eMedinewS
14th November 2014, Friday

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

Role of Folate or Folic Acid in Cancer Prevention

Several large observational studies have shown a decrease in risk of colorectal and other cancers with dietary folate, while other randomized trials of folic acid supplementation have raised the possibility of increased cancer risk from folic acid supplementation.

In the largest meta-analysis of individual patient data from randomized trials of folic acid for the prevention of cardiovascular disease (10 trials, n = 49,969) and colorectal adenoma (3 trials, n = 2652), during an average of 5.2 years of treatment, there was no significant difference in overall cancer incidence for patients assigned to folic acid or placebo.

There was also no significant effect on the incidence of specific cancers, including cancers of the large intestine, prostate, lung, or breast. (Lancet 2013;381:1029)

Fish oil and cardiovascular mortality

The Risk and Prevention Study enrolled patients with multiple cardiovascular risk factors or known vascular disease and, after a median follow-up of five years, found no reduction in coronary heart disease death with n-3 polyunsaturated fatty acid supplementation compared with placebo. (N Engl J Med 2013;368:1800)

Breastfeeding and obesity

There is increasing evidence that breastfeeding does not reduce the risk of obesity in the offspring. A follow-up study from a cluster-randomized trial of over 17,000 breastfeeding mother-infant pairs reported on outcomes of children at 11.5 years of age, and confirmed findings from 5 years earlier that there were no differences in the body mass index or rates of obesity and overweight. Population strategies to increase the duration and exclusivity of breastfeeding are unlikely to impact the obesity epidemic. (JAMA 2013;309:1005.)

News Around The Globe

  • Secondhand smoke exposure needs more attention for heart attack and other ischemic coronary artery disease patients, researchers urged. Only 17.3% of such patients interviewed at one center remembered any nurse or physician asking about their exposure after admission, Nancy A. Rigotti, MD, of the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston, and colleagues found.(JAMA)
  • The composition of an individual's gut microbiome is influenced not just by environmental exposure but also by the genetics of the host. The resulting human gut microbiome affects host metabolism, thereby contributing to obesity. Julia K. Goodrich, a graduate student at Cornell University in Ithaca, New York, and colleagues published their analysis of the Twins UK population in the November 6 issue of Cell. They studied 416 twin pairs and sequenced the genome of microbes found in more than 1000 fecal samples.
  • Guideline Emphasizes Prophylactic Platelet Transfusion: A new guideline for administering platelet transfusions to adult patients emphasizes judicious use of the procedure to reduce patient risk and conserve resources, according to an article published online November 11 in the Annals of Internal Medicine.
  • In the strong recommendation, the AABB, formerly the American Association of Blood Banks, urges prophylactic transfusion of platelets to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia and a morning platelet count of 10 × 109 cells/L or less. They write that lower doses equal to a half of a standard apheresis unit are equally effective as higher doses.
  • Supplementation with vitamin B for 2 years did not affect cognitive performance in elderly people with raised homocysteine levels, reported a randomized placebo-controlled trial published online November 12 in Neurology.
  • The use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with a significant reduction in the risk of developing amyotrophic lateral sclerosis (ALS), reported a new case-control study. Researchers noted a dose-dependent inverse association between ACE-inhibitor use and the risk for ALS. The study was published online November 10 in JAMA Neurology.
  • An interferon-free combination drug regimen produces a high rate of sustained virologic response with good safety in liver transplant recipients with recurrent hepatitis C viral infection, suggests the open-label CORAL-1 study published online November 11 in the New England Journal of Medicine.
  • Intravenous recombinant tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke heightens the early risk for death but gives better odds of surviving without significant disability and possibly yields later mortality benefits, reported a recent meta-analysis presented at the 9th World Stroke Congress (WSC).
  • Radioactive iodine (RAI) is beneficial for improving overall survival among papillary-thyroid carcinoma patients across all tumor size categories, including the very smallest, suggests a new research presented at the 2014 Annual Meeting of the American Thyroid Association.

IMA News

Law to recognise new medicine systems soon; Aditi Tandon: Tribune News Service: New Delhi, November 7: In a move that will allow for the establishment of formal mechanisms to approve new systems of medicine for use in India, the government is working on a Bill for introduction in the winter session of Parliament.

“The Recognition of New Systems of Medicine Bill 2014”, the draft law will, for the first time in the country’s history, pave the way for statutory systems to recognise evolving systems of medicine which are being practiced across the country without government approvals and stamp. Some of the systems that could get approval once the Bill is passed by Parliament are – electro homeopathy and bio-chemic medication and remedies.

Sources in the government said the draft Bill is ready for presentation to the Cabinet after successful inter ministerial consultations and approvals from Ministry of Law. “The consultations are over. Comments have been received and there are no major objections to the Bill. It could be introduced in Parliament in Winter Session once the Cabinet approves it,” a source said. (Dr. Omparkash Singh Kande)

  • On November 11, 2014, while disposing off a Writ petition filed against IMA in the Supreme Court, the Hon’ble Court, after hearing the parties at length observed that although it is unethical for doctors to resort to strike and the prayer made in the Writ Petition is commendable but any such directions which cannot be executed/enforced, cannot be granted. Therefore, in the light of the above observation, the Hon’ble Supreme Court declined to grant any positive directions to the Writ Petitioner and disposed off the PIL with above observation. It may be recalled that IMA had contested and fought with full might, the Writ Petition filed in 2012 in the Supreme Court of India by “People for Better Treatment” against “Indian Medical Association” requesting direction by the Hon’ble Court to IMA for declaring any call for doctors’ strike be held as unethical, immoral and against the law and to issue directions to them not to go on strike in future. Efforts of IMA to put forth the issues of the medical profession have paid off. (HSG IMA)

Dr KK Spiritual Blog

Namkaran Sanskar

In India, a person is identified by his/her name, which usually is a reflection of his/her own family. It may contain not only your maiden name but also the name of your father and your surname/caste.

When you are born, you are usually given your special name, which you carry throughout your life unless it is changed for a specific purpose. For example, the surname may change after marriage or the in-laws may change your name, specifically, when you are a girl.

Artists often change their names to those which may reflect their profession. A classical example is Rajesh Khanna, who changed his name from Jatin to Rajesh, which was easier for the public to recall.

A name for a baby is chosen on any of the following grounds:

  1. The priest as per the horoscope decides the sound present in the universe and that Akshar (Alphabet) is given to the family to pick up a name starting with that Akshar.
  2. Sometimes, the name of the baby may be chosen depending upon the auspiciousness of the day he/she was born, e.g. a baby body born on Krishna Janmashtami, may be named ‘Krishna’ by the family after Lord Krishna.
  3. If the parents have vowed a Mannat to a deity, then they may name their child after one of the many names of that deity. For example, if parents have taken a Mannat from Vaishno Devi, their baby girl may be named as one of the forms of Goddess Durga or Parvati.
  4. People may also choose similar names for their children, e.g. Ramesh, Mahesh, and Suresh.
  5. People may also keep the name of the child in the form of known pairs. If the name of the first child is Luv, the parents may like to name the second child as Kush, especially when the parents have twins. Other examples are Karan Arjun, Sita and Gita etc.
  6. Sometimes, parents name their child after their favorite celebrity. For example, if someone is a big fan of Sachin Tendulkar, he may name his child Sachin. Sachin himself was named after the noted Hindi film music director Sachin Dev Burman by his father, who was a great fan of SD Burman.

Name has a lot of significance as Akshar in Sanskrit has a vibration and if that positive vibration matches with the vibrations of universe at the time of your birth, it helps in healing.

Normally, it is expected that you live up to your name. For example, if your name is Durga, you are expected to know all about Maa Durga and try to adopt characteristics of Durga.

Therefore, everyone is expected to know the literal meaning of his or her name and try to follow a lifestyle that is consistent with your name. For example, if you are named Ram, you are not expected to act like Ravana.

Namkaran Sanskar or the naming ceremony is a complete ceremony and is one of the 16 samskars. It is both a social and legal necessity. As the naming process creates a bond between the child and the rest of the community, it is considered auspicious.

Some people name their child before he/she is born but a Namkaran Sanskar is usually performed on the 12th day after birth but it may vary from religion to religion and custom to custom. The formal ritual involves a Namkaran puja, which is held at their home or a temple where the priest offers prayers to all the Gods, Navagrihas, five elements, Agni and the ancestors. The horoscope of a child is made and is placed in front of the idol of the deity for blessings. With the baby in the lap of the father, the chosen name of the child is whispered in the right ear.

Some people name child on the 101st day of the birth and still some others choose the first birthday to name their child.

The name of the child also entails certain etiquettes as it reflects a person. You cannot take the name of a person with disrespect. If you abuse a name it means you have abused a person.

Inspirational Story

Determination and Persistence

This is a real life story of engineer John Roebling building the Brooklyn Bridge in New York, USA back in 1870. The bridge was completed in 1883, after 13 years.

In 1883, a creative engineer named John Roebling was inspired by an idea to build a spectacular bridge connecting New York with the Long Island. However bridge building experts throughout the world thought that this was an impossible feat and told Roebling to forget the idea. It just could not be done. It was not practical. It had never been done before.

Roebling could not ignore the vision he had in his mind of this bridge. He thought about it all the time and he knew deep in his heart that it could be done. He just had to share the dream with someone else. After much discussion and persuasion he managed to convince his son Washington, an up and coming engineer, that the bridge in fact could be built.

Working together for the first time, the father and son developed concepts of how it could be accomplished and how the obstacles could be overcome. With great excitement and inspiration, and the headiness of a wild challenge before them, they hired their crew and began to build their dream bridge.

The project started well, but when it was only a few months underway a tragic accident on the site took the life of John Roebling. Washington was also injured and left with a certain amount of brain damage, which resulted in him not being able to talk or walk.

“We told them so.” “Crazy men and their crazy dreams.” “It’s foolish to chase wild visions.” Everyone had a negative comment to make and felt that the project should be scrapped since the Roebling’s were the only ones who knew how the bridge could be built.

In spite of his handicap Washington was never discouraged and still had a burning desire to complete the bridge and his mind was still as sharp as ever. He tried to inspire and pass on his enthusiasm to some of his friends, but they were too daunted by the task.

As he lay on his bed in his hospital room, with the sunlight streaming through the windows, a gentle breeze blew the flimsy white curtains apart and he was able to see the sky and the tops of the trees outside for just a moment.

It seemed that there was a message for him not to give up. Suddenly an idea hit him. All he could do was move one finger and he decided to make the best use of it. By moving this, he slowly developed a code of communication with his wife.

He touched his wife’s arm with that finger, indicating to her that he wanted her to call the engineers again. Then he used the same method of tapping her arm to tell the engineers what to do. It seemed foolish but the project was under way again.

For 13 years Washington tapped out his instructions with his finger on his wife’s arm, until the bridge was finally completed. Today the spectacular Brooklyn Bridge stands in all its glory as a tribute to the triumph of one man’s indomitable spirit and his determination not to be defeated by circumstances. It is also a tribute to the engineers and their team work, and to their faith in a man who was considered mad by half the world. It stands too as a tangible monument to the love and devotion of his wife who for 13 long years patiently decoded the messages of her husband and told the engineers what to do.

Perhaps this is one of the best examples of a never-say-die attitude that overcomes a terrible physical handicap and achieves an impossible goal.

Often when we face obstacles in our day-to-day life, our hurdles seem very small in comparison to what many others have to face. The Brooklyn Bridge shows us that dreams that seem impossible can be realised with determination and persistence, no matter what the odds are.

Rabies News (Dr A K Gupta)

What should be done with a patient who has had exposure but goes for treatment after considerable delay (weeks to months)?

An early and correct administration of modern anti-rabies vaccine is life-saving. The vaccination must be started immediately irrespective of the status of the biting animal. Patients who seek treatment after a delay of 48 hours or even months after having been bitten should be dealt in the same manner as if the exposure occurred recently.

Cardiology eMedinewS

  • A review of 12 randomized controlled trials of four popular weight-loss diets—Atkins, Weight-Watchers, South Beach, and Zone—could not determine a "winner" in terms of sustained weight loss or improvements in cardiovascular risk factors at 1 year. Patients had lost 1.6 to 5 kg on Atkins, Weight Watchers, and Zone diets, which was similar to the 2.2-kg loss in a control group. Additionally, the diets did not have any markedly different effects on blood pressure, glycemic control, or lipid levels. The study was published online November 11 in Circulation: Cardiovascular Quality and Outcomes.
  • Nonalcoholic fatty liver disease (NAFLD) is independently associated with advanced high-risk coronary plaque, points a study published online in Radiology. The association exists after correcting for traditional cardiovascular risk factors, as well as the extent of coronary atherosclerosis. The results point that NAFLD and coronary atherosclerosis are directly related to metabolic syndrome.

Pediatrics eMedinewS

  • Parental assessment of a child's asthma severity may sometimes underestimate the child's level of discomfort and control, suggest the results of a study presented at the American College of Allergy, Asthma & Immunology 2014. The results highlight the importance of taking the child's opinion into consideration when estimating the degree of asthma control and making management decisions.
  • Ventilated low-birth-weight neonates whose bed head is raised early have less tracheal pepsin, suggests new research. Additionally, in babies, the amount of microaspiration can be reduced by elevating the head of the bed to 13 or 14 degrees, which may reduce pneumonia. The report is published online in the Journal of Neonatal-Perinatal Medicine.
emedipicstoday emedipics

21st Perfect Health Mela 17th October 2014

Self-Assessment-Quiz

 

expert_choice
press release

Treating vitamin D deficiency in the country

video of day

Other Blogs

Video Library

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: An elderly patient after IV ondansetron 16 mg dose developed irregular heart rhythm
Dr Good: Its due to the drug
Dr Bad: It can not be due to the drug
Lesson: ECG interval changes, including prolongation of the QTc interval, are a class effect of the first-generation serotonin antagonists, including ondansetron; potentially fatal cardiac arrhythmias may result. QTc prolongation occurs in a dose-dependent manner, and is expected to be greater with faster rate of infusion and larger doses for IV administration.

The current recommendation is to limit single IV doses to no more than 16 mg.

Canadian guidelines place additional dosing restrictions on IV ondansetron to mitigate the risk of QT prolongation, particularly in older adults, in whom the initial dose should not exceed 8 mg (healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2014/39943a-eng.php (Accessed on June 16, 2014). (Is available as emeset)

Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

eMedinewS Humor

A guy is walking up to a doctor’s office when a nun comes running out screaming and crying.

The guy walks in and says, "Doc, what’s with the nun?"

The doctor says, "Oh, I just told her she’s pregnant."

The guy says, "The nun’s pregnant?"

The doctor says, "No. But it certainly cured her hiccups!"

Twitter of the Day

Dr KK Aggarwal: Dry fruits increases HDL good cholesterol
Dr Deepak Chopra: You must find the place inside yourself where nothing is impossible

Quote of the Day

  • Any change, any loss, does not make us victims. Others can shake you, surprise you, disappoint you, but they can't prevent you from acting, from taking the situation you're presented with and moving on. No matter where you are in life, no matter what your situation, you can always do something. You always have a choice and the choice can be power. Blaine Lee

Wellness Blog

How To Prevent Arthritis From Slowing You Down

  1. Keep moving
    • Avoid holding one position for long.
    • While working get up and stretch every 15 minutes.
  2. Discover your strength
    • Put the strongest joints and muscles to work.
    • Push open heavy doors with the side of the arm or shoulder. It will protect finger and wrist joints.
    • While climbing up let the strong leg lead you and while going down let the weaker leg lead you. It will reduce hip or knee stress.
  3. Plan ahead
    • Simplify and organize your routines so you minimize movements that are difficult or painful.
    • Keep items you need for cooking, cleaning, or hobbies near where they are needed
    • Have multiple sets of cleaning supplies, one for the kitchen and one for the bathroom
  4. Make use of labor-saving devices and adaptive aids.
    • Long-handled grippers, can be designed to grasp and retrieve out-of-reach objects.
    • Rubber grips can help one get a better handle on faucets, pens, toothbrushes, and silverware.
  5. Ask for help.
    • Only a very small percentage of people with arthritis become severely disabled and get dependent on others.
    • Educate family members and friends about how arthritis affects you.
    • Don’t be afraid to ask for help when you need it.

(Source Harvard Healthbeat)

ePress Release

All you need to know about Diabetes, its prevention and treatment on the occasion of World Diabetes Day

India is the diabetic capital of the world with more than 62 million individuals currently diagnosed with the disease. People with diabetes are nearly two times more likely to die from heart disease than people without diabetes. They also run a much greater risk of acquiring diseases related to the kidney, eyes and nerves amongst other dangerous ailments. On the occasion of World Diabetes Day, National Awardee, President of Heart Care Foundation of India and Sr. National Vice President of the Indian Medical Association – Dr KK Aggarwal discusses how Type 2 diabetes can be delayed or prevented, and both Type 1 and 2 diabetes can be managed to prevent complications.

According to him, when suffering from Type 1 diabetes, the patient’s body does not produce insulin. On the other hand in Type 2 diabetes the body does not make or use the produced insulin well. Women during pregnancy often suffer from gestational diabetes, which usually goes away after the birth, however makes both the mother and child at risk of developing Type 2 diabetes later in their lives.

The incidence of Type 2 diabetes is on the rise amongst young people in our country, the primary reason for this is the faced paced stressful lives each one of us is living today. Unhealthy diets, potbelly obesity, dependence on alcohol, lack of exercise are all leading causes of this growing trend.

He further feels that by losing a modest 15 pounds weight through diet and exercise can actually cut a person’s risk of getting type 2 diabetes by as much as 58 percent. In patients suffering from Type 1 diabetes, tight control of blood sugar can prevent diabetes complications.

In India and globally a healthy diet is often more expensive than an unhealthy one. The wide availability of cheap energy dense low-nutrient food is contributing to the global epidemic of Type 2 diabetes. The government needs to ensure that food items, which reduce the risk of type 2 diabetes such as vegetables, fresh fruit, whole grains and unsaturated fats, need to be more affordable and more widely available

He concluded by stating that up to 11% of total healthcare expenditure in every country across the globe could be saved by tackling the preventable risk factors for Type 2 diabetes and over 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles.

Diabetes Prevention Tips

  • Eat a healthy balanced diet
  • Make sure exercise on a daily basis
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make lifestyle changes to reduce the risk of acquiring diabetes and its complications — for yourself, your families and for future generations.

eMedi Quiz

The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Yesterday’s Mind Teaser: In a patient with a tumor in Superior medistinum compressing the superior vena cava, all the following venis would serve as alternate pathways forthe blood to return to the right atrium, except:

1.Lateral thoracic vein.
2.Internal thoracic vein.
3.Hemiazygos vein.
4.Vertebral venous plexus.


Answer for yesterday’s Mind Teaser: 4.Vertebral venous plexus.

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

Answer for 11th November Mind Teaser: b. Auspitz Sigh

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Tukaram Pagad.

Send your answer to email

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Can doctor–couple dispense drugs without license?

Dr P Kamalasanan, a private medical practitioner from Kollam in Kerala was punished last month for dispensing drugs without a license. Additional Sessions Judge, Kollam on August 7 sentenced Dr Kamalasanan of one-day “imprisonment” and also fined him Rs 1.20 lakh on the charges of running a pharmacy without a license from his clinic. Appearing before the court, Dr Kamalasanan reportedly served the sentence by remaining there till the rising of the court.

View1: Under the rules, only a single-doctor clinic is exempted from the process of obtaining a license before dispensing drugs and any clinic run with the help of more than one doctor falls under the category of hospital, for which it is mandatory to obtain a license to dispense medicines.

View 2: The Drugs & Cosmetics Act, 1940 & Rules, is very clear that private clinics, the place where professional activities of registered medical practitioners take place, are exempted from the drug licence. Private clinics are fully protected from harassment of drug controllers.

Clause–5 of Schedule-K of the Drugs and Cosmetics Rules allows a single doctor to stock, prescribe or dispense medicines without having a license, it does mandate a clinic run by more than one doctor to obtain a license. A doctor cannot dispense medicines on the prescription given by another doctor, neither can a visiting doctor dispense medicines from that clinic.

Item 5. Drugs supplied by a registered medical practitioner to his own patient or any drug specified in Schedule C supplied by a registered medical practitioner at the request of another such practitioner if it is specially prepared with reference to the condition and for the use of an individual patient provided the registered medical practitioner is not (a) keeping an open shop or (b) selling across the counter or (c) engaged in the importation, manufacture, distribution or sale of drugs in India to a degree which render him liable to the provisions of Chapter IV of the Act and the rules there under.” (Excerpts from a news in IMT)

medicolegal update
  1. We strongly oppose the recent MTP bill Neelu Khaneja

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