eMedinewS8th September 2013, Sunday

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; 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
www.facebook.com/Dr KKAggarwal

Chemical terrorism: Diagnosis and treatment of exposure to chemical weapons

Potential actions by terrorist groups span the NBC (nuclear, biological, chemical) threat spectrum.

  • Nerve agents, toxic asphyxiants, pulmonary irritants, and blistering agents are the major types of chemical weapons potentially available to terrorists. (See ‘Types of chemical agents’ above.)
  • The signature of a chemical weapon release is the sudden onset of symptoms within minutes, in the context of mass casualties.
  • It is inappropriate for responders to enter a situation until and unless they can do so without endangering themselves. Therefore, first response units organized to respond to chemical agent exposure must be equipped with appropriate protective clothing and equipment.
  • It is also inappropriate to bring patients who are not decontaminated to first receiving facilities (hospitals and emergency departments).
  • The approach and treatment vary according to the specific chemical agent.


  1. In 423 BC, a toxic smoke (sulfur and pitch) was used by the Spartan allies in the Peloponnesian War to force their enemies to abandon a fortification.
  2. The first modern use of chemical warfare (CWF) was on April 22, 1915 near Ypres, Belgium, where the Germans dispersed 150 tons of chlorine gas from about 6000 cylinders, generating 5000 pulmonary casualties among the 15,000 Allied troops on the battlefield.
  3. Sarin, the prototypical nerve agent and most significant current chemical terror threat, was synthesized in 1937.
  4. In 1983 Iraq used tabun against Iran, and Iran responded with a nerve agent of unidentified type. This exchange generated at least 10,000 deaths and casualties in the two armies.
  5. On March 16,1988, Iraq launched an attack on the Kurd population of Halabja, Iraq where there were 5000 deaths and a high number of casualties from both sarin and from sulfur mustard.
  6. A 1995 Tokyo subway attack by the religious cult Aum Shinrykio utilized sarin and caused 12 deaths and 5000 casualties.
  1. Nerve agents (cholinesterase inhibitors): The prototypical nerve agent is sarin. These organophosphate esters are colorless, odorless, and tasteless agents that do not irritate the skin. They are hazardous in liquid, vapor, and aerosol forms. Exposure can occur via the lungs, skin, or eyes. The weapons are transported in liquid form and transform into gas upon release due to their volatility. The weapon produces a state of acetylcholine excess. The resulting excessive cholinergic activity produces severe secretions from many sites and stimulation of smooth muscle. Nerve agents inhibit nerve transmission in skeletal muscle; this affects respiratory muscles and causes respiratory failure.
  2. Toxic asphyxiants: The prototypical toxic asphyxiant is cyanide (hydrocyanic acid, HCN). It is a colorless liquid or gas that smells like almonds. Arsine (arsenic trihydride) is another agent in this class. It leads to lactic acidosis and cytotoxic hypoxia.
  3. Pulmonary irritants: The prototypical pulmonary irritant is phosgene. It is a colorless liquid that when exposed to air gives off a gas that smells like newly mown hay. Chlorine and ammonia are other agents in this class that can generate casualties from industrial accidents or from terrorist acts. They causes direct lung tissue injury, with subsequent pulmonary edema.
  4. Blister agents (vesicants): The prototypical blister agent is sulfur mustard. It is a brown oily liquid at room temperature that converts to a gas with weapon system delivery. It smells like garlic or onions. Toxicity to the eyes, skin, and lungs occurs via direct contact with the toxic substance. Lewisite is another agent in this class.


The feature of a chemical weapon release is the sudden onset of symptoms within minutes, in the context of mass casualties. In contrast, bioweapon release may take many hours or days to become apparent. The main symptoms are neurologic, pulmonary, and skin and eye symptoms.

Nerve agents

  • Symptoms can begin in seconds to minutes depending upon the extent of exposure.
  • Death can occur in 1 to 10 minutes.
  • If a liquid agent is splashed on the skin, it could take as long as 30 minutes before symptoms commence.
  • Those exposed to nerve agent should leave the exposure area at once, and head to fresh air.
  • Nerve gas vapors are heavier than air and tend to settle; therefore, do not lay down and do not remain in below-ground spaces.
  • Cover the nose and mouth with a wet cloth if possible.
  • Remain calm and try not to inhale until you are away from the exposure area.
  • Take shallow breaths only if you must.
  • Gas masks are not recommended unless the person is trained in their use. Incorrect use of such masks has caused fatalities.
  • Remove all clothing and all jewelry, which should be placed in sealed double plastic bags. Shower immediately with soap and water. Also, flush the eyes with water for five to ten minutes because nerve agents can enter via the ocular route as well as via the skin. Wash clothing with bleach.
  • Atropine will antagonize the ACh actions at muscarinic receptor sites including salivation, tracheobronchial secretion and bronchoconstriction, bradycardia, and to a moderate extent the central actions of ACh excess state. Atropine has little effect on the peripheral neuromuscular compromise.

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."

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

Ringtone – CPR 10 Mantra English

sprritual blog Can I postpone death?

Yes. If I read Vedic science, it is possible to postpone death. As per Chandoghya Upnishad, death is a process in which first Karma Indriyas die, then Gnan Indriyas die followed by mind, intellect, memory, ego, and then Prana vayu merges with Udana vayu and that merges with Tejas and finally Tejas leave to merge with the Sat. That means at every step it is possible to help the body.

1. At the level of Karma Indriyas, the immunity can be strengthened by providing adequate fat and oil based nutrition to the dying person.

2. Karma Indriyas, mind, intellect, memory and ego can be strengthened by giving non–fat based earthy food to the dying person that means maintaining full calories.

3. Prana Vayu can be strengthened by providing liquid hydration and with the assistance of ventilator as and when required.

4. At the level of Tejas, it is possible to postpone death by creating artificial therapeutic hypothermia in which the body temperature is brought down to less than 95, preferably to 89.

5. If the heart has stopped, it is possible to revive it by the CPR technique which is based on the formula – within 10 minutes of death (earlier the better), for the next 10 minutes (longer the better), compress the centre of the chest of the victim with a speed of 10×10=100 per minute. ….

cardiology news

A Story for Passover

A good Passover story should always involve cakes. Austrian baker Manfred Klaschka is the subject of this year’s story. He was in the news because of his most recent catalogue of cake designs; Klaschka is a pastry specialist.

Of course, Austrian pastries are famous the world over. Now, pastry baker Manfred Klaschka’s most recent catalogue of such tasty delights was in the news this week because it included cakes decorated with swastikas as well as one with a baby raising its right arm in a Nazi salute.

Herr Klaschka insists he is not a Nazi. After the news story broke, he even met with a Holocaust awareness group, and apologized for what he had done, and he then baked a cake to say he was sorry a cake with Jewish and Christian symbols. The point of the story – the bit I found interesting is Herr Klaschka’s explanation for what he did.

"I see it was a mistake, anyone who knows me knows what kind of person I am. I am no Nazi", said Klaschka, who had earlier said he was just a pastry maker fulfilling his customers wishes. Fulfilling his customers wishes? There is a market in Austria in 2011 for cakes with babies raising their arms in Nazi salutes, cakes with swastikas on them? There are parties where people serve such cakes? Maybe birthday parties for babies?

Of course there are such people, and there are such parties, and because of that, there is a market there is consumer demand for swastika cakes. Which is why Herr Klaschka was happy to bake them. And not only in Austria.

You may remember the case of the Campbell family from New Jersey.

When Kurt Waldheim was exposed as a war criminal his popularity rose. The neo–Nazi Freedom Party headed by the late Jorg Haider, won 27% of the vote in the 2000 elections and became part of the coalition government the first time since 1945 that Nazis had sat in a European government.

But this never happened in New Jersey which is why I want to talk about the Campbell family. The Campbell family in New Jersey made the news back in 2008 when they tried to get a birthday cake made for their son — they have a son and two daughters — at the local Shop Rite in Holland Township. The store refused their request.

And the reason was that Mr. Campbell wanted the cake to read "Happy birthday Adolf Hitler". Because, you see, his son’s name was Adolf Hitler Campbell. One of the daughters is named is named Joyce Lynn Aryan Nation Campbell. Well, you get the point.

When I read about the Austrian baker Manfred Klaschka, I thought – here was a marketing opportunity for him. He would have happily baked a cake for the Campbell family. So what does all this have to do with Passover?

This week, when we are forbidden to eat Sachertore or Linzer tort or even the delightfully named Punschkrapfen, we might want to pause and think about something we say every year at the Passover seder: 'In every generation it is the duty of man to consider himself as if he had come forth from Egypt’.

Because in this generation, as in all others, there are those who order custom–made swastika cakes. There are those who name their children after Adolf Hitler. And there are others who fire anti–tank missiles at school busses with Jewish children in them. Because there are those who are building nuclear weapons, having told the world that their intention is to wipe the Jewish state off the face of the earth. Because people like that make Pharaoh look like a nice guy. Because getting out of the house of bondage, out of slavery in Egypt, was not the end of the story for the Jewish people, but was the beginning.

It is a story of a never–ending struggle for freedom, for dignity, for respect, for human rights, that has universal resonance and meaning— for all people, everywhere, always.

News Around The Globe

National Day of Head and Neck Cancers

Dr Manoj Sharma

Head and neck cancers remain the leading cause of mortality in India. One single cause being the usage of tobacco in various form.

The late stage presentation is the disgusting order of the day in our OPDs even after 66 years of independence. Cure in these cases becomes impossible due to the reasons other than the cancer and its late stage presentation.

Prominent extra-malignancy reasons being

1. the Medical Cause: Long waiting lists for the treatment in Oncological departments, unavailability of proper expertise , virtually nonexistent "Combined Modality/Tumour Board Approach" in treating these patients, defunct radiotherapy departments with their defunct leadership,

2. Social Causes: Long distance from the treatment centres, poverty and everyday rising cost of treatment, nuclear families with all the indifference towards the suffering family member. Total lack of NGOs who can help a great deal these La` miserables.

Political cause is rather more important one to be added as it directly relates to the root……the failure in putting total ban on tobacco by the socio political agencies that allegedly play in hands of Merchants of Death, the tobacco magnets. While the public drama of educating, counselling and de addiction goes on, the backstage crime of tobacconomics continues.

The whole gamut of the Head and Neck Cancers is so vast that focussing attention on it as a tobacco related cancers alone cannot handle the issue adequately. Oro–dental hygiene and Dental Surveillance, malnutrition, illiteracy and tobacco alcohol combo and the birth of ready to use killers such as Gutkha,Khanee and Panmasala (despite statuary ban).

Recently added threat of electromagenetic radiations EMRs due to massive advertising that leads to excessive usage of mobile phones, cordless phones, mobile towers and high tension wires. (Acoustic neuroma, gliomas and threat to parotid)

The observance of this day was widely welcomed by like minded people involved in various cancer prevention forum.

All those concerned with untimely death and morbidity that affects the younger generation now must participate in form of creating awareness through all possible media channels so that literate as well as illiterates are educated and counselled, policy makers shaken at best to help curb tobacco and Mobile phone usage.


Ministry of Health and Family Welfare announces former Indian cricket team captain Rahul Dravid as brand ambassador for its National Tobacco Control Campaign ahead of the Conference.

Despite effective, evidence–based tobacco control policies, reduction in smoking prevalence in developed countries has started to slow down and smoking continues to increase in many low–and middle income countries. This disturbing trend has sparked interest among public health experts to propose innovative and even dramatic ‘endgame’ strategies to address the global tobacco epidemic.

With India implementing a ban on Gutkha in 33 states and Union Territories, countries like New Zealand, Finland and Norway proposing to become tobacco-free within next three decades and Singapore and Tasmania proposing tobacco–free future generations by restricting sale of tobacco products to individuals born after the year 2000, an initiative towards an endgame for tobacco is springing in different regions of the world. With the World Health Assembly adopting a target of 30% relative reduction in tobacco use prevalence by 2025, the global narrative on tobacco control is increasingly exploring the concept of ‘tobacco endgame’, which envisions reducing tobacco prevalence and availability to minimal levels.

While the global discourse on tobacco control so far has mostly emphasized demand reduction measures, the need to curb this industry driven epidemic becomes even more urgent in the context of sustainable development. Since tobacco also degrades the environment in many ways and contributes to food and water security, actions to reduce the production and marketing of tobacco must also now be vigorously pursued alongside effective implementation of demand reduction measures.

With support from the Ministry of Health and Family Welfare (MoHFW)and World Health Organization, Public Health Foundation of India (PHFI) and HRDIAY is organizing the International Conference on Public Health Priorities in the 21st Century: The Endgame for Tobacco from 10th – 12th September, 2013 at Taj Palace Hotel, New Delhi, at which nearly 500 participants from over 50 countries will come together to deliberate and present actionable strategies to fight the global tobacco epidemic.


HRIDAY is a voluntary organization of public health scientists, health professionals and lawyers engaged in research, education and advocacy related to tobacco control, alcohol control, non–communicable disease prevention through tobacco control, alcohol control, promotion of healthy diet and physical activity. HRIDAY is a recipient of WHO’s Director General Award for tobacco control (2002) for contributions to tobacco control. The programme has also been listed as a ‘Best Practice Model’ and recommended for global replication by WHO. HRIDAY has also been a recipient of the Best Practices in Global Health 2011 award by the prestigious Global Health Council. HRIDAY actively engages with the Ministry of Health and Family Welfare, Government of India, WHO, State Governments and District administrations in various tobacco control initiatives and policy research.

HRIDAY is also a technical and collaborating NGO partner of the Public Health Foundation of India (PHFI), in projects relating to adolescent & youth health and health policies, in particular related to substance abuse (Tobacco, Alcohol and Drugs) and non–communicable disease (NCD) prevention.

Public Health Foundation of India (PHFI)

The Public Health Foundation of India (PHFI) is committed to working towards a healthier India. PHFI is helping to build public health institutional capacity in India, through interdisciplinary and health system connected education and training, policy and programme relevant research, evidence based & equity promoting policy development, people empowering health communication & advocacy for prioritised health causes. Established in 2006 as a public private initiative, PHFI is an independent foundation headquartered in New Delhi and its constituent Indian Institutes of Public Health (IIPH) set up by PHFI have a presence in Hyderabad (Andhra Pradesh), Delhi NCR, Gandhinagar (Gujarat) and Bhubaneswar (Odisha). The Foundation is managed by an empowered governing board comprising senior government officials, eminent Indian and international academic and scientific leaders, civil society representatives and corporate leaders.

World Lung Foundation

Dr. Judith Mackay, Senior Advisor, World Lung Foundation who is a global leader of the tobacco control movement and was Advisor to WHO during the FCTC negotiations, said "every historical achievement was preceded by many people saying it couldn’t be done, wouldn’t work, or would create new problems. An end-game scenario is a very recent idea (with less than 5 countries in the world having announced a target date).

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Rabies News (Dr. A K Gupta)

Are there any variations in signs of rabies between different species of animals?

There are few variations in signs of rabies between different species of animals. Cattle with furious rabies attack man and other animals. A common clinical sign is a characteristic abnormal bellowing. Head butting is a characteristic sign in case of rabies in cattle, sheep and goats.

cardiology news

Researchers have reported at the ongoing ESC meeting that despite having a higher risk burden for cardiovascular disease, high income countries appear to have lower incidences of cardiovascular disease and cardiovascular mortality. The incidence of fatal cardiovascular disease in low income countries studied was 7.25 times higher in low income countries than in high income countries.

Valvular Heart Disease News

Vegetation occurs when blood travels from an area of high pressure to an area of lower pressure.

(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

Vaccinate children against the flu as soon as possible rather than holding out for the new quadrivalent versions, the American Academy of Pediatrics urged in its annual influenza recommendations. Four–strain vaccine wasn’t preferred over the trivalent vaccine in the recommendations published in the October issue of Pediatrics. (Medpage Today)

cardiology news

Be Alert from Symptom of Heart Attack

If you aren’t sure whether you are having heartburn or something more serious –– like a heart attack –– you should get yourself checked out, said Padma Shri and Dr B C Roy Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India.

The most common symptom of coronary heart disease is chest pain (angina) or discomfort, which can also occur in the shoulders, arms, neck, jaw or back. People may mistake this pain for indigestion, which can be dangerous. Sometimes, it’s impossible to tell the difference between the symptoms of heartburn, angina and heart attack.

A heart attack occurs when the blood supply to part of the heart muscle is severely reduced or stopped. This can result in death or disability, depending on how much of the heart muscle is damaged. Unfortunately, many people may not be aware they are having a heart attack.

There are some useful pointers that might help a person know whether they're having a heart attack or not, but when in doubt, one should check it out.

Symptoms of a heart attack include the sudden onset of tightness, pressure, squeezing, burning or discomfort in the chest, throat, neck or either arm. When these symptoms are accompanied by nausea, vomiting, sweating, shortness of breath or a fainting sensation, Dr. Aggarwal says one should be especially suspicious that you might be having a heart attack. People who have any risk factors that may predispose them to a heart attack should be particularly cautious.

Main points

Heart attack pain is never pinpointed

Heart attack pain never lasts less than 30 seconds.

If you smoke, have diabetes, high cholesterol, high blood pressure, are overweight or have a strong family history of heart disease and have any symptom related to the chest or heart, you should be alert.

cardiology news

Chief Minister of Delhi Smt. Shiela Dikshit to host a dinner for CMAAO India conference faculty

Smt. Shiela Dikshit, Chief Minister of Delhi will be hosting an invited limited faculty dinner at CM’s residence on 12th September at 8pm. The invitees will include the international and national faculty of CMAAO India conference.

cardiology news

Total CPR since 1st November 2012 – 62980 trained

CPR Classes 62980

Media advocacy through Print Media

sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping
sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping

29th August: Veer Arjun

Media advocacy through Web Media

When Constipation May be a Serious Problem 30th August


TB more dangerous than FLU 29th August


Do not ignore Sore throat in children

In the ongoing dengue problem in Delhi, many respiratory viral infections are presenting with cough and nasal discharge. These patients do not require any antibiotic, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

However, school children with any cough should not be ignored and a local family doctor should rule out bacterial sore throat, which if goes undetected, can cause rheumatic involvement of the valves of the heart, a condition called as rheumatic fever.

Such children invariably will have pain in throat while swallowing, red angry–ooking tonsils and painful enlargement of lymph nodes at the angle of the mouth. Immediate antibiotics are needed to prevent future involvement of the heart.

Children also should not be given aspirin indiscriminately as it is known to be associated with fatal liver disease, in susceptible children.

The first attack of rheumatic fever is rare after the age of 35.

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 63400 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."

today emedipics

A CPR 10 Training Camp was organized by Heart Care Foundation of India to train the students of Modern School Noida on 14th August

press release

Cultural Evening at IMA

today video of the dayCultural Evening at IMA

Dr KK Aggarwal on Sleeping Disorder

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client’s uremia. Which finding signals a significant problem during this procedure?

a. Potassium level of 3.5 mEq/L
b. Hematocrit (HCT) of 35%
c. Blood glucose level of 200 mg/dl
d. White blood cell (WBC) count of 20,000/mm3

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 post procedure 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. Check the client’s pedal pulses frequently.

Correct answers received from: Dr Prakash Khalap, Narahari Kandakatla, Dr. V.P. Thakral, Anil Sarin, Bitaan Sen & Dr.Jayashree Sen, pruthvi doshi, Dr. P. C. Das, DR ARPAN GANDHI, Dr Kanta jain, Dr.K.V.Sarma, Anil Bairaria , Dr Pankaj Agarwal, Dr pooja khullar, Vasdev Bhagia

Answer for 6th September Mind Teaser: a. 1 minute.

Correct answers received from: Dr.K.V.Sarma, Anil Bairaria .

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medicolegal update

Another time, he gave a patient six months to live.
At the end of the six months, the patient hadn’t paid his bill,
So, the doctor gave him another six months.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

medicolegal update

The qualities of a great man are vision, integrity, courage, understanding, the power of articulation, and profundity of character. Dwight David Eisenhower

medicolegal update

Dr KK Aggarwal: Birth defects linked to mother’s use of cold medicines http://bit.ly/16wknsh #Health

Dr Deepak Chopra: Does technology have a place in religion & spirituality? http://tinyurl.com/l6x3eo4

medicolegal update

Wish you very happy birthday and many thanks to Dr kk for his great teaching and service on occasion of Teacher’s Day 2013. Regards: Dr Saurabh

Forthcoming Events

29thSeptember–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

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medicolegal update

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