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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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

11th May 2012, Friday

The benefits of napping

With age come changes in the structure and quality of our sleep. After about age 60, we have less deep (slow–wave) sleep and more rapid sleep cycles, we awaken more often, and we sleep an average of two hours less at night than we did as young adults. It was once thought that older people didn’t need as much sleep as younger ones, but experts now agree that’s not the case. Regardless of age, we typically need seven–and–a–half to eight hours of sleep to function at our best. So if you’re not getting enough sleep at night, what about daytime naps? Or does napping disrupt the sleep cycle, ultimately yielding less sleep and more daytime drowsiness?

These questions were addressed in a recent study by researchers at the Weill Cornell Medical College in White Plains, N.Y., and published in the Journal of the American Geriatrics Society (February 2011). The authors concluded that napping not only increases older individuals’ total sleep time—without producing daytime drowsiness—but also provides measurable cognitive benefits.

This small but well–designed study involved 22 healthy women and men ages 50 to 83 who agreed to be evaluated in a sleep laboratory. During a one– to two–week preliminary period, participants kept sleep logs at home and wore monitors to track their nighttime movements. They were then brought into the sleep laboratory for three nights and two days and given a thorough sleep evaluation (using polysomnography and other techniques) and a battery of cognitive tests. After this initial laboratory session, participants started a month–long daily napping routine at home: half took short (45–minute) naps, and half took longer (two–hour) naps. After the second and fourth weeks, all returned to the lab for repeat assessments.

By study’s end, total sleep time had increased by an average of 65 minutes in the participants assigned to two–hour naps, and by an average of 20 minutes in those assigned to 45–minute naps. Participants found it harder to adhere to the two–hour nap schedule, but neither long naps nor short naps disrupted nighttime sleep or led to daytime sleepiness. Napping increased the time spent in slow–wave and rapid–eye–movement (REM) sleep, which are thought to play important roles in restoring the body and brain. Whether they took long naps or short naps, participants showed significant improvement on three of the four tests in the study’s cognitive–assessment battery.

Only people in good physical and mental health were included in the study, so it’s unclear whether a 45–minute or two–hour napping regimen would be as helpful to older adults with sleep disorders or medical conditions. The study tells us nothing about the effects of shorter naps (for example, so–called power naps) on waking function. Moreover, the study was brief: napping–related cognitive function was measured after only two weeks and four weeks. Whether the improvements observed during the study would continue during subsequent weeks of napping is not known. Nevertheless, the findings provide further evidence that for older people, a daily nap can add to total sleep (as well as time in restorative sleep) and improve daytime function.

(Source: Harvard Healthbeat, reproduced for the benefits of doctors)

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Strenuous exercise may increaes risk of cardiac disorder

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

World Earth Day 2102

Students of Delhi Public School, Mathura Road celebrated World earth day in their school premises.The event was jointly organised with Heart Care Foundation of India and Ministry of Earth Sciences.

 
Dr K K Aggarwal
 
    National News

Sparrow decline indicates serious environmental change: Experts

New Delhi: House sparrows are an indicator of the environmental health of an area, and their disappearance could be linked to a rise in infectious diseases and ecological change, say experts. These common birds have been edged out of Delhi homes by changes in architecture and agriculture as well as urban predators like crows and cats, some top ecologists said at the India International Centre here Tuesday at a public lecture to discuss the mystery of the missing sparrows. Starting the discussion after a small clip on the sparrow’s declining habitat by filmmaker Nutan Manmohan was shown, bird expert Surya Prakash said the birds had not vanished, but had been pushed out of their regular haunts. Ecologist Koustubh Sharma said in Britain, the declining yard birds, which include house sparrows, was one of the 15 critical indicators of the quality of life in any area. Citing the absence of large–scale community–based data regarding house sparrows and other common birds in the country, Sharma claimed that a new citizen–scientist project website, www.citizensparrow.in, had been launched in April which focuses on the issue.
(Source: http://zeenews.india.com/news/eco–news/sparrow–decline–indicates–serious–environmental-ch_774258.html, May 09, 2012)

For comments and archives

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

New Equation May Help Predict Chronic Kidney Disease Risk

Compared with use of the standard Modification of Diet in Renal Disease (MDRD) Study equation for the classification of individuals with chronic kidney disease (CKD), use of the new Chronic Kidney Disease Epidemiology Collaboration equation (CKD–EPI) more accurately classified the risk for mortality and end–stage renal disease (ESRD) and may provide better clinical risk prediction across a broad range of populations, according to the findings of a new study published in the May 9 issue of JAMA. (Source: Medscape)

For comments and archives

Group B Neisseria meningitidis vaccine shows promise

An investigational vaccine may represent a strong lead in the fight against group B Neisseria meningitidis, according to results of a phase 2 study published online in the Lancet. Administered in 3 doses over the course of 6 months, a new bivalent vaccine was well tolerated and induced a strong immune response against multiple strains of the potentially deadly bacterium in approximately 90% of participants in the vaccine group. (Source: Medscape)

For comments and archives

Four bad actors cause most infection–related cancer

Three types of viruses and 1 bacterium cause the vast majority of the new cases of cancer worldwide that are attributable to infections, according to a new study of global data. The study found that in 2008 there were 12.7 million new cases of cancer worldwide, including 2 million that were related to infections. Helicobacter pylori, hepatitis B and C viruses (HBV and HCV), and human papillomaviruses (HPV) were responsible for 1.9 million of those infection–related cases. Most of these new cases were gastric, liver, and cervix uteri cancers, according to study authors, who are from the International Agency for Research on Cancer in Lyon, France. Their study is published online in the May 8 issue of Lancet Oncology. (Source: Medscape)

For comments and archives

FDA Panel votes against rilonacept for gout flare prevention

The United States Food and Drug Administration (FDA) Arthritis Advisory Committee voted against the use of rilonacept (Arcalyst) to prevent gout flares.

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   Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Natural fast food is good for healt…: http://youtu.be/0FdTNQSXkC8 via @youtube

@DeepakChopra: Peace in the world will only come with our inner peace

 
    Spiritual Update

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

Science Behind Gift

I normally tell my patients to observe every Wednesday as a ‘Gift Day’. On this day, one should give and receive gifts.

The gifts invariably should be non–materialistic and may consist of giving a compliment, smile, hug, respect or appreciation. The return gift will always be stronger than the gift. For example, if you tell someone that he/she is looking good, he will invariably say in return that you are also looking good.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How is hysteroscopy performed?

  • Diagnostic hysteroscopy. Hysteroscopy is sometimes used to diagnose a condition involving the uterine cavity. If your doctor performs this procedure in the office, he or she may give you ibuprofen and medication to numb your cervix. The doctor will then insert the hysteroscope through your vagina into the cervix. Because the hysteroscope is attached to a camera, both you and your doctor can watch the procedure on a television screen. After the procedure is performed, you can usually return to your normal activity.
  • Operative hysteroscopy. Hysteroscopy can also be performed to remove tissue or growths that interfere with fertility. The hysteroscope that is usually used for operating is larger than the one used for diagnosing problems in the uterus, so you will need general, epidural or spinal anesthesia. After operative hysteroscopy, there is very little discomfort since there were no incisions made. If the cervix was stretched (dilated), your doctor may advise you to avoid swimming, taking a bath, or placing anything in the vagina for up to two weeks (this includes avoiding sexual intercourse). This will allow the dilated cervix to return to its normal size and will reduce the risk of infection.

For comments and archives

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

(Dr. Sujay Shad, Senior Consultant Cardiac Surgeon and Director of Heart–Lung Transplantation, Sir Ganga Ram Hospital, Delhi)

Heart: Failure, Therapies & Transplantation

When humanity must take over from medicine (Part 4)

As I wrote in my previous post, surgery is not the art of miracles. It is an art of hard, grueling scientific work. Breaking backs when they can take no further loads, giving blood transfusions when blood bank is going dry, treating hypotension when the whole vascular tree is paralyzed, feeding patients when they do not want food, turning them about when a bed sore has to be prevented and so on and so forth.

A miracle did not happen for Mr. Dass.

Option 3: We held a meeting of all the treating doctors and looked at all the patients and lab parameters in detail, every one of those data sifted through a fine tooth comb. Six senior doctors all interested in the patient’s wellbeing. The only question asked was: is there anything we can do to make him Better, Healthier, Comfortable?

Once everyone responded and said not much, we had to evaluate palliative options. Non–invasive ventilation is but one. That was started promptly.

The family was informed that the group felt that as doctors we could go no further than providing him succor. We violated the hospital protocols and allowed free access to his relatives in the ICU where he was "being cared for" not treated. This continued till his last breath. The patient asked me directly eye to eye: can you do nothing for me doctor?

"I can only make you comfortable in the present situation and we will do everything to see that you are comfortable". He squeezed my hand ever so gently in appreciation.

He passed away peacefully in his bed shortly that evening. No alarms. no CPR. no cardiac compressions. no useless medications. no shouting and no disturbance. That I believe is what we were trained for.

For comments and archives

 
   An Inspirational Story

(Dr Anupam Sethi Malhotra)

Once upon a time there was a girl who had four boyfriends.

She loved the fourth boyfriend the most and adorned him with rich robes and treated him to the finest of delicacies. She gave him nothing but the best.

She also loved the third boyfriend very much and was always showing him off to neighboring kingdoms. However, she feared that one day he would leave her for another.

She also loved her second boyfriend. He was her confidant and was always kind, considerate and patient with her. Whenever this girl faced a problem, she could confide in him, and he would help her get through the difficult times. The girl's first boyfriend was a very loyal partner and had made great contributions in maintaining her wealth and kingdom. However, she did not love the first boyfriend, although he loved her deeply, she hardly took notice of him! One day, the girl fell ill and she knew her time was short. She thought of her luxurious life and wondered, ‘I now have four boyfriends with me, but when I die, will I be alone.’

Thus, she asked the fourth boyfriend, ‘I loved you the most, endowed you with the finest clothing and showered great care over you. Now that I’m dying, will you follow me and keep me company?

‘No way!’ replied the fourth boyfriend, and he walked away without another word.

His answer cut like a sharp knife right into her heart. The sad girl then asked the third boyfriend, ‘I loved you all my life. Now that I’m dying, will you follow me and keep me company?’

‘No!’ replied the third boyfriend. ‘Life is too good! When you die, I’m going to marry someone else!’ Her heart sank and turned cold.

She then asked the second boyfriend, ‘I have always turned to you for help and you've always been there for me. When I die, will you follow me and keep me company?’ ‘I’m sorry, I can’t help you out this time!’ replied the second boyfriend. ‘At the very most, I can only walk with you to your grave.’ His answer struck her Like a bolt of lightning, and the girl was devastated.

Then a voice called out: ‘I’ll go with you. I’ll follow you no matter where you go.’ The girl looked up, and there was her first boyfriend. He was very skinny as he suffered from malnutrition and neglect. Greatly grieved, the girl said, ‘I should have taken much better care of you when I had the chance!’

In truth, you have four boyfriends in your lives:

Your fourth boyfriend is your body. No matter how much time and effort you lavish in making it look good, it will leave you when you die.

Your third boyfriend is your possessions, status and wealth. When you die, it will all go to others.

Your second boyfriend is your family and friends. No matter how much they have been there for you, the furthest they can stay by you is up to the grave.

And your first boyfriend is your spirit. Often neglected in pursuit of wealth, power and pleasures of the world.

However, your spirit is the only thing that will follow you where ever you go. Cultivate, strengthen and cherish it now, for it is the only part of you that will follow you to the throne of God and continue with you throughout Eternity.

Thought for the day: Remember, when the world pushes you to your knees, you’re in the perfect position to pray. Being happy doesn’t mean everything’s perfect. It means you’ve decided to see beyond the imperfections.

For comments and archives

 
   Cardiology eMedinewS

Cardiovascular Risk Assessment In Women Read More

The Use Of Cardiac MRI To Guide Endovascular Interventions Read More

Genetic Insights of Cardiomyopathy in Indian Population Read More

Functional Genomics Of Blood Cellular LXR–a Gene in Human Coronary Heart Disease Read More

 
   Pediatric eMedinewS

Surgery Alone Effective For Low–Risk Neuroblastoma Read More

Bottle Delivery, Not Milk Type, Linked To Infant Weight Gain Read More

Maternal Perception of Toddler Size Is Often Inaccurate Read More

 
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    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low–dose aspirin.
Lesson: In dengue, lose–dose aspirin needs to be stopped.

For comments and archives

Make Sure

Situation: A patient died after receiving 30 ml IV KCL bolus.
Reaction: Oh my God! Why was KCL given as bolus?
Lesson: Make sure that IV KCL is not given at a rate of more than 10 mEq per hour.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. The CT and MRI facility of a hospital are registered under the PNDT Act. The radiologist visits the hospital for 4 hours a day. CT and MRI are being done round the clock and are being reported on the inter net by other radiologists. Is there any illegality?

Ans. Yes. There is illegality.

  • CT and MRI are being done in the hospital in the absence of a radiologist by technicians alone. It is presumed that the hospital is not disclosing to the patient that the CT and MRI would be done by technicians alone in the absence of the radiologist. It is also possible that no informed consent is taken before doing these tests. A patient can successfully file a consumer complaint alleging that:
    • He availed of the hospital’s CT and MRI service under the belief that the radiologist whose name is displayed on the hospital announcements etc. will perform the test but only technicians did so. This is violative of the provisions of the CPA, 1986.
    • No informed consent was taken. Nobody informed him of the dangers of excessive radiation inherent in such procedures.
  • Complaint to the state/central Clinical establishment Authority/nursing Home Registration Authority/Health Directorate made on the same lines is likely to be successful against the hospital.
  • Complaint to the PNDT authority is likely to invite a notice as well.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

The biggest human temptation is to settle for too little. Thomas Merton

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Bilirubin

Increased total: Hepatic damage (hepatitis, toxins, cirrhosis), biliary obstruction, hemolysis, fasting.

Increased direct (conjugated):
Biliary obstruction/cholestasis, drug induced cholestasis

 
    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Management of exposure to Hepatitis C virus

Hepatitis C is also transmitted by parenteral route and is a common agent of co–infection with HIV. Like the other blood–borne infections, the mainstay of preventing occupational infection is through prevention of exposure. Risk of transmission after needle stick injury is 2–3%. There is no vaccination at this time, and no recommended chemoprophylaxis. For HCW exposed to hepatitis C virus, follow up care by the designated Hepatology expert is recommended.

For comments and archives

 
    Mind Teaser

Read this…………………

Kenneth who has been diagnosed with uremic syndrome has the potential to develop complications. Which among the following complications should the nurse anticipate?

a. Flapping hand tremors
b. An elevated hematocrit level
c. Hypotension
d. Hypokalemia

Yesterday’s Mind Teaser: Nurse Maureen is aware that a client who has been diagnosed with chronic renal failure recognizes an adequate amount of high–biologic–value protein when the food the client selected from the menu was:

a. Raw carrots
b. Apple juice
c. Whole wheat bread
d. Cottage cheese

Answer for yesterday’s Mind Teaser: d. Cottage cheese

Correct answers received from: Dr Avtar Krishan, Dr PC Das, Dr kanta Jain, Dr Thakor Hitendrsinh G, Dr BB Aggarwal, Raju Kuppusamy, Dr Chandresh Jardosh, Dr Lc Dhoka, Dr Jainendra Upadhyay, Dr U Gaur.

Answer for 9th May Mind Teaser: b. Positive ELISA and western blot tests
Correct answers received from: Dr B Rajammal, Dr Lc Dhoka.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Class room is like a train

First two benches are reserved For VIP…

Next two benches are the General coach

Then Last two benches are much in demand

Because it’s the "SLEEPER COACH"

 
    Medicolegal Update

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

Admission and discharge of a person admitted as a medicolegal case

Issuance of the discharge certificate is the mandatory duty of the treating doctor; failure to do so renders the doctor liable for "negligence" and "deficiency of service

A medicolegal case should be registered as soon as a doctor suspects foul play and the same is applicable on later stage of admission or even if it is brought after several days of the incident.

In some cases, I have found that the patient was admitted in hospital as non MLC but later on after admission of the patient the case required to be converted as MLC and the police was informed. This duty should also be extended in cases of discharged patient. The nearest police station must be informed at the earliest whenever there is an admission, death or discharge of a medicolegal case and a medicolegal register should be maintained with necessary entries of patient details. While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge.

In N. K. Kohli v Bajaj Nursing Home, the Madhya Pradesh State Consumer Disputes Redressal Commission said that "issuance of the discharge certificate is the mandatory duty of the treating doctor and the Nursing Home/Hospital and the non–issuance of the same amounts to grave negligence and deficiency in service on the part of the doctor and the hospital." If the patient is not serious and can take care of himself, he may be discharged on his own request; after taking in writing from him that he has been explained the possible outcome of such a discharge and that he is going on his own against medical advice. Police have to be informed before the said patient leaves the hospital. Sometimes the patient, registered as a medico–legal case, may abscond from the hospital. The police should be informed immediately, the moment such an instance comes to the notice of the doctor/hospital staff.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Dementia: Nurses the mainstay of care

Dementia is not a normal part of ageing – 12th May is Nurse’ Day

A cause of serious disability among those who live with the condition, dementia has a wide–ranging impact on families and close friends, who can experience stress, frustration and exhaustion in caring for a loved one, as well as feelings of loss for the person they love.

Dementia is not a normal part of ageing. Nurses have a central role to play in raising public awareness and recognition of dementia, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Nurses can promote the importance of assessment and early diagnosis; the need for inclusive community support services and accommodation options; the value of education and training for formal and informal caregivers. They can encourage and support caregiver self–help groups and multidisciplinary collaboration in dementia–oriented practice and research. They can also advocate for the protection of patients’ rights and interests.

The prevalence of dementia among those aged 65 to 69 years is 2.17% for males and1.10% for females; in those 75 to 79 years, 5.04% for males and 6.67% for females; in 85 to 89 year olds, 18.45% for males and 22.76% for females; and among 90 to 94 year olds, 32.1% for males and 32.25% for females. Women tend to live longer than men.

Alzheimer’s disease is perhaps the best–known type of dementia. Here, brain cells shrink or disappear over time, in the process affecting an individual’s behavior and ability to perform day to day functions.

Dementia can also be the result of vascular insults, such as stroke; HIV–related illness; excessive alcohol use; or metabolic imbalances.

Most dementias, like that due to Alzheimer’s are progressive and irreversible; however, some types of dementia, such as that due to metabolic imbalance or vitamin deficiency, may be reversible if caught and treated early.

The most common early symptoms of dementia are: memory loss, difficulty performing familiar tasks, problems with language, disorientation to time and place, poor or decreased judgment, problems, keeping track of things, misplacing things, changes in mood or behavior, changes in personality, and loss of initiative. These symptoms can sometimes be linked to conditions other than dementia, such as adverse drug reactions, thyroid gland dysfunction, infections, alcohol abuse and, in older people, depression.

There is no simple test to diagnose dementia. Diagnosis is usually made after taking a careful history from a close family member or friend, and examination of the person’s physical and mental status. Brain imaging technologies (CT, MRI and PET) can help give more weight to a diagnosis of Alzheimer’s disease.

Role of nurses in caring for these patients is the most important as there is no cure for Alzheimer’s disease or most other types of dementia. Thus, treatment focuses on improving quality of life. This includes minimizing symptoms and addressing their cause where possible. Drug treatments may be effective in controlling depression and agitation. In the early stages of dementia, it may also be possible to improve an individual’s memory using medication.

 
    Readers Response
  1. Medical errors should always assessed with available infrastructure to consultants. We have managed our almost full career with unqualified nursing staffs and ayurvedic doctors as junior doctors. We cannot do anything because that is the best available to us. With this infrastructure, how can you asses your errors and mistakes. We have been doing all routine surgical work like hydrocele, hernia, appendicectomy and cholecystectomy with this infrastructure for last 33 years. Vivek Kumar, Varanasi.
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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