eMedinewS12th February 2014, Wednesday

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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ACIP Issues 2014 Immunization Schedule for Adults

Updated vaccination recommendations for adults aged 19 years and older for 2014 have been released by the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization.

  1. Haemophilus influenzae type b (Hib): The vaccine is recommended for certain adults at increased risk for Hib who have not received the vaccine before, except for those with HIV because their risk for Hib infection is low. Adults who have had a successful hematopoietic stem cell transplant are recommended to receive a 3–dose series of Hib vaccine 6 to 12 months after the transplant regardless of Hib vaccination status.
  2. Influenza vaccine: The update adds information on the use of the recombinant influenza (RIV) and inactivated influenza (IIV) vaccines among egg–allergic patients was added to the footnote and indicates that RIV or IIV can be used among persons with hives-only allergy to eggs, as it contains no egg protein.
  3. Td/Tdap: The tetanus, diphtheria, acellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines footnote was edited to harmonize with the language used in the pediatric immunization schedule. A single dose of Tdap vaccine is recommended for previously unvaccinated persons aged 11 years or older, and Td booster should be administered every 10 years thereafter.
  4. Human papillomavirus: "Information was added to the human papillomavirus…vaccine footnote to clarify the timing between the second and third doses and to harmonize language between the pediatric and adult immunization schedules. No changes in recommendations were made.
  5. Zoster: "Being a healthcare worker is no longer an indication for vaccination."
  6. Pneumococcal vaccines: "PCV13 (the 13–valent pneumococcal vaccine) is recommended to be administered before PPSV23 (the 23–valent pneumococcal vaccine) among persons for whom both vaccines are recommended. The PCV13 footnote now precedes the PPSV23 footnote and includes wording to remind providers of the appropriate order of these vaccines when both are indicated."
  7. Meningococcal vaccine: The footnote "was edited to clarify which persons need either one or two doses of vaccine and to provide greater clarity regarding which patients should receive meningococcal conjugate (MeanACWY–D) versus the meningococcal polysaccharide (MenACWY–CRM)."

Ann Intern Med. 2014;160:190–197

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."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Always Respect Others Viewpoints

sprritual blog

It is an old saying that one is proud of his or her own intelligence and somebody else’s partner and wealth. Most disputes occur when there is an ego clash and that occurs when you want your point to be noticed by everybody. But remember that for every situation, invariably, there will be multiple opinions.

In one of my meetings, I asked my lifestyle students–cum–colleagues to imagine Rahul Gandhi as the Prime Minister of the country. Following were the views of various people:

• He is too young.
• He is immature.
• He is childish
• It will be failure of democracy
• He has no political will
• He has no strength for taking decisions
• He has no experience
• He is open minded
• He will bring youth to politics
• He has experienced team behind him
• He will bring a new approach to politics etc. etc.

The message is very clear that everybody has their own perception and we should learn to respect that.

cardiology news

A Simple Gesture

A little boy selling magazines for school walked up to a house that people rarely visited. The house was very old and run down and the owner hardly ever came out. When he did come out he would not say hello to neighbors or passers by but simply just glare at them.

The boy knocked on the door and waited, sweating from fear of the old man. The boy’s parents told him to stay away from the house, a lot of the other neighborhood children were told the same from their parents.

As he was ready to walk away, the door slowly opened. "What do you want?" the old man said. The little boy was very afraid but he had a quota to meet for school with selling the magazines.

"Uh, sir, I uh am selling these magazines and uh I was wondering if you would like to buy one." The old man just stared at the boy. The boy could see inside the old man’s house and saw that he had dog figurines on the fireplace mantle. "Do you collect dogs?" the little boy asked. "Yes, I have many collectibles in my house, they are my family here, they are all I have." The boy then felt sorry for the man, as it seemed that he was a very lonely soul. "Well, I do have a magazine here for collectors, it is perfect for you, I also have one about dogs since you like dogs so much." The old man was ready to close the door on the boy and said, "No boy, I don't need any magazines of any kind, now goodbye."

The little boy was sad that he was not going to make his quota with the sale. He was also sad for the old man being so alone in the big house that he owned. The boy went home and then had an idea. He had a little dog figure that he got some years ago from an aunt. The figurine did not mean nearly as much to him since he had a real live dog and a large family. The boy headed back down to the old man’s house with the figurine. He knocked on the door again and this time the old man came right to the door. "Boy, I thought I told you no magazines."

"No, sir I know that, I wanted to bring you a gift." The boy handed him the figurine and the old man’s face lit up. "It is a Golden Retriever, I have one at home, this one is for you." The old man was simply stunned; no one had ever given him such a gift and shown him so much kindness. "Boy, you have a big heart, why are you doing this?" The boy smiled at the man and said, "Because you like dogs."

From that day on the old man started coming out of the house and acknowledging people. He and the boy became friends; the boy even brought his dog to see the man weekly.

This simple gesture changed both of their lives forever.

News Around The Globe

  • Oncologists seeing a new patient with cancer should take a family history, specifically asking about cancer in first– and second–degree relatives, says the American Society of Clinical Oncology (ASCO) in a new expert statement published online February 3 in the Journal of Clinical Oncology.
  • The US Endocrine Society has called for a fuller assessment of the risks and benefits of testosterone treatment in older men with declining levels of the hormone. The 2 decisions come in the wake of new studies that have raised concerns about testosterone therapy in older men with a history of cardiovascular disease.
  • Surgical margins with no ink on tumor have the lowest risk of ipsilateral breast cancer recurrence and represent the clinical standard for management of early disease, according to a new consensus guideline from several major oncology groups. Positive margins associated with ink on tumor for ductal carcinoma in situ (DCIS) doubles the risk of ipsilateral recurrence compared with negative margins. Wider excision does not reduce the risk of recurrence compared with no ink on tumor. The adverse impact of ink on tumor persists irrespective of favorable biology, endocrine therapy, or radiotherapy boost, according to simultaneous online publications in Annals of Surgical Oncology, International Journal of Radiation Oncology Biology Physics, and the Journal of Clinical Oncology.
  • Elevations in blood pressure in the first trimester of pregnancy, even those below the cutoff for overt hypertension, may increase the risk for preeclampsia among women receiving aspirin prophylaxis, according to a new study published in the March issue of Obstetrics & Gynecology.
  • The common antifungal drug itraconazole may be useful in treating basal cell carcinoma (BCC), according a phase 2 study published online last week in the Journal of Clinical Oncology. Itraconazole showed anti–BCC activity in a 29–patient study: 24% of the 19 patients treated for a month with common doses of the drug had a reduced tumor area. Also, itraconazole reduced cell proliferation by 45%.

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

eMedinewS e–gifts to our readers

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Rabies News (Dr. A K Gupta)

What are monoclonal antibodies?

Monoclonal antibodies (mAb) are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.

cardiology news

New form of heart failure on the rise

Heart failure is routinely described as the progressive loss of ability of the heart to pump blood. But, there is another form of heart failure where the blood–pumping ability of the heart remains near normal. This second form of heart failure is too often overlooked and is just as lethal.

In this condition the heart muscle becomes thickened. The chamber inside gets smaller and the heart is unable to relax to accommodate the blood it needs to pump out. As there is no room for the heart to relax, the blood backs up into the lungs. This kind of anomaly is not picked up by standard measurements of "ejection fraction" – the percentage of blood in the heart that goes out with every beat.

This form of the disease is called "diastolic heart failure" because the problem occurs during the diastole portion of heart activity, as the heart relaxes after a beat. Nearly one–third of these patients have an ejection fraction greater than 50 percent, which is very near normal. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure, with more than 20% of all the patients dying within a year. There is a steady increase over 15 years of heart failure with normal or near–normal ejection fraction.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising and fluid retention in the body. Physicians cannot make a diagnosis on the basis of symptoms or routine examinations. One has to have an echocardiogram and see the heart pumping and see if the ejection fraction is normal or reduced. Until now, relatively little attention has been paid to diastolic heart failure. Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.

Pacing for heart failure

For patients with advanced heart failure waiting for cardiac transplant, biventricular pacing not only improves the quality of life but also prolongs life. If the ejection fraction is low the combo device also gives an electric shock when the heart stops. It is said that all patients with low ejection fraction should ask their doctors for possible implantation of these devices.

Signals of heart failure

One of the commonest presentations is breathlessness on exertion, which is often confused as a part of aging or being obese. Not being able to climb stairs may be the earliest sign of hypertensive diastolic heart failure. Other signals are:

  1. Feeling extra tired even after a good night’s sleep. People with heart failure may limit activities they like to do or take naps to avoid feeling tired.
  2. Weight gain: Call your doctor if you gain weight for more than 2 days in a row or if you gain 2 or more pounds.
  3. Shortness of breath: Heart failure makes breathing harder, especially during exercise. Lying position may make it worse.
  4. Swollen ankles, legs, belly, and/or lower back, the swelling is often worse at the end of the day.
  5. Going to the bathroom more at night.
cardiology news

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

An analysis of more than 220 US hospitals reveals wide variation in the use of noninvasive imaging in patients presenting to the emergency department with chest pain. Despite the variation, hospitals with high rates of imaging did not have lower MI readmission rates than those with lower rates of noninvasive cardiac imaging. Patients treated at hospitals that were larger users of noninvasive imaging were more likely to be admitted to the hospital and to undergo coronary angiography, however. Dr Harlan Krumholz (Yale University School of Medicine, New Haven, CT said the study, published online February 10, 2014 in JAMA: Internal Medicine, was intended to provide some data on the nationwide evaluation of patients with suspected ischemic heart disease, specifically those with acute coronary syndromes. These patients are often difficult to track because they can be lost to follow–up once they enter into the hospital.

cardiology news

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

Renal and bladder ultrasound (RBUS) is a poor screening tool for genitourinary (GU) abnormalities identifiable on voiding cystourethrogram (VCUG) after febrile urinary tract infections (UTIs) in children, according to a study published online February 10 in Pediatrics.

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

Prevention – The best treatment to stay away from stress

Heart Care Foundation of India released tips for stress prevention for before, during and after the exams. The best treatment is prevention, said Padma Shri, Dr B C Roy National & DST National Science Communication Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association.

Before the exam: Plan, Prioritize and Practice; do what needs to be done first; prepare well, do timely rehearsals; review often, and test yourself as anxiety can lead to "blanking out"; be regular as its what you’ve studied through the year that will be useful, not what you do at the last minute; gather information about the exam; learn quick relaxation and breathing techniques; take compulsory rest for 10 minutes every hour, and do something different. Do not focus on any past experiences of blanking out or performing badly in exams. Instead, focus on the quality of your performance and not the outcome as this would only damage your concentration.

During the exam: Jot down hard to remember formulae; quickly scan the exam paper before answering; decide where to begin; decide how much time to spend on each question; read directions carefully; do easy questions first and relax.

After the exam: Reward yourself, keep practicing positive self–talk and analyze your exam.

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 86664 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."

emedipicstoday emedipics

CPR Training, Chinmaya Vidyalaya at Vasant Vihar, Delhi 4th February 2014

press release

PPIs may be associated with a higher risk for clostridium difficile–associated diarrhea

vedio of day

today video of the dayHeart disease starts in youth

Cholesterol tips released

Padma Shri & Dr B C Roy National Awardee, Dr KK Aggarwal on Tackling tension headaches

eMedi Quiz

A vitreous aspirate has been collected in an emergency at 9 pm. What advice you like to give to the staff on duty regarding the overnight storage of the sample.

1. The sample should be kept at 4°C.
2. The sample should be incubated at 37°C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37°C.

Yesterday’s Mind Teaser: A 60 year old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

1. Thymoma
2. Lung cancer.
3. Hodgkin’s lymphoma.
4. Superior vena caval obstruction.

Answer for yesterday’s Mind Teaser: 4. Superior vena caval obstruction.

Correct answers received from: DR.A.K.GAJJAR, Dr.Sridhar Deivasigamani, drjella, Dr Mathew Abraham, Sangeetha Raja

Answer for 10th February Mind Teaser: 1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer

Correct answers received from: Dr Mathew Abraham, Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update

Health Professionals in Heaven

Three nurses died and went to Heaven. They were met at the Pearly Gates by St. Peter, who questioned them.

"What did you used to do back on Earth?" he asked the first nurse. "Why do you think you should be allowed into Heaven?"

She told him, "I was a nurse at an inner city hospital. I worked to bring healing and peace to many sufferers, especially poor children."

"Very noble. You may enter." And he ushered her through the gates. He asked the same questions to the next nurse.

"I was a missionary nurse in the Amazon. For many years I worked with a small group of doctors and nurses to help people in numerous tribes, healing them and telling them of God's love." The second nurse replied.

"Excellent!" said St. Peter. And he ushered her through the gates as well. Finally he posed his questions to the third nurse. She hesitated, and then explained, "I was just a nurse at an HMO."

St. Peter considered her answer for a moment, then told her, "Well, you can enter too."

"Wow!" the nurse exclaimed in relief. "I almost thought you weren’t going to let me in."

"Oh, you can certainly come in," St. Peter told her, "but you can only stay for three days."

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why did you ignore the blood pressure of 90/80?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

medicolegal update

Productive achievement is a consequence and an expression of health, self–esteem, not its cause. Nathaniel Branden

medicolegal update

Dr KK Aggarwal: Heart disease starts in youth: http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: At our core we are all capable and deserving of love http://bit.ly/DC_Ananda #ananda

Forthcoming events

Date: Saturday 2PM-Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

medicolegal update
  1. Dear Dr. Aggarwal, I loved the issue of 5 Feb especially the write-up about stress, positive attitudes and potatoes. God bless you, Dr. R.K. Anand

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