eMedinewS8th August 2014, Friday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Ebola Virus a new terror agent: Dengue like illness with rabies like mortality

  1. The filoviruses, Marburg and Ebola, are among the most virulent human pathogens.
  2. Case fatality rates are 80 to 90 percent.
  3. Ebola viruses are also classified as "hemorrhagic fever viruses" based on their clinical manifestations, which include coagulation defects, a capillary leak syndrome, and shock.
  4. Other types of viral HF include Rift Valley fever, Crimean–Congo HF, Lassa fever, yellow fever, and dengue HF.
  5. The filoviruses, Marburg and Ebola, are among the most virulent human pathogens, causing severe hemorrhagic fever that resembles fulminant septic shock.
  6. Person–to–person transmission requires direct contact with blood or other virus-containing body fluids.
  7. The reservoir host of the filoviruses is not known.
  8. Various bat species may serve as a source of infection for both humans and wild primates.
  9. Flavi viruses cause extensive tissue damage
  10. They also induce a systemic inflammatory syndrome by causing the release of cytokines, chemokines, and other proinflammatory mediators from infected macrophages.
  11. The incubation period is usually 5 to 7 days, but may exceed two weeks.
  12. Patients usually have an abrupt onset of non–specific symptoms, such as fever, malaise, and myalgias.
  13. As the illness progresses, patients develop worsening prostration, stupor, and hypotension.
  14. Signs of impaired coagulation generally remain limited to conjunctival hemorrhages, easy bruising, and failure of venipuncture sites to clot.
  15. Due to their virulence, stability as aerosols, and high infectivity, Marburg and Ebola viruses are classified as Category A bioterror agents.
  16. The occurrence of even a single human infection outside of Africa is therefore a public health emergency requiring immediate investigation, since it could represent the leading edge of an impending outbreak.
  17. Rapid diagnostic tests for Marburg and Ebola virus infection have been developed, based on the detection of viral antigens by enzyme–linked immunosorbent assay (ELISA) or specific RNA sequences by reverse–transcription polymerase chain reaction (RT–PCR) in blood or other body fluids. The diagnosis is confirmed through cell culture.
  18. No specific therapy is available for patients who have developed Ebola or Marburg hemorrhagic fever; care is supportive.
  19. Health care workers should employ isolation and barrier procedures recommended by the Centers for Disease Control and the World Health Organization when caring for patients with suspected or known filovirus infection.
  20. Platelets count may fall and SGOT may be more than SGPT as seen in dengue fever.


The CDC has identified a number of pathogens that could be used in biological terrorism and have ranked them into various categories based on their overall potential to cause harm. High–priority agents include organisms that:

  • Can be easily disseminated or transmitted person–to–person
  • Cause high mortality
  • Might cause public panic and social disruption
  • Require special action for public health preparedness
  1. The highest priority agents (Category A) include anthrax and smallpox. These agents are of particular concern because they can be grown easily in large quantities and are sturdy organisms, resistant to destruction. They are also particularly well suited to airborne dissemination, thereby infecting large numbers of people.
  2. Second highest priority agents (Category B) include those that are moderately easy to spread, and generally cause less morbidity and mortality than Category A, but may require enhanced diagnostic capacity or surveillance techniques. Examples include agents of Q fever or brucellosis.
  3. Category C agents include pathogens that could be engineered for mass dissemination either because of ready availability, or ease of production and transport. They are usually agents of significant potential morbidity and/or mortality. Examples include hantavirus or multidrug–resistant tuberculosis.

Because of their virulence, stability, and high infectivity as small–particle aerosols, Marburg and Ebola virus are classified as Category A bioterror agents by the Centers for Disease Control and Prevention (CDC) and the National Institute of Allergy and Infectious Diseases (NIAID).

The occurrence of even a single human infection outside of Africa is therefore a public health emergency requiring immediate investigation, since it could represent the leading edge of an impending outbreak. Marburg and Ebola hemorrhagic fever occur naturally only in central Africa.

News Around The Globe

  • Women who have sex with circumcised partners have modestly lower rates of new HIV infection as compared to the women whose partners are not circumcised, suggests first real–world evidence presented at the 20th International AIDS Conference.
  • Oral mandibular advancement devices have the potential to reduce apneic/hypopneic events in patients with mild to moderate obstructive sleep apnea–hypopnea syndrome (OSAHS), suggests a study published online in Thorax.
  • It has been noted for the first time that the benefits of taking aspirin to prevent some types of cancer outweigh the harms. The findings are published online August 6 in the Annals of Oncology.
  • New guidelines from the American College of Gastroenterology have put forward some new approaches to treating irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) and have illuminated the traditional interventions. The guidelines are presented in an article published in the August issue of the American Journal of Gastroenterology.
  • A new study published online in PLOS One has stated that a couple handfuls of tree nuts a day may improve glycemic control in patients with type 2 diabetes.

Rabies News (Dr A K Gupta)

Can rabies be transmitted to a dog that has eaten the flesh of a dead rabid cow or buffalo?

Yes. The rabies virus after multiplying in the brain spreads to other organs of the body like the heart, muscles, skin, etc. So the dog can definitely get infected because the virus can spread through oral mucous membrane.

Cardiology eMedinewS

  • In a large population of patients being treated for hypertension, those who attained blood–pressure (BP) levels above or below an optimal range had increased odds of dying or developing end-stage renal disease (ESRD) during a three–to five–year follow–up. The study is published in the August 12 issue of the Journal of the American College of Cardiology.
  • Use of implantable cardioverter–defibrillators (ICDs) programmed with long–detection intervals for ventricular arrhythmias was associated with an increase in the time to first hospitalization and reductions in hospitalization rate, length of stay and costs, in comparison with standard interval programming, reported a study published in the August 6 issue of JAMA.

Pediatrics eMedinewS

  • Children with autism spectrum disorders (ASD) may have less flexible brain states as measured by functional MRI, and this may be associated with repetitive behaviors, suggests a study published online in Cerebral Cortex.
  • A new study by researchers at Stanford University School of Medicine, California has shown that plasma oxytocin concentrations and polymorphisms in the oxytocin receptor (OXTR) predict social impairments in children with and without autism. The findings are published online August 4 in the Proceedings of the National Academy of Sciences.

Dr K K Spiritual Blog

How long can one fast?

As per allopathy, one cannot live without air or oxygen for more than 3 minutes, without water for more than three days and without food for more than 3 weeks. As per Chandogya Upanishad, food is responsible for the making of motor organs (Karmendriyas), sensory organs, manas (mind, intellect, memory and ego) and prana.

The fiery foods are responsible for making the motor indriyas, earthy foods for sensory indriyas and manas and water for making Prana Vayu.

Therefore, it is possible for a person to live on water for up to few weeks because he will keep making Prana and keep breathing but absence of food on 14th day onward will start affecting his Gnanaindriyas and Manas. The person will start losing power of hearing, touching and sensing and will start showing impairment in mental status, memory, intellect functions and egoistic

Wellness Blog

Summer Diarrhea Treatment

One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. They need no antibiotics. The only treatment is oral rehydration solution.

One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.

Inspirational Story

Knowing Yourself

Control, fear, doubt and anger; these are the real deadly killers of the human race. We hurt ourselves by feeling these emotions and we hurt others by directing these emotions at them.

But what if we could direct unconditional love to whomever we meet? What then? Could we help the world be a better place? Maybe, maybe not but we'd certainly help ourselves. Why do we let other people hurt us? Because we put expectations on them, expectations that we ourselves have failed to live up to with others.

If you love someone you feel it and that feeling is yours. Look at children. We still love our children when they disappoint us why not our workmates, teachers, friends and most of all partners? It’s because we put conditions on what we give out. Who hasn’t bought a present or done a job around the house expecting something in return – why? If you want to help someone or give something you choose to do it because you want to, not for "Brownie Points". No other reason than just because you want to – that is showing love.

You can help an old lady with her groceries and it feels good so why not with everything else When you learn that giving love without expectation is the purest of all faith, then and only then, will you be on the road to really knowing yourself.

ePress Release

Do not mix salt with milk

A high–salt diet may increase the risk of developing gastric and duodenal ulcers. High concentrations of salt in the stomach can induce gene activity in the ulcer–causing Helicobacter pylori bacterium that causes it to become more virulent. Bacterial cells exposed to increased salt exhibit striking morphological changes. Cells become elongated and form long chains.

Salt restriction also reduces the diastolic blood pressure by 2–8 mmHg, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and Senior National President IMA.

A WHO report, said that reducing salt intake would be a cost–effective way to reduce the risk of developing high blood pressure directly and reducing the risk of heart attack and stroke indirectly. The report recommends people to reduce consumption of sodium to less than 2 gm per day for each person. Common salt is chemically called sodium chloride (NaCl). About 2.5 gm of table salt contains one gm of sodium. This would mean that about 5 gm of table salt is the current recommended level of consumption per day.

According to a report published from the All India Institute of Medical Sciences in the year 2000, the average intake of salt in India is 10 gm per day for each person. This would amount to about 4 gm of sodium. The current recommendations suggest reducing this consumption by half.

A study from Harvard Medical School and published in the British Medical Journal, found that reducing salt intake by 25% reduced the risk of developing heart disease by 25% and reduced the chance of death from heart disease by 20%.

In 2002 WHO estimated that globally about 62% of strokes and about 50% of heart attacks were attributable to high blood pressure.

Adding a pinch of salt to milk will keep it fresh longer is a common Internet tip but traditional Ayurveda teaching goes against it.

As per Charaka Samhita, too much of pipalli, alkali and salt are bad for the health. Ayurveda totally prohibits taking salt with the milk.

eMedi Quiz

A self practicing dermatological needs

a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. A combination of store and forward, online discussion group, and author based second opinion teledermatology

Yesterday’s Mind Teaser: Bacitracin acts on:

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

Answer for yesterday’s Mind Teaser: 1. Cell Wall

Correct answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Arvind Diwaker, Dr.Chandresh Jardosh, Daivadheenam Jella, Dr Avtar Krishan, Dr Prakash Khalap,

Answer for 6th August Mind Teaser: 1. Hydatid cyst of liver.

Correct answers received from: Dr K V Sarma, Dr Poonam Chablani, Dr Sushma Chawla, Dr P C Das,Deepak Ambli, Dr Vijayakumar R R, Dr Meenakshi, Dr K Raju, rajanish shetty, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Bitaan Sen, Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

eMedinewS Humor

A Modern Panchtantra story

Once upon a time, there was a software engineer who used to develop programs on his Pentium machine, sitting under a tree on the banks of a river. He used to earn his bread by selling those programs in the Sunday market. One day, while he was working, his machine tumbled off the table and fell in the river. Encouraged by the Panchatantra story of his childhood (the woodcutter and the axe), he started praying to the River Goddess. The River Goddess wanted to test him and so appeared only after one month of rigorous prayers. The engineer told her that he had lost his computer in the river.

As usual, the Goddess wanted to test his honesty. She showed him a match box and asked, "Is this your computer?" Disappointed by the Goddess’s lack of computer awareness, the engineer replied, "No."

She next showed him a pocket–sized calculator and asked if that was his.

Annoyed, the engineer said "No, not at all!!"

Finally, she came up with his own Pentium machine and asked if it was his.
The engineer, left with no option, sighed and said "Yes."

The River Goddess was happy with his honesty. She was about to give him all three items, but before she could make the offer, the engineer asked her, "Don’t you know that you're supposed to show me some better computers before bringing up my own?"

The River Goddess, angered at this, replied, "I know that, you stupid donkey! The first two things I showed you were the Trillennium and the Billennium, the latest computers from IBM!". So saying, she disappeared with the Pentium!!

Moral: If you’re not up–to–date with technology trends, it’s better to keep your mouth shut and let people think you’re a fool than to open your mouth and remove all doubt.





Zee News – Health Wealth Shows

Cancer Prevention
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Fluid Intake


Total CPR since 1st November 2012 – 96458 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

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

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Health Check Up and CPR 10 Camp at NP Middle School Babar Road on 6th August 2014

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Longer CPR efforts may improve survival chances

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IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :


Make Sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.

Reaction: Oh my God! Why was ACE inhibitor continued?

Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

Quote of the Day

Education is the best friend. An educated person is respected everywhere. Education beats the beauty and the youth. Chanakya

Twitter of the Day

Dr KK Aggarwal: : Poor hygiene habits may lead to Typhoid fever http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: When you discover your true nature and know who you really are, you stand fearless http://bit.ly/DC_Ananda #ananda

medicolegal update

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  1. Dear Sir, Very informative newspaper. Regards: Dr Karan

Forthcoming Events


Dear Colleague,

Hypertension Society of India is organizing its "23rd Annual Conference HSICON–2014" to be held on 9th & 10th August, 2014 at Kempinski Ambience Hotel, Near Yamuna Sports Complex, New Delhi

Dr. N. P. Singh                          Dr. Neeru P. Aggarwal

Organizing Chairperson               Organizing Secretary

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