eMedinewS5th February 2014, Wednesday

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
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Stress is the reaction of the body and mind to the interpretation of a known situation

You cannot be stressed unless you know the person, place or the situation. The same situation may or may not cause stress unless it is interpreted in such a way that it is uncomfortable to the person, and then it ends up causing stress.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible.

The modality, therefore, is to change your interpretation towards the stressful situation for which one should start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathy is described as cognitive behavior therapy, the origin of which comes from Ayurveda and in Bhagwad Gita where Lord Krishna counsels Arjuna following principles of Cognitive Behavioral Therapy.

In the first chapter, Lord Krishna only listens to Arjuna explaining the importance of listening, listening and listening. The second counseling session or the second chapter is the longest conversation between Arjuna and Krishna and shows the importance of first effective counseling session. From 3rd to 17th chapters, Krishna explains what he has conveyed in chapter 2 and that tells us the importance of reasoning out every doubt that a person under stress has. During this session, Krishna creates both fear as well as consoles Arjuna again indicating the importance of these two factors in counseling. In the last chapter, Krishna revises what he has taught, which is consistent with the last rule of counseling to make sure that the patient has learnt what has been taught to him.

Apart from counseling, one can also prepare the body in such a way that stress does not bother him. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise, Dosh-specific diet and using certain Ayurvedic Rasayans, which sterilize the brain functions. Brahmi, an Ayurvedic herb, is one such Rasayan, which boosts the brain.

One should avoid taking allopathic anti–anxiety drugs, unless necessary which, of course, may be required in an acute panic state.

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."

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Ringtone – CPR 10 Mantra Hindi
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Positive Attitudes

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All those out there who feel you are at your wits end wondering how things don’t ever work out for you, can now relax and dwell on all those failures that life has taken you through and turn failure into success.

1. Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
2. Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
3. Failure doesn’t mean you have been a foolish. It does mean you had a lot of faith.
4. Failure doesn’t mean you’ve been discouraged. It does mean you were willing to try.
5. Failure doesn’t mean you don’t to do. It does mean you have to do it in a different way.
6. Failure doesn’t mean you are inferior. It does mean you are not perfect.
7. Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
8. Failure doesn’t mean you should give up. It does mean you must try harder.
9. Failure doesn’t mean you’ll never make it. It does mean it will take a little longer.
10. Failure doesn’t mean God has abandoned you. It does mean God has a better idea.

cardiology news

Planting Potatoes

When I was a boy growing up we had several gardens around our old house. The largest one of all was used just for growing potatoes.

I can still remember those potato planting days. The whole family helped. After my Dad had tilled the soil, my Mom, brothers, and I went to work. It was my job to drop the little seed potatoes in the rows while my Mom dropped handfuls of fertilizer beside them. My brothers then covered them all with the freshly turned earth.

For months afterward I would glance over at the garden while I played outside and wonder what was going on underneath the ground. When the harvest time came I was amazed at the huge size of the potatoes my Dad pulled out of the soil. Those little seedlings had grown into bushels and bushels of sweet sustenance. They would be turned into meal after meal of baked potatoes, mashed potatoes, fried potatoes, and my personal favorite: potatoes slowed cooked in spaghetti sauce. They would keep the entire family well fed throughout the whole year. It truly was a miracle to behold.

Thinking back on those special times makes me wonder how many other seeds I have planted in this life that have grown unseen in the hearts and minds of others. How many times has God used some little thing that I said or did to grow something beautiful? How many times has Heaven used these little seedlings to provide another’s soul with sweet sustenance?

Every single day of our lives we step out into the garden of this world. Every single day we plant seeds that can grow into something wonderful. We may never see the growth that comes from the kind words or loving acts we share but God does. I hope then that you always tend the garden around you with care. I hope that you plant only goodness, peace, and compassion in the lives of everyone you meet. I hope that every day you help miracles to grow.

News Around The Globe

6th International Conference "Recent Advances in Cardiovascular Sciences" 31st January &1st February, 2014

Dr. Martin Morad, PhD
Director, Cardiac Signaling Center, of USC, MUSC and Clemson University Charleston, USA

Professor Morad did his PhD in 1965 from State University of New York. He did postdoctoral work at Heidelberg University and UCLA. He was Prof of Physiology and Medicine, university of Pennsylvania from 1980–1993. He Joined Georgetown

University in 1993 as Chair of Physiology, and Prof of Pharmacology. In 2008, he became Prof – Director of University of South Carolina, MUSC. Dr. Morad is an internationally recognized scientist in the field of cardiac electrophysiology and calcium signaling, specifically in the area of calcium-binding proteins. The cardiac muscle is a complex system composed of 40,000 proteins. These proteins "tell" the heart how to contract and how fast; they also control how heart muscle grows and regenerates. Calcium acts as a signaling mechanism in the function of these c proteins. Dr. Morad seeks to discover what causes these calcium signaling mechanisms to stop working properly, which can result in congestive heart failure. Understanding this process could lead to new therapeutic approaches to treat congestive heart failure and other conditions. His work could lead to the world’s first tissue–derived human heart pacemaker. A biological pacemaker derived from genetically engineered cells has great commercial viability as a replacement for current pacemaker technology made from artificial materials

Topic: Mechanisms of Spontaneous Rhythmic Beating in Developing Cardiomyocyte.

Spontaneously beating is the quintessential property of developing cardiac myocytes. The molecular mechanisms underlying the spontaneous rhythmic activity of developing cardiomyocytes remain unclear and not fully understood. Here, I will explore the mechanisms responsible for spontaneous beating in cells derived from human inducible pluripotent stem cell–derived cardiac myocytes (hiPS–CM) and will compare them to those of rat Neonatal Cardiac Myocytes (rNCM), a generally used cardiomyocyte model. Both cell types continued their rhythmic spontaneous beating (60–140⁄min) even after the cells were whole–cell clamped at –50 mVs holding potentials and dialyzed with weak Ca2+–buffering solutions (100 nM Fluo–4 + 100 nM Ca2+).Spontaneous Ca2+oscillations and their in–phase accompanying current oscillations (INCX), were suppressed on withdrawal of (Ca2+)o , application of NCX–blocker KBR–7943, or Ni2+, and RyR2–blocker tetracaine, but were insensitive to Inhibitors of L–type Ca2+ channels (nifedipine),and If blockers Ivabradine, and 2mM Cs+. Caffeine-induced Ca2+–releases also activated NCX currents that were significantly larger in hiPSCs than rNCM (2.64±0.41 pA⁄pF, n=9 vs. 0.91±0.10 pA⁄pF, n=16, respectively). Surprisingly, short application of mitochondrial un-couplers (50–200 nM FCCP) rapidly and reversibly suppressed the spontaneous Ca2+–oscillations in both cell types as it suppressed the rate of sequestration of Ca2+. In cells infected with mitochondrial Ca2+–sensor mitycam E31Q, INCXrhythmic oscillations were accompanied by in–phase, regionally specific release and uptake of Ca2+ from different populations of mitochondria. These Mitycam signals as well as those triggered by caffeine applications were also slowed or suppressed by FCCP. We conclude that the interplay between the three cellular Ca2+–signaling pathways (NCX, RyR⁄SR, and mitochondria) underlies the initiation and modulation of spontaneous rhythmic beating in hiPSC–CM and rNCM independent of changes in membrane potential.

Dr. Naranjan S. Dhalla, PhD

Distinguished Professor of Physiology, Institute of Cardiovascular Sciences, St. Boniface Hospital Research, Faculty of Medicine, University of Manitoba, Winnipeg, Canada

Naranjan Dhalla is a Distinguished Professor of the University of Manitoba at the St. Boniface Hospital Research Centre in Winnipeg. In view of his dedicated services and high profile leadership qualities, he is known for promoting cardiovascular science and medicine all over the world. In his capacity as Secretary General and then as President during 1972–1995, he developed and promoted the International Society for Heart Research for the exchange of scientific information and to foster research collaborations. He also founded the International Academy of Cardiovascular Sciences for promoting education and research and has been serving as Executive Director since 1996. He has been serving as Editor–in–Chief of a major international journal "Molecular and Cellular Biochemistry" for the past 26 years. He has edited⁄authored 48 books in the area of cardiovascular health and disease, primarily for the benefit of developing investigators. He has given 526 invited talks at national and international conferences and symposia as well as academic institutions around the globe. He has organized (as Chairman)12 highly successful conferences in Winnipeg, which were attended by 400 to 2,000 established and young investigators, in addition to serving as a Member for the organization of another 106 international meetings for the past 40 years. He has published more than 776 full length research papers and review articles in the area of cardiovascular pathophysiology, biochemistry and pharmacology throughout his professional career and his work has been cited more than 14,000 times in the literature. He has trained 161 graduate students, postdoctoral fellows and visiting scientists in the field of experimental cardiology. He served as Founding Director of the Institute of Cardiovascular Sciences for 19 years and recruited several highly talented investigators with diverse expertise in biomedical sciences to build a multidisciplinary centre for the prevention and therapy of heart disease.

Topic: Role of Protease Activation in Ischemia-Reperfusion Injury in the Heart It is now well established that both calpains and matrix metalloproteases (MMPs) are activated in the heart during the development of ischemic-reperfusion injury. By employing isolated rat hearts, subjected to 30 min ischemia followed by 30 min reperfusion, we have shown that the depressed contractile function was associated with marked increases in calpain and MMP–2 activities as well as reduced sarcoplasmic reticular Ca2+–pump and sarcolemmal Na+–pump activities. These alterations in cardiac contractile behavior, proteolytic activities and subcellular function were not only dependent upon the concentration of extracellular Ca2+ but were also simulated upon perfusing the hearts with an oxyradical generating mixture as well as with an oxidant, H202. Furthermore, the ischemia-reperfusion induced abnormalities in cardiac function, activation of proteolytic enzymes and defects in subcellular activities were attenuated upon treatment with antioxidants (N–acetylcysteine and mercaptopropionylglycine) as well as with inhibitors of both calpain (MDL 28170) and MMP–2 (doxycycline) activities. These observations support the view that oxidative stress as well as the activation of proteolytic enzymes and subcellular defects plays a critical role in cardiac dysfunction due to ischemia–reperfusion injury. (Supported by a grant from the Canadian Institutes of Health Research).

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)

Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

cardiology news

Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hrs a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling –Less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence, is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting ten minutes.

cardiology news

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

  • People who had excessive amounts of added sugar in their diet carried greater risks of dying from cardiovascular disease (CVD). Quanhe Yang, PhD, of the CDC’s Division for Heart Disease and Stroke Prevention in Atlanta, and colleagues report that through a median follow-up of nearly 15 years, those who had 10% to 24.9% of calories come from added sugar were 30% more likely to experience cardiovascular death than those with less than 10%. In addition, the risk of death during the follow-up period jumped greatly – to 175% – for those getting 25% or more of their calories from added sugar. The findings are reported online in JAMA Internal Medicine.
  • Diabetic patients in late middle–age receiving intensive anti–hypertensive therapy in a randomized trial in JAMA Internal Medicine showed the same rates of cognitive decline as those assigned to standard treatment. Among some 3,000 participants in the ACCORD study with no clinical evidence of cognitive impairment or dementia, those randomized to intensive blood pressure–lowering therapy showed a mean decrease in scores on the Digit Symbol Substitution Test (DSST) of 1.86 points after 40 months of follow up, compared with a decline of 1.61 points in those receiving standard anti–hypertensive treatment.
cardiology news

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

  • Children who were overweight when entering kindergarten in 1998 in the United States were 4 times as likely as their normal–weight classmates to become obese by age 14 years, according to an article published in the January 30 issue of the New England Journal of Medicine.
  • New research suggests that for maintaining O2 saturation within the desired range in preterm infants, an automatic oxygen control system is better than routine manual control. The study is reported January 27th online in Pediatrics.
cardiology news

Total CPR since 1st November 2012 – 86083 trained

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Even children and adolescent can die with sudden cardiac death

In the United States alone, 2000 individuals younger than 25 years die every year of sudden cardiac death. The number in India is estimated to be 8–10 thousand.

The common causes of sudden death in children aged 3–13 years, include congenital heart disease – 21%, hypertrophic heart muscle – 18% and abnormal ECG 25% and mitral valve prolepses – 7%. Chronic blockages as a cause of sudden death are only seen after the age of 25 years.

In children, the warning signs of possible future sudden cardiac death include episodes of chest pain, fatigue, light headedness and episodes of loss of consciousness, which are seen in upto 50% of children before the actual death episode.

To prevent sudden cardiac death in children, Padma Shri – Dr. B C Roy National Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India, trained over 1000 children of Chinmaya Vidyalaya at Vasant Vihar, Delhi. Dr. Aggarwal said that all teachers and school children should learn cardiac first aid, which includes how to revive a child after sudden cardiac death.

Dr. Aggarwal said that hands–only CPR 10 can be attempted on children and it differs from adult CPR with the compression being lighter than in the adults. The way to remember is to put pressure, which can only compress the centre of the chest by 1 ½ – 2".

Dr. Aggarwal revised the CPR 10 mantra as – "To revive a person from sudden cardiac death, 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 by 1 ½" distance continuously with a speed of 10x10 i.e. 100 per minute."

In Hindi, the mantra can be remembered as – "Marne ke dus minute ke andar (jitna jaldi utna behtar), kam se kam agle dus minute tak (jitni der tak utna behtar, 10×10=100 ki gati se, apni chhati peetne ke bajaye mare hue aadmi ki chhati peeto."

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 86083 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."

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Over 1000 children of Chinmaya Vidyalaya at Vasant Vihar, Delhi in Cardiac First Aid

press release

Weight loss may improve sexual health of obese diabetes

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

Bacitracin acts on:

1. Cell wall
2. Cell membrane.
3. Nucleic acid.
4. Ribosome.

Yesterday’s Mind Teaser:As a part of space-research program, a physiologist was asked to investigate the effect of flight–induced stress on blood pressure. Accordingly, the blood pressures of the cosmonauts were to be measured twice: once before the take–off, and once after the spacecraft entered the designated orbit around the earth. For a proper comparison, the pre–flight blood pressure should be recorded in:

1. The lying down position.
2. The sitting position.
3. The standing position.
4. Any position, as long as the post–flight recording is made in the same position.

Answer for yesterday’s Mind Teaser: 1. The lying down position.

Correct answers received from: Dr Ajay Gandhi,drjella,Dr. Vishal D Wahane,Dr.K.Raju,Muthumperumal Thirumalpillai,Dr.K.V.Sarma

Answer for 2nd February Mind Teaser: 4. Gentamicin.

Correct answers received from: Dr.A.K.Gajjar,Dr.K.Raju,Tukaram Pagad,Dr Ashok Barat

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update

Organized Crime

No matter how much the government fights it, organized crime just seems to get more organized every day. The police pulled in a Mob kingpin recently and reminded him he had the right to make a phone call.

"Just fax the arrest report to my lawyer," the mobster said calmly.

medicolegal update

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medicolegal update

Situation: A patient with pseudomonas meningitis was not responding.
Reaction:Oh my God! Why was aminoglycoside not added?
Lesson: Make surethat when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

medicolegal update

Ability is a poor man’s wealth.    John Wooden

medicolegal update

Dr KK Aggarwal:Diabetes is a progressive disease http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Dealing with stress in a better way is the key to breaking the cycle of stress eating http://bit.ly/15QdVeB #Health

medicolegal update
  1. Unclogged coronaries, uncluttered mind without strife, Thy regular bowel habit, Secret to healthy long life!
    Regards: S Dwivedi, Dean⁄ Principal, Professor of Medicine⁄Preventive Cardiology, Hamdard Institute of Medical Sciences and Research, Delhi.

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