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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

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  Editorial …

2nd June 2013, Sunday

Energy Drinks May Put Heart at Risk for Sudden Death

Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death.

In a meta-analysis by Sachin A. Shah at University of the Pacific in Stockton, Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms.

In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks.

Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life-threatening arrhythmias.

Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle and AMP have three times the amount of caffeine as colas. A 16-oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as 5 cans of soda.

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

Day care PCI is the future

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

MDGs: India won’t give up on achieving targets

With the deadline for achieving Millennium Development Goals (MDGs) nearing, India on Tuesday said it was not giving up yet on reaching the targets. At the Third Women Deliver 2013 that began here, Mission Director of National Rural Health Mission (NRHM) Anuradha Gupta India was still hopeful of achieving the targets. She enumerated the measures taken to bring down infant mortality rate (IMR) and maternal mortality ratio (MMR) of 42 per 1,000 live births and 109 per 1,00,000 live births respectively by December 31, 2015. Official statistics suggest that India was far from achieving the goals, particularly those on reducing child and maternal mortality. As per latest data, of the 1,000 children born, 52 are dying before reaching the age of five, while IMR is still 212 per 100,000 live births.


Admitting that the implementation of the maternal death audit, mandatory under law, was still far from satisfactory, Ms. Gupta said enhanced focus on reproductive and child health, augmentation of health systems and placing Accredited Social Health Activists (ASHAs) under NRHM as mobilisers had been game-changers. Inaugurating the conference, Malaysian Prime Minister Mohd. Najib Tun Abdul Razak said political will and stable policies, investment in health and a commitment to improving quality care were some of the essentials of his country’s success. “It is my hope that countries still lagging behind in meeting the MDGs would be able to learn from our experience.” Malaysia has one of the lowest maternal mortality ratios in the region. Describing universal access to reproductive health services as a basic human right that should not be denied, Mr. Razak said life-saving interventions should be made available especially where cultural differences made access more difficult. India’s schemes of delivering contraceptives on the doorstep and training of auxiliary nurse midwives (ANMs) for insertion of intrauterine devices (IUDs) for better spacing of children received much appreciation at the conference. Ms. Gupta said efforts were on to provide post-partum IUDs to 12.5 million women accessing public health facilities at the 1.5-lakh sub-centres. “The challenge, however, is to reach out to the unreached, and our focus will be on that. Our dependence on qualified doctors has been huge. But we are now training ANMs for providing basic family planning services,” she said. India had identified 17,000 facilities that need to be decongested because of heavy patient load and this would be done by adding dedicated maternal and child health wings in addition to focusing on districts with bad maternal and child mortality indicators. (Source: The Hindu, May 29, 2013)

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

    Valvular Heart Disease Update

Transesophageal echocardiography may be required in some patients to distinguish valvular stenosis from subvalvular or supravalvular obstruction.

(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)


Childhood abuse is associated with structural impairment in the ventrolateral prefrontal cortex and aggressiveness in patients with borderline personality disorder

Volume reduction and functional impairment in areas of the prefrontal cortex (PFC) have been found in borderline personality disorder (BPD), particularly in patients with a history of childhood abuse. These abnormalities may contribute to the expression of emotion dysregulation and aggressiveness. In this study we investigated whether the volume of the PFC is reduced in BPD patients and whether a history of childhood abuse would be associated with greater PFC structural changes. Structural MRI data were obtained from 18 BPD patients and 19 healthy individuals matched for age, sex, handedness, and education and were analyzed using voxel based morphometry. The Child Abuse Scale was used to elicit a past history of abuse; aggression was evaluated using the Buss-Durkee Hostility Inventory (BDHI). The volume of the right ventrolateral PFC (VLPFC) was significantly reduced in BPD subjects with a history of childhood abuse compared to those without this risk factor. Additionally, right VLPFC gray matter volume significantly correlated with the BDHI total score and with BDHI irritability and negativism subscale scores in patients with a history of childhood abuse. Our results suggest that a history of childhood abuse may lead to increased aggression mediated by an impairment of the right VLPFC.

(Source: Morandotti N, Dima D, Jogia J, et al. Psychiatry Res. 2013 May 18.)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Universal MRSA Tx in ICU cuts infections

Taking precautions to disinfect all ICU patients as if they had methicillin-resistant Staphylococcus aureus (MRSA) cuts infections substantially more than other more targeted strategies, according to the REDUCE MRSA trial. (Source: Medpage Today)

PTSD: Mindfulness exercises improve symptoms, cortisol level

Mindfulness-based stretching and deep breathing exercises (MBX) may elicit symptom relief in intensive care unit nurses with posttraumatic stress disorder (PTSD), a new study shows. (Source: Medscape)

High-dose NSAIDs hike risk of heart attack

High doses of some commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) increased the risk of major vascular events by about a third, according to a new meta-analysis of clinical trials. (Source: Medpage Today)

CHMP backs pomalidomide for multiple myeloma

The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has recommended approval of oral pomalidomide for use in the treatment of multiple myeloma. (Source: Medscape)

CDC: Injection guidelines target safety

With the stated goal of increasing injection safety, the CDC unveiled a new set of guidelines powered by a catchy phrase -- "the four Es" and then worked to tailor a set of clunky descriptions phrase. The "Es" in question are:

  • Epidemiologic surveillance of unsafe injection
  • Education
  • Enforcement of safe practices
  • Engineering devices to reduce risks

Among safe injection practices that help prevent the spread of disease, healthcare professionals should never administer medications from the same syringe or single-dose vial to multiple patients, nor should they enter a vial with a used syringe or needle. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Water Hygiene http://blog.kkaggarwal.com/2013/05/water-hygiene/ …

@DeepakChopra: You are not in the world; the world is in you #CosmicConsciousness

    Spiritual Update

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

What is the importance of silence?

The true silence is the silence between the thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. The process of achieving silence is what meditation is.

For comments and archives

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

What are the characteristics of a normal sperm?

A normal sperm has:

  • A smooth, oval shaped head that is 5-6 micrometers long and 2.5-3.5 micrometers around (less than the size of a needle point)
  • A well defined cap (acrosome) that covers 40-70% of the sperm head
  • No visible defect of neck, midpiece, or tail
  • No fluid droplets in the sperm head that are bigger than one-half of the sperm head size.
    An Inspirational Story

Who Named the Curiosity Mars Rover?

The Curiosity Mars rover was named by an 11 year old girl in Lenexa, Kansas, USA. Her name is Clara Ma and below is her inspiring story.

On Aug. 5 at 10:31 p.m. PST, a rover named Curiosity touched down safely on the surface of Mars, and I was lucky enough to have a front-row seat.

My name is Clara, and when I was in 6th grade, I won the essay contest NASA held to name its next Mars rover. The essay I wrote was not even 250 words long, but somehow it was enough to change my life.

I still remember that chilly December day, sitting in science class. I’d finished a worksheet early and decided to get a TIME for Kids magazine off of Mrs. Estevez’s bookshelf. It was the 2008 Invention Issue, but that wasn’t the only thing that caught my eye. In the magazine, there was an article about a girl who named the Mars Exploration Rovers, Spirit and Opportunity.

The article also talked about the essay contest NASA was holding to name its next Mars rover. Before I even knew anything else about it, a single word flooded my 11-year-old mind: Curiosity.

I couldn’t wait for the bell to ring so I could get started on my essay. That afternoon, I raced home from the bus stop, sat down at the computer, and typed until my fingers ached. It turns out I was just in time. A few days later, and the contest would have closed.

Five months later, shortly after I had turned 12, I was watching a National Geographic special on mammoths when the phone rang. My mom answered, and immediately, a wide smile spread across her face.

When she told me that I had won, I was happier than I could ever remember being. I screamed and ran up and down the stairs and all around the house. I completely forgot about the mammoths and did not even remember to turn off the TV until it was really late.

Curiosity is such an important part of who I am. I have always been fascinated by the stars, the planets, the sky and the universe. I remember as a little girl, my grandmother and I would sit together in the backyard for hours. She’d tell me stories and point out constellations.

Here in the heart of the country, my grandmother would say, there were no bright city lights to compete with the brilliance of the stars.

There was just the chirping of the cicadas and the soft summer breeze.

My grandmother lived in China, thousands of miles away from my home in Kansas. I loved the stars because they kept us together even when we were apart. They were always there, yet there was so much I didn’t know about them. That’s what I love so much about space. No matter how much we learn, it will always possess a certain degree of mystery.

In the past, space exploration may have been a competition to see who got somewhere first or the fastest. But now, it is one of the few things that bring people together. Science is a language that needs no translation. It doesn’t matter where you’re from or what you look like — you just have to have a thirst for knowledge and a passion for learning in order to succeed.

People often ask me why we go to faraway places like Mars. Why do we explore? My answer to that is simple: because we can. Because we’re curious. Because we as human beings do not just stay holed up in one place. We are constantly wondering and trying to find out what’s over the hill and beyond the horizon.

The Curiosity rover is more than just a robot. It is more than just a titanium body and aluminum wheels. Curiosity represents the hard work, passion, love and commitment of thousands of people from all over the world who were brought together by science.

Science is so awesome. It is breathtaking and mind-blowing, intertwining and unifying; and sometimes, it’s just a little bit crazy. The discoveries we make about our world are incredibly humbling. They move us forward and have the potential to benefit all of mankind.

This December it will be four years of my life that have been tied to Curiosity in some way. I’ve met so many amazing people through this experience, from scientists to engineers to administrators to volunteers. Their dedication and fervor inspire me immensely. My journey with Curiosity and the MSL mission team has shaped the person that I am today, as well as the person I would one day like to become.

I am deeply grateful to everyone who made it possible for me to have this amazing adventure. And to you, I hope your curiosity takes you far.

By Clara Ma

Source: http://academictips.org/blogs/who-named-the-curiosity-mars-rover/

For comments and archives

    Cardiology eMedinewS

Heartburn raises cancer risk, antacids may offer protection Read More

    Pediatric eMedinewS

Study backs wider use of fecal calprotectin in Pediatric IBD Workup
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    Schizophrenia- split in personality

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

If a patient is not responding to antipsychotics it's worth considering the following:

  • Is the patient under dosed?
  • Wrong diagnosis
  • Organic problem
  • Patient using Illicit substance use
  • Treatment resistant
    Rabies Update

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

If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia was put on 750 mg levofloxacin.
Dr Bad: Take 500 mg for 10 days.
Dr Good: Take it for 5 days.
Lesson: The anti–pneumococcal fluoroquinolones (e.g., levofloxacin, moxifloxacin, gemifloxacin) have been used for 5 to 14 days in inpatients and outpatients with community–acquired pneumonia with most patients having a good clinical response within 2 to 3 days. Using a higher dose of a levofloxacin may decrease the duration of therapy; 750 mg for 5 days was as effective as 500 mg for 10 days and was associated with a more rapid resolution of fever (Clin Infect Dis 2003;37:752–60).

Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

    Quote of the Day (Dr GM Singh)

Man’s troubles are rooted in extreme attention to senses, thoughts, and imagination. Attention should be focused internally to experience a quiet body and a calm mind. Buddha

   Mind Teaser

Read this…………………

Which is often a physiological response to surgery-related stress?

1. Bronchial constriction
2. Decreased cortisol levels
3. Peripheral vasodilation
4. Sodium and water retention

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s  Mind Teaser: 4. Sodium bicarbonate via IV push.

Correct answers received from: Tukaram Pagad, Dr Monica Gandhi, DR ARPAN GANDHI, Usha, DR P K SAHU, Dr.Nageswara Rao Patnala, DR SANTHAKUMARI, Dr. B.B. Gupta, Dr.(Maj. Gen.) Anil Bairaria,, Dr.K.V.Sarma, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Gajveer, Muthumperumal Thirumalpillai, Dr. Thakor Hitendrsinh G, Dr Avtar Krishan, DR Chandresh Jardosh, Dr B K Agarwal, Dr. P. C. Das, Dr.Jayashree Sen & Dr.Bitaan Sen, Dr.V.M.Kartha.

Answer for 31st May Mind Teaser: C. Evaluate the client’s muscle strength hourly after medication

Correct answers received from: DR Chandresh Jardosh, Dr B K Agarwal, Dr. P. C. Das, Dr.Jayashree Sen & Dr.Bitaan Sen, Dr.V.M.Kartha.

Send your answer to ijcp12@gmail.com

   Laugh a While (Dr GM Singh)

Funny definitions

Cardiovascular: The three kinds of blood vessels are arteries, veins and caterpillars.

    Medicolegal Update

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

What are the organophosphorous poisons?

They are derived from phosphoric acids and form two series of compounds known as alkyl phosphates and aryl phosphates.

  • These are basically chemical insecticides and used to prevent agricultural products but when ingested by humans adversely affect health or may become life–threatening.
  • Fatal dose: TEPP 50 mg IM or 100 mg orally/OMPA 80 mg IM or 175 mg orally/Parathion 80 mg IM or 175 mg orally/HETP 60 mg IM or 350 mg orally/Malathion and diazinon 1g orally
  • The fatal period is usually within 24 hours in untreated cases and within 10 days in those treated cases when treatment is not successful. In non–fatal cases, the acute effect lasts for 6 to 30 hours which disappear in 2 to 3 days but may sometime persist for 2 weeks. Complete recovery occurs in 10 days in patients treated early.
  • Atropine is the antidote.
  • Cause of death is by paralysis of respiratory muscles, respiratory arrests due to failure of respiratory centre or intense bronchi constriction resulting in respiratory failure.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Asian Indians more likely to develop heart disease

Being an Indian is now considered a heart attack risk hazard. An Indian doctor settled in the US is 17 times more likely to suffer from heart disease than their US counterparts. Heart disease in Indians develops 10 years earlier than in the Americans. The disease in the Indians is more diffuse and more lethal. This was stated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Indians also have more chances of developing diabetes. What’s more, diabetes in Indians is also different. Their criteria for the diagnosis are tighter. While a body mass index (BMI) of 25 in the US is considered normal, in India the same is regarded as overweight. Indians also develop osteoporosis 10 years earlier than the US citizens.

However, when it comes to other diseases, Indians have less chances of developing cancers of the colon (number one cancer in the US), cancers of the skin, melanomas, Alzheimer’s disease etc.

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 Responses
  1. Dear Sir, Nice Coverage. Regards: Dr SP Khanna
    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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