eMedinewS10th January 2014, Friday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at
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Cardiology Update

  1. Leading the list was the new set of prevention guidelines covering the assessment of atherosclerotic cardiovascular disease risk and management of weight, lifestyle, and cholesterol that were released in November in collaboration with the American College of Cardiology. The guidance sparked controversy, mostly centered around the removal of treatment targets for LDL cholesterol, a new risk calculator, and recommendations widening the potential pool of patients eligible for statins.
  2. Other advances highlighted by the AHA/ASA included hypertension control, cardiovascular health in children and young adults, cardiac rehabilitation, the genetics of congenital heart disease, how intestinal bacteria affect cardiovascular disease risk, atrial fibrillation, therapeutic hypothermia in cardiac arrest, endovascular stroke treatment, and more neutral results for niacin.
  3. FDA takes another look at Dabigatran safety: The FDA has announced its intention to conduct a new study into the safety of dabigatran through its Mini–Sentinel pilot project. Since approval of dabigatran in 2010 for the prevention of stroke in patients with atrial fibrillation, questions have been raised about the safety of the agent, particularly regarding excess bleeding. In 2012, the FDA concluded that dabigatran was not associated with a higher rate of bleeding compared with warfarin among new users, but said that the safety review would continue.
  4. There is a disparity in the awareness of weight and the risk for heart disease between Hispanic and non–Hispanic white women, according to a study in the Journal of Women's Health. Elsa–Grace Giardina, MD, of Columbia University Medical Center in New York City, and colleagues explored the issue in 683 women enrolled in the Heart Health in Action database who completed a questionnaire. After accounting for age, education, and body mass index, Hispanic women were less likely to identify heart disease as the leading cause of death among women compared with non–Hispanic white women (27% versus 88%). Hispanic women also were less likely to correctly estimate their weight (69% versus 83%), with underestimation more likely for Hispanic women among the participants who were overweight (48.5% versus 12.7%) and obese (17.2% versus 0%).
  5. TAVI beneficial for oldest patients: Patients into their 80s and 90s can have good outcomes from transcatheter aortic valve implantation (TAVI), according to a study in the Annals of Thoracic Surgery.
Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

cpr10 Mantra 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 10×10 i.e. 100 per minute."

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VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Curses in Mythology

sprritual blog

There were no judges in mythological era. The role of judges was performed either by Rishi Munis or by the kings.

We have heard lot of examples of curses (shraps) being given by Rishi Munis. In all probabilities, these were the sentences uttered by them to the guilty or the culprit person. Following are a few examples:

• Rishi Munis giving curse (shrap) of Bhasama can be equated to today’s ‘death sentence’ by electrocution.

• Rishi Gautam giving a Shrap to Lord Indra and made him impotent for some time can be equated to chemical castration. He was later relieved by Lord Ganesha which can be equated to acquittal from the higher court.

• Rishi Gautam giving a Shrap to Ahilya of becoming a ‘stone’ can be equated to imprisonment for a number of years in isolation where movements are not possible (solitary confinement). Lord Rama relieving her from imprisonment (converting back to a woman) may mean a Presidential pardon and reducing the imprisonment time.

There are several similar cases of curses (shraps) in mythology that can be equated to today’s judicial system. If you have any, please forward the same to me.

cardiology news

The Thirst and the Rusty Well

There is a legend of a man who was lost in the desert, dying of thirst. He stumbled on until he came to an abandoned house. Outside the dilapidated, windowless, weather–beaten, deserted shack was a pump. He stumbled forward and began pumping furiously, but no water came from the well. Then he noticed a small jug with a cork at the top and a note written on the side: "You have to prime the pump with water, my friend. P.S. And fill the jug again before you leave." He pulled out a cork and saw that the jug was full of water.

Should he pour it down the pump? What if it didn’t work? All of the water would be gone. If he drank the water from the jug, he could be sure he would not die of thirst. But to pour it down the rusty pump on the flimsy instruction written on the outside of the jug?

Something from inside told him to follow the advice and choose the risky decision. He proceeded to pour the whole jug of water down the rusty old pump and furiously pumped up and down. Sure enough, the water gushed out! He had all he needed to drink. He filled the jug again, corked it and added his own words beneath the instructions on the jug: "Believe me, it really works. You have to give it all away before you can get anything back."

That’s why giving is important…!!!

News Around The Globe

News

  • Italian researchers report that switching to a different TNF–alfa inhibitor can be effective in some patients with psoriasis, particularly those who respond initially and then lose the response (secondary inefficacy). However, for those patients who show primary inefficacy, the value of switching to another agent is less clear. The findings are published in the Journal of the American Academy of Dermatology.
  • Induction chemotherapy (IC) is significantly inferior to primary surgery in patients with advanced tongue cancer, according to a comparative study published online December 26, 2013, in JAMA Otolaryngology – Head and Neck Surgery.
  • The US Food and Drug Administration (FDA) is warning about possible harm from exceeding the recommended dose of over–the–counter (OTC) sodium phosphate products to treat constipation. In a statement posted online today, the agency said using more than 1 dose in 24 hours can cause rare but serious harm to the kidneys and heart, and even death. There have been reports of severe dehydration and changes in serum electrolyte levels (hyperphosphatemia, hypocalcemia, and hypernatremia) from taking more than the recommended dose of OTC sodium phosphate products, resulting in serious adverse effects on organs, such as the kidneys and heart, and in some cases resulting in death.
  • The FDA has approved dapagliflozin (Farxiga) for treatment of type 2 diabetes in adults, along with diet and exercise. The drug, supplied as a tablet, is a sodium glucose co–transporter 2 inhibitor that blocks the reabsorption of glucose by the kidney, increases glucose excretion, and lowers blood glucose levels. However, the manufacturers, Bristol–Myers Squibb and AstraZeneca, must conduct six post–market studies, which include a cardiovascular outcomes trial in patients with baseline cardiovascular disease risks, a bladder cancer risk trial, an animal study looking at drug–induced urinary flow and bladder tumor promotion, two trials on risks in pediatric patients, and an enhanced pharmacovigilance program to study liver abnormalities and pregnancy outcomes
  • Life expectancy at birth has increased for most Americans, regardless of gender, race, or ethnicity, according to a National Vital Statistics Report released Monday. In 2009, life expectancy at birth was 78.5 years, an increase of 0.4 years, from 78.1 years in 2008, says the report, authored by Elizabeth Arias, PhD, of the Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics. The increase in life expectancy in 2009 over 2008 stems from decreases in death from heart disease, cancer, unintentional injuries, stroke, and chronic lower respiratory diseases, the report notes.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

Can rabies vaccine be given to a patient with jaundice?

Rabies vaccine can be given to a patient with jaundice.

cardiology news

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

  • A retrospective study suggested that using equations that incorporate height, weight, age, and sex to predict heart mass may better allocate donor hearts to transplant recipients than considering body mass alone. Although differences in body mass were not predictive of survival after heart transplantation, differences in predicted heart mass using those equations were related to survival up to 5 years after the operation, according to Robert Reed, MD, of the University of Maryland School of Medicine in Baltimore, and colleagues. Specifically, patients who received the most undersized hearts had significantly increased risks of dying at 1 year (HR 1.25, 95% CI 1.02–1.54) and 5 years (HR 1.20, 95% CI 1.04–1.39), the researchers reported online in JACC: Heart Failure.
  • Being fit during the transition from the teenage years into adulthood may protect against heart disease decades later, a Swedish cohort study suggested. Men who had lower aerobic fitness levels when they were examined before entering mandatory military service at age 18 were more likely to have a myocardial infarction (MI) during a median follow–up of 34 years (P<0.001 for trend), according to Peter Nordstrom, MD, PhD, of Umea University in Sweden, and colleagues. But obese men continued to have higher rates of MI compared with their leaner counterparts regardless of fitness level. The findings are published in the European Heart Journal.
cardiology news

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

  • In a study in the Jan. 9 issue of New England Journal of Medicine, tight glycemic control in critically ill children had no significant effect on major clinical outcomes. Researchers compared a group of children assigned to tight control with another group assigned to conventional control. The mean difference between the two groups in days alive and free from mechanical ventilation at 30 days was 0.36 days. As per the authors, a difference of 2 days would have been considered clinically important.
  • Most over–the–counter pediatric liquid medications adhere to US Food and Drug Administration recommendations for dosing directions and devices, according to results from a newly published study published online January 6 in Pediatrics. However, further improvements are needed.
cardiology news

Clinicians should aggressively treat unhealthy lifestyles

Health care providers should treat unhealthy behaviors as aggressively as they treat hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create "interprofessional practices" to connect patients with behavior–change specialists.

They must implement five As when caring for patients

  • Assess a patient’s risk behaviors for heart disease
  • Advise change, such as weight loss or exercise
  • Agree on an action plan
  • Assist with treatment
  • Arrange for follow–up care.
cardiology news

Total CPR since 1st November 2012 – 84073 trained

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press release

Low Vitamin D Linked to Heart Risk

Low blood levels of vitamin D are associated with an increased risk of cardiovascular problems such as heart attack and stroke, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and Sr. National Vice President Indian Medical association.

The five years of research with participants in the Framingham Heart Study included 1,739 people, average age 59, living in Massachusetts city found that those with the lowest levels of vitamin D had a 62 percent greater risk of a cardiovascular event than those with the next highest levels.

As per a report published in the issue of Circulation of sunlight on the skin each week allows the skin to produce blood levels of about 30 nanograms of vitamin D per liter of blood, more than enough to prevent a deficiency such as rickets.

Food sources of vitamin D include milk (which is fortified) and oily fishes such as salmon.

Recommendations from the U.S. Institute of Medicine call for a daily intake of vitamin D ranging from 200 International Units (IU) for young people, to 400 IU for the middle–aged, to 600 IU for older people.

But getting that amount from food and sunlight may not be easy. A glass of fortified milk contains only about 100 IU of vitamin D. The suggested recommendation is 1,000 – 2,000 IU. The cardiovascular risk associated with low vitamin D levels was especially greater for people who also had high blood pressure. Their incidence of cardiovascular events was double that of people with higher blood levels of vitamin D.

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 84073 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 10×10 i.e. 100 per minute."

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Suraj Bhan D.A.V. Public School students learned CPR–10

press release

Ventilator–associated tracheobronchitis

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

A 10–year old girl presents with swelling of one knee joint. All of the following conditions can be considered in the differential diagnosis, except:

1. Tuberculosis.
2. Juvenile rheumatoid arthritis.
3. Hemophilia.
4. Villonodular synovitis.

Yesterday’s Mind Teaser: In actinomycosis of the spine, the abscess usually erodes:

1. Intervertebral disc.
2. Into the pleural cavity.
3. Into the retroperitoneal space.
4. Towards the skin.

Answer for yesterday’s Mind Teaser: 3. Into the retroperitoneal space.

Correct answers received from: Dr Chandresh Jardosh, Dr P C Das, Dr Pankaj Agarwal,
Dr Bitaan Sen & Dr Jayashree Sen, Dr Avtar Krishan, Dr B K Agarwal, Dr Prakash Khalap.

Answer for 8th January Mind Teaser: 2. Full term pregnancy

Correct answers received from: Dr Pankaj Agarwal, Dr B K Agarwal.

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update

Unspeakable

A man walks into his doctor’s office and puts a note on the table for the doctor to read. It said, "I can’t talk! Help me!"

The doctor nodded sagely, and instructed the man to put his thumb on the table. The man thinks to himself that his thumb has nothing to do with his inability to talk, but he does as the doctor ordered.

The doctor quickly picked up a big book and whacks the man’s thumb with it as hard as he could.

"AAAAAAAAAAAAAA!!!" the man yelled.

"Good, good," the doctor said. "Come back tomorrow and we’ll work on the ‘B’."

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with suspected pneumonia and normal x–ray died 12 hours after admission.
Reaction: Oh my God! Why were antibiotics not started?
Lesson: Make sure that all patients with suspected pneumonia are given antibiotic at the first suspicion as x–ray can be normal in the first 24 hours.

medicolegal update

Don’t concentrate on what someone else can do that you cannot, concentrate on what you can do that others cannot.

medicolegal update

Dr KK Aggarwal: longer the life line http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Photons cannot be seen but make seeing possible http://bit.ly/15QdVeB #Health

medicolegal update
  1. Dear Sir, emedinews is very informative. Regards: Dr Keshav

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