eMedinewS 6th August 2013, Tuesday

Dr K K Aggarwal Padma 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; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08 "09); Hony Finance Secretary National IMA (07 "08); Chairman IMA Academy of Medical Specialties (06 "07); President Delhi Medical Association (05 "06), President IMA New Delhi Branch (94 "95, 02 "04);
For updates follow at
www.facebook.com/Dr KKAggarwal

Role of Folate or Folic Acid in Cancer Prevention

Several large observational studies have shown a decrease in risk of colorectal and other cancers with dietary folate, while other randomized trials of folic acid supplementation have raised the possibility of increased cancer risk from folic acid supplementation.

In the largest meta-analysis of individual patient data from randomized trials of folic acid for the prevention of cardiovascular disease (10 trials, n = 49,969) and colorectal adenoma (3 trials, n = 2652), during an average of 5.2 years of treatment, there was no significant difference in overall cancer incidence for patients assigned to folic acid or placebo.

There was also no significant effect on the incidence of specific cancers, including cancers of the large intestine, prostate, lung, or breast. (Lancet 2013;381:1029)

Fish oil and cardiovascular mortality
The Risk and Prevention Study enrolled patients with multiple cardiovascular risk factors or known vascular disease and, after a median follow-up of five years, found no reduction in coronary heart disease death with n-3 polyunsaturated fatty acid supplementation compared with placebo.  (N Engl J Med 2013;368:1800)

Breastfeeding and obesity
There is increasing evidence that breastfeeding does not reduce the risk of obesity in the offspring. A follow-up study from a cluster-randomized trial of over 17,000 breastfeeding mother-infant pairs reported on outcomes of children at 11.5 years of age, and confirmed findings from 5 years earlier that there were no differences in the body mass index or rates of obesity and overweight.  Population strategies to increase the duration and exclusivity of breastfeeding are unlikely to impact the obesity epidemic.  (JAMA 2013;309:1005.)

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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 10x10 i.e. 100 per minute."

VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi

Ringtone – CPR 10 Mantra English

sprritual blog Its only the physical body which dies, the souls never dies

Dear Dr. Aggarwal
We act on behalf of our client ……….. and we write in relation to the above mentioned matter. Our client's father, ………….. passed away on the 28th July 2013 in London, England. The body is currently in the care of the …………..Coroner.

An external examination was carried on the body on 02 August 2013 by a pathologist who has agreed for a MRI to be carried out to determine the cause of death.

Our client explored options to revive her father and looked for assistance from a physician, namely Dr. …………. in relation to carrying out a medical procedure in her efforts to resuscitate her father. But he unfortunately stated that he could not assist in this matter.

Our client has now become aware of your work in this field and is hoping to enlist your assistance in initiating a procedure which may assist her in reviving her father.

Our understanding is that the body has been stored in temperatures in the region of 3 - 4 degrees and that the body has also been moved to areas where there has been ambient temperature. 

We would be grateful if you could provide your comments on this matter by email to allow us to advice our client accordingly.

We would state that the fact of whether we or anybody else believes that reviving her father would be successful or not is not the issue, the main issue is whether our client believes that this can be done.

Our client had a very profound and intense relationship with her father since childhood and has always been accustomed to having her father there for her and being able to reach out to him at any time of the day.   Our client accepts that there has to be time when we all pass away but she is of the opinion that she wants to use the resources available to her in an effort to revive her father.

Our client has been deeply saddened by her father's sudden demise and has not been able to come to terms with the loss. She is unwilling to accept the fact that her father is no more and is adamant in her belief that there is still hope of reviving her father.

We fully accept that this request is an unusual request but again we would state that given the sensitivities involved we would be grateful for your comments on this as a matter of urgency.

We have no doubt that you fully appreciate the tragic loss to our client and her family with the passing of her father.  We are also of the opinion that you will no doubt do whatever is reasonably possible to ease the current emotional strain upon our client and her family.

Ans: Thanks for asking me to respond.
1. Once a person is dead, he or she can be revived up to 10 minutes at normal body temperature.
2. Once the consciousness leaves the body, one cannot be revived.
3. As I am given to understand the body was frozen after two hours of death in that case, the revival chances are zero.
4. The mentioned literature is only for cases where therapeutic hypothermia is created at the time of death and such cases can be revived by rewarming the body with heart lung circulation and then doing CPR. But this is not the situation in this case.
5. I believe in Hindu philosophy and in rebirth. Under my spiritual belief her father’s consciousness has already been born in someone else’s body and is not circulating the external hell or heaven.
6. For her time is the biggest healer.   
7. As per our teachings, it’s only the physical body which dies, the souls never dies. His memories, deeds and teaching which always remain with us and we should keep it alive all the time.

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cardiology news

The Law of the Garbage Truck

One day I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a car jumped out of a parking space right in front of us. My taxi driver slammed on his brakes, skidded, and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. And I mean he was really friendly. So I asked, 'Why did you just do that? This guy almost ruined your car and sent us to the hospital!'

This is when my taxi driver taught me what I now call 'The Law of the Garbage Truck.'

He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger, and full of disappointment. As their garbage piles up, they need a place to dump it and sometimes they'll dump it on you. Don't take it personally. Just smile, wave, wish them well, and move on. Don't take their garbage and spread it to other people at work, at home, or on the streets.

The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so..... 'Love the people who treat you right. Forgive the ones who don't.'

Life is ten percent what you make it and ninety percent how you take it.

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News Around The Globe

  • Bacterial virulence level is the main predictor of visual prognosis in patients who develop acute bacterial endophthalmitis after cataract surgery. An article reported in JAMA Ophthalmology states that although postoperative endophthalmitis occurs in less than 0.1% of cataract procedures, the consequences can include anatomical or functional loss of the eye. Identifying baseline prognostic factors may help find patients who need aggressive therapy as early as possible.  (Source: Medscape)
  • New guidelines for the diagnosis and treatment of achalasia, a primary motor disorder of the esophagus were published online July 23 and in the August issue of the American Journal of Gastroenterology. Achalasia is an incurable disease, characterized by insufficient relaxation of the lower esophageal sphincter and difficulty in swallowing and is often misdiagnosed as gastroesophageal reflux disease (GERD).  (Source: Medscape)
  • A new test that predicts metastases could prove useful in the management of patients with thymoma, a rare epithelial tumor arising in the thymus gland. The 9-gene signature DecisionDX-Thymoma test, being marketed by Castle Biosciences, is more accurate than traditional staging methods for predicting 5- and 10-year metastasis-free survival, according to study published in the July issue of Plos One.  (Source: Medscape)
  • As per a new research in the journal Diabetes Care, diabetes patients at all levels of glycemic control reported experiencing severe hypoglycemia. Incidence of severe hypoglycemia was common in 10.8% of diabetic patients surveyed, with rates of hypoglycemia ranging from 9.3% to 13.8% across all levels of HbA1c. (Source: Medpage Today)
  • Scientists have identified a metabolic signature that may help determine response to antidepressant treatment in patients with major depressive disorder (MDD). Several biochemical changes in patients who respond to the selective serotonin reuptake inhibitor (SSRI) sertraline were identified using "pharmacometabolomics". As per the researchers, these changes occur in the tryptophan pathway connected to the pineal gland that controls sleep, suggesting a further link between sleep, depression, and treatment outcomes. (Source: Medscape)

Rabies News (Dr. A K Gupta)

Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.

cardiology news
  • Measuring aortic stiffness may help identify patients with type 2 diabetes who are at high risk for a fatal or nonfatal MI, stroke, or other cardiac events, according to the Rio de Janeiro Type 2 Diabetes Cohort Study. In the study published online July 22 in Diabetes Care, patients with increased carotid-femoral pulse-wave velocity (PWV), a measure of arterial stiffness, were more likely to have a subsequent CVD event, even after adjustment for traditional cardiovascular risk factors compared with other patients. According to the authors, measurement of aortic stiffness, which is a rather simple, safe, and noninvasive method, should be incorporated into cardiovascular risk assessment of (at least) type 2 diabetic patients (who are) at high cardiovascular risk. (Source: Medscape)

  • A review of 6 studies involving more than 900,000 patients suggests that for patients with type 2 diabetes, having episodes of severe hypoglycemia may be putting them at risk for cardiovascular disease. The meta-analysis also supports the notion that avoiding severe hypoglycemia may be important to prevent cardiovascular disease in such individuals The review, a joint effort by researchers in Japan, the United States, and the Netherlands, is published online July 30 in BMJ.  (Source: Medscape)

Valvular Heart Disease News

Formal quantification of MR severity is indicated in all patients with more than mild MR, as it provides reliable prognostic information in patients with mitral valve prolapse.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • Preschoolers who consumed sugary drinks were more likely to gain excess weight and run the risk of being obese compared with non-drinkers, reports a study published in the journal Pediatrics. In the study, a higher rate of sugar-sweetened beverage consumption was associated with higher body mass index (BMI, P<0.05 and P<0.001, respectively) among 4- and 5-year-olds, while a higher odds ratio for obesity was seen at age 5 (1.43, 95% CI 1.10-1.85, P<0.01) , according to the authors, Mark DeBoer, MD, of the University of Virginia's Department of Pediatrics in Charlottesville, and colleagues. Though the association for obesity was not seen in 2-year-olds, those that drank sugary drinks had a greater increase in BMI over the next 2 years versus infrequent and non-drinkers. (Source: Medpage Today)

  • The roughly one in 20 middle and high schoolers who use "chaw," snuff, or other smokeless tobacco have typically added it on to their cigarette habit, a study showed, countering the idea of a less harmful replacement for smoking. Classroom surveys indicated 5.6% of 6th to 12th graders currently used any smokeless tobacco product, of whom 72% also smoked. Israel T. Agaku, DMD, MPH, of the Harvard School of Public Health's Center for Global Tobacco Control in Boston, and colleagues report in the September issue of Pediatrics that peer pressure was the biggest influence, with nearly 10-fold higher likelihood of using smokeless tobacco use if a close friend did. (Source: Medpage Today)
cardiology news

Stent benefit questioned in stable angina

For patients with stable coronary artery disease (CAD), stent placement offered no more benefit than optimal medical therapy, according to a meta–analysis by Kathleen Stergiopoulos, MD, PhD, and David Brown, MD, of Stony Brook University Medical Center in Stony Brook, N.Y reported in the journal Archives of Internal Medicine.

Stents had no significant effect on the risk of nonfatal myocardial infarction, unplanned revascularization, or persistent angina. The current guidelines prefer initial medical treatment with aspirin, statins, angiotensin–converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs), combined with lifestyle changes. The researchers included eight trials with a total of 7,229 patients, including the landmark COURAGE trial. For a study to be included, at last half of the patients assigned to PCI had to have been given a stent; the proportions ranged from 72% to 100%. The death rate for stent implantation was 8.9% compared with 9.1% for medical therapy. The rates for nonfatal MI were also similar –– 8.9% for stents and 8.1% for medical therapy. The rate of unplanned revascularization in the stent group was 21.4%, compared with 30.7% in the medical treatment group. The rates of persistent angina were 29% for stents and 33% for medical therapy.

Up to 76% of patients with stable CAD can avoid PCI altogether if treated with optimal medical therapy.

Simply putting in a stent in a blockage does not address the underlying problem. Lifestyle changes and aggressive medical management are far more important than just putting in a stent.

cardiology news

Paternal age and fertility

Bulk of data point to a decrease in fertility with increasing age. This may be due to a number of factors, including decreased coital frequency, reduced sexual functioning, and poorer semen quality as men age

cardiology news

HCFI Activities


CPR 10 Camp - Balwant Rai Mehta School, G K 2, New Delhi

Total CPR since 1st November 2012 – 59332 trained

2nd August: CPR 10 Balwant Rai Mehta School, GK 2, New Delhi (1800)

3rd August: CPR 10 Police Personnel Training Camp DCP South Delhi (315)

TV and Radio Coverage

30th July: Dr KK Aggarwal on India News

Video Chats and uploads

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News JULY

Media advocacy through Web Media

All police personnel under DCP (South Zone) to be trained in CPR10 3rd August


Eating refined sugar can cause diabetes

Eating too much refined white sugar can cause insulin resistance and future diabetes said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Diabetes does not mean that one cannot have desserts forever. While eating too many sugary foods should be avoided, one can have an occasional dessert, especially if one exercises and otherwise eats healthy. It’s better to substitute brown sugar or Jaggery in that case. Artificial sweeteners including stevia are the other options.

Fruits are healthy for diabetics but cannot be consumed in huge amounts, as they contain carbohydrates.

As per Ayurveda, diabetes is a Kapha disorder and diabetics should limit the intake of sweet, salt and sour taste in the diet. Any fruit or vegetable which is bitter and dark green has anti diabetic properties.

One should combine a bitter taste with a sweet taste when choosing a vegetable of a fruit. For example one should not combine peas with potatoes but one can combine potatoes with methi or palak.

Diabetics are not more susceptible to colds and other illnesses but may have more complications of flu.

Taking insulin does not cause hardening of the arteries or high blood pressure.

Diabetes is not contagious and one cannot catch diabetes from someone else.

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 59332 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 10x10 i.e. 100 per minute."

today emedipics

A CPR 10 Training Camp was organized by Heart Care Foundation of India at Universal Public School on 5th August 2013. Students were trained on CPR 10 technique.

press release

Excerpts from a CME talk by Dr KK Aggarwal

today video of the dayDr KK Aggarwal on Doctors Day SAHARA SAMAY News

Dr KK Aggarwal on How to Stay Fit

Smart Phones Benefits and Hazards

eMedi Quiz

Read this…………………

A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:
a.    Keep the client’s knee on the affected side bent for 6 hours.
b.    Apply pressure to the puncture site for 30 minutes.
c.    Check the client’s pedal pulses frequently.
d.    Remove the dressing on the puncture site after vital signs stabilize.

Yesterday’s Mind Teaser: A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in…
a.    1 minute.
b.    30 minutes.
c.    1 hour.
d.    24 hours.

Answer for yesterday’s Mind Teaser: a. 1 minute.

Correct answers received from: Dr Prakash Khalap, Dr. Sushma Chawla, Tukaram Pagad, Dr. V.P. Thakral, Dr Abbas Vakil, Dr Satish Bhat, Dr. P. C. Das, Dr Arpan Gandhi, Dr. Vishal D Wahane, Dr.(Maj. Gen.) Anil Bairaria, Dr Pankaj Agarwal, Dr.K.V.Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr B K Agarwal, Dr Santhakumari,

Answer for 4th August Mind Teaser:d. Foul-smelling discharge from the penis

Correct answers received from: Dr Santhakumari

Send your answer to ijcp12@gmail.com

eMedi Apps

medicolegal update

Click on the image to enlarge

medicolegal update

A group of expectant fathers sat nervously in the hall. A nurse beckoned to one of them and said, "Congratulations, you have a son!" Another man dropped his magazine, jumped up and said, "Hey, what's the idea? I got here two hours before he did!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

medicolegal update

Money is not the most important thing in the world. Love is. Fortunately, I love money. Jackie Mason

medicolegal update

Dr KK Aggarwal :Poor hygiene habits may lead to Typhoid fever http://bit.ly/1666DSO #Health

Dr Deepak Chopra: Empirical facts are not descriptions of fundamental reality but descriptions of modes of human observation using a human nervous system

medicolegal update

Dear Dr K K Aggarwal, The Inspirational Story (of a broke woman being helped by a worker, her rising in life, and paying her debt by helping the worker now in trouble), in 4th August eMedinews, is truly a great story. Dr. Narendra Kumar Ophthacare Eye Centre

Forthcoming Events

29th September–Dil Ka Darbar at NDMC Convention Centre, CP New Delhi

20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India

eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

medicolegal update

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