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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; 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

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial…

2nd November 2012, Friday

Heart Care Foundation of India to be in Limca Book of Records – trains 1010 people in CPR 10: Continuous Compression-only CPR in on session

Heart Care Foundation of India today created an Indian record by training 1010 students and teachers in one session in Continuous Compression-only CPR called CPR-10. The event was held at Birla Vidya Niketan School. Two hundred human dummies were used for the training.

Celebrities who witnessed and addressed the event were Dr Sadhvi Sadhna Ji Maharaj Chairperson World Fellowship of Religions, Ms Geeta Chandran, Noted Bharat Natyam Exponent, Mr Satish Upadhyay, Chairman Education Committee MCD South Zone, Dr Aparna Jaswal Sr Cardiologist Escorts Heart Institute, Dr H K Chopra Vice President Cardiological Society of India, Dr Anil Bansal Jt Secretary National IMA, Mr Rakesh Paveria Additional DCP, Ms Minakshi Kushwaha Principal Birla Vidya Niketan and Ms Tapati Singhi Administrator Birla Vidya Niketan.

Launching the campaign, Ms Geeta Chandran said that 1% of the population at any given time should be trained in CPR-10.

Speaking on the occasion, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that resuscitation mantra is that within 10 minutes of clinical death, for the next 10 minutes the chest of the victim should be compressed with a speed of 100 (10 x 10) per minute. If the electric shock machine is not available, one can give two thumps in the centre of the chest from a distance of one foot.

Dr. Aggarwal said that all relations of heart patients, healthcare workers, health journalists should be trained in this procedure. The difference between CPR 10 and traditional CPR is that mouth to mouth respiration is not needed in CPR 10. The Foundation plans to train one lakh people in the next two years.

Learning can be one to one on a human dummy, called single-rescuer CPR or it can be multiple rescuer training with multiple people performing resuscitation on one person.

Single-rescuer training will be held on 9th November 2012 at the Perfect Health Mela ground where 200 nurses will learn the technique in one go.

The function also launched the various other activities to be held in MTNL Perfect Health Mela.

CPR 10

  1. Cardiac death is reversible in the first 10 minutes. In this period the brain remains alive even though the heart and respiration have stopped. This period is called clinical death.
  2. In Ayurvedic language, the consciousness and the Prana Vayu do not leave the body in the first 10 minutes and therefore if the heart can be revived, one can be revived.
  3. The best way to resuscitate is to provide mouth to mouth respiration combined with chest compressions but if a sole lay rescuer is present or multiple lay rescuers are reluctant to perform mouth-to-mouth breathing, the Heart Care Foundation of India recommends performance of CPR 10 using chest compressions alone, called continuous compression-only CPR.
  4. CPR 10 mantra (Formula of 10): Within 10 minutes of clinical death for the next 10 minutes continuously and effectively compress the centre of the chest with a speed of 100 (10x10) compressions per minute.
  5. Clinical death means no respiration, no heart breathing and no response on painful stimuli.
  6. Ten minutes mean as early as possible. The chances of revival reduce by 10% each minute.
  7. Centre of the chest means in the centre of a line between two nipples.
  8. Continuously means with minimum interruptions
  9. Effectively means compressing the chest up to 5 cm with each down stroke and allowing the chest to recoil completely between each down-stroke
  10. Remember: Push hard (compress 5 cm with each down stroke) and push fast (100 per minute) on the center of the chest.
  11. Do not interrupt chest compressions to palpate for pulses. Instead continue CPR 10 until electric shock machine is available or a doctor takes over or the patient wakes up.
  12. CPR 10 is not for children or cardiac arrest that occurs due to drowning. In these cases, mouth to mouth breathing is still necessary.

For Video

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Polyethylene glycol (PEG) 3350 is a non-absorbable, non-metabolized osmotic agent used in lavage solutions for gut cleansing. To compare the efficacy of PEG and lactulose in chronic constipation, a total of 115 patients with chronic constipation entered a multicentre, randomized, comparative trial. They initially received two sachets containing either PEG (13 g/sachet) or lactulose (10 g/sachet) and were given an option to change the dose to one or three sachets/day, depending on response. Ninety nine patients completed the trial. After four weeks, patients in the PEG group (n=50) had a higher number of stools and a lower median daily score for straining at stool than patients in the lactulose group (n=49). Overall improvement was greater in the PEG group. Clinical tolerance was similar in the two groups, but flatus was less frequently reported in the PEG group. There were no serious adverse events and no significant change in laboratory tests in either group. At the end of the study, the number of sachets used by the patients was 1.6 (0.7)/day in the PEG group and 2.1 (0.7)/day in the lactulose group. Sixty one patients completed a further two months open study of one to three sachets PEG daily; there was no loss of efficacy and no serious toxicity. The study concluded that low dose PEG 3350 was more effective than lactulose and better tolerated. (Attar A, Lémann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44(2):226)

For Comments and archives…

 
Dr K K Aggarwal
  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 HCFI Photo Gallery)

Heart Care Foundation of India to be in Limca Book of Records – trains 1010 people in CPR 10: Continuous Compression-only CPR in on session

Heart Care Foundation of India today created an Indian record by training 1010 students and teachers in one session in Continuous Compression-only CPR called CPR-10. The event was held at Birla Vidya Niketan School. 200 human dummies were used for the training.

 
Dr K K Aggarwal
    National News

19th MTNL Perfect Health Mela 2012 From 1st November to 11th November 2012

click for Programme

Infant mortality rate comes down in Rajasthan

JAIPUR: The infant mortality rate (IMR) in the state has come down from 55 per 1000 live births to 52 per 1000 live births, says the recently released Sample Registration Survey (SRS), 2011, conducted by the Registrar General of India. The IMR in the state has reduced by 3 points over the last one year, which is equal to the amount of decrease in the IMR in the country. As per the SRS 2010, the IMR in the state was 55 per 1,000 live births. Also, the IMR in India was 47 as per SRS 2010 but it has come down to 44 according to the survey released in October. An official of health department said that they have become successful in reducing IMR in the state by 3 points because of various schemes launched by the state government to improve maternal and infant healthcare services which include Janani Shishu Suraksha Yojna. (Source: TOI, Nov 1, 2012)

For comments and archives

My Profession My Concern

Quality control

Manual removal of placenta (MRP)

  • MRP should be carried out only by the Medical Officer in a health facility (PHC/CHC) setting.
  • If the placenta was partially separated (as could be diagnosed by the presence of vaginal bleeding), the ANM should try and see if a part of the placenta could be seen coming out from the os. Then she could assist the removal of the placenta
  • The ANM should be trained in the active management of the third stage of labour.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

The term “critical” stenosis was defined based upon theoretical considerations showing that the aortic valve area must be reduced to one-fourth of its natural size before significant changes in circulation occur. As a result, since the triangular orifice area of the normal (adult) aortic valve is approximately 3.0 cm2, an area exceeding 0.75 cm2 would not be defined as critical.

(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)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Chromosome screening method boosts IVF success

The use of comprehensive chromosome screening (CCS) in recently frozen embryos resulted in significantly higher implantation rates and fewer first-trimester pregnancy losses among infertile women older than 35 years compared with standard morphology-based screening in a randomized controlled trial. Researchers reported the trial results here at American Society for Reproductive Medicine (ASRM) 68th Annual Meeting. (Source: Medscape)

For comments and archives

PCOS: Impaired insulin sensitivity from atorvastatin

Atorvastatin impaired insulin sensitivity in women with polycystic ovary syndrome (PCOS) and should not be prescribed unless patients also demonstrate risk factors for cardiovascular disease, according to research presented here at the American Society of Reproductive Medicine (ASRM) 68th Annual Meeting. (Source: Medscape)

For comments and archives

SPECT bests ECG in coronary artery disease

SPECT myocardial perfusion imaging (MPI) can pick up perfusion defects that don't show up with normal cardiac stress testing and can predict cardiovascular death or morbidity out to 10 years, researchers found. Half of 650 patients with known or suspected heart disease and normal exercise ECGs had an abnormal SPECT MPI, and 20% had indications that the ischemia was reversible, reported Arend F.L. Schinkel, MD, of the Erasmus MC Thoraxcenter in Rotterdam, the Netherlands, and colleagues. The summed rest score, which accounts for the amount of infarcted myocardium, was an independent predictor of death, whereas the summed stress score, which measures both infarcted and ischemic myocardium, was an independent predictor of major adverse cardiac events (MACE), they wrote in a study published in the November European Heart Journal: Cardiovascular Imaging. (Source: Medpage Today)

For comments and archives

Recurrence rate may doom cervical Ca regimen

Adding a targeted agent to chemoradiation led to encouraging 2- and 3-year survival in locally advanced cervical cancer, but a high rate of local recurrence left investigators wondering whether they should continue evaluating the regimen. Almost 90% of patients remained alive at 2 years and 80% at 3 years, following concurrent treatment with bevacizumab (Avastin) and cisplatin-based chemoradiation. However, more than 40% of 49 patients had locoregional recurrence at 3 years, William Small, MD, of Northwestern University and colleagues reported at the American Society for Radiation Oncology meeting. (Source: Medscape)

For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: Padma Shri Dr KK Aggarwal on Health PART 2 at DPS Mathura
Road…..http://youtu.be/Ia06Xbol14Q

@DeepakChopra: That which can be proved scientifically through empirical facts is not reality but a form of mentation and perception #Science #Atheism

 
    Spiritual Update

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

Pairs of Vedanta are inseparable

Luv-Kush, Shubha-Labha, Riddhi- Siddhi are inseparable pairs of Vedanta. They signify that it is not possible to get one without the help of the other.

In Luv-Kush, Kush is a symbol of purity and Luv symbolise the spiritual love. To achieve love one has to be pure in consciousness. To acquire love and inner happiness in life one may has to use kush, a herb, in daily life. No traditional Hindu ritual is complete without the use of kush grasses.

For comments and archives

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

How does contraception work?

Contraceptive agents are usually divided into those that are either hormonal or non hormonal. Most of the hormonal contraceptives work by changing a woman's hormone levels to mimic a pregnancy, therefore preventing eggs from being able to be released from the ovary. In contrast, non hormonal contraceptive agents or devices work by preventing a man's sperm from joining a woman's egg.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Safe blood products, used correctly, can be life saving. However, even where quality standards are very high, transfusion carries some risks. If standards are poor or inconsistent, transfusion may be extremely risky.

For comments and archives

 
   An Inspirational Story (Ms Ritu Sinha)

Improving self confidence

Are you the type of person who easily gets influenced by negative advices? Follow this short self confidence lesson…

When Henry Ward Beecher was a young boy in school, he learned a lesson in self confidence which he never forgot. He was called upon to recite in front of the class. He had hardly begun when the teacher interrupted with an emphatic, “No!” He started over and again the teacher thundered, “No!” Humiliated, Henry sat down.

The next boy rose to recite and had just begun when the teacher shouted, “No!” This student, however, kept on with the recitation until he completed it. As he sat down, the teacher replied, “Very good!” Henry was irritated. ”I recited just as he did,” he complained to the teacher.

But the instructor replied, “It is not enough to know your lesson, you must be sure. When you allowed me to stop you, it meant that you were uncertain. If the world says, ‘No!’ it is your business to say, ‘Yes!’ and prove it. The world will say, ‘No!’ in a thousand ways.

‘No! You can’t do that.’

‘No! You are wrong.’

‘No! You are too old.’

‘No! You are too young.’

‘No! You are too weak.’

‘No! It will never work.’

‘No! You don’t have the education.’

‘No! You don’t have the background.’

‘No! You don’t have the money.’

‘No! It can’t be done.’

And each ‘No!’ you hear has the potential to erode your confidence bit by bit until you quit all together. Though the world says, ‘No!’ to you today, you should be determined to say, ‘Yes!’ and prove it!”

Source: http://academictips.org/blogs/category/awakening/page/3/

For comments and archives

 
   Cardiology eMedinewS

Smoking bans cut MI rate Read More

Warfarin discontinuation rates high Read More

 
   Pediatric eMedinewS

Sickle cell kids vulnerable to brain infarcts Read More

Target obesity early to succeed in kids Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A young patient with pre-diabetes was found to have raised liver enzymes.
Dr. Bad: It has no significance.
Dr. Good: It can increase your chances of diabetes.
Lesson: According to the Bogalusa heart study, raised liver enzymes are related to the development of prediabetes and type 2 diabetes in younger adults. The follow-up prevalence rate of adult diabetes status by quartiles of baseline alanine aminotransferase (ALT) and ?-glutamyl transferase (GGT) levels showed an adverse trend for both prediabetes and diabetes. In a longitudinal multivariate logistic regression analysis that included anthropometric, hemodynamic, and metabolic variables, as well as alcohol consumption and smoking, individuals with elevated baseline ALT and GGT levels were 1.16 and 1.20 times, respectively, more likely to develop diabetes (Diabetes Care 2011 Dec;34(12):2603-7).

For comments and archives

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

For comments and archives

 
    Legal Question of the Day (Dr MC Gupta)

Need, purpose, efficacy and changes needed in the PC&PNDT Act

There is lot of criticism about the PC&PNDT Act. Some critiques want it to be scrapped on the ground that it has resulted in harassment of doctors and has led to corruption and has been ineffective in improving the sex ratio. Others agree with the grounds of criticism but want the act to be amended rather than scrapped. Let us examine the issue.

Q. What problems have been caused because of the PC&PNDT Act/Rules?

Ans.

The Act/Rules have caused many problems. The reasons for such problems are that either the Act/Rules are defective or they are implemented by bureaucrats by a too rigid administrative approach. A few problems are highlighted below:

  • The PNDT Act has placed such excessive and bureaucratic restrictions upon ultrasonography that the use of this extremely important diagnostic tool has become very much restricted and costly. Nobody can buy an ultrasound machine without permission and registration under the Act. The associated administrative/bureaucratic procedures are so extensive and stringent that many doctors prefer not to get registered under the Act. Some doctors, already registered under the Act, have given up or are thinking of giving up their registration.
  • There is so much of harassment of doctors that in some instances, sonologists simply refuse to perform sonography, duly advised by the gynecologist for medical reasons, upon those women who already have two female children. They are afraid that the concerned authorities would unnecessarily trap them under the provisions of the Act.
  • The obsession of the authorities with sex selection through ultrasound has reached such a degree that portable ultrasound machines have been banned/restricted unmindful of the fact that an ultrasound machine has got many more uses than prenatal sex detection. The medical profession and the public are deprived of those uses. Such an approach has rendered illegal even the transport of an ultrasound machine for the purpose of demonstration in meetings/conferences etc.
  • The PNDT Act imposes restrictions not only upon ultrasonography technique and machines but all other techniques and machines that are “capable of determining sex of the foetus” as mentioned in Section 2 (E) of the Act.
  • The Act Has led to corruption and wide-spread harassment of doctors. Attempts are frequently made to harass them and extort money from them. Many doctors have told me that they are asked Rs. 30-50,000/- as the price for avoiding an adverse inspection report and Rs. 3-4 lakhs as the price for avoiding litigation. Some PNDT authorities even charge a monthly “protection money”.
 
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  Quote of the Day (Dr GM Singh)

Those who wish to sing, always find a song. Swedish Proverb

 
    Mind Teaser

Read this…………………

What is special about the following number sequence?
8, 5, 4, 9, 1, 7, 6, 10, 3, 2, 0

Yesterday’s Mind Teaser: I am the owner of a pet store. If I put in one canary per cage, I have one bird too many. If I put in two canaries per cage, I have one cage too many. How many cages and canaries do I have?

Answer for yesterday’s Mind Teaser: Four canaries and three cages.

If you put one canary in each cage, you have an extra bird without a cage. However, if you put two canaries in each cage then you have two canaries in the first cage, two canaries in the second cage and an extra cage.

Correct answers received from: Dr Manu Shankar, Kanta Jain, Rajanish Shetty, Dr Arvind Khanijo,
Dr BB Aggarwal, Dr Pankaj Agarwal, Dr Rajiv Dhir, Dr Kanta Jain, Dr K Raju, Dr Thakor Hitendrsinh G,
Dr Avtar Krishan, Dr Jainendra Upadhyay.

Answer for 31st October Mind Teaser: next number in the sequence is 1113213211
Correct answers received from: Dr Kanta Jain, Dr K Raju, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Sympathy! You can get from anybody... But Jealousy! You have to earn it..!

 
    Medicolegal Update

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

Post mortem discoloration does not have the same connotation as cyanosis produced during life

  • A gravitational pooling of blood in the veins and capillary beds of the dependent parts of the body occurs as the body remains lying in a position and cessation of the circulation after death. Postmortem coloration helps the doctor to estimate the time since death.
  • The skin of deceased may show dark purple discoloration due to accumulated blood. The process begins immediately after the circulation stops, and in a person dying slowly with circulatory failure, it may be pronounced very shortly after death.
  • Postmortem lividity is first apparent about 20–30 minutes after death and is seen as dull red patches or blotches, which deepen in intensity and coalesce over the succeeding hours to form extensive areas. Lividity is present in all bodies, although it may be inconspicuous in some and thus escape notice.
  • Postmortem lividity is usually well–marked in the earlobes and in the fingernail beds. In a supine corpse, there may be isolated areas of lividity over the front and sides of the neck resulting from incomplete emptying of superficial veins. If the head is slightly flexed on the neck, then lividity may have a linear distribution corresponding to the skin folds.
  • Fading of the primary pattern of lividity and development of a secondary pattern of lividity will be quicker and more complete if the body is moved.
  • Cyanide poisoning results in lividity, which has been described by different authors as pink, bright scarlet, and violet.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Now the west says Yoga is good for paralysis patients

Since ancient times, yoga exercises in India have been recommended for many diseases including paralysis. And now, a study published in Stroke, Journal of American Medical Association has said that a yoga-based rehabilitation programme can improve the balance, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

In the 8-week study, yoga showed significant progress in static and dynamic balance which was much higher than the people who were on conventional treatment. Yoga has also shown benefit in those with chronic back pain and it also cuts the frequent arterial fibrillation episodes.

Yoga involves a combination of postures, breathing and meditation.

 
    Readers Response
  1. Dear Sir, I must say that the content of your blog is superb. I like the way you describe the meanings of spiritual content of religious themes of our culture. Keep up the good work sir. Regards. DrNeeraj Gupta Victoria , Australia.
 
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