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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 ...

13th October 2010, Wednesday

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

Hanuman – The Right Prescription

The epic Ramayana has two faces. The first face is characterized by Rama, Lakshmana and Sita with Dashratha and the second face is characterized by Rama, Lakshmana and Sita with Hanuman. Rama, Lakshmana and Sita represent mind, body and soul. They can only be together once the 10 senses are under control. The controlled 10 senses represent Dashratha (Dash means 10 and ratha of horses means senses). For body, mind and soul to be together, one needs to control these 10 senses. Lust, or Kama can easily destroy these ten senses; lust in Ramayana is represented by Kaikeyi.

Once the 10 senses are destroyed (Dashratha killed), mind is easily diverted by Lobha (represented by Mareech, the illusion of golden deer). Once this happens, one can reunite the mind, body and soul only with the help of Hanuman, which represents control of mind by conquering the internal prana. In the modern and in the ancient naturopathy science, it represents learning the process of Pranayama as mentioned in swaryoga. Pranayama is also mentioned in Yoga Sutras of Patanjali as one of the essential eight limbs of yoga. To conquer the mind, one needs to practice the process of pranayama. Conquering the mind means conquering the thoughts. Thoughts are likened to monkeys with their habit of wandering here and there. Conquering the mind means not only conquering Hanuman but also its army of vanaras or monkeys. According to Yoga Vashistha and Yoga Sutras of Patanjali, by conquering the mind one can acquire different yogic powers of siddhis known to be possessed by Hanuman.

Hanuman has a unique distinction of being great in physical strength, mental stability and virtuous character.

Another description of Hanuman comes as a representative of true bhakti, which is a triad of doing one's duty with devotion and discipline. This represents the triad of Rama, Lakshmana and Hanumana as the triad of devotion (Rama), duty (Lakshmana) and discipline (Hanumana).

Hanumana in Ramayana is equated to Bheema in Mahabharata representing the inner strength of a person who has acquired dharma, artha, kama and moksha.

One aspect of Hanuman was that to conquer any evil through its inner powers he had to be prompted for the same. He, on his own, was not able to achieve the same. This is what Jambavan did when he reminded Hanuman of his inner powers to travel the ocean to reach Lanka in search for Sita. This represents the path of meditation where intent is the most important component. Doing meditation without intent does not achieve any siddhi or powers. In his book the ‘Seven spiritual laws of Success’, Deepak Chopra talks in great detail about the powers of this intent. He says that everybody should have desires, treat them as intents, sow these seeds in their consciousness and wait for their fulfillment over a period of time.

The journey of Hanumana across the ocean also has spiritual significance. It represents the journey of meditation and the ocean represents the ocean of mind with wandering waves (ideas/thoughts). On the way, he conquers three basic obstacles in the form of Mainaka Mountain, Sarasa or ‘sursa’ the mother of snakes, and Singhika or Simhika the demon. They in turn represent tamas (Mainaka Mountain), ego (Sursa) and desires (Simhika).

Hanuman also represents the benefits of doing japa or meditation. Japa is the continuous chanting of a seed mantra. In this case it was ‘Rama’. If one continuously chants the mantra "Rama” in any one of the seven chakras, one can achieve the benefits of that chakra. These seven chakras are located in the sacrum, sex gland, celiac plexus, thymus gland, thyroid gland, pituitary and penile gland.

The story of Hanuman tearing opening his chest and showing the image of Rama denotes that chanting of the word ‘Rama’ and focusing this chanting on heart or anahata chakra present in the chest near the thymus gland, one can achieve the powers of Hanumana. It shows that the word ‘Rama’ was stitched to Hanumana’s consciousness.

Dr KK Aggarwal
Editor in Chief
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  Dengue Update

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.

What is platelet failure?

If repeated transfusions do not lead to expected rise of platelets or obtain homeostasis one should suspect platelet refractoriness called platelet allo-immunization and is due to antibodies to platelet antigens or to HLA.

  Photo Feature (from the HCFI Photo Gallery)

Perfect Health Parade 2004

Dept of Science and Technology (DST), Govt of India observed the year 2004 as Year of Scientific Awareness. Following the guidelines of DST, the Perfect Health Parade in 2004, an annual event of Heart Care Foundation of India, had Scientific Awareness as its theme.
In the photo: Geeta Chandran, Famous Bharatnatyam exponent; Shri Yoganand Shastri, Minister of Health & Family Welfare and Social Welfare and Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI at the Perfect Health Parade.


Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Phosphodiesterase type 5 inhibitor use and hearing impairment

In a large population–based sample, sildenafil use was associated with hearing loss; no association was found for tadalafil or vardenafil.

(Reference: McGwin G, et al. Phosphodiesterase type 5 inhibitor use and hearing impairment. Arch Otolaryngol Head Neck Surg 2010;136:488).

  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.

Is the new fever in Delhi Chikungunya fever?

Diagnosis of Acute Chikungunya infection

  • The most common laboratory abnormalities are lymphopenia and thrombocytopenia. Liver enzymes may be elevated.
  • Serology is the primary tool for diagnosis in the clinical setting. IgM anti–Chikungunya virus antibodies (detected by direct enzyme–linked immunosorbent assay (ELISA)) are present starting about 5 days (range 1 to 12 days) following onset of symptoms and persist for several weeks to 3 months. IgG antibodies begin to appear about 2 weeks following onset of symptoms and persist for years.

Sequelae & Complications of Acute Chikungunya infection

In earlier reports, Chikungunya fever has been described as a self–limited illness, although severe complications and death have been reported in the more recent outbreaks. It is unclear whether these differences reflect a modulation in virus virulence, improved epidemiologic observation, or both. Severe complications and death occur more often among patients older than 65 years and in those with underlying chronic medical problems.

  • Following acute illness (usually lasting 7 to 10 days), some patients may experience persistent rheumatologic signs and symptoms including arthritis/arthralgia, edematous polyarthritis of fingers and toes, morning pain and stiffness and severe tenosynovitis (especially of wrists, hands and ankles)
    The duration of persistent symptoms is variable. Among 47 patients with acute chikungunya fever followed in Marseilles, France, 82 % had persistent joint symptoms. At one, three, and six months following acute illness, symptoms persisted in 88, 86, and 48 % of patients, respectively; at 15 months, 4 % remained symptomatic. In contrast, among 88 patients in Reunion evaluated a mean of 18 months after confirmation of acute Chikungunya infection, 63 % reported persistent polyarthralgia.Morning stiffness was reported by 75 % of individuals, and almost half reported that the pain had a negative impact on daily activities. One study in South Africa reported arthralgia 3 years after the acute illness in 12 % of patients.
  • Carpal tunnel syndrome may result from hypertrophic tenosynovitis.
  • In addition, patients may report joint or bone pain at sites of previous injury. Occasionally, unusual joints (such as sternoclavicular or temperomandibular joints) are involved.
  • New–onset Raynaud phenomena in the second or third month following infection have been described in up to 20 % of cases.

Severe complications include respiratory failure, cardiovascular decompensation, myocarditis, acute hepatitis, renal failure and neurologic involvement.

  • Meningoencephalitis is the most common neurologic complication; other manifestations include acute flaccid paralysis and Guillain Barre syndrome.
  • Ocular manifestations (iridocyclitis, retinitis, episcleritis, macular choroiditis) and sensorineural hearing loss have also been described.
  • In Reunion, the estimated incidence of severe disease (e.g., hospitalized patients with complications, such as respiratory failure, meningoencephalitis, acute hepatitis, or kidney failure) was 17 per 100,000 population.

Differential diagnosis

  • Dengue fever: Chikungunya and Dengue virus infections have some common clinical symptoms and areas of geographic distribution; distinguishing them may be difficult in the setting of acute febrile illness with rash. However, polyarthralgia occurs in virtually all cases of Chikungunya fever but is not typical of dengue fever (though dengue fever patients commonly have myalgias).
  • Other infections in the differential diagnosis include other viral infections (primary HIV infection, measles, rubella, Ross River virus), malaria, rickettsial infections, relapsing fever, leptospirosis, meningococcal infections, EBV, and enteric fever (typhoid and paratyphoid fevers).
  • If the clinical course is atypical or fever persists longer than 5 to 7 days, the possibility of dual infection should be considered.
  • Chikungunya virus outbreaks have occurred simultaneously with outbreaks of dengue or yellow fever, and coinfection with Chikungunya virus and other pathogens has been described (eg, Chikungunya and dengue, Chikungunya and yellow fever, Chikungunya and amebiasis.

Treatment of Chikungunya fever

  • Treatment consists of supportive care including anti-inflammatory agents that relieve symptoms in many patients and analgesic agents.
  • No antiviral agents have been shown to be effective in human infection, although ribavirin and interferon-alpha appear to have in vitro activity against virus replication.
  • Chloroquine sulfate has been suggested as a possible treatment because of its anti-inflammatory properties.
  • For seriously ill patients, there are insufficient data for use of corticosteroids or antiviral therapy.
  International News

(Dr Monica and Brahm Vasudev)

Girls living in higher–income households without biological father may undergo puberty earlier

There may be a link between early puberty and girls living in higher–income households without a biological father, according to a study published in the Journal of Adolescent Health.

FDA taking more time to review bevacizumab for breast cancer

Drugmaker Roche said Friday that US health regulators will take more time to review its drug Avastin [bevacizumab] for breast cancer, a use that has generated vigorous debate among cancer specialists and patients.

Indacaterol more effective than standard medicine in patients with smoker’s cough

Novartis AG’s Onbrez Breezhaler (indacaterol) was more effective than a standard medicine used in a GlaxoSmithKline Plc product in a late–stage study of patients with smoker’s cough.

FDA panel recommends against approving diet drug Lorcaserin

An FDA panel has recommended against approval of a new diet pill, lorcaserin, which is the latest setback in efforts to develop treatments for the nation’s obesity epidemic.

  Hepatology Update

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

Is ROME III criteria for functional abdominal pain in children reliable?

Diagnosis of functional abdominal pain conditions is based on the pediatric Rome criteria. The reliability of the Rome III criteria has not been established. A total of 10 pediatric gastroenterologist specialists and 10 pediatric gastroenterology fellows were provided with 20 clinical vignettes and a list of 17 possible diagnoses (all pediatric categories of the Rome criteria plus "none of the above" or "not enough information") and instructed to select one or more diagnosis for each vignette.
The average percentage of agreement among the raters was 50% for the pediatric gastroenterologists and 45% for the pediatric gastroenterology fellows. The inter-rater percentage of agreement per clinical case was >50% in only 7 out of 20 (35%) vignettes for the gastroenterologists and only 6 out of 20 (30%) cases for the fellows. The IRR among pediatric gastroenterologists and fellows was found to be fair to moderate for the Rome III criteria. Only slight to fair agreement between raters existed for important subcategories of pain and constipation. The results from this current study are almost similar to that of the IRR study done for the Rome II criteria. This indicates the need for further refinement of the Rome criteria to make them more encompassing and user friendly.

Am J Gastroenterol 31 August 2010

  Infertility Update

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

What causes infertility in women?

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis. Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages. Aging is also an important factor in female infertility. The ability for ovaries to produce eggs declines with age, especially after age 35.

  ENT Update

Dr. Aru Handa MS, DNB (Department Co–ordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

What are the ENT manifestations of AIDS ?

About 70% of patients of AIDS have some ENT problem at different stages of the disease. The various ENT manifestations include neck swellings, nasopharyngeal lymphatic tissue hypertrophy which may manifest as ear and sinus infection, oropharyngeal candidiasis, oral hairy leukoplakia, recurrent aphthus ulcers, gingivitis, squamous cell carcinoma, extranodal lymphoma, parotid swellings, nodal tuberculosis, Kaposi’s sarcoma, peripheral facial paralysis, herpes Zoster, seborrheic otitis externa.

The clinician should have a high degree of suspicion in patients with these presentations and get them evaluated and investigated.

  Medicolegal Update

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

What is poisoning from misuse of chemical products or medicines?

Phosphodiesterase type 5 inhibitor use and hearing impairment. Arch Otolaryngol Head Neck Surg 2010;136:488People who take someone else’s medicine may suffer harm if they take the wrong dose or take a medicine that is not meant for treating their condition. Women who take medicine to try to end a pregnancy are misusing the medicine, and may poison themselves. Poisoning accidents can happen when safety warnings are ignored and chemicals are used in the wrong way. The following are illustrative.,

  • Bleach containers usually contain a warning that bleach should not be mixed with any other cleaner. If people ignore the warning and use bleach with another household cleaner, they may be poisoned by the gases given off.
  • Insecticides meant to be used on plants or buildings, if used to kill insects living on people, in their hair or on their bodies may cause accidental poisoning.
  • Sometimes people poison themselves by misusing medicines. They may take more than the doctor prescribed because they think, wrongly, that a larger dose will make them better more quickly.
  • Taking someone else's medicine is also a kind of misuse.
  Medi Finance Update

Individual Mediclaim policy

Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X–ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of organs and similar expenses.

  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 Chloramphenicol with any other drug for internal use

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum angiotensin converting enzyme factor is used to help diagnose and monitor sarcoidosis and to help differentiate this systemic condition from other disorders causing similar symptoms.

  IJCP Special

Dr Good Dr Bad

Situation: A CKD patient wanted to know if she should go for brachial artery flow mediated test for arterial stiffness.
Dr Bad: It’s not needed.
Dr Good: Get it done.
Lesson: Increased arterial stiffness is noted in patients with CKD and end–stage renal disease, and is a possible risk factor for increased cardiovascular mortality.

Make Sure

Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Rection: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lasson: Make sure to remember that higher incidence of hepatitis with cholestatic jaundice occur in pregnancy with erythromycin estolate.

Quote of the Day (Dr. G M Singh)
"Jealousy is the dragon in paradise; the hell of heaven; and the most bitter of the emotions because associated with the sweetest." A.R. Orage

  Mind Teaser

Read this…………………

dont red

Answer for yesterday’s Mind Teaser: "A bird in the hand is worth two in the bush "

Correct answers received from: Dr Virender Prakash Gautam, Dr. Susheela Gupta, Dr Vijay Kansal, Dr Himanshi Manaktala, Dr Sudha Nayyar, Dr Jainendra Upadhyay, Dr Neelam Nath, Dr. Naorem Sharat, Dr Muthumperumal Thirumalpillai, Dr S Upadhyaya, Deepti Katyal Uppal, Dr.K.V.Sarma, Dr. R.K.Goel, Dr. Harkiran Kaur, Dr R S Bajaj, Dr Shashi Saini,Dr Suparna khera, Dr. Dinesh Kumar S, Dr Anupam Sethi Malhotra, Dr. Rohini Vaswani, Dr Meera Rekhari, DR R S BAJAJ, Dr Rraghuveer Rao,

Answer for 11th October Mind Teaser is: "Think before you act"
Correct answers received from: Dr. Ajay Gandhi, Dr Rashmi Chhibber, Dr. Harkiran Kaur, Dr.Satish Gunawant, Dr. S Upadhyaya, Dr Neelam Nath, Dr Vijay Kansal, Dr U Gaur, Dr. Rajiv Khosla

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)
Mass Hysteria

A professor of clinical psychology at Victoria University in Wellington, New Zealand, included a lecture on crowd psychology in his annual course. To illustrate mass hysteria, he regularly showed TV news footage of teenage crowds greeting the Beatles at the local airport in the 1960’s.

One year, when he ran the footage, he heard squeals and bursts of laughter from his students. When the film ended he asked what had caused the hilarity. Replied one student, "We recognized some of our mothers!"

You are an Indian if (Anuj Goel)
You buy and display crockery, which is never used, as it is for special occasions, which never happen.

  An Inspirational Story

The Power of Encouragement ( Dr. G.M.Singh)
The word encourage (en= in + courage) simply means to put courage into another—something we all need to do and receive regularly.

Years ago—when I was a young teenager—one of the men in our church gave me a light manly punch on my arm and gave me a compliment about my football game as I passed by him. I’ve never forgotten that compliment which to me was a big encouragement when I needed it. Some years later I recall how in my beginning days of ministry, after speaking to a youth group, one of the members in attendance said to me, "Thank you for being God's messenger to me today." I’ve never forgotten her words and those of many others along the way either. (Sadly, a cutting word can have the opposite long–term effect.)

As Leo Buscaglia said, "The majority of us lead quiet, unheralded lives as we pass through this world. There will most likely be no ticker–tape parade for us, no monuments created in our honor. But that does not lessen our possible impact, for there are scores of people waiting for someone just like us to come along; people who will appreciate our compassion, our unique talents. Someone who will live a happier life merely because we took the time to share what we had to give. Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have a potential to turn a life around. It’s overwhelming to consider the continuous opportunities there are to make our love felt."

Suggested prayer: Dear God, thank you for all the people who have encouraged me along the way. They are greatly appreciated. And please help me to be an encourager to someone else every single day just as others have encouraged me. Thank you for hearing and answering my prayer.

  Readers Responses
  1. Dear Sir, emedinews is really the best medical newspaper. If one uses it for updates, it will certainly enhance the clinical knowledge. An example for this is an update on modified Chikungunya fever outbreak in Delhi. We can also think of variety of viral fevers like Ross river fever. Thanks to our beloved Dr KK Aggarwal: Dr Valluri Ramarao, Joint Secy CGP, TN
  Public Forum

(Press Release for use by the newspapers)

Relieve Stress by Changing the Interpretation

Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body the yogic way in such a way that stress does not affect the body, said Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Yoga would be a major activity 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 23 to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi. Yoga Competitions would also be held for school children on 28th October.

He said that studies have shown that anger, hostility and aggression are the new risk factors for heart disease. It has been shown that even recall of anger can precipitate a heart attack.

Talking about prayer, Dr. Aggarwal said that many studies have shown that in front of unconscious patients in ICU when doctors talk positive their outcome is better than those patients in whose presence doctors talk negative.

Dr. Aggarwal said that the best way to practice spiritual medicine is to experience silence in thoughts, speech and action. Simply walking in the nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. He said that 20 minutes of meditation provides the same physiological parameters as does seven hours of deep sleep.

  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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