eMedinewS11th January 2014, Saturday

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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2013 Top 10 Advances in Heart Disease and Stroke Science

  1. Prevention guidelines

    In November, the American Heart Association and American College of Cardiology published a set of four guidelines on obesity, cholesterol, risk assessment and lifestyle to help patients and physicians prevent more heart attacks and strokes. The guidelines, based on a thorough review of scientific evidence, were completed by the AHA and ACC after being initiated by the National Heart, Lung, and Blood Institute in 2008. Highlights:

    Obesity requires long–term professional management

    Obesity is more than a lifestyle issue, according to the AHA, and patients are more likely to stay on track when guided long–term by a trained professional in a healthcare setting. Losing weight and maintaining weight loss requires eating fewer calories than your body uses, exercising more and changing unhealthy behaviors. This guideline features a roadmap with multiple different approaches to help patients lose weight and keep it off, starting with evaluating every American’s body mass index – a ratio of height to weight. Patients with a BMI of 30 or higher are considered obese and need treatment and chronic follow–up. In the U.S., nearly 78 million adults are obese.

    Lower overall heart attack and stroke risk, not just cholesterol: After lifestyle changes, cholesterol–lowering statin drugs could benefit about 33 million Americans who have a greater than 7.5 percent 10–year risk for heart attack and stroke. The term "ASCVD" in this guideline refers to the type of cardiovascular disease caused by atherosclerosis, or hardening of the arteries that can lead to heart attack or stroke.

    The guideline recommends that patients and their healthcare providers assess the patient’s risk of ASCVD events, and then discuss treatment options, including patient preferences. It also describes four major groups of people whose benefit from lowering their heart attack or stroke risk would clearly outweigh the risk of side effects from statin medications. These include patients: 1) with diagnosed ASCVD; 2) with LDL, or "bad," cholesterol of more than 190 mg/dL with no secondary cause; 3) who are 40-75 years old with type 2 diabetes, an LDL cholesterol of 70 to 189 mg/dL, and don’t have diagnosed ASCVD; and 4) who have an estimated 10–year risk of ASCVD of more than 7.5 percent, but don’t have diagnosed ASCVD or type 2 diabetes with the LDL levels described above.

    Treating for higher overall risk using the criteria in the guideline will replace the previous approach of treating LDL cholesterol to a specific target level.

    Assessing risk of heart attack and stroke in more people: Updated risk equations for white men and women – and a new risk equation for African–Americans – were published in the risk assessment guideline. To calculate 10–year risk, the equations use race, gender, age, total cholesterol, HDL "good" cholesterol, blood pressure, use of blood pressure medications, diabetes status and smoking status. Importantly, stroke risk is included, giving patients a better assessment of their future cardiovascular health.

    Lifestyle guidelines: dietary patterns and exercise: Lifestyle recommendations target the many people who need to lower cholesterol and blood pressure. They recommend an overall heart-healthy dietary pattern and 40 minutes of moderate to vigorous aerobic exercise 3 to 4 times a week. Dietary patterns should emphasize fruits, vegetables, whole grains, low–fat dairy products, poultry, fish and nuts, and limit red meat and sugary foods and beverages. To lower blood pressure, the guideline recommends a step-down approach to no more than 2,400 milligrams of sodium a day. To lower it further, the guidelines recommend getting sodium down to 1,500 mg a day.
  2. Controlling high blood pressure: Although researchers understand the best ways to treat hypertension, many patients do not know they have it, and only half of the 75 percent of patients being treated control it to a healthy level.

    One important study showed a dramatic increase in patients whose hypertension was controlled — from 44 percent to more than 87 percent over 10 years — through an evidence-based program implemented by a large healthcare provider. It strongly encouraged lifestyle changes, improved tracking of patient information, simplified drug therapies, made in-office blood pressure checks more accessible, provided doctors more feedback and overall, treated patients according to scientific evidence. This program also followed other principles recommended by the AHA, including cost considerations, simple approaches and easy–to–understand patient materials.
  3. Combating poor childhood and early adulthood heart health and its aftermath: Two studies looked at heart health in young people — one used the American Heart Association’s Life’s Simple 7 health measures to determine how ideal health affected brain function in middle age. The other evaluated a preschool curriculum’s effect on the health habits of preschoolers and their families. A study of nearly 3,000 people aged 18–30 over 25 years found that those maintaining ideal health had better brain function in middle life. Each one of the seven health measures — avoiding being overweight or obese, eating a healthy diet, not smoking, and being physically active, and keeping total cholesterol, blood pressure, and fasting glucose at goal level — improved cognitive function. A structured curriculum based on Sesame Street’s Healthy Habits for Life used in Bogota, Columbia improved hundreds of preschoolers’ knowledge, attitudes and heart-healthy habits. The program resulted in a 13 percent improvement in the percentage of children at a healthy weight — from 62 percent to 75 percent.
  4. Getting more people to cardiac rehabilitation has big results: Following hospitalization for cardiovascular disease, simple changes can greatly increase enrollment and participation in cardiac rehabilitation, and rehabilitation significantly lowered the death rate after heart bypass surgery, according to several 2013 studies. Not enough eligible patients participate in cardiac rehabilitation, despite known benefits, said study authors. Setting outpatient rehabilitation appointments soon after leaving the hospital improved participation significantly, as did providing a non–medical "navigator" or "coach" while patients were still in the hospital. Hospitals promoting cardiac rehabilitation and more certifications for rehab programs also were effective. The 10–year death rate for people who participated in cardiac rehabilitation after heart bypass surgery was 50 percent lower than those who did not participate.
  5. Breakthroughs in congenital heart disease genetics: Two new papers have significantly increased our understanding of the genetics of congenital heart disease. One identified 400 genes potentially responsible for congenital heart disease, and found that 10 percent of mutations leading to severe congenital heart disease were new and not passed down by a parent. Another study showed for the first time that, mutations within a genetic pathway that regulates early development may be responsible for congenital heart disease, and may also have a link to autism.
  6. How intestinal microbes raise the cardiovascular disease risk from red meat: An emerging area of nutrition science is the study of bacteria, or microbes, in the digestive system and how they affect heart disease risk. A 2013 study discovered that microbes in the digestive system may be responsible for red meat elevating two chemicals associated with cardiovascular disease, L–carnitine (a nutrient that can be measured in the blood) and a substance called trimethylamine–N–oxide, or TMAO, produced by bacteria in the digestive tract from L– carnitine, and linked to major cardiac events. Vegans, vegetarians and omnivores (who eat meat and vegetables) were studied. Vegans and vegetarians had less L–carnitine in their blood than omnivores and when they consented to eat meat for the study, their digestive system produced less TMAO than their meat–eating counterparts.
  7. Atrial fibrillation: Atrial fibrillation, an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart–related complications, affects 2.7 million Americans. One study found that atrial fibrillation also may affect cognitive function. Warfarin is the most common treatment for atrial fibrillation and proper dosing is critical. Recent analyses have suggested that newer drugs may be as effective as warfarin in preventing strokes, and may reduce the risk of some bleeding complications. Two studies found that using genetic testing to determine the best dose of warfarin may not be worth the extra testing and cost. Other studies compared warfarin to newer drugs called novel oral anticoagulants. A meta–analysis compared four of them and found they significantly reduced stroke, bleeding in the brain, and death, although they increased gastrointestinal bleeding.
  8. Simplifying the cooling of cardiac arrest patients and extending life support: Resuscitation studies provided guidance on cooling cardiac arrest patients — called therapeutic hypothermia — and on how long to provide life support after they’ve been rewarmed. Cooling patients who have survived sudden cardiac arrest can improve their survival and brain function, and two studies suggest simplifications to the process. The first suggested that cooling before patients reach the hospital did not help their survival or brain function. The second study found no differences in survival or brain function for patients cooled to 33 degrees Celsius vs. 36 degrees Celsius. Incorporating these ideas could save emergency medical services from investing in special equipment and training, and hospitals can more easily lower their patients’ temperatures. After cooling and rewarming, another study recommends that healthcare providers wait 48-72 hours before withdrawing life support, because patients can still survive with good brain function after 72 hours. Before therapeutic hypothermia is used, most patients are put into a medically induced coma.
  9. Endovascular treatment for stroke: Several studies evaluated the use of endovascular treatment of strokes caused by blocked blood vessels supplying the brain. Endovascular treatment either delivers tissue plasminogen activator (tPA) near the blockage in the blood vessel or mechanically restores blood flow in the vessel. Most studies found it led to more blood vessels supplying the brain being open after treatment, but newer studies did not demonstrate that this led to better outcomes for patients than standard drug treatment, intravenous tPA. One particular study found that brain imaging failed to identify people who might benefit more from endovascular treatment. Endovascular therapy has also been used after IV tPA to treat patients with moderate to severe ischemic stroke. The largest study to compare this combined approach with IV tPA alone found more open vessels with endovascular therapy, and similar safety outcomes between the approaches, but the trial was stopped early because the combination approach did not change stroke survivors’ functional independence enough to be statistically significant. Investigators have suggested that endovascular therapy might still provide benefit if the relevant vessels could be opened earlier in the course of stroke, and feel more trials are warranted.
  10. Niacin doesn’t lower heart risks, may be harmful: In 2013, the largest study of niacin showed that the drug, combined with laropiprant, added to reduce the facial flushing caused by niacin, does not benefit people at risk for heart disease or stroke, and may even be harmful. Niacin is a B vitamin traditionally used to raise HDL or "good" cholesterol and lower LDL or "bad" cholesterol. The new study of 25,000 people showed the drug combination failed to reduce the chances of non–fatal heart attack or heart–related death, stroke, or the need for angioplasty or bypass surgery. People taking the drug also had more bleeding, infections, diabetes and related complications, indigestion and diarrhea and itchy skin, compared to those taking a placebo. Based on these results, patients taking niacin are encouraged to ask their healthcare providers if they should keep taking it.
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

You can reverse heart disease

sprritual blog

Every cell in the body eventually dies and is replaced by a new cell. Every day is a new opportunity to build a new body. The entire body totally rebuilds itself in less than two years with 98% in less than one year.

• Stomach lining rebuilds itself in 5 days.

• Your skin rebuilds itself in 1 month.

• Liver rebuilds itself in 6 weeks.

• Your DNA rebuilds itself every 2 months.

• Bone rebuilds the whole new skeleton in 3 months

• Blood rebuilds itself in 4 months

• Brain rebuilds itself in 1 year

You cannot swim in the same river twice. With every breath, we inhale 1022 atoms coming from all cells present in the universe. We share everything with everybody with every breath. Quadruplet atoms in the last three weeks have gone through our breath. Billion atoms out of them may have been those of Christ or Mohammad.

The very fact that our body rebuilds itself, it is possible to change the Dharma of the new cells and even prevent or regress cancers and heart diseases.

cardiology news

A Field Mouse or an Osprey

Life offers two choices: We can live scurrying for survival or soaring to the unlimited heights. The choices are modeled by these two creatures.

A few months back while sitting in a boat fishing with a couple of friends, I noticed a field mouse on the river bank. He emerged out of his hole, darted in a couple of directions, and then scurried back. I thought of the existence of this little creature. His life is spent running around, frightened and frantic, following his nose. He darts here, scurries there, turns in circles, but never really sees much beyond his nose. He is trying to sniff his way to successful living, which defined, by a mouse’s existence, is finding some daily morsel to consume, to sustain him, so that he can carry on for the rest of his life, frightened and frantic. Sound familiar.

A few minutes later I glanced up and noticed soaring high above was an Osprey. Rather than a picture of a frightened and frantic existence, I saw a wide winged creature using the air currents to maneuver majestically in the unlimited heights. Rather than sniffing out a meager existence, this keen eyed hunter with a panoramic view of the river and lake beneath was simply waiting for the appropriate time to swoop and capture his prey. The amazing creature, rather than return to some tiny hole in the river bank, glides toward a nest fashioned at the top of the tallest of trees.

The strength in his wings, the power in his talons, the amazing capacity of his vision, the effortless capacity to soar, It is the osprey, not the field mouse that models our human potential.

I don’t know about you, but it is easy for me to decide which creature I want to exemplify my life. I want to soar. I want to explore. I want to see the big picture. I want to conquer. I want to climb higher, go farther, dive deeper, and experience more. I want my soul enlarged, my mind expanded, my heart enlivened and my spirit energized. I want the scurrying to stop. I want the frantic darting about following my nose, to end. I want new strength, fresh thinking, clear vision and resolved courage.

I want to be more and more like the osprey and less like the field mouse, for to live like this field mouse is to insult my creator and deny my true destiny.

News Around The Globe

News

  • Avocado (Makhan Phal) – As per a French study published in Annals of Rheumatic Diseases, supplements containing abstract of avocado (Makhan Phal) and soya bean can be an effective treatment for osteoarthritis. Those who were given the supplements there were at least 10% reduction in the progression of the disease.
  • In an editorial in the Journal of Clinical Oncology, Richard Bleicher, MD, from the Fox Chase Cancer Center in Philadelphia writes that it is time to stop the routine use of MRI before surgery for non–high–risk breast cancer. According to him, routine preoperative MRI is not appropriate because the evidence now includes a meta–analysis, published in the journal, which found that the imaging does not reduce either the local ipsilateral or distant return of disease.
  • Meditation may provide small to moderate improvement in negative aspects of psychological stress, including anxiety, depression, and even pain in some individuals, according to a systematic review and meta–analysis published online January 6 in JAMA Internal Medicine.
  • The US Food and Drug Administration (FDA) has approved the first–ever combination therapy for advanced melanoma. The combination of trametinib (Mekinist, GlaxoSmithKline), a MEK inhibitor, and dabrafenib (Tafinlar, GlaxoSmithKline), a BRAF inhibitor, was approved through the FDA Accelerated Approval Program. Both drugs were approved last year for single–agent use. The 2–drug combination is indicated for the treatment of patients with unresectable or metastatic melanoma and BRAF V600E or V600K mutations. These mutations must be detected with an FDA–approved test.
  • In a study from UK published December 12 in the journal Gut, ondansetron relieved some of the most annoying symptoms of irritable bowel syndrome with diarrhea (IBS–D). At doses commonly used in clinical practice, ondansetron improved stool consistency, stool frequency, urgency, and bloating but not abdominal pain.
  • More MBBS seats added: The Cabinet on Thursday cleared a proposal to create 10,000 new MBBS seats in government medical colleges as reported in the TOI, January 10. At present, there are around 22,500 MBBS seats in government colleges. There are 381 medical colleges – both government and private — in the country with around 50,000 MBBS seats registered with the Medical Council of India (MCI). The proposal is aimed at increasing the number of doctors to reduce the doctor–patient ratio from the current 1:2000 to 1:1000. This is also likely to increase availability of doctors in the hinterland where people have to travel long distances to get medical treatment.

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)

What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.

cardiology news

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

  • Cardiologists need to be aware of the radiation doses associated with the tests they order for their patients, according to a position document from the European Society of Cardiology published in the European Heart Journal. Even though cardiovascular imaging accounts for about 40% of medical radiation exposure in the general population (after excluding radiotherapy), cardiologists are often not aware of the radiation doses –– and accompanying risks –– from the exams. The
  • The SYMPLICITY HTN–3 trial, a phase 3 study testing catheter-based renal denervation for the treatment of resistant hypertension, failed to achieve its primary efficacy end point, according to a statement released by Medtronic. Despite no safety concerns, the study, which randomized 535 treatment–resistant hypertension patients, failed to show that treatment with the investigational procedure resulted in a sustained reduction in systolic blood pressure.
cardiology news

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

  • Following a concussion, young athletes engaging the most in activities requiring concentration and attention (e.g., doing homework, text messaging, and playing video games) take the longest time to recover, a new study has found. The study was published online January 6 in Pediatrics. The study results are in line with current recommendations for limiting extensive cognitive activity after a head injury. However, the study does not suggest being completely idle following a concussion.
  • The US FDA has approved the HIV medication raltegravir (Isentress, Merck) for pediatric oral suspension. According to the FDA, the oral suspension may be used in patients as young as 4 weeks of age, weighing at least 3 kg to less than 20 kg. Raltegravir belongs to a drug class called HIV integrase strand transfer inhibitors that slow the spread of HIV in the body. The safety and efficacy of the drug have not been established in infants younger than 4 weeks of age.
cardiology news

Prescribing antibiotics

Your doctor is at fault while prescribing antibiotics, when he/she

  • Prescribes antibiotics when no bacterial infection exists.
  • Prescribes the wrong antibiotic or the wrong dose.
  • Prescribes antibiotics for longer than necessary.
  • Prescribes strong antibiotics, when a less strong would be as effective.
  • Prescribes an expensive antibiotic when a cheaper but equally effective antibiotic is available.

You at fault, when

  • You demand antibiotics even when the doctor thinks it is unnecessary
  • You buy an antibiotic without prescription.
  • You buy an antibiotic without a bill
  • You stop antibiotics as your symptoms start improving and you do not take a full course of antibiotics.
  • When you change brands without the doctor’s knowledge.
cardiology news

Total CPR since 1st November 2012 – 84073 trained

Media advocacy through Web Media

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press release

Eating fast food can cause liver damage

Quoting a Swedish study by Dr. Fredrik H. Nystrom of University Hospital of Linkoping, published in the medical journal Gut, 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 said that eating aleast two fast foods meals every day and restricting levels of physical activity to no more than 5,000 steps a day can lead to signs of liver damage or weight gain.

At the end of the 4 weeks, the fast food eaters had put on an average of 6.5 kilograms (14.3 pounds). After just 1 week on the fast food diet, blood tests showed sharp increases in a liver enzyme called SGPT. SGPT levels were more than quadrupled over the 4–week study period. Increased SGPT levels are used to diagnose liver disease before symptoms develop. In 11 fast food dieters, SGPT rose to levels suggestive of liver damage. The SGPT increases were linked to weight gain and higher sugar and Carbohydrate intake.

Sutra: Eating 2 fast food meals a day, walking <5000 steps a day can cause liver damage or gain weight as per a Swedish study.

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

Cabergoline can restore normal orgasm new

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 vascular necrosis can be possible sequelae of fracture of all the following bones, except:

1. Femur neck
2. Scaphoid
3. Talus
4. Calcaneum

Yesterday’s Mind Teaser: 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

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

Correct answers received from: Dr Sushma Chawla, Arvind Gajjar, Bharti Singh, Tukaram Pagad, Dr Chandresh Jardosh, Dr K Raju, Dr B K Agarwal, Sangeetha Raja, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Answer for 8th January Mind Teaser: 3. Into the retroperitoneal space.

Correct answers received from: Dr B K Agarwal, Sangeetha Raja.

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update

Visa

A businessman called and had a question about the documents he needed in order to fly to China. After a lengthy discussion about passports, I reminded him he needed a visa.

"Oh no I don’t, I’ve been to China many times and never had to have one of those."

I double checked and sure enough, his stay required a visa.

When I told him this he said, "Look, I’ve been to China four times and every time they have accepted my American Express!"

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with large intestinal diarrhea developed sepsis after he was given antimotility drugs.
Reaction: Oh my God, Why was an antibiotic not given?
Lesson: Make sure that if antimotility drug is given in a large intestinal diarrhea, it is always given with an antibiotic.

medicolegal update

The more you recognize and express gratitude for the things you have, the more things you will have to express gratitude for. Zig Ziglar

medicolegal update

Dr KK Aggarwal: Promising Medical Advances Insights into brain injury A study by NIH researchers provided insight into the (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Happiness can be woven into every aspect of life once you make new choices http://bit.ly/15QdVeB #Health

medicolegal update
  1. Dear Sir, very informative newspaper. Regards: Dr Shagun

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