eMedinewS 7th August 2013, Wednesday

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

National Patient Safety Goals Effective January 1, 2013

Goal 1 is to improve the accuracy of patient identification. Use at least two patient identifiers when providing care, treatment and services.

  1. Wrong–patient errors occur in virtually all stages of diagnosis and treatment.
  2. The intent for this goal is two–fold: first, to reliably identify the individual as the person for whom the service or treatment is intended; second, to match the service or treatment to that individual. Acceptable identifiers may be the individual’s name, an assigned identification number, telephone number, or other person–specific identifier.
  3. Use at least two patient identifiers when administering medications, blood, or blood components; when collecting blood samples and other specimens for clinical testing; and when providing treatments or procedures. The patient’s room number or physical location is not used as an identifier.
  4. Before initiating a blood or blood component transfusion:
    • Match the blood or blood component to the order.
    • Match the patient to the blood or blood component.
    • Use a two–person verification process or a one–person verification process accompanied by automated identification technology, such as bar coding.
    • When using a two–person verification process, one individual conducting the identification verification is the qualified transfusionist who will administer the blood or blood component to the patient.
    • When using a two–person verification process, the second individual conducting the identification verification is qualified to participate in the process, as determined by the hospital. ....Read More

Why one year compulsory rural posting before PG is not the answer

  1. There are one lakh doctors waiting for PGs in the country for only 12000 PG seats as per IMA.
  2. As per an RTI only less than 3000 posts are vacant in rural areas.
  3. It will lead to capitation fee in rural service and will add to the already high corruption in the medical profession.
  4. Another one year of medical study will add to more misery for the students.
  5. Safety of female students will be compromised.
  6. Why can’t the PG exam take place along with the final MBBS exam or mid way in internship after you finish 6 months clinical postings. Rest six months and first six months of PG can be a rural posting and the exam of PG can be linked to rural posting experiences.

Survey by Medical Students Association of India, participated by 11727 students, with 8963 medical students, 6451 males.

  1. 99% do not agree with the government proposal.
  2. 79% want government to cancel the move.
  3. None of them said that they oppose to serve in the rural areas but do not want to link it to education entry.
  4. 32% said that this move will lead to one more additional year to waste.
  5. 19% said that the infrastructure is not ripe for rural postings at this age.
  6. 15% said that the family cannot afford one more year of study.
  7. 4% said that they are getting old and cannot afford additional year of posting.
  8. 4% said that rural posting is not incentive–based.
  9. 58% said that even if they were paid double the amount they would not accept a rural posting
  10. 92% said that the government should first infuse money and make the infrastructure better.
  11. 92% said that after one year of rural service, it will be too late to join PG.
  12. Over 70% said that making it a six-month posting will not matter.....Read More

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 A Jewish perspective on organ donation

Modern technology has made it possible to transplant hearts, kidneys, pancreas, corneas, lungs and livers from one human being to another. It is beyond dispute that organ and tissue transplants save and extend the quality of lives. The ultimate act of altruism is for a living donor to make the gift of an organ to a spouse, a sibling or a friend and there is no greater legacy for the deceased than to serve as a life giver to the others. Respect does not end with the death of a beloved. The dead body is the shell of a living image of God. Rather than deepen our pain at the time of our loved one’s death, this ultimate act of generosity to donate organs may actually soften our loss and uplift us. Recently on 28th June, 2013, my aunt passed away after a brief illness in Israel and as per her last wish, her children donated her body to science for legitimate medical purpose.

There are 613 Commandments in the Old Testament and the most important Commandment is to love your neighbor as yourself (Leviticus 19:18). The Jews were commanded to demonstrate a love for God as well as for their fellowmen. Being willing to donate an organ from our own bodies would seem to be an extreme example of selfless sacrifice for another. The Torah does not specifically address the issue of organ transplantation or donation. Obviously organ transplantation or donation would have been unknown in Bible times. Organ transplantation and donations were once prohibited by Jewish Laws and tradition because they were experimental and endangered life. Today organ donation and transplantation are essentially successful medical procedures. Accordingly Rabbis and Scholars across the spectrum of Jewish life have upgraded.

Organ donation from a corpse to the status of Mitzvah chiyuvit (an obligatory commandment) of "Pikkuah Nefesh" that of saving a life. Organ donation from a living donor so long as it will not significantly risk the donor’s life is a mitzvah kiyumit (a praiseworthy). However there are verses that illustrate broad principles that may apply. One of the most compelling arguments for organ donation is the love, mercy and compassion, such an act demonstrates toward others. Saving a life is a fundamental imperative in Judaism.

Charity (in Hebrew Tzedakah) is an attribute of God himself. Both the Prophets Isaiah and Ezekiel considered charity as an indispensable requirement for a life. The Hebrew word "Tzedakah" means righteousness or justice. Charity to donate organs is greater than all the sacrifices. Giving charity is the way in which man can "walk after the Lord your God (Deuteronomy 13:5). Charity saves us from the death.(Proverb 1:2). Charity of saving life of another is as important as all other commandments put together. Proverb 21:3 says – To do righteousness (Tzedakah) and justice is more acceptable to the Lord than sacrifice to mean that charity is greater than all the sacrifices.

In principle, Judaism supports and encourages organ donation in order to save lives (in Hebrew "Pikkuah Nefesh"). Most rabbinical authorities not only permit it but also encourage it. The Talmud Tractate Yoma 65b reminds us to remember the commandment "You shall live by them, you shall not die because of them". (Leviticus 19:16) This means that we should not stand idly by the blood of our neighbor. This principle overrides the Jewish objections to any unnecessary interference with the body after death and the requirement for immediate burial. On the contrary the body is sewn up quickly and the funeral can occur without much delay.

Judaism considers organ donation as the highest mitzvah (Commandment) and the most religious person should perform it. The ultimate respect for the dead is to enable them to save a life; giving life is the highest form of respect of life. In the Talmud, saving a life supersedes most everything and many commandments may be transgressed if the goal is to save a life and therefore organ donation fulfilled the highest religious and spiritual virtue because Judaism holds life as being sacred. For humanistic Jews, there is no greater value than the sanctity of life. Saving a person’s life is to sacred, a value in Judaism that if a person’s organ can be used to save someone else’s life, it is actually an honour for the deceased. As Mishnah Sanhedrin 4:6 says, "Whoever saves one life, it is as if he saved the entire world."

Jewish Law distinguishes between donating organs during your life time and after death while you are alive and donate an organ that you can live without like a kidney or parts that will replenish themselves like blood, or bone marrow in order to save or vastly improve another life is one of the greatest acts you could do.

However there can be significant emotional, spiritual blocks and psychological factors to fulfilling a mitzvah (commandment) such as organ donation. Sometimes leads to family member to block their deceased loved one's organ donation out of emotional discomfort or misplaced devotion. But it is our responsibility to honor God's name and to save lives by giving the gift of life by donating organs.

All religious and spiritual leaders as well as all inter-faith organizations and NGOs may unitedly come together (6th August, 2013 was Organ Donation Day) and create awareness among their followers, students in schools and colleges by communicating their willingness to donate organs on online "www.Ileadeindia2013.com" and let us say with one voice "I would like to help someone to live after death."

Let us remember a favorite bumper sticker which reads "Don’t take your organs to heaven because heaven knows we need them here". Organ donation needs to be seen as a true mitzvah, a commandment, a "must". ….Read More

cardiology news

In the year 1962, a professional from Rewari got appointed at Sir Ganga Ram Hospital in New Delhi. He received a letter from another professional from Hardoi saying that he was very hopeful of getting the job and was disappointed having lost it.

N. K. Gupta, having noticed the PGI advertisement the same day, wrote back, "Should you be needing this job in Delhi so badly, I can leave it, but send an application to PGI at Chandigarh, and one never knows, there might be a silver lining waiting for you"…and simultaneously wrote to the institute director, "Everyone aspires to join a prestigious institution like yours, but I’m not making an application as ‘so–and–so’ is in greater need of the job".

While N. K. Gupta served at GRH, H. O. Rastogi served at PGI for around 30 years. ….Read More

News Around The Globe

  1. eMedinewS mourns the sudden demise of Shri Jaywantrao Bhosale – Founder, Chairman & Chancellor of Krishna Institute of Medical Sciences University (KIMS), Karad – India. Medical Students Association of India (MSAI–India) was founded here in 2011. He was one of the pillars. (Dr Swapnil Bumb, BDS for MSAI)
  2. NEET review petition in Supreme Court: A petition has been filed in the Supreme Court seeking a review of its judgement scrapping the single common entrance test for admissions to MBBS, BDS and post–graduate courses in all medical colleges. The plea filed by NGO ‘Sankalp’, through lawyer Prashant Bhushan, has sought a review of the July 18 majority (2–1) verdict of the apex court that had quashed the notifications for National Eligibility–cum-Entrance Test (NEET) on the ground that it violated the rights of state and private institutions to administer such institutions, reports Indian Express.

    Seeking the review on the grounds including that of rampant corruption in the absence of NEET, the plea said the verdict also needed to be re-looked as there was "no discussion at all among the judges before delivering it, which is apparent from the minority judgement itself." "In fact, in the very second para of the judgement, it has been observed 'as the learned Chief Justice is to retire within a few days, I have to be quick and therefore, also short. Prior to preparation of our draft judgements, we had no discussion on the subject due to paucity of time", It is respectfully submitted that this observation in the minority judgement makes it all the more necessary that the aforesaid judgement is reviewed," it said.

    The judgement quashing the NEET was delivered by a three–judge bench headed by Chief Justice Altamas Kabir (now retired) by a 2–1 division. The view of the then CJI was shared by Justice Vikramjit Sen, while Justice A R Dave had dissented and upheld the NEET saying the policy was "legal" as it would stop corrupt practice which enabled undeserving students to get admissions by paying huge capitation fees or donations. The review petition also said the minority view in the judgement rightly held that if the NEET is conducted under the supervision of the apex professional body, no extraneous and irrelevant factors like caste, creed, social or economic standing would come into play.
  3. Around 2,500 radiologists across the state have threatened to down shutters next week after a Nanded doctor was booked for allegedly revealing the gender of a female foetus that was later aborted. They claim the radiologist has wrongfully been charged under stringent IPC sections despite evidence that his assistant had leaked the gender information for Rs 2,000. Last week, Savita Assture (25) was admitted to a civil hospital in Nanded with excessive bleeding and a fluctuating blood pressure. She told the doctors that she had "aborted" a female foetus. The authorities immediately alerted the police. The police found that a quack, Arifabee Begum, had allegedly carried out the abortion. She reportedly told the police that radiologist Dr Gopal Battalwar had conducted Assture’s fetal anomaly scan a month ago. Cops recovered papers corroborating the claim from Dr Battalwar’s clinic. On July 26, Battalwar was arrested on charges under section of IPC 312 (voluntarily causing a woman with child to miscarry), 315 (act done with intent to prevent child being born alive) and 316 (causing death of unborn child by act amounting to culpable homicide). "Cops have found the doctor’s assistant, Noorjahan Begum, had passed on the details," said Dr Vijay Patil, a radiologist from Nanded. "A radiologist is not trained to carry out an abortion. The charges are unacceptable," said Dr Jignesh Thakker, secretary of Indian Radiology and Imaging Association.
  4. Restructure public health system: National Advisory Council: ET Bureau: The Sonia Gandhi–led National Advisory Council has asked the government to move ahead with making universal healthcare a reality by restructuring the public health system. With elections barely nine months away, the Congress is looking to shore up its image as the party committed to improving the aam aadmi’s lot. Following popular schemes on rural employment, right to education and right to food, the ruling party is now focusing on health, which is a major cause of impoverishment. India is among the countries with the lowest public spend on healthcare – about 1% of the GDP, compared with China’s 2.9% and Thailand’s 3.1%.
  5. Personalized Vaccine Targets Leukemia: A new personalized cancer vaccine that was deployed soon after bone marrow stem cell transplantation saw 13 of 18 chronic lymphocytic leukemia patients live a median of almost three years in complete remission. Six patients in the phase I trial that received the maximum vaccine doses produced CLL–specific CD8+ T cells. The results suggest that the new regimen could enhance anti–tumor response post transplantation, said Catherine J. Wu, MD, medical oncologist and researcher at Dana–Farber Cancer Institute. They reported the results of the new approach in the Journal of Clinical Investigation.

    Wu and her colleagues injected the vaccines once a week with three doses and then three more every other week. Median follow–up was 2.9 (range, 1 to 4) years and showed an estimated 2–year progression–free survival rate for vaccinated patients at 82%. Overall survival rate was 88%. The investigators extracted whole tumor cells from each patient and irradiated the cells for the vaccine formulation. Their goal was to trigger an immunogenic response that would target personalized antigens. In tandem with the irradiated tumor cells, the researchers also injected cells engineered to secrete GM–CSF, as a cytokine adjuvant.

Rabies News (Dr. A K Gupta)

What should be done with a patient who has had exposure but goes for treatment after considerable delay (weeks to months)?

An early and correct administration of modern anti–rabies vaccine is life–saving. The vaccination must be started immediately irrespective of the status of the biting animal. Patients who seek treatment after a delay of 48 hours or even months after having been bitten should be dealt in the same manner as if the exposure occurred recently.

cardiology news
  • The first observational study of long-term antihypertensive use and breast cancer risk has found that calcium–channel blockers are associated with a more than 2–fold increased risk and that angiotensin–converting–enzyme (ACE) inhibitors are associated with a reduced risk. In a study published online August 5 in JAMA Internal Medicine, women who had taken CCBs for 10 years or more had more than double the usual risk for invasive ductal breast carcinoma (odds ratio (OR), 2.4) and for invasive lobular breast carcinoma (OR, 2.6). (Source: Medscape)
  • According to results of a randomized trial published in the August issue of the Journal of the American College of Cardiology: Heart Failure., the calcium channel blocker amlodipine (Norvasc) was found not to reduce the risk of death in patients with heart failure due to non–ischemic cardiomyopathy. The drug and placebo yielded essentially the same results –– about a third of patients died in each arm over a median of 33 months of follow–up. As per the authors, the findings demonstrate that amlodipine "does not exert favorable effects on the clinical course of patients with heart failure (Source: Medpage Today)

Valvular Heart Disease News

In elderly adults: Mitral valve repair, if possible, is the surgical treatment of choice for mitral regurgitation. It preserves all of the functional components of the native valve, avoids the use of a prosthesis with its attendant complications and overall is associated with lower rates of morbidity and mortality than mitral valve replacement.

(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
  • Newborn screening for critical congenital heart disease (CCHD) in the United States could be reasonably cost–effective, according to the first US cost–effectiveness analysis of such screening, published online August 5 in Pediatrics. According to Cora Peterson, PhD, from the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues, clinical evidence indicates newborn (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns." (Source: Medscape)

  • For newborn babies, taking ethnicity into account may help determine how small is too small. Canadian researchers have found that birth–weight standards based on population averages did not predict which babies born at or near term were likely to suffer problems associated with being small for gestational age. Gillian Hanley of the School of Population and Public Health at the University of British Columbia in Vancouver said that based on her results, adjusting the standards may be necessary. (Source: Medscape)
cardiology news

Even the elderly should exercise

Research spanning two decades has found that older runners live longer and suffer fewer disabilities than healthy non–runners. This observation applies to a variety of aerobic exercises, including walking.

A study by authors, from Stanford University School of Medicine, published in Archives of Internal Medicine has shown that being active reduces disability and increases survival.

There are benefits of vigorous activity late in life. Earlier many experts believed that vigorous exercise would actually harm older individuals. And running, in particular, would result in an epidemic of joint and bone injuries. But this new study proves otherwise.

Two hundred and eighty–four runners and 156 healthy "controls," or non–runners, in California completed annual questionnaires over a 21–year period. The participants were 50 years old or over at the beginning of the study and ran an average of about four hours a week. By the end of the study period, the participants were in their 70s or 80s or older and ran about 76 minutes a week.

At 19 years, just 15 percent of the runners had died, compared with 34 percent of the non–runners.

In the study, running delayed the onset of disability by an average of 16 years. It’s so important to be physically active your whole life, not just in your 20s or 40s, but forever. Exercise is like the most potent drug. Exercise is by far the best thing you can do.

One should take lessons from Yudhishtir in Mahabharata who walked till his death.

However a word of caution, if an elderly is walking or entering into an exercise program, he or she should have a cardiac evaluation to rule out underlying heart blockages. …Read More

cardiology news

Children and adolescents in the United States spend an average of 6.5 hours per day watching television, playing video games, or using computers. Children’s television (particularly cartoons), movies, music videos, and video games are potential sources of violent content.

cardiology news

HCFI Activities


CPR 10 Camp – E Book Balwant Rai Mehta School, G K – 2, New Delhi

Total CPR since 1st November 2012 – 59332 trained

CPR Classes: Persons trained (3193)

5th August: CPR 10 at Universal Public School (1078)

CPR VIP Sensitization

CPR Classes 59332

Video Chats and uploads

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News JULY

Media advocacy through Print Media

Media press clipping 4th August 2013.

Media advocacy through Web Media

Eating refined sugar can cause diabetes 6TH AUG LINK


Low BP may be normal

There is nothing like low blood pressure. If it is low, keep it low and is good for the heart said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela, National Vice President Elect – IMA.

Low blood pressure, medically called hypotension, however can be a medical problem if there is an acute or chronic fall of blood pressure from a baseline blood pressure value.

Any fall of upper blood pressure of more than 30 mm Hg will be called as an acute low blood pressure and cause symptoms and reduced flow to vital organs.

An acute fall in blood pressure can occur in heart failure, acute heart attack, and reactions to some drugs, acute allergic reaction, dehydration, blood infection or irregular heart rhythms.

Blood pressure may become permanently low in heart valve stenosis, chronic heart failure or with some cardiac drugs.

Some individuals routinely may have blood pressures of 90/50 with no symptoms and therefore do not have low blood pressure. However, others who normally have higher blood pressures may develop symptoms of low blood pressure if their blood pressure drops to 80/60 or a fall of 30 in the above reading.

Arbitrary criteria for low blood pressure is upper BP lower than 90 or lower BP lower than 60 or a fall of more than 30 mm Hg in upper blood pressure acutely.

If there is an acute fall in blood pressure, kidney shutdown is a risk. If the patient does not pass urine in the next 8 hours the patient can end up with acute kidney failure.

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

Dr KK Aggarwal Speaks on Additional Lab tests: eGFR>60

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 female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the client’s risk of:
a. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
b. A decreased serum phosphate level secondary to kidney failure.
c. An increased serum calcium level secondary to kidney failure.
d. Metabolic alkalosis secondary to retention of hydrogen ions.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: c. an increased serum calcium level secondary to kidney failure.

Correct answers received from: dr p j khalap, Dr. P. C. Das, Dr shashi saini, Dr.Brijesh Soni, Dr Arpan Gandhi, Dr.(Maj. Gen.) Anil Bairaria, Dr. V.P. Thakral, Dr.K.V.Sarma, Dr Pankaj Agarwal. Dr Pankaj, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr.K.Raju, Muthumperumal Thirumalpillai, daivadheenam, Dr Avtar Krishan, Dr Valluri Ramarao.

Answer for 5th August Mind Teaser:d. a. 1 minute.

Correct answers received from: Dr Valluri Ramarao

Send your answer to ijcp12@gmail.com

eMedi Apps

medicolegal update

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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

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medicolegal update

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, came for follow up.
Reaction: Oh My God! Why didn’t you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

medicolegal update

Sunbeams out of the clouds Faith out of all my doubt. Terri Guillemets

medicolegal update

Dr KK Aggarwal: Eating refined sugar can cause diabetes http://bit.ly/16wknsh #Health

Dr Deepak Chopra: Why do you stay in prison When the door is so wide open–Rumi

medicolegal update

Dear Sir, Good Work, Keep It Up. Regard: Dr Kaniska

Forthcoming Events

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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

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