7th December 2014, Sunday

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

Prevention Strategy Relies on Lifestyle

Stenting may not always be the answer to treating heart disease with stable.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event-free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event-free survival -- no stroke, heart attack, or death -- compared with 50% of stented patients after four years.

Exercise is an important part of any type of prevention, and it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home.

Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

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66th Annual Conference of Cardiological Society of India (CSI) -2014 conference newsletter day 3

66th Annual Conference of Cardiological Society of India (CSI) -2014

Dr Vijay Trehan

An Interview with: Dr Vijay Trehan, New Delhi

While choosing statin in different population, what criteria you think is ideal?
There are no ideal criteria. The criteria proposed by the recent 2014 guidelines are the most inclusive so far. As per the current recommendations, the patient subsets in which statins are most beneficial include • Patients with clinical CVD or diabetes mellitus • Patients with multiple CV risk factors • Patients with hypercholesterolemia
However the situations in which there is no clear consensus as to the usefulness of statins are • Heart failure • ESRD • Hypertriglyceridemia • Elderly individuals
The use of statins in these population subgroups should be based on an individualistic approach. Each patient should be evaluated for the extent of cardiovascular risk involved in a given setting and the decision to use statins should be based on individual risk benefit ratio keeping in mind the probability of adverse effects and higher cost of therapy with the use of statins.
“New onset of Diabetes with statin” is a hot subject of debate. What is your opinion on this?
Recent trials have shown that statin use may be associated with an increased incidence of new onset diabetes but at the same time, the use of statins have been associated with a highly significant reduction in cardiovascular events. The benefits of statins have been proved beyond doubt in a multitude of trials with more than 500 000 patient-years of treatment.
A review of the data shows that the risk of developing diabetes with statin use is 1 case per 250 patients treated with statins for 4 years. However in the same patient population, 5.5 more CV events will be prevented by using statins. The risk benefit ratio turns out to be 9:1 in favor of net CV benefit. So the benefits derived from the use of statins in high risk patients clearly outweigh the small amount of risk involved.
Do you think statins + antiplatelets can make a significant contribution in primary prevention of CAD? Which patient population can benefit the maximum with the combination?
Statins have been proven to be highly efficacious and cost effective in primary prevention of CAD but the same cannot be said for aspirin and other anti-platelets. They are primarily useful in preventing further events in patients with acute coronary syndromes and clinical CAD. In this cohort the benefits derived from using antiplatelets significantly outweigh the associated elevated risk of bleeding but its role in primary prevention is controversial. In a large meta-analysis including 9 trials and over 100,000 patients, aspirin failed to show unequivocal benefit.
As such the use of this combination cannot be justified in the setting of primary prevention. The evidence so far advocates the use of statins alone in this population. However, it may prove highly beneficial in patients with clinical CAD where both statins and antiplatelets have been shown to have a significant beneficial effect.
What is your opinion on AHA 2014 late breaking trial – IMPROVE IT trial?
The IMPROVE IT trial showed that in patients post high-risk ACS, ezetimibe 10 mg/simvastatin 40 mg is superior to simvastatin 40 mg alone in reducing CV events, with a NNT of 56 to prevent 1 event. The mean LDL-C of the patients included in this study at the time of ACS was 125 mg/dl which was reduced to around 70 mg/dl with simvastatin alone and to approximately 50 mg/dl with simvastatin + ezetimibe.
This is the first study to assess whether the addition of a nonstatin drug to further lower LDL-C in patients who are already on a statin with borderline baseline LDL-C levels, will provide any additional benefit in clinical outcomes. But, a significant drawback of this trial is that ezetimibe was compared with add on therapy with a statin with lesser potency instead of high potency statins like atorvastatin and rosuvastatin which are more likely to be used in this setting.
Further studies are still required to generate solid evidence to unequivocally prove benefits with ezetimibe when compared to high dose statins or when used in combination with low dose statins in patients who are unable to tolerate high dose statins due to adverse effects and stop a potentially beneficial drug. Furthermore the use of this drug in primary prevention settings is still unclear.
How important is addition of fenofibrate to statin in the Indian context particularly when hyperlipidemia is prevalent in T2DM population? Fenofibrate has no proven role in the management of dyslipidemia. Previous trials did show borderline benefit especially in the subset of patients with retinopathy but HPS Thrive, a large well-conducted randomized trial has negated all previous claims. This trial is particularly relevant to our context because it had included a substantial number of Asians in the trial. Nevertheless, in clinical practice, fenofibrate may still be useful in the patients who present with predominant hypertriglyceridemia which is much more commonly seen in patients with diabetes.
What role does polypill therapy play in combination therapy with statin?
Polypill definitely improves compliance. It has now been proven beyond doubt that despite the different chemical and pharmacological properties of drugs, they can be safely and effectively combined into one pill while maintaining the stability and efficacy of each individual component. The combination provides the same clinical responses and adverse effects that are expected with each drug used separately.
A fixed dose combination drug which is administered once daily could intervene simultaneously on several common risk factors and theoretically reduce CVD to a larger extent for primary prevention.
Furthermore, polypill is easier to administer requiring lesser monitoring and may lead to more widespread and cost-effective secondary prevention.

News Around The Globe

  • Lower esophageal sphincter (LES) electrical stimulation therapy via the EndoStim system can provide ongoing relief to patients with refractory gastroesophageal reflux disease, suggests a new study published online in Surgery.
  • New research has shown that an oligosaccharide that binds more than one region of amyloid-ß (Aß) enhances clearance of the protein from the brain and improves cognition among patients with mild to moderate Alzheimer's disease (AD). The findings were presented at the 7th Clinical Trials Conference on Alzheimer's Disease (CTAD).
  • The risk of developing venous thromboembolisms (VTEs) and other types of blood clots increases with longer surgeries, suggests a new study published online December 3 in JAMA Surgery.
  • The Anti-Infective Drugs Advisory Committee voted 11 to 1 in favor of recommending approval of the combination of ceftazidime and avibactam (CAZ-AVI) for treatment of complicated intra-abdominal infections (cIAI) and 9 to 3 in favor of recommending approval of CAZ-AVI for treatment of complicated urinary tract infections. However, the recommendations carry the wording "when limited or no alternative treatments are available."
  • A probiotic drink containing Lactobacillus casei Shirota can significantly reduce antibiotic-associated diarrhea in patients with spinal cord injury, suggests a new study presented at Healthcare Infection Society 2014 International Conference.

Dr KK Spiritual Blog

Always Respect Others Viewpoints

It is an old saying that one is proud of his or her own intelligence and somebody else’s partner and wealth. Most of the disputes occur when there is ego clash and that occurs when you want your point to be noticed by everybody. But remember that for every situation, invariably, there will be multiple opinions.

In one of my meetings, I asked my lifestyle students-cum-colleagues to imagine Rahul Gandhi as the Prime Minister of the country. Following were the views of various people:

  1. He is too young.
  2. He is immature.
  3. He is childish
  4. It will be failure of democracy
  5. He has no political will
  6. He has no strength for taking decisions
  7. He has no experience
  8. He is open minded
  9. He will bring youth to politics
  10. He has experienced team behind him
  11. He will bring a new approach to politics etc etc.

The message is very clear that everybody has his or her own perception and we should learn to respect that.

Inspirational Story

Carrots, Eggs and Coffee

A certain daughter complained to her father about her life and how things have been so hard for her. She did not know how she was going to make it and she wanted to give up. She was tired of fighting and struggling. It seemed that just as one problem was solved another arose.

Her father, a chef, took her to the kitchen, filled three pots with water and placed the fire on high. Soon the three pots came to a boil. In one he placed carrots, in the other he placed eggs, and in the last he placed ground coffee beans. He let them sit and boil, without saying a word.

The daughter sucked her teeth and impatiently wondered what he was trying to do. She had problems, and he was making this strange concoction. In half an hour he walked over to the oven and turned down the fire. He pulled the carrots out and placed them in the bowl.

He pulled the eggs out and placed them in the bowl. Then he ladled the coffee out and placed it in a bowl.

Turning to her he asked. "Darling what do you see," Smartly, she replied. "Carrots, eggs and coffee"

He brought her closer and asked her to feel the carrots. She did and noted that they were soft. He then asked her to take an egg and break it. After pulling off the shell, she observed the hard-boiled egg. Finally, he asked her to sip the coffee. Her face frowned from the strength of the coffee.

Humbly, she asked. "What does it mean Father?" He explained. "Each of them faced the same adversity, 212 degrees of boiling water. However each reacted differently." "The carrot went in strong, hard, and unrelenting. But after going through boiling water, it softened and became weak."

"The egg was fragile. A thin outer shell protected a liquid center. But after sitting through the boiling water, its inside became hardened." "The coffee beans are unique however. After they were in the boiling water, it became stronger and richer." "Which are you," he asked his daughter.

When adversity knocks on your door, how do you respond? Are you a carrot, an egg, or a coffee bean? Are you the carrot that seems hard, but with the smallest amount of pain, adversity, heat you wilt and become soft with no strength?

Are you the egg, which starts off with a malleable heart? A fluid spirit. But after a death, a breakup, a divorce, a layoff you became hardened and stiff. Your shell looks the same, but you are so bitter and tough with a stiff spirit and heart, internally.

Or are you like the coffee bean? The bean does not get its peak flavor and robust until it reaches 212 degrees Fahrenheit. When the water gets the hottest, it just tastes better. When things are there worst, you get better. When people talk the most, your praises increase. When the hour is the darkest, trials are their greatest, your worship elevates to another level.

How do you handle adversity? Are you a carrot, an egg, or a coffee bean?

Rabies News (Dr A K Gupta)

Can the animal bite wounds be cauterized?

Cauterizing the wound is not advisable as it leaves a very bad scar and also does not confer any additional advantage over washing the wound with water and soap. It amounts to malpractice and the doctor can be sued for compensation under COPRA.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at Sarvodaya Kanya Sec. School, Pushp Vihar on 7th November 2014


video of day
press release

AHA – ACS update

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 :


Dr Good and Dr Bad

Situation: A patient was diagnosed with HIV–AIDS.
Dr Bad: You will die within ten years.
Dr Good: You can live a fairly normal life span.
Lesson: In the 1980s, a young adult diagnosed with AIDS typically survived less than one year. Today, a similar person can expect to live to age 70 or beyond if he or she is diagnosed with HIV infection early, has access to and receives appropriate therapy, and can tolerate the drugs and their side effects.

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 gms of carbohydrates.

eMedinewS Humor

There were these two friends, Bill and Bob, and they both loved baseball. So, they made a promise to each other, the first one to die, will come back and let the other know if there's baseball in heaven. Well, the day comes and Bob passes. Weeks turn to months while Bill is still waiting to hear from his friend.

Then one day, Bill is walking down the street, and Bob appears. Bill all excited, says: "I’ve been waiting forever! So tell me, is there or isn’t there Baseball in heaven?" Bob kinda perks up and says: "I’ve got good news and bad news." "1st, there is Baseball in heaven! The bad news is you’re pitching Friday!"

Twitter of the Day

Dr KK Aggarwal: TB more dangerous than FLU by Dr KK Aggarwal.
Dr Deepak Chopra: Our most natural state is joy. It is the foundation for love, compassion, healing, and the desire to alleviate suffering.

Cardiology eMedinewS

  • A natural substance present in red wine, resveratrol, inhibits the formation of inflammatory factors that trigger cardiovascular diseases, suggests a study published in the scientific journal Nucleic Acids Research. Researchers stated that despite eating more fatty foods, the French tend to less frequently develop cardiac diseases than Germans. This so-called French Paradox could be due to the higher consumption of red wine in France
  • Very obese young men and women are likely to have diabetes and cardiovascular disease for nearly 20 years and die 8 years sooner than their normal-weight peers, suggests new research published online December 5 in Lancet Diabetes & Endocrinology.

Pediatrics eMedinewS

  • A novel intervention that focuses on increasing parental nurturing and decreasing frightening behavior may provide long-term beneficial effects on diurnal cortisol rhythms in at-risk children, indicating decreased stress levels, suggests new research published online December 1 in JAMA Pediatrics.
  • Children with dyslexia do not have the same brain network for reading as children with ocular motility disorders, points new research, thereby suggesting that ocular motility disorders do not cause dyslexia. The research findings were presented at the Radiological Society of North America 100th Annual Meeting.

Quote of the Day

  • Men for the sake of getting a living forget to live. Margaret Fuller

Wellness Blog

Heart risks detected by age 7 in overweight kids

Children at risk of future obesity should be examined for body mass index rebound. BMI rebound is the age at which body mass index (BMI) reaches its lowest point before increasing through later childhood, adolescence and adulthood.

An earlier BMI rebound age is associated with adverse risk factors for heart disease as measured at age 7: higher BMI, higher systolic and diastolic blood pressures, higher serum insulin and leptin levels, higher left ventricular mass and left atrial size.

Early BMI rebound age for children is lower than 4.4 years for boys and 4.2 years for girls. Normal values are 4.4 to 6.6 years for boys and 4.2 to 5.7 years for girls. All children who start gaining weight between 3-4 years should be classified as a high risk for future diabetes and heart disease.

ePress Release

Rise in blood pressure during mental stress is a strong predictor of plaque progression.

Rise in blood pressure during mental stress is a strong predictor of plaque (heart early blockages) progression 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.

Therefore, mental stress test should be done in every patient with neck artery plaques and if positive, these patients should be put on plaque stabilizing drugs. If the plaque is stabilized, one can reduce the chances of heart attack and paralysis.

Presence of plaque in the neck artery in an asymptomatic person is highly indicative of a future heart attack or paralysis. Plaque can be measured by using high resolution ultrasound in any echocardiography laboratory. Plaques progress along the neck artery 2.4 times more than its thickness.

eMedi Quiz

A patient using contact lens develops corneal infection. Laboratory diagnosis of acanthamoeba keratitis was established. The following is the best drug for treatment:

1. Propamidine.
2. Neosporine.
3. Ketocanazole
4. Polyhexamethylene biguanide.

Yesterday’s Mind Teaser: A 20 year old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:

1. Macular edema.
2. Sympathetic ophthalmia.
3. Optic nerve avulsion.
4. Delayed vitreous hemorrhage.

Answer for yesterday’s Mind Teaser: 2. Sympathetic ophthalmia.

Correct answers received from: Dr G V Premkumar, Dr Sajeev Kumar, Dr Rakesh Sharma, Arvind Diwaker, Dr Avtar Krishan, Dr Nirmala Agarwal, Dr Jainendra Upadhyay.

Answer for 5th December Mind Teaser: 1. The sample should be kept at 4°C.

Correct answers received from: Dr Rakesh Sharma, Tukaram Pagad.

Send your answer to email

medicolegal update
  1. eMedinewS is the only excellent news bulletin we are receiving so far, kindly continue to send the same as before. All of you deserve high appreciation and thanks for the wonderful service rendered by the team. Regards. Dr N. Sarmah.

eMedinewS Special

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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)