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Dr KK Aggarwal

From the Desk of Editor in Chief
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

  Editorial ...

11th October 2010, Monday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Hanuman: The Spiritual Journey to Lanka

Hanuman is the typical example of one who has control over the breath. He had obtained all the siddhi powers after mastering the mind using the breath control. Therefore, he was called as the ‘son of the wind’. Monkey represents a wandering animal and symbolizes thoughts of the mind, which are wavering or ‘chanchal’.

When the monkey army under the control of Sugriva (intellect) was in trouble, and did not know how to look for Sita, Jambvan reminded Hanuman about his hidden spiritual powers and then Hanuman traveled across the ocean and reached Lanka.

The whole process represents the method and the steps of breathing pranayama. The Ocean represents the ‘wavering mind’. The reminder to Hanuman represents the intention to meditate. Using Hanuman (breathing) makes it easier to cross the Ocean and attain a controlled state of mind. While doing breathing ‘pranayama’ in the initial process, one is bound to face obstruction or obstacles to the breathing sadhana. The same is represented by hanuman encounters with Mainaka Mountain; Sarasa or ‘sursa’ the mother of snakes, and Singhika or Simhika the demon.

The spiritual obstacles are the tendencies to rest (tamas), the ego and the desires. The Mainaka Mountain represents the tamas, ‘Sursa’ the ego and ‘Simhika’ the desires. Initially, Hanuman is obstructed by the Mainaka Mountain and asked to rest. But Hanuman willfully avoids it and continues the journey, signifying that tamas has to be willfully controlled by the mind.

Next, the mother of the snakes ‘sursa’ obstructed him. Snake in Vedantic language represents the uncontrolled mind or the ego. Ego becomes bigger and bigger if you try to defend it and can only be controlled by humility. This is what Hanuman did. Till he was trying to fight ‘sursa’ by expanding his size, she was reciprocating by increasing her size. But when Hanuman became small (humility) and came out of her mouth, she lost the battle.

The last obstacle was ‘Simhika’ the demon. She had the power of catching flying creatures’ by holding their shadows in the water. Desires have to be killed and this is what Hanuman did to her.

While meditating one may tend to sleep (tamas), and get disturbed with the ego or desires (rajas). The same should be tackled before one attains control of the mind. Meditation involves concentrating on the breath and giving preference to the breath over the disturbing thoughts.

Dr KK Aggarwal
Editor in Chief
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  Dengue Update

What is a safe platelet count? What is a safe platelet count?

The concept of a "safe" platelet count can only be considered if all other aspects of hemostasis are normal. Patients with platelet counts >50,000/microL will most likely never be recognized unless a platelet count is performed, as this platelet count level appears adequate for hemostasis in virtually all circumstances.

  • Patients with platelet counts in the range of 30,000 to 50,000/microL rarely have purpura, even with significant trauma.
  • Patients with persistent platelet counts of 10,000 to 30,000/microL may be asymptomatic, even with the usual trauma of everyday activities. However, these patients may be at risk for excessive bleeding with more extensive trauma.
  • Spontaneous bleeding symptoms typically do not occur unless platelet counts are <10,000/microL. Such patients commonly have some spontaneous bruises and some petechiae, but even they may be entirely asymptomatic.
  • The platelet count must be <5000/microL (i.e. <2% of normal) to cause critical spontaneous bleeding.

Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal and Dr. N K Bhatia Medical Director Rotary Noida Blood Bank & President Mission Jain Jagriti Delhi, an NGO for empowerment of youth.

  Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2010

Heart Care Foundation of India observed World Earth Day 2010, in association with Delhi Public School, Mathura Road on April 22, 2010. The theme was -The Green Generation.

In the photo: Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, president Heart Care Foundation of India alongwith the students of DPS.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Lumbar spinal stenosis surgery

A review of data related to lumbar spine surgery found an association between an increased frequency of complex fusion procedures and the incidence of major complications and 30–day mortality.

(Reference: Deyo RA, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010 Apr 7;303(13):1259–65)

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Delhi to host World Congress of Paediatric Surgery

India will be hosting the third World congress of Paediatric Surgery in Delhi from October 21 to 24 to share new scientific ideas with the paediatric surgical fraternity from across the world. The congress is held once every three years under the aegis of the World Federation of Associations of Paediatric Surgeons (WOFAPS). It will be held jointly with the fourth Congress of the Federation of Associations of Paediatric Surgeons from SAARC countries and the 36th Conference of the Indian Association of Paediatric Surgeons. A pre-congress full-day course on minimally invasive surgery will be held in Delhi on October 21. Over 2,000 eminent paediatric and neo-natal surgeons, urologists, laparoscopic surgeons, radiologists, endocrinologist and gynaecologists from 108 associations around the world will attend the congress. According to Professor and Head at the Department of Paediatric Surgery at AIIMS Dr. D. K. Gupta, The congress will have lectures, free papers and poster presentations. Symposia and meet the expert sessions will also be held on focused theme subjects. A nurse's forum will deliberate on paediatric intensive care and patient care safety. (Source: The Hindu)

  International News

(Dr Monica and Brahm Vasudev)

‘Lazy Eye’ screening program found cost–effective

Photoscreening can be a cost–effective way to detect amblyopia in preschool children (Susannah Q. Longmuir, MD, of the University of Iowa Hospitals and Clinics in Iowa City, Iowa).

One or two drinks a week during pregnancy may not harm child’s cognitive development

Having one or two drinks a week during pregnancy does not harm the baby, according to a study published Oct. 5 in the Journal of Epidemiological and Community Health.

For some people, middle–age may be danger zone for suicides

New research funded by the National Institutes of Health (NIH) and published in Public Health Reports reveals that for some people, middle–age may be the danger zone for suicides.

Workplace noise tied to heart disease risk

Persistent, loud noise in the workplace more than doubles the risk for heart disease, as per Canadian researchers. Among those at highest risk are younger men who smoke, which by itself is a risk factor for heart disease, said Dr. Wen Qi Gan, from the School of Environmental Health at the University of British Columbia in Vancouver. In the study, noise was defined as industrial noise, such as noise in mining, lumbering and wood product manufacturing. The report is published in the Oct. 6 online edition of Occupational and Environmental Medicine.

  Hepatology Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta Medicity

Medical management of neonatal cholestasis

First line drugs
  • Ursodeoxycholic acid 10–20 mg/kg/day
  • Rifampicin 10mg/kg/day,
  • Cholestyramine 4–8gm/kg/day
  • Phenobarbitone 5mg/kg/day
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

We have been trying for a baby for three years and I was diagnosed as having endometriosis. Will test–tube baby treatment solve my problem?

A. IVF is the treatment of choice in women with severe or moderate endometriosis. However, depending on the severity of the endometriosis, surgery, intrauterine insemination can also be used.

We were told that we need IVF treatment, what is our chance of achieving a live birth?

A. The overall live birth rate per treatment cycle is in the region of 20–30%.

  Diabetes Update: Question of the Day

What is the importance of preconception counseling in diabetes mellitus? What areas should it cover? (Dr Abdul Hamid Zargar)

The management of diabetes before, during and after pregnancy can serve as a model of preventive healthcare. Diabetes mellitus is one of the most common medical complications of pregnancy. Two percent to 5% of pregnancies are complicated by diabetes, of which 90% are classified as GDM.

Preconception care in women with diabetes reduces the risk of spontaneous abortions and congenital malformations as a result of improved glycemic control before and during organogenesis. Prepregnancy planning encompasses optimizing glycemic control and also affording the opportunity for genetic counseling, contraceptive selection, management of diabetes complications, and evaluation of psychosocial aspects of pregnancy, childbearing and diabetes care. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Substantial level II evidence indicates that tight glycemic control before conception and early in pregnancy reduces the rate of congenital malformations.

  • Primary care physicians often have frequent and early contact with women of reproductive age; they are ideal candidates for providing type 1 diabetic women with preconception evaluation and counseling.
  • Medications for hypertension, epilepsy, thromboembolism, depression and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant.
  • Counseling about exercise, obesity, nutritional deficiencies and the use of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.
  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Grievous Hurt as per IPC (Part II)

As per Section 320 Indian Penal Code (IPC), the following kinds of hurt are designated as "grievous";
  • Permanent disfiguration of the head or face: The word ‘disfigure’ means to cause some external injuries which detracts from his personal appearance but does not weaken him
  • Fracture or dislocation of a bone or tooth: It is not necessary that a bone should be cut through and through cut should be up to the medulla. If there is a break by cutting or splintering of the bone or there is a rupture or fissure in it, it would amount to a fracture but the doctor must document the dimension of fracture and duration/age correlation with age of injury. Dislocation means displacement. Mere looseness of teeth will not amount to dislocation. It has to prove that the tooth was originally not loose and that there was fracture or dislocation by the injury.
  • Any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days: A wound may cause intense pain, prolonged disease or long lasting body injury but does not fall under any of the seven clauses. A body injury/beating may not mutilate the sufferer or fracture his bones but may be so harsh and painful may cause even death. The eighth clause provides for such hurts. Under this, three different clauses of hurt are included. These are:
  • Any hurt which endangers life
  • Any hurt which causes the victim to be in severe bodily pain for a period of 20 days
  • Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days
  Medi Finance Update

Money Market Funds

The rate of return of money market funds tends to be lower than that of funds that are managed for long–term gains, but they are a very low–risk investment.

  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combinations of Hydroxyquinoline group of drugs with any other drug except for preparations meant for external use.

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Cervical cancer is the only cancer suggested by WHO for routine screening.

  IJCP Special

Dr Good Dr Bad

Situation: A patient had LDLC of 100 mg/dL and HDLC 61 mg/dL.
Dr Bad: Start statins.
Dr Good: No treatment is required yet.
Lesson: HDL–C ≥60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count.

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh My God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

Quote of the Day (Dr Chandresh Jardosh)

"Teaching is the greatest act of optimism." Colleen Wilcox

Ethics and Misconduct

Can one wean off the lifesaving devices?

Yes. As per section 6.7 MCI act "Practicing euthanasia shall constitute unethical conduct. However on specific occasion, the question of withdrawing supporting devices to sustain cardiopulmonary function even after brain death, shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor in charge of the patient, Chief Medical Officer / Medical Officer in charge of the hospital and a doctor nominated by the in–charge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994."

  Mind Teaser

Read this…………………


Answer for yesterday’s eQuiz: "Correct answers are C & E.

CURB–65 is a validated clinical prediction rule used to assess severity of pneumonia and need for inpatient care. It is an acronym for each of the risk factors measured. Each risk factor scores one point, to a maximum score of 5:

  • (C)onfusion of new onset
  • (B)lood Urea Nitrogen > 19mg/dl or 7mmol/l
  • (R)espiratory rate of 30 breaths per minute or greater
  • (S)ystolic blood pressure < 90 mmHg or diastolic blood pressure 60 mmHg or less
  • Age (65) years or more

Those with a score of 0–1 should be treated on an outpatient basis and those with a score of 2 could either be discharged home with close follow up or be admitted briefly for inpatient treatment. Those with a score of 3–5 should certainly be admitted and may even need to be on the intensive care unit for closer monitoring. This score correlates closely with risk of death due to pneumonia:

  • 0–0.6%
  • 1–3.2%
  • 2–13.0%
  • 3–17.0%
  • 4–41.5%
  • 5–57.0%

Correct answers received from: Dr Bhavisha Brahmbhatt, Dr Chandresh Jardosh

Answer for 9th October Mind Teaser is: "Dark under the eyes"
Correct answers received from: Dr Anurag Jain, Dr Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr Chandresh Jardosh)
“My doctor told me to take two of these pills on an empty stomach.”
“Did they do any good?”
“I don’t know. They keep rolling off in the night.”

You are an Indian if (Anuj Goel)

You use plastic to cover anything new in your house whether it’s the remote control, VCR, carpet or new couch.

  An Inspirational Story

A lesson learned in your past that you will never forget completely
When I was in elementary school, I got into a major argument with a boy in my class. I have forgotten what the argument was about, but I have never forgotten the lesson learned that day.

I was convinced that "I" was right and "he" was wrong – and he was just as convinced that "I" was wrong and "he" was right. The teacher decided to teach us a very important lesson. She brought us up to the front of the class and placed him on one side of her desk and me on the other.
In the middle of her desk was a large, round object. I could clearly see that it was black. She asked the boy what color the object was. "White," he answered.
I couldn’t believe he said the object was white, when it was obviously black! Another argument started between my classmate and me, this time about the color of the object.
The teacher told me to go stand where the boy was standing and told him to come stand where I had been. We changed places, and now she asked me what the color of the object was. I had to answer, "White." It was an object with two differently colored sides, and from his viewpoint it was white. Only from my side was it black.
My teacher taught me a very important lesson learned that day: You must stand in the other person’s shoes and look at the situation through their eyes in order to truly understand their perspective.

  Readers Responses
  1. Respected Editor, one of the best things in 9th  October emedinews is your editorial on Navratras. In a very simple way, you have explained the significance of Navratras fast and festival. Regards to all & thanks to emedinews for making our lives near to God by presenting us such great thoughts in our mechanical professional life. Regards Dr Anupam
Public Forum

(Press Release for use by the newspapers)

Focus on competitions at Perfect Health Mela

Health awareness would be created through interactive competitions in the forthcoming MTNL Perfect Health Mela being organised by Heart Care Foundation of India in association with various Departments of Delhi Government, NGOs and public sector undertakings from 23rd to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi.

The focus of the Mela this year will be on the rising "Lifestyle Disorders". The Mela is likely to target over eight lakh members of the public. This was stated by Dr. KK Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela.

Inter nursing school, Inter medical college, Inter school, Inter dancing school and a Carnival for children with special needs will be organised at the Mela venue. The competitions will include Fashion show, Choreography, Rock show, Western dance, Yoga, Role play, Health model, Quiz, Poster, Slogan writing, Cartoon drawing, Rangoli, Talent search, etc. He said that the purpose of these competitions is to make health awareness interactive and reason based.

Emphasis will be laid on laughter and the fact that 20 minutes of laughter is equivalent to 20 minutes of exercise and has similar significance. Adding laughter to daily routine can reduce the level of stress, blood pressure, diabetes, and heart disease in the community. Hospitals, all over the world, which have incorporated humor department, have more healing rates, less anesthesia time and early recovery period.

He said that role play competitions can have a significant impact on health awareness. Children and students from various schools and colleges should participate in more and more role play exercises involving health themes. The right time to avoid a lifestyle disorder in middle age is to change the lifestyle during adolescence, he further emphasised.

  Forthcoming Events

CPLD 2010:Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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