eMedinewS10th May 2014,Saturday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, 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 :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Healthy obesity does not exist

New research published online in the Annals of Internal Medicine suggests that individuals cannot be simultaneously overweight and physically fit.

As BMI rose, so did blood pressure, waist circumference and insulin resistance. As BMI increased, levels of HDL cholesterol, thought to protect against heart attack and stroke, decreased.

While participants who were either overweight or obese "may not yet have reached the points that define metabolic illness, they appeared to be on that road as their weight" increased.

An Emotional night

Dr K K Aggarwal

When my colleague Mr Yogesh Pant told me that Kamu is no more, I was disturbed. In my 30 years of medical practice, I have seen people die but I have never been disturbed so much.

Death is inevitable but this death disturbed me a lot. He was a young, aged 22 years and suffered from Rheumatic Heart Disease. He needed replacement of two valves – mitral and aortic. His family could not afford the surgery, so he approached us at the Sameer Malik Heart Care Foundation Fund for financial assistance. His estimate from the hospital came for Rs 1.4 lakhs.

The same was sanctioned and then we started coordinating for him to get an early date for the operation. The earliest date was June, a couple of months later.

Before I could arrange for his surgery at some other place in a private hospital, he died of sudden cardiac death at home.

Over 24 lakh people die because of sudden cardiac death in the country. He was one of them. But this death was preventable. The money was available, the will to treat was there, a hospital was there to do the surgery but the only thing, which was not available to us was ‘time’; we ran out of time.

I recall in 1981–82, when I was posted in AIIMS for a short time in the Department of Immunology and Rheumatology, a patient became the talk of the hospital. He was brought to the emergency department for admission with TB Brain. He came exactly on the date, which was given to him for admission six months back. Of course he died with a few days. This was a clear case of total system failure for a patient with TB brain.

I have been watching the systems in government hospitals across the country where the dates are given by the administrative department. It is better to refuse a patient than to give a date, which is unrealistic. It is the duty of the doctors who are treating to decide which patient should get an earlier date and which patient can wait. If one starts giving an unrealistic date, by the time the date comes, many of them either would have got operated in private sector or would have died.

Recently, I was sitting with a neurosurgeon, who had referred a patient with brain hemorrhage due to an aneurysm to a government hospital as the patient could not afford private treatment. The patient required an immediate coiling of the aneurysm. But the date given was in November. Most people would die before that if not operated.

I recently spoke to a producer of a newly started news channel and I asked him why do they make such a big fuss of dengue deaths in the city when every day they see preventable cardiac deaths. In dengue, out of 1000 people hospitalized, 4 will die irrespective of the facilities available. So for me dengue death is not a story but a young person dying of a heart disease just because he or she cannot afford is a matter of great concern.

We, at Heart Care Foundation of India, have recently launched the Sameer Malik Heart Care Foundation Fund wherein we will be assisting upto 500 surgeries in a year. But, will that be able to take care of the burden of cardiovascular diseases in the country?

When I argued this, one of the professors at a government hospital said that the workload is more. This is one typical politically correct answer but beyond my understanding.

As per Article 21 of the Constitution of India, it is the responsibility of the Central and the State Governments to see to it that no one dies just because he or she cannot afford.

What is the idea of spending so much money on state or national elections when voters in your own country are dying every day for want of treatment?

In a country where money is a concern why not adapt an electronic mode of election where people can vote from wherever they are. I am sure in a country where the world’s best IT brains are available, one can come out with an inexpensive and reproducible election mechanism.

News Around The Globe

  • An extended–release formulation of oxycodone and naloxone in a fixed ratio of 2:1 may be effective as an abuse–deterrent formulation (ADF) option for the treatment of opioid–experienced patients with chronic low back pain, reported a recent study presented at the American Pain Society (APS) 33rd Annual Scientific Meeting.
  • The European Commission recently cleared the combination of umeclidinium and vilanterol as once–daily maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults. The licensed strength of umeclidinium is 55 µg and for vilanterol it is 22 μg, to be delivered in the inhaler.
  • A new research presented at the American Psychiatric Association’s 2014 Annual Meeting has shown that cannabis use among college students with psychiatric disorders is quite high and has a negative impact on function in these subjects. Researchers noted that almost 25% of college students under treatment for a mental illness abused cannabis that was associated with marked functional impairment.
  • A study published online May 8 in Stroke has revealed that eating more fruits and vegetables could help reduce the risk for stroke globally. Studies across Europe, US and Asia have revealed that for every 200 g/day increase in intake of fruits and vegetables, the risk for stroke fell by 32% and 11%, respectively.
  • Canadian researchers have issued a precaution against using dabigatran as an anticoagulation therapy option for pregnant women since the drug has been noted to cross the placenta to the fetus and could adversely affect fetal blood coagulation. The research has been published online May 6 in Obstetrics & Gynecology.

Rabies News (Dr A K Gupta)

Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titre level but this is rarely practicable due to scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:

  • 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history
  • 40% of dogs vaccinated only one time lost most of their immunity 4–6 months later.
  • Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.

Cardiology eMedinewS

  • The US Food and Drug Administration (FDA) has recently approved vorapaxar, a protease–activated receptor 1 (PAR–1) inhibitor, to reduce the risk of MI, stroke, cardiovascular death, and need for revascularization in patients with a previous MI or peripheral artery disease.
  • The US FDA has approved omega–3 carboxylic acids for use as an adjunct to diet to lower triglyceride levels in adults with severe hypertriglyceridemia (triglyceride levels >500 mg/dL). The approval has come up following the success of the phase 3 Epanova for Lowering Very High Triglycerides (EVOLVE) trial.

Pediatrics eMedinewS

  • Immunoprophylaxis with palivizumab has the potential to reduce respiratory syncytial virus (RSV)–related hospitalizations among children with Down syndrome, reported a registry study. The findings were published online May 5 in Pediatrics.
  • A randomized controlled trial conducted in 32 neonatal ICUs in the United States has reported that treating extremely premature infants with fluconazole does not markedly reduce their risk of invasive candidiasis or death. Thus, routine fluconazole prophylaxis should be restricted to units with moderate–to–high incidence of invasive candidiasis.

Dr K K Spiritual Blog

The psyche behind the cricket players playing in IPL

In the last few years, we have seen every cricket player with ups and downs. We saw Sachin Tendulkar in his last days not in the best of form.

Recently, we have seen Virat Kohli who successfully performed in 25 consecutive innings failing match after match after that.

The same has been seen with the opening pair Shikhar Dhawan and Rohit Sharma who came like a bang and then stopped performing after that.

One of the ways to understand this is to understand the chemistry of serotonin and melatonin. Serotonin is a positive hormone and melatonin is a negative hormone. In depression serotonin becomes low and melatonin becomes high.

When you fail to perform a couple of time, you go into a reactive phase of depression with low levels of serotonin. Once you are in a reactive depression, you will not be able to perform because of performance anxiety.

Performance anxiety can classically be understood from an example of premature ejaculation where you lose control just before the climax.

MS Dhoni is a successful captain and cricketer because he remains cool and is not so explosive in his nature.

One can clearly see both Virat Kohli and Gautam Gambhir showing expressions of anxiety when things do not go their way. Any anxiety can end up with judgment failure.

Cricket is like driving a car and any judgment failure can lead to accident and the same accident in cricket means that as a batsman you are out and as a bowler you are hit for a six.

Wellness Blog

High HgbA1c linked to hypoglycemia in diabetics with kidney failure

A retrospective study of patients with diabetes enrolled in a large hemodialysis program found an association between high baseline HbA1c and an increased risk for hypoglycemia hospitalization in. Higher baseline HbA1c was also associated with greater variability in HbA1c levels.

The investigators suspect that the greater risk of severe hypoglycemia associated with high HbA1c may derive from glucose variability during treatment for hyperglycemia. The study is published in Hemodialysis International.

Inspirational Story

Where there is a will there is a way

A 72–year–old male came to Sameer Malik Heart Care Foundation Fund to get financial assistance for his heart condition. He was suffering from heart failure, which required biventricular pacing device to help him relieve his symptoms and live a better quality of life.

The private sector gave him an estimate of Rs. 7.50 lakhs. At AIIMS, the estimate was lowered to Rs. 2.25 lakhs for a reasonable device.

He approached Prime Minister’s Fund and was sanctioned an amount of Rs. 50000/– but the due six months passed as he could not raise further funds. Because of the large sum of money required, most of the family members refused to help him.

When he approached us, he had also sold his only buffalo for Rs 30000/–.

When we first met him, he was an enthusiastic elderly person and said, "Mein jeena chahta hoon" (I want to live) and these words impressed me immensely.

From Sameer Malik Heart Care Foundation Fund, we sanctioned an amount of Rs. 1 lakh towards his surgery and then talked to his family members and convinced them that when we are helping him all of them should also help.

His brother–in–law called us next day and said that he has arranged the balance amount of Rs 90000/–. Ultimately, a total amount of Rs 2.25 lakh was collected and deposited with AIIMS and his rightful surgery was done.

The message is very clear – "where there is a will there is a way."

He showed us his will to live by selling his only buffalo and that paved the way for his successful surgery.

ePress Release

Avoid chocolate for heartburn

"People with heartburn should avoid chocolate as it can worsen heartburn," said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

One should also avoid other reflux-inducing foods (fatty foods, peppermint and excessive alcohol, which may reduce lower esophageal sphincter pressure).

A number of beverages have a very acidic pH and can exacerbate symptoms. These include colas, red wine and orange juice (pH 2.5 to 3.9).

Promotion of salivation by either chewing gum or use of oral lozenges may also be helpful in mild heartburn. Salivation neutralizes refluxed acid, thereby increasing the rate of esophageal acid clearance.

Restriction of alcohol use and elimination of smoking; smoking is deleterious in part because it diminishes salivation.

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 88972 people since 1stNovember 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."

eMedi Quiz

The primary role of chaperones is to help in:

1.Protein synthesis.
2.Protein degradation.
3.Protein denaturation.
4. Protein folding.

Yesterday’s Mind Teaser: The conversion of an optically pure isomer (enantiomer) into a mixture of equal amounts of both dextro and levo forms is called as:

1.Polymerization.
2.Stereoisomerization.
3.Racemization.
4.Fractionation.

Answer for yesterday’s Mind Teaser: 3.Racemization.

Correct answers received from: Kavita Menghani, Dr K.V.Sarma, Nirmala Agarwal, Dr K.Raju, Dr Poonam Chablani, Sachin, Dr Chandresh Jardosh, Daivadheenam Jella, Abhay Naik, Dr Avtar Krishan, Dr Arpan Gandhi, Dr Uma Gaur

Answer for 8th May Mind Teaser: A. Hypertension and aging.

Correct answers received from: Dr Avtar Krishan, Dr Arpan Gandhi, Dr Uma Gaur, Dr Prakash Khalap

Send your answer to ijcp12@gmail.com

Zee News – Health Wealth Shows

Alcohol
Cancer Prevention
Depression
Paralysis
Pneumonia
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Vitiligo
Fluid Intake

 

Total CPR since 1st November 2012 – 88972 trained

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."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

World Earth Day Celebration at DAV Public School, RK Puram, New Delhi.

press release

Obesity reduces life expectancy

video of day video of day

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.

eMedinewS Humor

‘X’ Marks the Spot

Paul and Jim decided to rent a boat on a lake for their favorite sport. After fishing for 4 hours at various places around the lake with no luck at all they decided to try one more spot before calling it quits.

Suddenly things started to happen, and they caught their limit inside of 20 minutes.

Paul said, "Hey, we should mark this spot, so next time we will know where to come."

Jim says, "Good idea," and he took out a can of spray paint and made a large X on the floor of the boat to mark the spot.

With that Paul says, "Why did you do that? Now anyone who rents this boat will know where to fish!"

Quote of the Day

Apology is a lovely perfume; it can transform the clumsiest moment into a gracious gift. Margaret Lee Runbeck

 

Twitter of the Day

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Those who make wise choices in life should wind up happier & more successful http://bit.ly/DC_Ananda #ananda

 

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  1. Dear Sir, Thanks for the updated news. Regards: Dr Kishore
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