctors particularly in the context of public health needs (page 37)
  • Para 5.4 in order to address human resource issues in rural and remote areas, talks about state-specific mix of strategies that includes curricular and pedagogical measures as well as strategic location of medical colleges. (page 37)
  • Para 5.5 extensively deals with the shortage of specialist professionals; talks about the lack of training initiatives in family medicine except for sporadic ones; need for expanding the scope of NBE etc.(page 38)
  • Para 5.12 is about public health management education. (page 40)
  • Para 5.14 starts with the suggestion a common entrance exam for UG medical education with an objective to ensure quality. There is also a proposal to introduce Licentiate Exams at regular intervals for medical graduates. There is also recognition of the need to comprehensively revise the UG and PG curricula and the need to develop research centres. (page 41)
  • Para 7.1 includes health professional education among some of the areas requiring urgent regulatory reforms (page 43)
  • Para 7.3 further delves into regulation of HPE in terms of a regulatory framework (page 44)
  • Para 9.7 includes clinical and non-clinical education among areas that can benefit from health informatics and IT based solutions (page 49-50)
  • Para 10.2 envisages strengthening of health research in the country and particularly mentions "143 Government and over 150 private medical colleges in the nation". It quotes a statistic that in "2007, 96% of the research publications in India emanated from as little as 9 medical colleges that reflect how little most of them are geared to the challenges of health." (Also in Para 2.16) (page 51)

    Please review the document; discuss at appropriate levels within your institutions and elsewhere; and provide your inputs. Some of you may have reservations about the limitations and implications of a policy document, and the implementation challenges. Yet, let us not forget that once the final version is out, this will be a guiding document on health in the country for the coming few years if not a decade.

    Thanking you and with heartfelt wishes to all for the year ahead. (Dr Sanjay Bedi)

News around the Globe

  • Older adults who have greater heart and lung health also have better memory recall and cognitive capabilities, according to a study published in the online edition of the Journal of Gerontology.
  • A long-acting formulation of the somatostatin analogue pasireotide has been approved for treatment of acromegaly in patients “who have had an inadequate response to surgery and/or for whom surgery is not an option.
  • A new set of five points of guidance may help healthcare institutions and clinicians develop policies that incorporate clinician risk into decisions on how to care for patients with Ebola virus disease, according to an article published online December 30 in the Annals of Internal Medicine.
  • Results from a longitudinal, prospective study in JAMA Psychiatry show that children with a parent who has attempted suicide have nearly a fivefold increased risk of attempting suicide themselves.

Dr KK Spiritual Blog

The spiritual meaning of the word ‘Artha’

Dharma, Artha, Kama and Moksha are the four fundamental principles of our very existence, which means earning righteously with a desire to fulfill the inner happiness.

Righteous earning is called ‘Artha’ and it has been mistakenly linked to materialistic money. In mythology, Artha is synonymous with Lakshmi, Saraswati and Kali, where Lakshmi represents righteously earned materialistic wealth, Saraswati represents wealth of knowledge and Kali represents wealth of wisdom to fight the bad in you and in the society.

In any country, it is the wealth of knowledge, which is more important. India was ruled initially by warriors (Kali), later by money (Lakshmi) and in future will be ruled by knowledge (Saraswati).

It is the human resources, which today decide the growth of a company and the amount of money invested. If you have good human resources, your company is going to succeed.

Inspirational Story

Stay True To Your Goals

A personal goal or personal goals are yours - they are what you want not what others want for you. Believe in yourself - you can do anything. See what Jacquie has to say.

The key to being happy is to respect your desire to make your life better by your own choices-even if and, especially when others ridicule them. Do not let the ignorance or the short-sightedness of others redirect your life's goal.

Everyone has their own path to follow-their own map for the future. The key is to understand everyone is different and to respect their goals as well as your own. Do not accept behavior that goes against your beliefs or wishes, and do not accept behavior from friends, family, or a spouse that you wouldn't accept from a stranger.

Be true to yourself. Stand firm. And, do not postpone your dreams or wishes to please someone else's idea of what it should be...

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at G B S.S.School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014

video of day
press release

Five Things Physicians and Patients should question

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 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)


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 dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/70 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.

eMedinewS Humor

Scientists Competition!

Once there was a competition conducted with scientists from America, France and China.

The Americans reported: "We crossed chickens with cows. And now the new breed simultaneously produces milk, meat and eggs."

On this, Scientists from France came with the report: "We crossed flies and bees. Now, the hybrid flies over the trash fields and produces honey."

Chinese gave others run for their money.

They said: "We crossed a melon with cockroaches. And now when you cut this melon, seeds run away by themselves…"

Twitter of the Day

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer
Dr Deepak Chopra: When you joyfully surrender to the wisdom of uncertainty nothing goes wrong

Rabies News (Dr A K Gupta)

If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule for rabies vaccine?

The vaccine on Day 0 (first injection) must be doubled and given at two sites (deltoids or thigh in young children). In category II exposures, it is recommended to administer even RIGs along with vaccine. Rest of the schedule is same as for any other patient.

Cardiology eMedinewS

  • Researchers from the University of Oxford, say developing drugs to target and reduce the amount of fractalkine could be a new way to slow furring of the arteries, known as atherosclerosis, and reduce the risk of heart attacks and strokes. Their findings are published in the journal Arteriosclerosis, Thrombosis and Vascular Biology.
  • A 3-year serial optical coherence tomography study demonstrated less luminal loss at the edges than luminal loss within the scaffold after implantation of an everolimus-eluting bioresorbable vascular scaffold. The analysis focused on 40 patients from the ABSORB Cohort B study who were implanted with an 18-mm everolimus eluting bioresorbable scaffold (Absorb BVS, Abbott Vascular).

Pediatrics eMedinewS

  • Parents whose children were part of a school-centered, community-based obesity prevention program reported losing a modest amount of weight over the course of the 2-year intervention, according to a study published online December 18 in the American Journal of Public Health.
  • Young children with type 1 diabetes have slower brain growth compared to children without diabetes. As per a new study, in Diabetes, continued exposure to hyperglycemia, or high blood sugars, may be detrimental to the developing brain.

Quote of the Day

And in the end, it's not the years in your life that count. It's the life in your years. Abraham Lincoln

Wellness Blog

Flu in children

The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestation of respiratory tract illness – sore throat, sough and nasal discharge. But, all the above features may not be present in children. Flu sometimes may last for more than a week in children. Ear discharge, development into asthma and pneumonia are common complications in children. Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph.

During winter, flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat. Fever is present in over 95% of cases, often more than 39oC. Cough is present in over 77% patients. Nasal discharge is present in more than 78% patients. Headache is present in more than 26% patients. Muscle pain is present in more than 71 % patients. Incubation period is 1-4 days with high transmissibility. The treatment is often symptomatic. Cough hygiene should be practiced.

ePress Release

Rules for Preventing Heart Attack Deaths

Heart attack deaths can be prevented 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 Honorary Secretary General Indian Medical Association.

  • Rule of 30 sec: Chest pain, burning, discomfort, heaviness in the center of the chest lasting for over 30 seconds and not localized to a point, unless proved otherwise, is a heart pain.
  • Rule of pinpointing finger: Any chest pain, which can be pinpointed by finger is not a heart pain.
  • Rule of 40: First-onset acidity or first-onset asthma after the age of 40, rule out heart attack or heart asthma first.
  • Rule of 300: Chew a tablet of water-soluble 300 mg aspirin and take 300 mg clopidogrel tablet at the onset of cardiac chest pain. You will not die.
  • Rule of 10: Within 10 minute of death for the next 10 minutes do effective chest compression with a speed of 100 (10 x10) per minute Most people can be saved.
  • Rule of 180: Reach hospital within 180 minutes in heart attack to receive clot dissolving angioplasty or clot dissolving drugs.

eMedi Quiz

Ofleck’s phenomenon is seen due to which component?

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

Yesterday’s Mind Teaser: Isotopic response is seen in scars of which condition?

a. Orolabial herpes
b. Herpes genitalis
c. Pyoderma gangrenosum
d. Eosinophilic pustular folliculitis

Answer for yesterday’s Mind Teaser: c. Pyoderma gangrenosum

Correct answers received from: ........

Answer for 3rd January Mind Teaser: d. Epitope spreading phenomenon

Correct answers received from: .............

Send your answer to email

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  1. Dear Editor, Very Happy to receive this medical News on my Email. I always wait for the same daily. Happy and prosperous New Year 2015…Thanking you again. Dr. Suresh, Kalambi. Mumbai

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