eMedinewS
13th December 2014, Saturday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, 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

Smoking makes you older by 5 years

Men have a greater chance of dying then women, and smoking increases any adult’s risk of death just as if five years were suddenly added to their age.

  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

NATIONAL NEWS

Proceedings of 66th Annual Conference of Cardiological Society of India (4-7th December, Hyderabad)

Coronary disease in women (Dr Alexandra Lansky, USA)

  • India contributes 60% of world’s heart disease burden. About 48% of Indian population is female.
  • CAD is not just a disease of man. Postmenopausal women are at a greater risk of CAD and today 33 million women are over 55 years of age.
  • CAD is more difficult to diagnose in women.
  • Much of the opportunity in CV of women lies in appropriate stratification and diagnosis.
  • About 90% of symptomatic primary care patients are not related to obstructive CAD. Most symptomatic patients evaluated for suspected CAD are ultimately diagnosed with non cardiac causes. More than half of these are due to musculoskeletal condition or GI disease; one–third are psychological, pulmonary or non specific.
  • Symptoms are not as useful in women as in men. Symptoms in women can be very confusing, which is a great challenge. They present with atypical, non specific and milder symptoms of CAD.
  • There is a high rate of false negative and false positive non invasive test results.
  • Low rates of obstructive disease at invasive coronary angiography. Most patients undergoing diagnostic angiography may have no or minimal stenosis.
  • Older women are more likely to develop contrast induced kidney injury.

There is clearly a need to advance the field in terms of diagnostics.

Value based cardiac imaging (Dr Daniel S Berman, USA)

  • Technology/assessments will improve across modalities and clinical settings.
  • The challenge is that these technologies by themselves do not improve diagnostics.
  • Applications providing value will dominate. Their value
    • Depends upon use in appropriate clinical setting
    • Requires linkage to therapeutic/behavioral change
    • Evidence will be required
  • Imaging for prevention used in CAC screening; CAC is a marker of CAD. It provides incremental prognostic value vs other variables like Framingham risk score.
  • Coronary CTA has a sensitivity and specificity of 95% and 90% respectively; unlikely to miss high risk disease. The negative predictive value is very high.
  • Coronary arterial 18F–sodium fluoride uptake has the potential to identify vulnerable plaque.

The road to effective primary prevention (Dr K Srinath Reddy, Delhi)

  • CVDs are leaders in disease burden including premature mortality.
  • A small decrease in risk factor levels when achieved across the whole population results in a larger reduction in CVD events.
  • In persons at high risk of adverse events in the next 10 years, drug therapy is the most cost effective approach.
  • Combination of population–based prevention and high risk individual management approaches yield the best results.
  • The road seems to be attainable if we take early and concerted action. So we talk of behavioral goals and health system changes.
  • If we try to reduce tobacco by 50%, we are likely to achieve our goal by 2025. There is global evidence including from low middle income countries that taxation on tobacco is effective.

News Around The Globe

  • Starting treatment with the opioid analgesic tramadol is associated with an increased risk for hypoglycemia requiring hospitalization, suggests a new study published online December 8 in JAMA Internal Medicine.
  • The antipsychotic ziprasidone and its generic counterparts have been linked to a rare but potentially fatal skin reaction DRESS (drug reaction with eosinophilia and systemic syndromes), thus prompting the US Food and Drug Administration (FDA) to add a new warning to the drug's label.
  • The administration of progesterone immediately after acute traumatic brain injury (TBI) shows no benefit in improving functional outcomes, suggest two large, phase 3 randomized clinical trials published online December 10 in the New England Journal of Medicine.
  • A small trial has shown pancreatic islet–cell isolation can be performed in a location remote from surgery in patients undergoing total pancreatectomy followed by autologous islet–cell transplantation. The report is published online December 10 in JAMA Surgery.
  • Five years of tamoxifen continues to prevent breast cancer from developing in women at high risk for the disease, more than 15 years after they stopped taking it, suggest follow–up results from the IBIS-I (International Breast Cancer Intervention–I) trial presented at the San Antonio Breast Cancer Symposium.

Dr KK Spiritual Blog

Did all Gods suffer before death?

Most Gods and spiritual gurus had suffered in their last days. Lord Krishna had a nonhealing wound, Jesus Christ was crucified, Bhagwan Rajneesh had an infectious disease, Swami Chinmayanand had low functioning heart, Maharshi Mahesh Yogi had heart and pancreatic disease, Satya Sai Baba was put on a ventilator etc.

When they were God–like personalities, why did they suffer in their last days?

The answer to this comes from Vedic knowledge within the concept of rebirth. Vedanta says that the very fact that we are born means that in the last birth we did not attain moksha or liberation. In other words, this means that there were some sufferings yet to be faced. You are born to face those sufferings. When you face the last suffering, there are high chances that that suffering may be your last suffering before liberation.

Most Gods or saints who died in a phase of suffering may mean that they did not attain liberation.  A person who dies suddenly or unnaturally would mean that he would have to take rebirth to face more sufferings.

According to me, terminal sufferings are good from spiritual point of view.

Inspirational Story

Don’t hope, decide!

While waiting to pick up a friend at the airport in Portland, Oregon, I had one of those life–changing experiences that you hear other people talk about — the kind that sneaks up on you unexpectedly. This one occurred a mere two feet away from me.

 Straining to locate my friend among the passengers deplaning through the jet way, I noticed a man coming toward me carrying two light bags. He stopped right next to me to greet his family.

 First he motioned to his youngest son (maybe six years old) as he laid down his bags. They gave each other a long, loving hug. As they separated enough to look in each other’s face, I heard the father say, “It’s so good to see you, son. I missed you so much!” His son smiled somewhat shyly, averted his eyes and replied softly, “Me, too, Dad!”

 Then the man stood up, gazed in the eyes of his oldest son (maybe nine or ten) and while cupping his son’s face in his hands said, “You’re already quite the young man. I love you very much, Zach!” They too hugged a most loving, tender hug.

 While this was happening, a baby girl (perhaps one or one–and–a–half) was squirming excitedly in her mother’s arms, never once taking her little eyes off the wonderful sight of her returning father. The man said, “Hi, baby girl!” as he gently took the child from her mother. He quickly kissed her face all over and then held her close to his chest while rocking her from side to side. The little girl instantly relaxed and simply laid her head on his shoulder, motionless in pure contentment.

 After several moments, he handed his daughter to his oldest son and declared, “I’ve saved the best for last!” and proceeded to give his wife the longest, most passionate kiss I ever remember seeing. He gazed into her eyes for several seconds and then silently mouthed. “I love you so much!” They stared at each other’s eyes, beaming big smiles at one another, while holding both hands.

 For an instant they reminded me of newlyweds, but I knew by the age of their kids that they couldn’t possibly be. I puzzled about it for a moment then realized how totally engrossed I was in the wonderful display of unconditional love not more than an arm’s length away from me. I suddenly felt uncomfortable, as if I was invading something sacred, but was amazed to hear my own voice nervously ask, “Wow! How long have you two been married?

 “Been together fourteen years total, married twelve of those.” he replied, without breaking his gaze from his lovely wife’s face. “Well then, how long have you been away?” I asked. The man finally turned and looked at me, still beaming his joyous smile. “Two whole days!”

 Two days? I was stunned. By the intensity of the greeting, I had assumed he’d been gone for at least several weeks – if not months. I know my expression betrayed me.

 I said almost offhandedly, hoping to end my intrusion with some semblance of grace (and to get back to searching for my friend), “I hope my marriage is still that passionate after twelve years!” The man suddenly stopped smiling.

 He looked me straight in the eye, and with forcefulness that burned right into my soul, he told me something that left me a different person. He told me, “Don’t hope, friend… decide!” Then he flashed me his wonderful smile again, shook my hand and said, “God bless!”

Rabies News (Dr A K Gupta)

Is there a one–shot ARV? Is there any ARV that offers lifelong protection?

There is no single dose vaccine or a vaccine that gives lifelong immunity.

Cardiology eMedinewS

  • A new review article suggests that sugar, not salt, appears to contribute to the majority of the hypertension risk associated with processed food. The review is published in Open Heart.
  • A new analysis based on a randomized trial suggests that all healthy middle–aged and older women should not take low–dose aspirin for primary prevention of CVD or colorectal cancer, since the risk of major gastrointestinal (GI) bleeding outweighs the prevention benefits. The study is published online in Heart.
emedipicstoday emedipics

Health Check Up and CPR 10 Camp at Govt Boys Sr. Sec. School M.B Road, Pushp Vihar Sec-1 New Delhi on 1st December 2014

video of day
press release

Monitoring LFT in a patient on statins

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 trained

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 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A patient with hypertension had non–responding cough.
Dr. Bad: Take an X–ray.
Dr. Good: Stop ACE inhibitors.
Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

eMedinewS Humor

A patient on her second visit to the optometrist’s clinic: "I see specs before my eyes". The optometrist asks, "Didn’t the new spectacles help?" The patient replies, "Sure, the specs now appear clearer."

Twitter of the Day

Dr KK Aggarwal: : Do not eat more than 5 grams of salt in a day

Dr Deepak Chopra:We are the controllers of our own physiology, and we can take steps to restore our health and vitality

Pediatrics eMedinewS

  • Children who receive routine childhood immunizations are not more likely to develop allergies later in life, despite contrary claims from parents, and are even protected against allergic disease, reported a cohort study presented at the World Allergy Organization International Scientific Conference and Congress of the Brazilian Association of Allergy and Immunology.
  • Children who need maintenance hydration have lesser odds of developing hyponatremia with isotonic fluid than with hypotonic fluid, suggests a new trial published online in The Lancet.

Quote of the Day

  • He who closes his ears to the views of others shows little confidence in the integrity of his own views. William Congreve

Wellness Blog

Vitamin D Facts

  • Calcium has an indispensable assistant in building bones: vitamin D.
  • Vitamin D helps the body absorb calcium.
  • Increasing vitamin D can help prevent osteoporosis.
  • A small amount of sun exposure can help the body manufacture its own vitamin D.
  • Five to 30 minutes of sunlight between 10 a.m. and 3 p.m. twice a week to your face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin
  • People with fair skin that burns easily should protect themselves from skin cancer by limiting sun exposure to 10 minutes or less.
  • Food and sun exposure should suffice, but if not, get 2,000 IU of vitamin D daily from a supplement.

ePress Release

Snorers at risk of sudden death

The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea.
Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

eMedi Quiz

An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2, 3 DPG concentration.
4. Oxygen affinity of haemoglobin.

Yesterday’s Mind Teaser: The parameters of sensitivity and specificity are used for assessing:

1.Criterion validity.
2.Construct validity.
3.Discriminant validity.
4.Content validity.

Answer for yesterday’s Mind Teaser: 1.Criterion validity.

Correct answers received from: Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Rakesh Sharma, Dr Avtar Krishan, Dr Poonam Chablani, Dr Bitaan Sen & Dr Jayashree Sen.

Answer for 11th December Mind Teaser:4.X–ray diffraction.

Correct answers received from: Dr K V Sarma, Dr Rakesh Sharma Nohar, Dr Avtar Krishan.
Send your answer to email

medicolegal update

(Contributed by Dr MC Gupta, Advocate)

Q. How are paternity tests conducted? What are their legal aspects?

Ans.

Paternity tests are conducted:

  • When an unmarried woman needs to know the biological father for claiming child support
  • When a married woman is suspected of adulterous relationship
  • When there are accusations of rape
  • When child support is claimed and denied on grounds of paternity
  • Paternity tests are basically DNA tests where the DNA of the couple and the child are tested. Samples tested may be those of: Blood; cord blood; buccal swab; semen; hair; other tissue. Paternity tests are conducted to confirm the biological father. The test may be done for reasons of curiosity or legal need. Curiosity need may arise when a woman has had several sex partners.
  • Postnatal tests are risk free. Prenatal tests need a special procedure to collect the child’s tissue by one of the following means:
    • Amniocentesis: This test is performed in the second trimester, anywhere from the 14th–20th weeks of pregnancy. A small amount of amniotic fluid is collected from the uterus through a needle passed trans–abdominally under ultrasound guidance. There is a slight chance of miscarriage. Other side effects may include cramping, leaking of amniotic fluid and vaginal bleeding.
    • Chorionic villus sampling (CVS): The chorionic villus tissue, attached to the walls of the uterus, is obtained through a needle passed through the cervix under ultrasound guidance. This testing can be done earlier in pregnancy from the 10th–13th weeks. The chorionic villi and the fetus come from the same fertilized egg, and have the same genetic makeup.
  • Examples of legal need for paternity testing are as follows:
    • When paternity testing is done for legal need, it must be legally admissible. It may be legally admissible if done in a government laboratory or a recognised laboratory. The cost in USA can vary from $ 400 to $ 2000 depending upon the status/accreditation of the laboratory. The results are available within a week.
    • The American Pregnancy Association advises as follows:

      http://www.americanpregnancy.org/prenataltesting/paternitytesting.html

      "If there is a question on who the father is, paternity testing should be done as soon as possible. Most states have laws that require an unmarried couple to fill out an Acknowledgment of Paternity (AOP) form at the hospital to legally establish who the father. If the couple is unmarried and the mother has not been married in the last 300 days, then no father will be listed on the birth certificate until this legally binding form is filled out. The AOP is sent to the states Bureau of Vital statistics, is recorded, and the father listed becomes the legal father.

      After the AOP is signed, couples have a limited amount of time, depending on the state, to request a DNA paternity test to be done and amend the AOP; if this is not done, the father previously listed on the AOP could be held legally responsible for the child even if he is not the biological father.

      If the mother is married to someone other than the father of the baby or has not been divorced for over 300 days, her husband is presumed to be the father of the baby. The biological father can only be named the legal father if he fills out an AOP and the husband also signs a denial of paternity. If the husband does not sign the denial of paternity, then either biological parent would need to take action in court to establish true paternity.

      During the time that no father is listed as legal father, the baby’s rights are not fully protected. Naming a legal father is vital in ensuring that the baby is eligible for child support, and benefits such as social security, veterans’ benefits, and health care."
    • In India, the following may be contacted for paternity testing:

      Center for cellular and molecular biology, Uppal Road, Hyderabad 500007 Tel: 040–27192653, 040–27192748, nidan@ccmb.res.in, Nidan@gmail.com.
    • The following news item appeared in Express India on 8 December 2008

      http://www.expressindia.com/latest-news/men-in-doubt-of-paternity-should-bear-all-dna-costs-says-court/396415/

      “New Delhi–– A city court has held in a recent order that in case a man disputes the fatherhood of his child, he cannot ask his wife to share the cost of a paternity test. Deciding a revision petition on the issue of cost–sharing, Additional Sessions Judge Deepak Garg held that if a man questions his fatherhood, he has to pay for the DNA tests and other such medical provisions himself. There will be no liability on his wife, the court ruled.

      The case involved a couple who had filed for separation. When the wife sought maintenance for herself and her three daughters in a petition filed before a magistrate, the husband challenged the fatherhood of the youngest daughter and said he could not be held liable for paying alimony towards her maintenance. Allowing his application, the magistrate, in July, had asked the woman to share the cost of DNA test. The couple was asked to appear before the Medical Superintendent of the AIIMS to get paternity test done on the child. Aggrieved, the woman then moved the Sessions court to seek quashing of the order.

      Differing from the magistrate’s order, Additional Sessions Judge Deepak Garg took into account relevant provisions of the Hindu Marriage Act and observed that any child born to a married couple is presumed to be legitimate and any party questioning the same has to bear the sole onus of rebutting the presumption. "Admittedly, the child was born after the marriage of the parties and hence there is presumption in favour of the legitimacy of the child," the judge ruled. "If the respondent is disputing the legitimacy of the child in question, the entire cost of DNA test should be borne by the party challenging the same." The court also pulled up the magistrate for not passing appropriate directions to AIIMS, where doctors were to conduct the paternity test, and sent back the court records with a directive to issue correct instructions.
medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medicolegally. Som Datt Bherwal

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