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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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    Health Videos …
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  Editorial …

10th June 2013, Monday

All about depression

  • Depression is a major public health problem as a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinically significant depression never see a mental health professional but they often see a primary care physician.
  • A non-psychiatric physician misses the diagnosis of the depression 50% of times.
  • All depressed patients must be enquired specifically about suicidal ideations.
  • Suicidal ideation is a medical emergency
  • Risk factors for suicide are either known psychiatric disorders, medical illness, prior history of suicidal attempts or family history of attempted suicide.
  • Major risk factors for attempted suicide are psychiatric disorders, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.
  • The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • World over, one million people commit suicide every year.
  • 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only 1/3 contact their mental health service provider.
  • Twice as many suicidal victims had contacted with their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  • In the US, suicide rate is 10.5 per 100,000 people.
  • In America, suicide is increasing in middle-aged adults.
  • There are 10-40 non-fatal suicide attempts for every one completed suicide.
  • The majority of completed suicides in US are accomplished with firearms (57%), the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5-6 times more likely to make another attempt.
  • 50% of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are more often successful by three times.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicide rate in male clinicians is 1.41 and in female clinicians, it is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow-up.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Obesity reduces life expectancy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Excessive use of mobile phone can be injurious to your health

A press conference was organised by Heart Care Foundation of India on the occasion of World Environment Day.

Dr K K Aggarwal
    National News

17% of urban Indians have kidney disease: Study

NEW DELHI: In a worrying fallout of the rising diabetes and hypertension cases in urban India, a study across 12 cities found 17 out of every 100 people suffering from kidney disease. Of this, 6% had stage III kidney disease which necessitates medical attention and, in some cases, costly treatment like dialysis or transplant. The study used data from 13 hospitals, both private and government, across 12 cities — making it the largest screening study of kidney disease in the country. The most surprising finding, said doctors, was that a majority of individuals diagnosed with different stages of chronic kidney disease (CKD) had not undergone any kidney function test before. "In India, younger people do not go for preventive check-ups. This results in delayed diagnosis. In our study, we found 64.5% of the patients suffering from CKD also suffered from hypertension, 4.7% from anemia and 31.6% from diabetes," said one of the authors, Dr Sham Sunder, head of the nephrology department at Ram Manohar Lohia hospital in New Delhi. Dr Sunder said most patients suffering from CKD visit hospitals when their kidneys functioning had already reduced to half of its capacity. "If the disease can be diagnosed early, in stage I and II, the progression can be halted with medicines. Those with a family history of kidney failure, recurrent urinary tract infection, diabetes and hypertension must get themselves tested periodically," he added.

The cities included in the Screening and Early Evaluation of Kidney Disease (SEEK) study were Varanasi, Kanpur, Delhi, Ludhiana, Bhopal, Nadiad (Gujarat), Mumbai, Mysore, Bangalore, Cochin and Vishakhapatnam. "The highest prevalence of CKD was observed in Vishakhapatnam (46.8%) followed by Kanpur (41.7%) and Delhi (41%). The lowest prevalence were in Mysore (4.2%) and Bangalore (4%)," said Dr D S Rana, chairman, department of nephrology at Sir Ganga Ram hospital (SGRH).

Dr R K Sharma, head of the nephrology department at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, said, "Once a person has suffered from kidney failure, the only treatment options are life-long dialysis or a transplant. Both are costly and tedious. Also, in India, we have only about 1,000 kidney specialists or nephrologists. This means if preventive measures are not adopted, we will face a national crisis."

Experts say CKD is associated with metabolic abnormalities and bone disease and is also an important risk factor for peripheral vascular disease, cardiovascular disease and stroke, all of which cause mortality. Doctors also stress on the need for promoting cadaver donation to meet the growing need for kidneys for transplants.

Approximately 1,75,000 kidneys are needed for transplantation in India every year. At present, just about 4,000 transplants are conducted annually. More than 90% of the donors are family members. According to data released by the health ministry, the number of diabetes cases - a risk factor for CKD - had increased by 12% in a single year - from 50.8 million in 2011 to 61 million in 2012. (Source: TOI, Jun 8, 2013)

For comments and archives

24x7 ambulance service on national highways must

NEW DELHI: Now, developers and government agencies managing and maintaining National Highways (NHs) will have to ensure that ambulances and patrolling vehicles are available 24x7. National Highways Authority of India (NHAI) has decided to install vehicle tracking system (VTS) in all such vehicles with global positioning system (GPS) within a month to monitor their uninterrupted movement. In a circular issued last Monday, NHAI chairman R P Singh has directed all chief general managers (CGMs) to take up the issue with private developers. He has cited the provision of concession agreement, where private developers are bound to provide "round the clock" ambulance service for accident victims and patrolling vehicles for the entire project stretch.

Singh has pointed out there are often complaints of developers not deploying these vehicles crucial for shifting accident victims to hospital and to get crucial first report of jams, breakdowns or accidents from patrolling vehicles. As per rules, every developer needs to deploy one ambulance and one patrolling vehicle for every 50 km stretch. At present, though 244 life-support ambulances and 245 patrolling vehicles are deployed on highway stretches totaling around 10,360 km, the deployment is inadequate. Moreover, only a small portion of country's 80,000 km NH stretch has such a facility.

The most recent global road safety report, conducted by the World Health Organization (WHO), has also exposed how only less than 49% seriously injured victims are rushed to hospital by ambulances in India. "Robust ambulance services reduce fatalities significantly as the victims get immediate treatment at spot and are rushed to hospital. As per the order, in case of financial need to implement this project the fund can come from the decided road safety fund available with NHAI," said B S Singla, CGM in NHAI.

Road safety experts have welcomed the move considering the fact that 37% of countries' total road fatalities are reported from NH stretches. "Finally, the beginning has been made. But what we need is to monitor and control the facilities at local level for effective result," said Rohit Baluja. (Source: TOI, Jun 7, 2013)

Rescue apparatus on highways

  • Total No of Ambulances: 244 (10,481km)
  • No of Patrolling Vehicles: 245 (10,360 km)
  • No of Tow Away Cranes: 216 (10,360 km)
    Valvular Heart Disease Update

In the elderly, valvular heart disease is often associated with coronary blockages; therefore, angiography is a must in such cases to assess the need for concomitant coronary bypass surgery.

(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)


Types of child neglect

  • Physical neglect is failure to provide adequate food, cloth, shelter, hygiene, protection and safety.
  • Emotional neglect is failure to provide love, affection, security and emotional support.
  • Educational neglect is failure to enroll the child in school.
  • Medical neglect is refusal to seek or delay in seeking medical care when required.
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Blood test works for detecting Down syndrome

Blood screening that accurately detected Down syndrome and other genetic fetal abnormalities in the first trimester could reduce the need for invasive testing with amniocentesis or chorionic villi sampling, researchers reported. (Source: Medpage Today)

Comprehension a barrier to antiretroviral adherence

Brief counseling sessions improve adherence to antiretroviral therapy for people with HIV who have limited health literacy, but they do nothing for those with especially poor understanding. (Source: Medscape)

Poor vision tied to poor balance

Visual impairment -- correctable or not -- is associated with poor balance, researchers reported. (Source: Medpage Today)

Triple antithrombotic therapy unneeded after MI, PCI in AF patients

The addition of one antiplatelet agent to oral anticoagulation is sufficient in patients with atrial fibrillation (AF) who experience an MI or PCI, and the antiplatelet agent probably should be clopidogrel instead of aspirin, concluded a study of >12 000 patients from nationwide registries in Denmark. (Source: Medscape)

Apnea-related leg movements may signal CVD

Respiratory events that trigger leg movements predicted cardiovascular disease in older men with obstructive sleep apnea, researchers reported at the SLEEP meeting. (Source: Medpage Today)

Higher LV mass after preeclampsia predicts later hypertension

Persisting diastolic dysfunction and elevated LV mass after preeclampsia--even when postpartum blood pressures have returned to normal--suggest an increased risk of chronic hypertension later in life, according to a study published online June 3, 2013 in Hypertension. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Guidelines on Health by Dr K K Aggarwal http://bit.ly/13MpPUz #Health

@DrKKAggarwal: Every cubic cm of invisible & limitless space has the energy & organizing power to create the universe 3 times over #CosmicConsciousness

    Spiritual Update

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

Panchamrit body wash

Panchamrit is taken as a Prasadam and is also used to wash the deity. In Vedic language, anything which is offered to God can also be done to the human body. Panchamrit bath, therefore, is the original and traditionally full bath prescribed in Vedic literature. It consists of the following:

  1. Washing the body with milk and water, where milk acts like a soothing agent.
  2. Next is washing the body with curd, which is a substitute for soap and washes away the dirt from the skin.
  3. The third step is washing the body with desi ghee, which is like an oil massage.
  4. Fourth is washing the body with honey, which works like a moisturizer.
  5. Last step is to rub the skin with sugar or khand. Sugar works as a scrubber.

Panchamrit bath is much more scientific, cheaper and health friendly.

For comments and archives

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

What causes hyperprolactinemia?

Prolactin levels increase as a result of:

  • Certain medications, including commonly prescribed antidepressants, anti–psychotics, and blood pressure medications
  • Herbs, including fenugreek, fennel seeds and red clover
  • Chest wall irritation (from surgical scars, shingles) Stress Certain foods Exercise Sleep (prolactin levels are highest at night)
  • Nipple stimulation
  • Hypothyroidism, or underactive thyroid, pituitary tumors. These are usually very tiny, but account for about 30% of all cases of hyperprolactinemia
    An Inspirational Story

The loser who never gave up!

When he was a little boy his uncle called him “Sparky”, after a comic-strip horse named Spark Plug. School was all but impossible for Sparky.

He failed every subject in the eighth grade. He flunked physics in high school, getting a grade of zero. He also flunked Latin, algebra and English. And his record in sports wasn’t any better. Though he did manage to make the school’s golf team, he promptly lost the only important match of the season. Oh, there was a consolation match; he lost that too.

Throughout his youth, Sparky was awkward socially. It wasn’t that the other students disliked him; it’s just that no one really cared all that much. In fact, Sparky was astonished if a classmate ever said hello to him outside of school hours. There’s no way to tell how he might have done at dating. He never once asked a girl out in high school. He was too afraid of being turned down… or perhaps laughed at. Sparky was a loser. He, his classmates… everyone knew it. So he learned to live with it. He made up his mind early that if things were meant to work out, they would. Otherwise he would content himself with what appeared to be his inevitable mediocrity.

One thing WAS important to Sparky, however — drawing. He was proud of his artwork. No one else appreciated it. But that didn’t seem to matter to him. In his senior year of high school, he submitted some cartoons to the yearbook. The editors rejected the concept. Despite this brush-off, Sparky was convinced of his ability. He even decided to become an artist.

So, after completing high school, Sparky wrote to Walt Disney Studios. They asked for samples of his artwork. Despite careful preparation, it too was rejected…one more confirmation that he was a loser.

But Sparky still didn’t give up. Instead, he decided to tell his own life’s story in cartoons. The main character would be a little boy who symbolized the perpetual loser and chronic underachiever. You know him well. Because Sparky’s cartoon character went on to become a cultural phenomenon of sorts. People readily identified with this “lovable loser.” He reminded people of the painful and embarrassing moments from their own past, of their pain and their shared humanity. The character soon became famous worldwide: “Charlie Brown.” And Sparky, the boy whose many failures never kept him from trying, whose work was rejected again and again, is the highly successful cartoonist Charles Schultz. His cartoon strip, “Peanuts,” continues to inspire books, T-shirts and Christmas specials, reminding us, as someone once commented that life somehow finds a way for all of us, even the losers.

Sparky’s story reminds us of a very important principle in life. We all face difficulty and discouragement from time to time. We also have a choice in how we handle it. If we’re persistent, if we hold fast to our faith, if we continue to develop the unique talents God has given us, who knows what can happen? We may end up with an insight and an ability to inspire that comes only through hardship. In the end, there are no “losers” with God. Some winners just take longer to develop!

‘Peanuts’ is a syndicated daily and Sunday American comic strip written and illustrated by Charles M. Schulz, which ran from October 2, 1950, to February 13, 2000, continuing in reruns afterward.

The strip is the most popular and influential in the history of the comic strip, with 17,897 strips published in all, making it “arguably the longest story ever told by one human being”, according to Robert Thompson of Syracuse University. At its peak, Peanuts ran in over 2,600 newspapers, with a readership of 355 million in 75 countries, and was translated into 21 languages.

For comments and archives

  Cardiology eMedinewS

Afib hastens cognitive decline Read More

  Pediatric eMedinewS

Cardiac events predictable in kids with epilepsy Read More

    Rabies Update

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

Can IDRV be given to infants whose skin is thin?

For children below 5 years of age, it is advisable to adopt IM vaccination.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Go for Echo test.
Dr. Good: Go for Tissue Doppler Echo test.
Lesson: A patient with heart failure must go for Tissue Doppler Echo Test for evaluation of diastolic functions.

Make Sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

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  Quote of the Day (Dr GM Singh)

It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward

    Mind Teaser

Read this…………………

A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:

1. is an emotional reaction to the anticipated pain.
2. is in anticipation of future pain.
3. is more indicative of the need for pain medication than the pain rating.
4. may be in conflict with the pain rating, and accepts the report of pain.

Yesterday’s Mind Teaser: The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by:

1. Adding bulk fiber to the diet.
2. Giving the patient enemas as needed.
3. Increasing fluids and exercise.
4. Using a bowel stimulant and stool softener.

Answer for yesterday’s Mind Teaser: 4. Using a bowel stimulant and stool softener.

Correct answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Kanta jain, Dr shashi saini, Dr. Bharat Bhushan Aggarwal, DR SANTHAKUMARI, DR ANUSHA SUDHAKAR, DR B K AGARWAL, DR P K SAHU , Dr. P. C. Das, Dr. B.B. Gupta, DrValluriRamarao, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr. Thakor Hitendrsinh G, Dr Monica Gandhi, Dr. Thakor Hitendrsinh G, DR ARPAN GANDHI

Answer for 8th June Mind Teaser: 4. Unilaterally

Correct answers received from: Dr Uma Guar , Dr.Bitaan Sen & Dr.Jayashree Sen

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

A woman worries about the future -- until she gets a husband.

A man never worries about the future -- until he gets a wife.

    Medicolegal Update

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

What is the medical treatment of chemical contamination and burn?

  • In case of chemical contamination or burn injury of eye, put fluorescein drops in the eye. Burns will stain yellow.
  • If there are yellow stains with fluorescein, put chloramphenicol 1% eye ointment in the eye. Put more ointment into the eye every 2 hours. Continue until the eye is no longer red and the sclera is white and then for another 24 hours.
  • If the pain is severe, the patient may need an intramuscular injection of morphine.
  • If there is no water nearby, dab or gently wipe the skin and hair with cloth or paper.
  • Immediately wash the affected part of the body under cold or lukewarm running water, using soap if you have some. If there is no running water use buckets of water. Do it quickly and use a lot of water. Wear gloves and an apron if needed, to protect you from splashes of chemical. Some chemicals give off vapors, so be careful not to breathe in vapors.
  • Quickly remove any of the patient’s clothes contaminated with chemical or vomit, as well as shoes and wristwatch if necessary. Speed is important. Cut the clothes off if the chemicals are very poisonous or corrosive.
  • If large areas of the body are contaminated with chemical, wash the patient under a shower or a hose. Remember to clean the hair and under the fingernails, in the groin and behind the ears, if necessary.
  • Continue to pour water over the patient for 10 minutes or longer if you can still see chemicals on the skin. If the skin feels sticky or soapy, wash it until the feeling disappears. This may take an hour or more.
  • Make sure the water drains away freely and safely as it will have chemical in it.
  • Do not rub or scrub the skin.
  • Dry the skin gently with a clean, soft towel. If clothing stays stuck to the skin even after water has been poured over it, do not remove it.
  • Remember that many chemicals can pass through the skin very quickly. Look for signs of poisoning.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acid reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management together with empirical treatment is unsuccessful or those who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity. 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.

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight, and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes to prevent reflux involve elevation of head and the body, avoidance of food before sleep and avoidance of food which makes the valve of the food pipe lax. Examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

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. ...................
    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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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Dr Usha K Baveja