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  From the Desk of Editor–in–Chief
Dr KK 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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal
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  Editorial …

1st June 2013, Saturday

Heart disease starts in youth

Autopsy studies of young people who died in accidents have shown that by the late teens, the heart blockages, the kind of lesions that cause heart attacks and strokes are in the process of developing

The best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early. More than a third of children and adolescents are overweight or obese.

The first signs that men are at higher risk of heart disease than women appear during the adolescent years despite the fact that boys lose fat and gain muscle in adolescence, while girls add body fat.

Between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increases in the boys and drops in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, go down in boys but rise in girls.

Blood pressure increases in both, but significantly more in boys. Insulin resistance, a marker of cardiovascular risk, which is lower in boys at age 11, rises until the age of 19 years.

Any protection that the young women have for cardiovascular protection can be wiped out by obesity and hence obesity in girls at any cost should be handled on priority.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR 10 camp was organized by Heart Care Foundation of India at EPFO (Employees Provident Fund Organization), Wazirpur on 30th May 2013

Dr K K Aggarwal
    National News

World No Tobacco Day 2013: Rajasthan bags 2 WHO awards for curb on tobacco

Jaipur: Rajasthan bagged two out of five WHO director general's World No Tobacco Day awards in South East Asia region for its tobacco control efforts on Thursday, reports TOI. The directorate of medical and health services (DMHS) and city-based oncologist Dr Rakesh Gupta are among the five recipients for their efforts in tobacco control, including promotion and implementation of anti-tobacco policy and capacity building to control tobacco consumption in state.

In the past one year, the state has taken a lot of new initiatives to control tobacco consumption right from imposing a ban on gutkha to increasing VAT on tobacco products significantly, even more than the WHO prescribes. Also, the DMHS introduced first helpline 104 for free counseling for tobacco users, who wants to quit tobacco consumption. Moreover, the DMHS is also providing free medicines and nicotine chewing gums to tobacco consumers to help them quit the habit of smoking and chewing tobacco. Moreover, a proposal has also been sent to department of personnel to take an undertaking from the successful candidates before joining government jobs that they won't consume tobacco. Rajasthan has increased VAT on all tobacco products to 65% and it is apart from the 18% excise duty. The tobacco consumers in Rajasthan are paying 83% tax on tobacco products. (Source: TOI, May 31, 2013)

50% of smokers think limited smoking is not harmful: Survey

Mumbai: Half of the smoking population in the country thinks smoking "within limits" is harmless, a survey by a private general insurance firm has found. "Half of the smokers continue smoking as they feel doing so within limits does not lead to health issues," the survey, 'ICICI Lombard Smoking Habits 2013', said. A large portion of respondents (77 per cent) felt that smoking or limited puffing of cigarettes will not have any adverse impact on their health. The survey had a sample size of 914 habitual smokers from Mumbai, Delhi, Kolkata and Bangalore in the 18-35 age-group, who smoke at least once a day. The findings of the survey were today released on the eve of 'World No Tobacco Day'. The survey revealed that around 67 per cent of the smokers started the habit between the age of 16 and 20 years. "Friends or peers is the most important influencer to start smoking (87 per cent). Another key factor is work pressure", the survey said. While Mumbai leads the pack with 32 per cent (of the respondents there) smoking on an average 7-10 cigarettes a day, Kolkata has 29 per cent puffing out 4-6 cigarettes a day. Bangalore has 43 per cent of respondents smoking 2-3 cigarettes a day on an average and Delhi has the lowest with 35 per cent limiting their average consumption to just one stick a day. With reference to kicking the habit, the report said, "While will power has been cited as the key motivator, 22 per cent respondents in Mumbai and 32 per cent in Kolkata said support of the family and friends is a big factor." A large number of smokers in Delhi (29%) and Bangalore (31%) felt a counsellor with regular monitoring will help them quit the habit. As to the claim analysis done by ICICI Lombard for the last two years, the company said 5 per cent of the total cancer claims were tobacco-related. "Of these, 75 per cent were claims made by male customers", it said. (Source: Business Standard, May 31, 2013)

    Valvular Heart Disease Update

Failure of the leaflets to open widely may be seen with aortic stenosis; a decreased stroke volume is suggested if they open widely but drift shut just after achieving maximum separation.

(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)

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Preventing the recurrence of maltreatment

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences (2) entry into the juvenile justice system and (3) juvenile delinquency.

(Source: Carnochan S, Rizik-Baer D, Austin MJ. J Evid Based Soc Work. 2013 May;10(3):161-178).

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Tool predicts kidney injury risk in stenting

A technique using standard clinical factors shows promise for predicting kidney injury associated with contrast medium during coronary stenting, researchers found. (Source: Medpage Today)

Diet may ease psoriasis symptoms

Putting psoriasis patients on a low-calorie diet may improve quality of life and reduce psoriasis severity, researchers found. (Source: Medpage Today)

Thyroid disorder may mean tough pregnancy

Thyroid diseases and hypothyroidism in particular, increase the risk for problematic pregnancy outcomes, researchers found. (Source: Medpage Today)

Type of infusion not an issue in acute HF

In patients with acute decompensated heart failure, there is no clear advantage for using either a continuous infusion or intermittent boluses of intravenous furosemide over the first 24 hours, a trial conducted in Spanish emergency departments showed. (Source: Medpage Today)

Silent Afib linked to stroke in diabetics

Asymptomatic atrial fibrillation might lie behind stroke of unknown origin in patients with type 2 diabetes, researchers suggested. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: Four of 10 cancer cases due to tobacco abuse In India, four out of every 10 new cancer cases are... http://fb.me/2utZv2zPC

@DeepakChopra: Why can't I detach myself from their emotions? http://tinyurl.com/oy25ktf

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Can prasad cause poisoning?

Normally, when we attend any spiritual ceremony, we consume prasad without any fear or taking any precautions as a gift of the God. The devotees feel that prasad is different from food as after being offered to God or touching the God’s lotus feet, any offered food becomes prasadam.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the risks and complications of HSG?

A hysterosalpingogram or HSG is considered a very safe procedure. Some complications occur in less than 1% of cases.

  • Infection: The most common serious problem with HSG is pelvic infection. This usually occurs in the presence of previous tubal disease. In rare cases, infection can damage the fallopian tubes or necessitate their removal.
  • Fainting: Rarely, the patient may get light–headed during or shortly after the procedure.
  • Radiation exposure: Radiation exposure from a HSG is very low, less than a kidney or bowel study and there have been no demonstrated ill effects from this radiation, even if conception occurs later the same month.
  • Iodine allergy: Rarely, a patient may have an allergy to the iodine contrast used in an HSG. A patient should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Patients who are allergic to iodine may have a sonohysterogram performed instead of HSG since that procedure uses non–iodine containing fluids.
  • Spotting: Spotting commonly occurs for 1 to 2 days after the HSG. A patient should notify her doctor if she experiences heavy bleeding after the HSG.
    An Inspirational Story

Attitude is everything

Jerry was the kind of guy you love to hate. He was always in a good mood and always had something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!"

He was a unique manager because he had several waiters who had followed him around from restaurant to restaurant. The reason the waiters followed Jerry was because of his attitude. He was a natural motivator. If an employee was having a bad day, Jerry was there telling the employee how to look on the positive side of the situation.

Seeing this style really made me curious, so one day I went up to Jerry and asked him, "I don't get it! You can't be a positive person all of the time.

How do you do it?" Jerry replied, "Each morning I wake up and say to myself, 'Jerry, you have two choices today. You can choose to be in a good mood or you can choose to be in a bad mood.' I choose to be in a good mood. Each time something bad happens, I can choose to be a victim or I can choose to learn from it. I choose to learn from it. Every time someone comes to me complaining, I can choose to accept their complaining or I can point out the positive side of life. I choose the positive side of life."

"Yeah, right, it's not that easy," I protested.

"Yes, it is," Jerry said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people will affect your mood. You choose to be in a good mood or bad mood. The bottom line: It's your choice how you live life."

I reflected on what Jerry said. Soon thereafter, I left the restaurant industry to start my own business. We lost touch, but I often thought about him when I made a choice about life instead of reacting to it.

Several years later, I heard that Jerry did something you are never supposed to do in a restaurant business: he left the back door open one morning and was held up at gunpoint by three armed robbers. While trying to open the safe, his hand, shaking from nervousness, slipped off the combination. The robbers panicked and shot him.

Luckily, Jerry was found relatively quickly and rushed to the local trauma center. After 18 hours of surgery and weeks of intensive care, Jerry was released from the hospital with fragments of the bullets still in his body.

I saw Jerry about six months after the accident. When I asked him how he was, he replied, "If I were any better, I'd be twins. Want to see my scars?" I declined to see his wounds, but did ask him what had gone through his mind as the robbery took place.

"The first thing that went through my mind was that I should have locked the back door," Jerry replied. "Then, as I lay on the floor, I remembered that I had two choices: I could choose to live, or I could choose to die. I chose to live." "Weren't you scared? Did you lose consciousness?" I asked.

Jerry continued, "The paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the emergency room and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read, 'He's a dead man.' "I knew I needed to take action."

"What did you do?" I asked. "Well, there was a big, burly nurse shouting questions at me," said Jerry. "She asked if I was allergic to anything. Yes,' I replied. The doctors and nurses stopped working as they waited for my reply. I took a deep breath and yelled, 'Bullets!' Over their laughter, I told them. 'I am choosing to live.

Operate on me as if I am alive, not dead."

Jerry lived thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything.

For comments and archives

  Cardiology eMedinewS

Tobacco's role in movies falls, alcohol's rises Read More

  Pediatric eMedinewS

AAP: Docs must focus on minds of military children Read More

    Schizophrenia- split in personality

(Dr Amit Singh, MBBS, AMC, DPH, FRANZCP (BT), MPM (Melbourne University), Box Hill Hospital, Melbourne, Australia)

Schizophrenia is characterized by positive/negative/ memory and mood symptoms.

Rule of 1/3 in Schizophrenia

  • 1/3 get better
  • 1/3 get symptoms under stress
  • 1/3 become chronic
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Does kissing a rabies patient call for anti-rabies vaccination?

Kissing a rabies patient may transmit disease because there may be contact with rabies patient’s saliva. Full post-exposure immunization must be given either by intramuscular (IM) or intradermal (ID) route.

If there are ulcers in the mouth of the exposed person, then rabies immunoglobulins (RIG) must be given by IM route.

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    IJCP Special

Dr Good Dr Bad

Situation: A man who was to be married was found to be HIV–positive.
Dr Bad: Keep the report secret.
Dr Good: I will inform the girl to–be married.
Lesson: Sections 269 and 270 of the Indian Penal Code provide as under: "269. Negligent act likely to spread infection of disease dangerous to life – whoever unlawfully or negligently does not act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

Make Sure

Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure, to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

  Quote of the Day (Dr GM Singh)

Next to trying and winning, the best thing is trying and failing. Lucy Maud Montgomery

    Mind Teaser

Read this…………………

Metabolic acidosis is best treated with:

1. Calcium gluconate via IV push.
2. Normal saline via bolus IV.
3. Oxygen.
4. Sodium bicarbonate via IV push.

Yesterday’s Mind Teaser: Helen is diagnosed with myasthenia gravis and pyridostigmine bromide therapy is started. The dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:

A. Administer the medication exactly on time
B. Administer the medication with food or mild
C. Evaluate the client’s muscle strength hourly after medication
D. Evaluate the client’s emotional side effects between doses

Answer for Yesterday’s Mind Teaser: C. Evaluate the client’s muscle strength hourly after medication

Correct answers received from: Dr.B.R.Bhatnagar, Dr .Deepali Chatterjee, Tukaram Pagad, Dr. Bharat Bhushan Aggarwal, Dr. B.B. Gupta, Dr kanta jain, Dr Monica Gandhi , DR AYYAVOO ERODE, DR ARPAN GANDHI, Dr.K.V.Sarma, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr. Thakor Hitendrsinh G, DR Chandresh Jardosh, Dr Kanta Jain, ANAND DIWAN, Dr Avtar Krishan, parveen monga

Answer for30th May Mind Teaser: C. Maintain the present muscle strength

Correct answers received from: DR Chandresh Jardosh, Dr Kanta Jain, ANAND DIWAN, Dr Avtar Krishan parveen monga

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

A doctor of psychology was doing his normal morning rounds, and he entered a patient's room to find his patient sitting on the floor, sawing at a piece of wood with the side of his hand.

Meanwhile, another patient was in the room, hanging from the ceiling by his feet.

The doctor asked his patient what he was doing, sitting on the floor.

The patient replied in an irritated fashion, "Can't you see I'm sawing this piece of wood in half?"

The doctor inquired, "And what is the fellow hanging from the ceiling doing?"

"Oh. He's my friend, but he's a little crazy. He thinks he's a light bulb."

The doctor asks, "If he's your friend, don't you think you should get him down from there before he hurts himself?"

"What? And I work in the dark!?!"

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well–known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.

  • Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
  • Section 46 IPC states that death denotes the death of a human being unless the contrary appears from the context.
  • Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Doctors should quit smoking

Even doctors find it hard to quit smoking. Therefore, in the first place, the answer is not to start smoking or quitting as early as possible before it becomes a hard hitting habit, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Doctors are a role model for the society and should not smoke at all and even if they do, it should not be in front of patients or social gatherings. It is impossible for a doctor to advice patients to quit smoking if he/she himself/herself smokes.

Most doctors start smoking before they enter medical colleges and continue to do so because of hardships they go through during their medical college education. These doctors can set an example in the society for quitting smoking. It is easier for doctors to quit smoking than the patients or general public as counseling a doctor is much easier than a non-doctor. However, doctors cannot counsel themselves, therefore, need a counselor and help from another doctor.

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 54572 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.”

    Readers Response
  1. Dear Sir, Emedinews is very useful. Regards:Dr Shelly
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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