eMedinewS11th September 2013, Wednesday

Dr K K Aggarwal Padma 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
www.twitter.com/DrKKAggarwal
www.facebook.com/Dr KKAggarwal

Polypill benefit high risk patients with CVD: UMPIRE

Findings, from the Use of a Multidrug Pill in Reducing Cardiovascular Events (UMPIRE) study published September 4, 2013 in the JAMA shows that taking a single pill with a fixed–dose combination of an aspirin, a statin and two antihypertensives improved adherence to medication and slightly improved systolic blood pressure and LDL–cholesterol levels compared with usual care in a 15–month study of patients with or at high risk of CVD.

These data suggest that FDCs could play a role in increasing uptake of statins, aspirin, and combination blood–pressure–lowering drugs in patients with CVD not currently receiving such treatment."

According to the researchers, UMPIRE was designed to meet an appeal from the European Commission in 2009 for research to test "a single daily… fixed–dose–combination pill (that is) low–cost and suitable for production and widespread use in resource-poor countries."

UMPIRE randomized 2004 patients with known or at high risk for CVD living in India, England, Ireland, and the Netherlands. Half of the patients received usual care and half received a daily tablet containing 75 mg of aspirin, 40 mg of simvastatin, 10 mg of lisinopril, and either 12.5 mg of hydrochlorothiazide or 50 mg of atenolol (depending on physician preference).

After a mean follow–up of 15 months, compared with patients in the usual–care group, those in the polypill group had improved adherence (86% vs 65%) and a small but statistically significant greater improvement in systolic blood pressure (–2.6 mm Hg) and in LDL cholesterol (–4.2 mg/dL).

Benefits were larger in the subgroup of 727 patients with low adherence to begin with. In this group, randomization to a polypill resulted in a threefold increase in adherence: 77% vs 23%.

Waist circumference a better indicator of mortality

As per a press conference at the European Society of Cardiology meeting a high body mass index (BMI) appears to be protective in certain populations.

Abdominal obesity –– measured using waist circumference –– was a better predictor of 5–year mortality among French survivors of an acute myocardial infarction (MI) than was BMI, according to a study presented by Tabassome Simon, MD, of HĂ´pital Saint Antoine in Paris.

Looking at BMI, there was an increased risk of dying for those with the lowest body mass (less than 22 kg/m2) and those with the highest (35 kg/m2 and higher), but not for those in the middle of those two groups, which included individuals who were overweight and mildly obese.

Within each category of BMI, however, increased waist circumference was associated with an elevated risk of dying within the follow–up period. After adjusting for BMI in a multivariate analysis, waist circumference in the upper quartile was associated with a 44% greater risk of dying through 5 years. …

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."


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

Ringtone – CPR 10 Mantra English

sprritual blog What are the celebrated formulas of Vedanta?

• Satyam Jnanam Anantam Brahma: Brahman is Truth, Knowledge and infinity.
• Brahmavid Brahmaiva Bhavati: The knower of Brahman becomes Brahman.
• Santam Sivam Advaitam: Brahman is Peace, auspiciousness and Non– Duality.
• Ayam Atma Santah: This Atman is Silence.
• Asango Ayam Purusha: This Purusha is unattached.
• Santam Ajaram Amritam Abhayam Param: This Brahman is Peace, without old age, Immortal, Fearless and Supreme.

cardiology news

A Poor Young Boy and the Dog

A few days ago I landed at the Bombay Airport (India) and took a cab to my scheduled destination in South Bombay. I was enjoying the busy traffic with people rushing in every possible direction then we got stranded at a very busy intersection.

As we waited for the signal to turn green, my eyes met up with a poor young boy, about 12 years old. He removed a piece of bread from his pocket and took a bite. As he was about to take his next bite, a stray dog wagged his tail looking at him. Without hesitation, he sat down and put the bread on the road for the dog to eat. The dog sniffed the bread and walked away. The boy waited until he was sure the dog was gone then he picked up the bread and ate it!

My heart cried and wanted to walk up to the boy but before I could open the door the signal turned Green and our car drove away. I kept thinking about the boy and later during my evening meal I realized that I was thinking of approaching the boy but never did, I could have stopped the car and walked up to him which again I never did.

All I did was "thinking" and this poor little boy who had only one piece of bread without any hesitation sharing it with the dog, though he himself seemed to be very hungry.

I learnt one of the biggest lessons in my life which that boy taught me without a conversation. He taught me to share with love and happiness. I am so blessed to have learnt this beautiful lesson from my ‘little unknown master’. It is my moral duty to share this incident with all my friends across the globe and be blessed with happiness.

Thank you friends for making this world a beautiful place to dwell.

News Around The Globe

5th Dil Ka Darbar

Date: Sunday, 29th September 2013, Venue: Constitution club of India, Rafi Marg, Time: 8 AM to 6 PM

Programme: A non stop question answer–session between all top cardiologists of the NCR region and the public.

The focus of the discussions will be prevention of heart diseases in women and young men. Special discussion will be held on Sex and Heart Diseases. Practical training will also be given to people on Hands–only Cardiopulmonary Resuscitation. Another focus of the discussion will be the launch of the Project Dhadkan (Palpitations) and Project Murmur (Congenital and valvular heart diseases in children).

Entry free…

  • As per a Danish report whether young women had metabolic disorders was more predictive of the risk of heart attack and ischemic stroke than was BMI. Michelle Schmiegelow, MB, of Gentofte Hospital in Copenhagen, and colleagues showed that through a median follow–up of 5.5 years, the rate of MI or ischemic stroke was lowest among the women who had a normal weight and were free from any of the metabolic disorders (16.7 per 100,000 person–years). Compared with them, the risk of MI or stroke was elevated among the women who had at least one of the metabolic disorders, regardless of BMI. The risk was not higher, however, among the women who were overweight but metabolically healthy.
  • In patients with hypertension and diabetes, the risk of cardiovascular events was highest among those with the lowest body mass, a Japanese study showed. Takanori Nagahiro, MD, of Nagoya University Hospital in Japan, and colleagues used data from the Nagoya Heart Study showed that the rate of acute MI, stroke, heart failure hospitalization, coronary revascularization, or sudden death through a median follow–up of 3.2 years declined from the lowest BMI group to the highest. The rates per 100 person–years were 4.6, 2.3, 2.8, and 1.5.
  • Independent of starting BMI, weight loss was associated with shortened survival among women with coronary heart disease, according to a study presented by Aziza Azimi, MB, of Gentofte Hospital in Copenhagen. Weight loss, defined as a drop in body weight of more than 2 kg (4.4 lbs.) in a year was associated with a greater risk of dying during follow–up in normal–weight women (HR about 3), overweight women (HR about 6), and obese women (HR about 9). Weight gain was associated with an increased mortality risk in obese women only.
  • The US Food and Drug Administration (FDA) has approved brimonidine topical gel 0.33% (Mirvaso, Galderma Laboratories) for facial redness resulting from rosacea in adults aged 18 years or older. Facial redness is the most common symptom of rosacea.
  • A warning about serious skin reactions, some of which have been fatal, has been issued in Canada for sunitinib (Sutent, Pfizer). These serious skin reactions have been "very rarely reported," but some cases have been fatal, notes a letter issued to health professionals by Pfizer Canada, which is endorsed by the government agency Health Canada. The product labeling has been updated to include a note that cases of toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) have been reported in patients taking sunitinib, mostly in the postmarketing setting. If a patient on sunitinib is showing signs or symptoms of either TEN or SJS, the drug should be discontinued. If TEN or SJS is confirmed, treatment must not be restarted.

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Rabies News (Dr. A K Gupta)

What is "paralytic form" of rabies in animals?

Paralytic or dumb rabies refers to animals in which the behavioral changes are minimal or absent and the disease is manifested mainly by paralysis. This is first manifested by paralysis of the throat and masseter muscles, often with profuse salivation and inability to swallow. Dropping of lower jaw is common in dogs. The animals are not vicious and rarely attempt to bite. The paralysis progresses rapidly to all parts of the body leading to coma and death follows in a few hours.

cardiology news
  • Findings from an animal study suggest that a new stent coating showed promise for limiting restenosis while promoting vascular repair. According to Shi–You Chen, PhD, from the department of physiology and pharmacology at the University of Georgia in Athens, and colleagues, blocking the expression of CTP synthase 1 (CTPS1) suppressed the proliferation of smooth muscle cells, which cause neointimal hyperplasia, one of the major obstacles limiting the long–term clinical efficiency" of percutaneous coronary intervention (PCI). But the blockade of CTPS1 did not interfere with and actually promoted re-endothelialization, a critical step in healing the arterial injury caused by stent implantation. The study is published online in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.
  • A pooled analysis of three pivotal CHAMPION trials, CHAMPION–PCI , CHAMPION–PLATFORM , and CHAMPION–PHOENIX suggests that cangrelor can reduce the risk of periprocedural thrombotic complications during PCI compared with placebo or clopidogrel, at the expense of some mild bleeding. The results of the patient–level analysis were presented at the European Society of Cardiology (ESC) 2013 Congress and published concurrently September 3, 2013 in the Lancet.

Valvular Heart Disease News

After successful medical treatment of infective endocarditis on echo may level persistent vegetation for months or years.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • The causes of disease, its subtypes, and risk factors present at the time a child is diagnosed with hypertrophic cardiomyopathy can help predict the likelihood of death or need for heart transplantation, according to a registry study. The worst prognosis was for children whose underlying causes were inborn errors of metabolism, who had a rate of death or transplantation at 2 years of 57%. Children with mixed functional phenotypes also fared badly. The combined outcome of death or transplantation was 45% for those classified as having mixed hypertrophic and dilated cardiomyopathy, while the rate was 38% for those diagnosed with mixed hypertrophic and restrictive cardiomyopathy.
  • A new test for pepsin in bronchoalveolar lavage (BAL) fluid identifies aspiration–associated extra–esophageal reflux disease (AERD) in children with chronic respiratory symptoms. Using pepsin as a marker for AERD demonstrated a high prevalence of AERD in patients with chronic respiratory symptoms and tracheostomy, with more than 70% of the patients in the two groups having pepsin detected in the BAL specimen, according to a recent case–control study reported online August 29 in JAMA Otolaryngology Head and Neck Surgery.
cardiology news

Expired drugs potent up to decades

As per a new analysis of 8 drugs, published in the Archives of Internal Medicine, most of the active ingredients in the drugs are present in adequate amounts decades after the drugs’ expiration dates.

As per US FDA standards, adequate means that an active ingredient must be present in 90% to 110% of the amount indicated on the label. Normally drug expiration dates are set for 1–5 years after production.

In the study, Lee Cantrell, PharmD, from the California Poison Control System tested drugs which had expired 28 to 40 years ago.

In the study tested, 12 of the 14 active ingredients persisted in concentrations that were 90% or greater of the amount indicated on the label. These 12 compounds retained their full potency for 336 months or longer. Eight of them retained potency for at least 480 months.

Only aspirin and amphetamine fell below the 90% cutoff. Three compounds persisted in greater than 110% of the labeled contents: methaqualone, meprobamate and pentobarbital.

cardiology news

Smt. Krishna Tirath to inaugurate the Child Abuse seminar on "Be Human–Stop Child Abuse"

On 13th September, 2013, Smt. Krishna Tirath, Minister of Women and Child Development will be inaugurating the seminar at 1.30pm. The topic has been so chosen as child and sexual abuse has been the talk of the country in the recent past. The deliberations will be held where representatives of over 13 countries will come out with their presentations on the subject.

cardiology news

Total CPR since 1st November 2012 – 62980 trained

CPR Classes 62980

Media advocacy through Print Media

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29th August: Veer Arjun

Media advocacy through Web Media

When Constipation May be a Serious Problem 30th August

NETLOG, FREEPRESS RELEASE, PRLOG, FREEPRESSINDEX , AFRICANNEWSWIRE

TB more dangerous than FLU 29th August

NETLOG, FREEPRESS RELEASE, PRLOG, AFRICANNEWSWIRE

Dil Ka Darbar to be held on 29th September

Heart Care Foundation of India will be organizing a unique Dil Ka Darbar to earmark the World Heart Day on Sunday, 29th September, 2013 at the Constitution Club of India Auditorium from 8am to 4pm. The Darbar will be a non–stop interaction between top cardiologists and cardiac surgeons of the city and heart patients, nurses and family physicians.

Addressing a press conference here, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that the very fact that in our mythological era, there is no mention of heart attack among the kings, it corroborates that heart disease is a recent phenomenon and a preventable lifestyle disorder.

Co–addressing the press conference, Dr. Smita Mishra, Sr. Pediatric Cardiologist said that heart disease amongst children is equally preventable.

Others who spoke on the occasion were Sh Deepak Chanduka General Manager (Mkt.), MTNL Corporate Office, Dr. N V Kamath, and Dr. K S Baghotia from DHS and Sr. representatives from Central Bank of India.

Sore throat and join pains in children should not be ignored. An angry–looking throat in patients of cough should be immediately treated with an antibiotic to prevent rheumatic heart disease. If a child is diagnosed to have red angry–looking throat, he or she should be referred to a pediatric cardiologist for opinion.

She also said that school health programs should pick up murmurs so that congenital heart diseases can also be detected in time.

About the Darbar, Dr. Aggarwal said over 500 heart patients, nurses and family physicians will interact non–stop with the top cardiologists of the city on subjects related to heart care. The focus of the discussions will be prevention of heart diseases in women and young men. A special discussion will be held on Sex and Heart Diseases.

Practical training will also be given to people on Hands-only Cardiopulmonary Resuscitation.

Dengue Update

This year the city is in the grip of dengue epidemic and the epidemic this year is a serious one.

Facts about severe dengue

  • As per the WHO, dengue can be classified as dengue and severe dengue.
  • Severe dengue needs care and prevention of death.
  • Severe dengue is characterized by severe plasma leakage, shock, fluid accumulation with respiratory distress, severe hemorrhage, SGOT and SGPT levels more than 1000, impaired consciousness, severe involvement of heart and other organs.
  • Mild dengue can be with or without warning signals. The warning signals are:
    • Abdominal pain or tenderness
    • Persistent vomiting
    • Clinical fluid accumulation
    • Mucosal bleeding
    • Lethargy
    • Restlessness
    • Increased in PCV with rapid fall in platelet count
    • Liver enlarged more than 2 cm

Remember the Formula of 20

  • If pulse rate increases by more than 20
  • If upper blood pressure falls by more than 20
  • If the difference between upper and lower blood pressure is less than 20
  • If platelet count is less than 20,000
  • If blood thickens by more than 20% by increase in PCV

Presence of any of these features indicates need for hospitalization.

Dengue in patients with heart disease needs special attention. These patients need to be hospitalized and treated.

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 63400 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."

today emedipics

A press conference was organized by Heart Care Foundation of India to announce the date of Dil Ka Darbar to earmark the World Heart Day on Sunday, 29th September, 2013 at the Constitution Club of India Auditorium.

press release

Healthcare worker fatigue and patient safety

today video of the dayDr KK Aggarwal Birthday 5th September

Cultural Evening at IMA

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

A 26–year–old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She’s placed on trimethoprim-sulfamethoxazole to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed?

a. Nitrofurantoin
b. Ibuprofen
c. Acetaminophen with codeine
d. Phenazopyridine

Yesterday’s Mind Teaser: A male client with acute pyelonephritis receives a prescription for co–trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

a. Urine output increases to 2,000 ml/day.
b. Flank and abdominal discomfort decrease.
c. Bacteria are absent on urine culture.
d. The red blood cell (RBC) count is normal.

Answer for yesterday’s Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr Prakash Khalap, Narahari Kandakatla, DR ARPAN GANDHI, chandulal parmar, Dr.Bitaan Sen & Dr. Jayashree Sen, Dr. P. C. Das, daivadheenam, Dr. Vishal D Wahane, Dr.K.Raju, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr skjindal muktsar, DR AVTAR KRISHAN, Dr pooja khullar, Dr Kanta Jain

Answer for 9th September Mind Teaser: d. Cardiac glycosides

Correct answers received from: Dr skjindal muktsar, DR AVTAR KRISHAN

Send your answer to ijcp12@gmail.com




medicolegal update

Click on the image to enlarge

medicolegal update

A man was complaining to a railroad engineer. What’s the use of having a train schedule if the trains are always late?

The railroad engineer replied, "How would we know they were late, if we didn’t have a schedule?"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to remember that most painkillers (barring nimesulide) are not kidney–friendly drugs.

medicolegal update

Do not spoil what you have by desiring what you have not; remember that what you now have was once among the things you only hoped for. Epicurus

medicolegal update

Dr KK Aggarwal: Sudden Cardiac Death By Dr k k Aggarwal http://bit.ly/16wknsh #Health

Dr Deepak Chopra: How to Handle Difficult People | LinkedIn http://tinyurl.com/l6x3eo4

medicolegal update

Dear Sir, You really provides useful informations. Regards: Dr Shreya

Forthcoming Events

29thSeptember–Dil Ka Darbar at Constitution Club of India,New Delhi

20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India

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