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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

3rd August, 2010, Tuesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Just learn it: compression-only CPR

The rules of CPR are about to change, as two newly published studies question the present methods. At present, the American Red Cross still teaches mouth–to–mouth as part of CPR. The new research confirms that for bystanders with no training, chest compressions on adults are enough to restore life.

There is no benefit to performing mouth–to–mouth resuscitation. Only one–third of those who go into cardiac arrest get CPR from a bystander. By making it easier to do, more people will be willing to do it. The current guidelines encourage bystanders to at least do chest compressions, also known as hands–only CPR. Not interrupting chest compressions with rescue breaths might ultimately deliver more oxygen than standard CPR in the crucial seven or eight minutes before paramedics arrive. Both studies published in the July 29, 2010 issue of New England Journal of Medicine, found a trend in that direction.

During the first and larger study, a team comprised of researchers from the University of Seattle and London considered 1,941 people in cardiac arrest who needed bystanders to perform CPR until an ambulance arrived. They found no significant difference between the 981 patients who received chest compression alone and the 960 who received both that procedure and mouth–to–mouth breathing. In fact, the "first group survived to hospital discharge at a rate of 12.5 percent and the second had an 11 percent survival rate, the scientists wrote. The second Swedish study included 1,300 people and also reached similar conclusions.

We at Heart Care Foundation of India (HCFI) have been teaching this for the last many years. Our formula for performing chest compressions is the ‘Formula of 10" i.e. within 10 minutes of cardiac arrest for the next 10 minutes, with a speed of 10 x 10 = 100 per minute " just give chest compressions.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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Photo Feature (From HCFI file)

Book Presentation Function at President’s House

Loomba Foundation and Heart Care Foundation of  India, delegation led by Mr Raj Loomba and Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal with the President of India Smt Pratibha Patil. Occasion " Care of the widows" July 26th 2010.

Dr k k Aggarwal


News and views

National News 

Dr. Rajiv Parakh and his team (Dr. Tarun Grover, Dr. Rumneek Sodhi, Dr. Adarsh Kabra, Dr. Anurag Agarwal and Dr. Neha Srivastava) has moved from Sir Ganga Ram Hospital to set up the Division of Peripheral Vascular & Endovascular Sciences at Medanta-The Medicity. The division offers Hybrid cath lab with robotic facility for open and endovascular management of both arterial and venous disease.

H1N1 vaccine and fever

Mumbai doctors are reporting cases of fever, sinusitis, cold and bodyache in several patients soon after administering the nasal vaccine for influenza H1N1. However they are still recommending it to high-risk category patients saying that advantages of the vaccination outweigh its side effects. (TOI)


International News  (Dr Brahm and Monica Vasudeva)

Prostate cancer vaccine appears to extend lives by 4.1 months

Harvard researchers have found that a prostate cancer vaccine extends lives by 4.1 months. The active cellular immunotherapy, sipuleucel–T (Provenge) consists of the patient’s own peripheral–blood mononuclear cells, including antigen–presenting cells, that have been activated outside the body using an engineered protein called PA2024. The protein is a fusion of prostatic acid phosphatase, a prostate antigen, and granulocyte–macrophage colony–stimulating factor, which activates immune cells. It is the first drug that has been designed to train the body’s immune system to fight cancer and is the most effective treatment for certain patients with advanced prostate tumors.

Cephalon asks FDA to withdraw approval of fentanyl–buccal

Cephalon Inc. earlier this month filed a citizen petition to the FDA seeking to withdraw its approval of Watson Pharmaceuticals Inc.’s application to market a generic version of Cephalon’s pain drug Fentora (fentanyl–buccal).

FDA grants priority review for MS treatment

US regulators granted the cladribine multiple sclerosis pill priority review, reducing the time it would take for the FDA to decide on approval from 10 months to 6 months.

Drugmaker says pralatrexate injection met key goals in mid-stage study on lung cancer patients

As per a statement by Allos Therapeutics Inc., its drug Folotyn (pralatrexate injection) achieved the major goals in a midstage study on lung cancer patients. It is already approved as a treatment for relapsed or refractory peripheral T–cell lymphoma.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology
[Dr. Neelam Mohan: Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity]

Causes of pancreatitis

Children- Idiopathic, trauma, infections, biliary tract disease, drugs, congenital anomalies, transplantation (renal), hypercalcemia, hyperlipidemia, miscellaneous

Adults- 80% Alcoholism and biliary tract disease

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Cross–examination debate for standards of medical care (Contd…)

The Cross–Examination debate in medical cases/negligence uses a team–oriented, switch–sides format. Debates are held between two teams of doctors. The Affirmative Team is assigned the role of supporting the proposition, and the Negative Team is assigned the role of opposing the proposition.


Experts’ Views  

Question of the day

What is the relationship between diabetes and tuberculosis?
(Prof. Dr SK Rajan Chennai)

It is well known that diabetic patients suffer more from tuberculosis (TB) than the nondiabetic patients. The evidence for a mycobacterial cause of diabetes is mounting rapidly. Schwartz and Haas both linked type 2 diabetes to TB. And the pancreatic islet amyloid deposits that they found as a byproduct of systemic tubercular infection have recently been dissolved by rifampicin, a first–line drug against TB. Engelbach spoke of "transitory" diabetes in TB and Karachunskii noted changes in carbohydrate metabolism in patients with TB which commonly led to insulin deficiency with persistent hyperglycemia. Furthermore, mycobacterial elements have been shown recently not only to cause ‘autoimmune’ type 1 diabetes in NOD (nonobese diabetic) mice, but act as a vaccine to stop the inevitable diabetes that would otherwise materialize. The documentation of patient cases where tuberculosis has preceded and come before the development of diabetes is extensive yet underplayed and both Lin’s and Tsai’s studies speak of TB complicated by diabetes.

With advent of effective antituberculosis therapy (ATT) and antidiabetic drugs, the prognosis of pulmonary TB complicated by diabetes is not as grave as in the past. However, numerous difficulties still exist in the diagnosis and management of this grave association. Studies reviewing the association show that uncontrolled diabetes predisposed development of pulmonary TB, but effectively treated diabetics were no more liable for TB infection than nondiabetic. The poor prognosis for tuberculous diabetic can be attributed to delay in diagnosis as both diseases share common symptoms such as lassitude, loss of weight and appetite, etc.

  • The possibility of co–existent diabetes mellitus should be considered in a patient with poor clinical response to ATT.

  • Likewise the suspicion of an associated TB infection should be considered in patient with uncontrolled diabetic status.

No modification of standard antituberculous chemotherapeutic regimens (including short course chemotherapy) is made. But, rigid control of diabetic status must be aimed.

Suggested reading

  1. Broxmeyer L. Diabetes mellitus, TB and the mycobacteria: Two millenia of enigma. Med Hypotheses 2005;65(3):433–9.

  2. Ponce–de–Leon A, et al. tuberculosis and diabetes in southern Mexico. Diabetes Care 2004;27:1584–90.

Advantages of Breastfeeding

Advantages of Breastfeeding (Dr. Satwika Sinha, MMC, Khammam)

Breastfeeding enhances development and intelligence
• Higher IQ
• Cognitive Development
• Social Development


Public Forum (Press Release for use by the newspapers)

Frequent urination in night: look for snoring

Frequent urination during night, a condition called nocturia, is common among snorers with obstructive sleep apnea  (cessation of respiration during sleep) said  Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela. Nocturia is needing to void two or more times each night.

In obstructive sleep apnea, soft tissues in the back of throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness, and can be effectively treated with a breathing device that pushes air into the throat to prevent the tissues from collapsing called CPAP.

Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia was present in 41% of pateints with sleep apnea. The risk of nocturia was directly related to the severity of sleep apnea and the association was particularly strong in patients younger than 50 years of age.

Snorers at risk of sudden death

Dr Aggarwal said that the interrupted nighttime breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death.

A study published in the  edition of Sleep, suggests that the risk is present among all people with obstructive sleep apnea. The study showed a sixfold increase which, means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who doesn't have sleep apnea.

For the study, Marshall's team collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow-up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three-fold increased risk of dying.

In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea.

The forthcoming Dil Ka Darbar being held on 26th September at MAMC will focus on the problems of snoring and sudden death.


An Inspirational Story 

The Touchstone

When the great library of Alexandria burned, the story goes, one book was saved. But it was not a valuable book; and so a poor man, who could read a little, bought it for a few coppers. The book wasn't very interesting, but between its pages there was something very interesting indeed. It was a thin strip of vellum on which was written the secret of the "Touchstone"!

The touchstone was a small pebble that could turn any common metal into pure gold. The writing explained that it was lying among thousands and thousands of other pebbles that looked exactly like it. But the secret was this: The real stone would feel warm, while ordinary pebbles are cold.

So the man sold his few belongings, bought some simple supplies, camped on the seashore, and began testing pebbles.

He knew that if he picked up ordinary pebbles and threw them down again because they were cold, he might pick up the same pebble hundreds of times. So, when he felt one that was cold, he threw it into the sea. He spent a whole day doing this but none of them was the touchstone. Yet he went on and on this way. Pick up a pebble. Cold – throw it into the sea. Pick up another. Throw it into the sea.

The days stretched into weeks and the weeks into months. One day, however, about midafternoon, he picked up a pebble and it was warm. He threw it into the sea before he realized what he had done. He had formed such a strong habit of throwing each pebble into the sea that when the one he wanted came along, he still threw it away.

So it is with opportunity. Unless we are vigilant, it’s easy to fail to recognize an opportunity when it is in hand and it’s just as easy to throw it away.


IJCP Special

Dr Good Dr Bad

Situation: A patient with diarrhea was found to have increased pulse rate.
Dr. Bad: Nothing to worry.
Dr. Good: You have fluid deficiency.
Lesson: Increased heart rate is the first sign of hemodynamic decompensation

Make Sure

Situation: A patient on penicillin antibiotic developed a relapse of fever while still on antibiotic.
Reaction: Oh my God! Why was the antibiotic continued for so long?
Lasson: Make sure that drug fever is always excluded in such situations. Antibiotics are the most common cause of drug fever, accounting for approximately one-third of episodes. This especially applies to beta–lactams, sulfonamides and nitrofurantoin. (Am J Med Sci 1987;294:275.)

Are you fit to fly?

Heart Patient

  1. Severe decompensated congestive heart failure (CHF) is a contraindication to flight.

  2. Patients with class III or IV New York Heart Association CHF should be carefully assessed to determine whether they will need inflight oxygen.

  3. Symptomatic valvular heart disease is a relative contraindication to airline travel.

International Medical Science Academy Update (IMSA)

Two randomized trials evaluated HPV screening, in conjunction with cytology, for cervical cancer screening. HPV testing led to earlier detection of high-grade cervical lesions but identified large numbers of women, especially at younger ages, with lesions that would regress without treatment (Lancet Oncol 2009;10:672, Lancet Oncol 2010;11:249.)


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Sarpogrelate hydrochloride film coated Tablets 100mg.

For the improvement of ischemic symptoms including ulcer, associated with chronic arterial occlusion



Medi Finance

Q. A doctor gives prescription online to patients outside India and gets payment through credit card or any other source. Is that income taxable?

Ans. Yes, this income is taxable as it is accruing in India and subject to the residential status of doctor.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

INR International Normalized Ratio (INR)

To monitor the effectiveness of blood thinning drugs such as warfarin (anti clotting drug which inhibit the formation of blood clots).


Lateral thinking

Read this………………




Send in your answer to emedinews@gmail.com

The answer for yesterday’s puzzle "Operation without pain"

Correct answers received from:

Dr Mohit Joshi, Dr Rajiv Bhatt, Dr Anupam Sethi Malhotra, Dr Ashok Wasan, Dr Ashok Kumar


Humor Section


A little girl was taken to the dentist. It was discovered that she had a cavity that would have to be filled.

"Now, young girl," asked the dentist, "what kind of filling would you like for that tooth?"

"Chocolate, please," replied the youngster

Fumy One Liners

My wife thinks "freedom of the press" means no–iron clothes.


Readers Responses

  1. Dear Dr Aggarwal, As appreciated earlier, the first daily publication of "e-medinews" by you is focusing on important topics useful for both general practioners and specialists in medicine but if surgery, gynecology, pediatrics, eye, ENT, anesthesia, PSM etc is also included it will be a good reading for all doctors. Sending sms on twitter is also inspiring for us.
    Secondly, it should be a platform to raise voice of allopathic or modern scientific doctors to raise their concern before the society. The way MCI has been abolished and the way government is controlling it cannot be accepted as it will bring forth more corruption and autocratic power. Other issues are ‘gramin’ doctor course arming them with issuing death certificates and medical certificates;  encroachment of MBBS doctors by so called ayurvedic, homeopathic, Unani healers (as most  practice modern medicines);  quacks; optometrists, yoga teachers, Sadhus,  acupressure specialist, physiotherapists, medical psychologist, cancer psychologists, acupuncturists, RMP practitioners, sexologists etc all who write doctors before their name. They are all threat to the society. Your portal may bring forth some light if one column is given and at least some news of these quacks are published, so that atleast media exposes them sometime, so please send this paper to every media house and politician of our country. Dr.Dr. Makipuria, Central Council Member IMA, Dr. Mrs. R. Nakipuria, exe. Member, FOGSI. Ambika Multispeciality Hospital, 29, Agrasen road, Siliguri-734005, drnakipuria@hotmail.com.

  2. Thanks eMedinewS for comprehensive details of the scary news item on “Calcium supplements and heart attack risk.” It looks in the light of the BMJ report that the “Khatika Curna: Calcium Sandoz-250” is a dangerous thing, though it is being sold by Novartis as an Ayurvedic formulation. It has no trace of Vitamin D which normal Calcium Sandoz used to have. Vinod Varshney

  3. Respected Dr KK Aggarwal, Thanks for this gesture. Dr Yash Sharma

  4. Dear Sir, is it possible for a judge to give opinion/judgement regarding the topic which concerns saving lives without involving the experts in the medical field. Because CPA in medical field is introduced in this new era it cannot be taken for granted that the judge of the Supreme Court /High court is the authority to pass a judgement without involving the experts in the field of surgery
    I support the view of Prof. HL Kapoor and every one involved in the surgical patient care should object to this and we should approach the WHO Thank you and it is quite shocking. D.Papa

  5. Thanks, Dr KK Aggarwal, through the eMedinews u are awaking us about all latest up dating of Central as well as legal ups & downs of medical profession in day-to-day life which reflect responsibility of medicos as well as public. All the rules come after some action either in favour or against our desire. We Indians work most of the time according to the word JUGAD (adjustment and co ordination) and are not bothered about the law because our law system is good but it is slow and delayed, Justice delayed is justice denied. There is corruption everywhere so can we think corruption free??? DR K P Singh, Cardiologist, Fortis Escorts, New Delhi-25.

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

Foundation Workshop on Clinical and Laboratory Medicine for 2010 STS Winners

A 3 day “Foundation Workshop on Clinical and Laboratory Medicine” for the ICMR’s prestigious 2010 Short term Studentship (STS) recipients is being organised from August 17-19, 2010, at UCMS and GTB Hospital, dr.satendra@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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