eMedinewS13th September 2014, Saturday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Potassium Tricks

  • Dealing with hemolyzed sample: One can get a hemolyzed sample, where the serum on top of the clot may artificially have an increase in potassium owing to lysis of cells. It is not possible to assess the quantity of potassium when it is hemolyzed, so you always have to repeat the sample.
  • When the platelet count is high: There are issues of thrombocytosis in a platelet count above 5 00,000 cells/µL. If it participates in the clotting process (in a red-top tube), then what lies on top of it (the serum) will have a higher potassium concentration.
  • Serum or plasma: If the potassium level is high, then both serum and plasma potassium should be measured. If the platelet count is up, one can see a 0.3– to 1–mEq/L difference between serum (higher) and plasma (lower). Remember that plasma would be a purple top or a green top.
  • High K (> 6) get ECG done: Never ignore high potassium. Get an ECG to see whether it is really a problem. An ECG can show you that it is not cardiotoxic.
  • Look for aldosterone blockers (spironolactone or eplerenone). The RALES data showed that patients in systolic forms of heart failure with an average dose of about 25 mg of spironolactone clearly had more frequent hyperkalemia. When you start spironolactone, you should make an assessment of the risk factors for an inordinate increase in potassium. You are going to look at the glomerular filtration rate (GFR) and try to estimate the prevailing intake, the fluid status of the patient, other medicines that may influence potassium, and the sampling conditions in which you can obtain it. There is a finite rise that occurs. Not everyone goes up 2 mEq/L. An average increase might be 0.5–1.2 mEq/L, so if you start out at 4 mEq/L, you are in a safe range. If you start at 4.5 mEq/L, you are beginning to run into the chance that you may get closer to 6 mEq/L, which would be a problem area. If you are at 4.8 mEq/L, then that is going to dictate earlier surveillance.
  • How soon should K levels be checked after starting aldosterone blockers? If you have a reduction in GFR to start with, somewhere between 3 and 7 days would be reasonable.
  • Is eplerenone better? This has never been studied. But it is safer. Someone is given 25 mg of spironolactone. The patient becomes unnecessarily hyperkalemic. The potassium level goes to 5.7 mEq/L. You decide to make a switch to eplerenone, one can start on eplerenone 25 mg twice daily.
  • What about low K levels: Treatment of low K levels is a tricky issue. One should determine the threshold below which you want to treat. If it is a clearly reversible cause, short–lived in nature, and you could remedy it, then you may not need the supplement. Or it might be something more permanent in nature. One may be dealing with potassium–wasting disorders that occur sometimes with gentamicin therapy with certain cisplatin chemotherapy agents, in which case you are obligated to keep treating almost for perpetuity. If you are going to be on diuretic therapy persistently, you take certain steps, you limit the salt intake, and you limit the dose of the agent in question. If you have to give a potassium supplement, you give potassium chloride rather than potassium acetate or potassium citrate.
  • Why limit salt? Sodium exposure to the distal tubule creates the need to absorb, creating an intraluminal electronegativity in the distal tubule. Because potassium is a cation, it is secreted down an electrochemical gradient. If you limit sodium, there is less sodium to resorb, less electronegativity in the distal tubule, and less potassium loss or kaliuresis.
  • Why magnesium should be measured? In the presence of low magnesium levels, low K will not be corrected
  • When to look for primary aldosteronism? If the patient is on a low–dose diuretic, sodium intake is not that high, and the potassium level is very low –– 3 mEq/L or below –– that is a consideration for checking for aldosteronism.
  • What do you do if you suspect hyperaldosteronism? The screening test is a random plasma aldosterone/renin activity ratio.

News Around The Globe

  • The US Food and Drug Administration (FDA) has approved the use of Menactra in individuals 15 to 55 years of age for booster vaccination against meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W–135.
  • A research published online in JAMA Dermatology stated that compared to etanercept alone, etanercept plus methotrexate provided a 75% reduction in the Psoriasis Area and Severity Index scores for more patients; however, the benefit may be associated with a 25% increase in the risk of adverse events.
  • The US Food and Drug Administration (FDA) has approved the oral androgen receptor inhibitor enzalutamide as first–line therapy for metastatic castration–resistant prostate cancer (CRPC). The new indication is for use in men with metastatic CRPC who have not received chemotherapy.
  • Individuals who do not sleep well are at increased risk for death by suicide, irrespective of mood, suggests a new study. Researchers noted that poor sleep quality at baseline predicted increased risk for death by suicide at 10–year follow–up. The study was published online in JAMA Psychiatry.
  • Stopping inhaled glucocorticoids in patients with chronic obstructive pulmonary disease (COPD) who were using bronchodilators has little effect on symptoms, and there is no benefit of continuing treatment, suggest the WISDOM trial results presented at the European Respiratory Society (ERS) International Congress 2014.

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

  • Patients with retinal artery occlusion (RAO) may be at increased risk for acute coronary syndrome (ACS) and should undergo a thorough cardiovascular examination and medical prevention for ACS, suggests a new study published online in the British Journal of Ophthalmology.
  • A meta–analysis of 11 trials in patients 65 years or older reported that antihypertensive medications are significantly more effective than placebo in lowering blood pressure and are linked with significantly lower relative risks of death from all causes and from cardiac causes. However, only one study reported that blood–pressure–lowering medication was tied to a 21% increased risk of falls. The data were presented recently at the European Society of Cardiology (ESC) 2014 Congress.

Pediatrics eMedinewS

  • Premature infants are at increased risk for a potentially lethal gastrointestinal disease called necrotizing enterocolitis (NEC). A new study has pointed that a protein called neuregulin–4 (NRG4) – present in breast milk, but absent from formula – may protect against the intestinal destruction caused in NEC. The study was published online in the American Journal of Pathology.
  • A high school student who lives with two college–educated parents is significantly less likely to drink alcohol or smoke marijuana than a teenager who lives with one parent, suggests a new study published online in the journal Social Work in Public Health. Researchers noted that teens living with their mother only were 54% more likely to use alcohol, and 58% more likely to smoke if they lived only with their father.

Dr K K Spiritual Blog

Signs of Spiritual Awakening

  1. More experiences of telepathy
  2. More experiences of reverse telepathy
  3. More spontaneous fulfillment of desires
  4. Increased tendency to let things happen rather than make them happen. Work done with the least effort.
  5. Change in the nature, more smiling, laughter and thankful nature
  6. Feelings of being connected with others and nature.
  7. Frequent overwhelming episodes of appreciation.
  8. Tendency to think and act spontaneously rather than from fears based on past experience.
  9. Ability to enjoy each moment.
  10. Living in the present
  11. Loss of worry
  12. A loss of interest in conflict.
  13. A loss of interest in interpreting the actions of others.
  14. A loss of interest in judging others.
  15. A loss of interest in judging self.
  16. Gaining the ability to love without expecting anything in return.
  17. Quality of converting an adversity into opportunity
  18. Dislike for drugs, smoke and excess of alcohol.
  19. Happiness in doing random acts of kindness.
  20. Looking for good in every one.

Wellness Blog

When Constipation May be a Serious Problem

While most instances of constipation may not be serious, some cases of infrequent or difficult bowel movements need evaluation by a doctor.

List of warning signs:

  1. You’re constipated for the first time
  2. Constipation occurs for you very infrequently.
  3. You’ve been treating constipation at home with more fiber, fluids and exercise for at least three weeks, but have no improvement.
  4. You have abdominal pain.
  5. You have bloody stools.
  6. You have unexplained weight loss.

Inspirational Story

Making Change

Many of us do not like what we see around us but the last thing we ever do is to change it. I think that is the beginning of failure and that is why what we hate still remains around us. If you do not want the things you see around you, don’t just watch and hope it will change. There must be a work plan that will determine what you are going to do to change it.

We have such an amazing power of creativity inside us to change the way things work around us. Only lazy people go about and say that is the way things have been working and that is the way they are going to continually work.

I have come to discover that things around us are dependent on our actions and inactions. What I mean is that the circumstances that we like depend solely on the things we do and the things we do not do. Do you want your country to change? Start by changing the small things around you.

Before you think too far about any small thing to change, let me help you by saying that your habit should be the first thing to change. Change what you think about and change what you talk about. Change the things that get your attention before you plan to change a nation.

Can you remember how difficult it was for you to break a habit that you desired to break some years back? Do you remember that habit of yours that you are still struggling to break? If so, then you must accept that things are not just going to change by the stroke of a magic thought.

If it is not so easy to change yourself when you want to, it is not going to be so easy to change the people around you. Many people do not find it easy to change themselves yet they want to change a nation. I think the best way I have changed people around me is that I changed myself.

People are watching you. Some of them do not expect you to change so your change is going to be like a miracle to them. When you change, they will change. Just change yourself and see how many people will tell you later that you were the one who changed them. That is one simple way young people can change their nations. Go ahead now. Do it!

ePress Release

Debunking Diabetes Myths

If you’ve just been diagnosed with diabetes, it may be difficult to separate fact from fiction, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Heart Care Foundation of India debunks some popular myths about diabetes.

  • Diabetes is not contagious and one cannot get diabetes from someone else.
  • Diabetics can eat desserts, but with caution. While eating too many sugary foods is a bad idea, one can have an occasional dessert, especially if one exercises and otherwise eats healthy.
  • Eating too much sugar cannot "cause" diabetes. The disease stems from genetic and lifestyle factors. But consuming too much white sugar can cause insulin resistance and future diabetes. The healthy sugar is brown sugar or jaggery.
  • Diabetics aren’t more susceptible to colds and other illnesses but may have more complications of flu.
  • Taking insulin doesn’t cause hardening of the arteries or high blood pressure.
  • Fruit, while healthy, can’t be consumed in huge amounts, since it contains carbohydrates.

 

eMedi Quiz

A self practicing dermatological needs

a. videoconference
b. mobile teledermatology
c.store and forward teledermatology
d. a combination of store and forward, online discussion group, and author based second ipinion teledermatology

Yesterday’s Mind Teaser: L E cell is a

a. Neutrophil
b. Macrophage
c. Histocyte
d. Dendric cell

Answer for yesterday’s Mind Teaser: a. Neutrophil

Correct answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 11th September Mind Teaser: b. Procaine

Correct answers received from: Dr P C Das, Dr Sushma Chawla, Dr K V Sarma, Raju Kuppusamy, Smriti Aggarwal, Daivadheenam Jella, Dr Poonam Chablani, Dr Bitaan Sen & Dr Jayashree Sen, Rakesh Bhasin, Dr Jainendra Upadhyay.

Send your answer to ijcp12@gmail.com

Self-Assessment-Quiz

 

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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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Embolization shows success in benign prostatic hyperplasia

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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 :

 

Make Sure

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients with Rheumatoid Arthritis are started with specific treatments within 3 months of diagnosis.

eMedinewS Humor

A man returns from a trip to Shanghai and is feeling very ill. He goes to see his doctor and is immediately rushed to the hospital to undergo a series of tests. The man wakes up after these tests in a private room at the hospital and the phone by his bed rings.

"This is your doctor," says the voice on the phone. "We have the results back from your test and… I’m sorry, you have an extremely contagious deadly disease known as G.A.S.H."

"G.A.S.H?" replies the man. "What in the hell is that?"

"It’s a combination of Gonorrhea, AIDS, SARS and Herpes," explains the doctor.

"My gosh, Doc!" screams the man in a panic, "what are we going to do?"

"Well, we’re going to put you on a strict diet of pizza, pancakes, quesadillas and pita bread," says the doctor matter–of–factly.

"Will that cure me?"

"Well, no," says the doctor, "but it’s the only food that will fit under the door."

Quote of the Day

Some of us think holding on makes us strong; but sometimes it is letting go. Herman Hesse

Twitter of the Day

Dr KK Aggarwal: A mix of exercise protocol is better http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: The idea that consciousness may be an illusion is the ultimate expression of self doubt RT @RichardDawkins: "Is Consciousness an Illusion?"

   
medicolegal update

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  1. Dear Dr Aggarwal: Congratulations. Busy as you are this will be a challenge. But my observation is you are well organized and great skills for the same. Wish you success. Dr Suresh Amin MD. IFCAP CWC member, Hypertension IMA project; Consultant Pathologist, Vadodara (Guj)
  2. Dear Dr. Aggarwal, Please accept my heartiest congratulations on being elected as the Secretary general of IMA (National) for the current tenure. We are all very sure, the Association would strive for very high gains to each Hon’ble Member of the Association, under your most vibrant Leadership. Prof. Pramod Samantaray: (Former Corporate General Manager, Medical & Marketing Services, IDPL, Gurgaon), Life Member IM A, since 1968, Calcutta/Delhi/Odisha); Executive Director; Vision Foundation; New Delhi
  3. Dear Dr K K Aggarwal Sir, Please Accept My Hearty Congratulations For This Achievement. Regards. Dr J K Sharma
  4. Congratulations sir Padma Shri Dr K K AGARWAL ON BEING ELECTED unopposed as secretary general of national IMA for the year 2014–2016, Dr. Bharath Prakash Avula, Cwc Member, Past President, I M A Hyderabad city.

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