eMedinewS13th January 2014, Monday

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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India polio free from today

Ruksha’s the last recorded case of polio — on January 13, 2011 — in India, and if the nation’s polio eradication programme stays on track, it may well be India’s last. Being declared polio-free means the virus has died in the environment and new cases, if any, would be caused by infection in another country where infection persists.

Before a country can be certified polio-free, it should have at least three years of zero polio cases. Since the launch of the 1988 Global Polio Eradication Initiative to eradicate polio, 5 million people - mainly in the developing world - who would otherwise have been paralysed, will be free of polio.

Delivery months after the pregnant lady is brain dead

The case of a pregnant woman in Texas kept on life support against her family's wishes has captured international attention reports medpage.

Marlise Munoz, 33, has been on life support at John Peter Smith Hospital in Fort Worth, Texas, since late November, when she was declared brain dead following oxygen deprivation related to a possible blood clot in her lungs.

At the time of her legal death, she was 14 weeks pregnant. Her advanced directive, and the wishes of her husband and family, call for removal from life support. However, Texas law prohibits removing life support from pregnant women.

Keeping the mother's body stable and avoiding life-support-related infections throughout the pregnancy will be the key to a good fetal outcome, but there is considerable risk for brain damage from the initial injury.

As long as providers are able to keep Munoz stable (e.g., no further blood clots or bed sores, quality perfusion and oxygen levels), "the risk of continuing therapy is probably pretty minimal to the infant."

Mona Prasad, DO, MPH, a maternal-fetal medicine specialist at the Ohio State University Wexner Medical Center, speculated that the course of delivery would most likely involve a C-section, and that the timing of delivery would depend on how well the intrauterine environment could be controlled.

Prasad believes that the greatest risk to a mother on life-support would be infection. "The most quantifiable risk is that associated with a ventilator -- pneumonia in the mother. A mother on life support will also likely have a lot of lines and tubes that will increase the risk of infection and put the baby at risk.

NICU environment could provide more stability than the womb, a pre-term birth might be the best course of action.

Carter said the infant is at high risk of cerebral palsy. The real issue has to do with the event that caused her to go on life support. That damage is really hard to predict. We think that 80% to 90% of all cases of cerebral palsy are due to in utero events.

About 20% of cardiac output goes to the utero-placental unit and serves the fetus, so a maternal event such as has been described for this woman can’t help but impact the fetal development in a negative fashion.

Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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

Lohri: Adieu To Winter: "Til Tadake; Din Jhatake"

sprritual blog

This means ‘Good bye to Til or Sesame’, (which is used excessively in winters) and ‘welcome to longer days’ (which signify the dawn of summer).

Lohri, the festival of bonfire falls on 13th January. The earth, farthest from the sun at this point of time, starts its journey towards the sun, thus ending the coldest month of the year, Paush, and announcing the start of the month of Magh and the auspicious period of Uttarayan – January 14 to July 14 ("Uttar" North and "ayan" movement towards). Uttarayana is considered to be the holiest half of the year. In Bhagavad Gita, the Lord says, "I am Uttarayana among the ayanas."

Unlike other Indian festivals, Lohri reflects less of religion than culture. It is more a heritage of the agrarian Indian society than a felicitation of some Indian God.

Lohri is also the time to say good bye to winter foods. The lohri ritual starts at sunset when people circle around (parikrama) the bonfire and throw puffed rice, popcorn and other munchies into the fire, shouting "Aadar aye dilather jaye" (May honor come and poverty vanish!). This slogan coincides with the start of the harvesting season in North India.

After the parikrama, people exchange greetings and gifts, and distribute prasad comprising of five items: til, gajak, jaggery, peanuts, and popcorn followed by the traditional dinner of makki–ki–roti (multi–millet hand–rolled bread) and sarson–ka–saag (cooked mustard leaves). Eating of til (sesame of seeds) and rorhi (jaggery) is considered to be essential on this day.

Lohri therefore is the last day of eating heat producing winter foods. This is what the ritual of throwing these items in the bonfire is. It also signifies that from the day of lohri these items are for worship and to be taken in small amount like a prasadam and not as major part of the meals.

The bonfire or the artificial source of heat, to many, is embarked with festivity and supposedly the last need for heat for the season after which the warmth would come from the sun most naturally.

As per Ayurveda, the six months of Uttarayana (Adana –Dry Season) consists of Shishira, Vasanta and Grishma periods (Late winter, spring, summer). Bitter, pungent and astringent tastes are dominant in the soil. During the late winter chances of asthmatic attacks, vata imbalance, dryness of the body etc. are more. Maximum chances of vata emergencies liken heart attacks and stroke occur during full moon in this period.

The Dakshinayana (6 months, Visarga – Wet Season) consists of Varsha, Sharad, Hemanta (Rainy, autumn, early winter). Sweet, sour, salt tastes are dominant in the soil.

cardiology news

The Eagle and the Chickens

Once upon a time there was a large mountain side where there an eagle’s nest rested. The eagle nest contains four large eagle eggs. One day an earthquake rocked the mountain causing one of the eggs to roll down the mountain, to a chicken farm, located in the valley below. The chickens knew that they must protect and care for the eagle’s egg, so an old hen volunteered to nurture and raise the large egg.

One day the egg hatched and a beautiful eagle was born. Sadly, however the eagle was raised to be a chicken. Soon the eagle believed he was nothing more than a chicken. The eagle did what the other chicken did. It scratched in the dirt for seeds. It clucked and crackled. It never flew more than a few feet because that is what the other chickens did. The eagle loved his home and family but his spirit cried out for more. While playing a game on the farm one day he looked to the skies above and noticed an eagle soaring gracefully and majestically in the skies. He asked the chickens: "What is that beautiful bird?" The chickens replied, "That is an eagle. He is an outstanding bird, but you cannot fly like him because you are just a chicken." So the eagle never gave it a second thought, believing that to be truth. He lived the life of and died as a chicken depriving himself of his heritage because of lack of vision.

What a waste He was born to win but conditioned to lose.

The same thing is true for most people. The unfortunate part of life is as Oliver Wendall Holmes said, "We don’t achieve excellence because our own lack of vision."

Don’t let negative people drag you down. Remember that a person’s character is not only judged by the company they keep but also by the company they avoid.

News Around The Globe

News

  • A study from UK concluded that stage–stratified treatment greatly reduces the need for chemotherapy in patients with early–stage HIV–related Kaposi’s sarcoma (KS), leading to high overall survival rates in patients with early and advanced disease. The findings are published in the Journal of Clinical Oncology.
  • Older patients should receive sufficient vitamin D intake from all sources to lower their risk for falls and fractures, according to a new consensus statement published online December 18 in the Journal of the American Geriatrics Society. Dietary sources, sunlight, and supplements can all contribute to vitamin D levels of around 30 ng/mL (75 nmol/L), which appears to protect against fall–related injuries.
  • In a new study from US published online in the journal Plos One, researchers found that study participants who ate the most tree nuts – such as almonds, Brazil nuts, pistachios and walnuts – were between 37% and 46% less likely to be obese than those who ate the fewest tree nuts. People who ate the most nuts were also less likely to have metabolic syndrome, which is tied to increased risk of heart disease and diabetes.
  • Topical 5% 5–fluorouracil (5FU) applied intravaginally may be an effective treatment for cervical intraepithelial neoplasia (CIN) 2 in women, according to a prospective, nonblinded, randomized controlled trial in the American Journal of Obstetrics and Gynecology.
  • According to a new study in the American Journal of Ophthalmology, sleeping on one side may worsen glaucoma. In the study from South Korea, people with worsening glaucoma on just one side were also more likely to sleep with the affected eye facing downward. As per the researchers, position raises the eye’s internal pressure and probably hastens deterioration of the eye.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

What are the common adverse reactions to HRIG?

In rare cases, the following adverse reactions to HRIG may occur:

  • Allergic reactions including fall in blood pressure, dyspnea, cutaneous reactions and, in isolated cases reaching as far as anaphylactic shock, even when the patient has shown no hypersensitivity to previous administration of immunoglobulins.
  • Generalized reactions such as chills, fever, headache, malaise, nausea, vomiting, arthralgia and moderate back pain
  • Cardiovascular reactions, particularly if HRIG is inadvertently injected intravenously.
  • Local reactions such as local pain, tenderness or swelling at the injection site can be observed in rare cases.
cardiology news

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

  • Results from a large retrospective study in the European Heart Journal suggest that controlling the activation of the renin–angiotensin system (RAS) with antihypertensive medications reduces the risk of atrial fibrillation. Compared with beta–blockers and diuretics, the use of ACE inhibitors and angiotensin–receptor blockers (ARBs) was associated with a significantly reduced risk of atrial fibrillation. Compared with these other agents, however, the use of ACE inhibitors and ARBs did not reduce the risk of stroke.
  • A retrospective study of patients in the Atrial Fibrillation and Congestive Heart Failure (AF–CHF) trial suggests that four signs of congestion on physical examination—peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales—offer useful prognostic information beyond that obtained from standard clinical, ECG, or echo parameters. Each sign of congestion was associated with an increased risk of cardiovascular mortality, all–cause mortality, and heart–failure–related death over a mean follow-up of 37 months. The study was published online January 8, 2014 in JACC: Heart Failure.
cardiology news

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

  • Parents of young children with neurodevelopmental or autism spectrum disorders frequently try to help their children by adding alternative medical therapies to the conventional treatments the children receive, a study by California researchers has found. The report was published online January 11 in the Journal of Developmental & Behavioral Pediatrics.
  • A new Clinical Report by the American Academy of Pediatrics (AAP) Committee on Drugs and Section on Anesthesiology and Pain Medicine looking at iatrogenically–induced opioid dependence and withdrawal in children concluded that children’s use of prescription opioids is growing, but until now there has been no guideline on managing withdrawal in this age group. Since abrupt discontinuation of these drugs can lead to discomfort, it’s important to follow a set approach to opioid weaning. The report is published in the journal Pediatrics.
cardiology news

Early (Wet) vs late (Dry) winter

Winter can be divided into wet and dry winter. Wet winter is characterized by fall in temperature along with high humidity. Environmentally, we see fog and smog during this season. Dry or late winter on the other hand is characterized by absence of fog, smog and presence of chilly airy winds.

Most hypothermia illnesses occur in dry late winter. The transition phase between wet and dry winter is on Lohri. In terms of Ayurveda, it means shifting from Kapha to Vata atmosphere. The onset of dry winter is also the time for accelerated movement disorders in the body. Accelerated hypertension, arrhythmias, paroxysmal atrial tachycardia (PAT), brain hemorrhage, heart attack etc. all occur at the start of dry late winter.

Unpublished compilation of data has also shown that maximum temporary pacemakers are also put during this season.

The correct lifestyle in this season has been defined in Ayurveda and it involves reducing consumption of stringent, bitter and pungent foods.

cardiology news

Total CPR since 1st November 2012 – 84073 trained

Media advocacy through Web Media

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press release

Eating fast food can cause liver damage

Quoting a Swedish study by Dr. Fredrik H. Nystrom of University Hospital of Linkoping, published in the medical journal Gut, Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and Sr. National Vice President Indian Medical association said that eating alt east two fast foods meals every day and restricting levels of physical activity to no more than 5,000 steps a day can lead to signs of liver damage or weight gain.

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

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

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 84073 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Suraj Bhan D.A.V. Public School students learned CPR–10

press release

Treatment for constipation in the elderly

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

The following separation technique depends on the molecular size of the protein:

1.Chromatography on a carboxymethyl (CM) cellulose column.
2.Iso-electric focusing.
3.Gelfiltration chromatography.
4.Chromatography on a diethylaminoethly (DEAE) cellulose column.

Yesterday’s Mind Teaser: A ten–year old girl presents with swelling of one knee joint. All of the following conditions can be considered in the differential diagnosis, except:

1. Tuberculosis.
2. Juvenile rheumatoid arthritis.
3. Hemophilia.
4. Villonodular synovitis.

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

Correct answers received from: Dr Pankaj Agarwal, Dr. Dinesh Narain Saksena, Raju Kuppusamy, Dr Avtar Krishan, soni brijesh, Arvind Gajjar, Dr Bitaan Sen & Dr.Jayashree Sen, Dr. P. C. Das.

Answer for 11th January Mind Teaser: 4. Calcaneum

Correct answers received from: Arvind Gajjar, Dr. P. C. Das

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

Coffee Dilemma

A man and his wife were having an argument about who should brew the coffee each morning.

The wife said, "You should do it, because you get up first, and then we don’t have to wait as long to get our coffee".

The husband said, "You are in charge of the cooking around here and you should do it, because that is your job, and I can just wait for my coffee."

Wife replies, "No you should do it, and besides it is in the Bible that the man should do the coffee."

Husband replies, "I can’t believe that, show me."

So she fetched the Bible, and opened the New Testament and shows him at the top of several pages, that it indeed says:

"HEBREWS"

medicolegal update

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medicolegal update

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

medicolegal update

The bad news is time flies. The good news is you’re the pilot. Michael Altshuler

medicolegal update

Dr KK Aggarwal: Shorter the waist line, longer the life line http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Photons cannot be seen but make seeing possible http://bit.ly/15QdVeB #Health

medicolegal update
  1. Dear Sir, Thanks for providing the useful informations. Regards: Dr Kanak.

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