eMedinewS
14th December 2014, Sunday

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

Sugar, not salt, may be at fault for hypertension

Sugar, not salt contributes to the majority of the hypertension risk associated with processed food and a reduction in the consumption of added sugars and, in particular, processed foods may translate into decreased rates of hypertension as well as decreased cardiometabolic disease.

James J. DiNicolantanio, PharmD, from Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, published their review of epidemiological and experimental studies in Open Heart.

The authors conclude that high-sugar diets may make a significant contribution to cardiometabolic risk.
Highly refined processed foods should be replaced by natural whole foods.

NATIONAL NEWS

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

Impact of Sahaja yoga meditation as an adjunct to medical treatment on post myocardial infarction patients in a tertiary cardiac centre – 2 years experience
Dr. Geetha Subramanian, Dr. Sundar Chidambaram, Dr. S.Venkatesan,
Chennai

Introduction: Sahaja yoga meditation is a very simple yoga which does not involve yogic posturing or chanting of mantras or control of breath.

Aim: To assess the impact of sahaja yoga on the future MACE and the comorbid conditions and overall wellbeing of the patients.

Materials and Methods: 180 patients, 126 M 54 F all were cases of recent infarction within two weeks admitted in our hospital. Age ranged from 28 to 76 years with mean age of 52 years. Nondiabetics 65 diabetics 115, systemic hypertension 46, obesity 25, hypothyroidism 5, dyslipidemia 72, smokers 95 and alcoholic 110. The pattern of MI was AWMI 63, IWMI 110, and combined AMI and IWMI 7, Echo showed normal systolic I.V. function 95 and mild LV dysfunction 85.
Physiotherapist and the yoga teacher taught the yoga on three days a week prior to discharge and patients were instructed to take appropriate medications for MI and comorbid conditions along with daily practice of sahaja yoga which is unique in that it could be practised at any time of the day whenever patient finds time and any number of times making it the simplest yoga to practice without strict rules and regulations. Patients came for review once in 2 weeks for three months and subsequently once in a month or when there was any cardiac symptoms. TMT done during follow up showed mild positivity in 95 negative 60 and strongly in 25 pts. CAG was normal in 125 pts, insignificant CAD in 43, SVD 12 LAD 6 and RCA 6 who also continued on medical treatment.

Results: With well planned clinical ECG and echo evaluation with proper follow up and interaction with the attending medical officer yoga teacher and physiotherapist only 10% patients alone had mild anginal symptoms none had any MACE or any situation necessitating hospitalization comorbid conditions like SHT and NIIDM also showed better control smoking and alcoholic practice was spontaneously stopped by the patients without any difficulty.

Conclusion: Our experience with adding of alternative therapy like SAHAJA yoga has boosted the confidence and morale of our patients – more involvement on the part of the patients with strict compliance and adherence to pharmacotherapy reduced the incidence of recurrent MACE events highlighting the importance of yoga as a relaxation technique having positive influence on the autonomic system leading to better clinical ECG, ECHO, metabolic and emotional stability. This is only an observational study. It needs much more broad based study involving more no of patients.

ß-blockers in AMI (Dr KK Sethi, New Delhi)

  • IV beta-blockers in carefully selected patients of STEMI at presentation (HT, ongoing Ischemia, ? Pre PCI).
  • Early oral beta blockers (within 24 Hours) useful.
  • Long-term beta-blockers in all with or without thrombolysis.
  • Long-term beta-blockers in high risk sub groups in PCI cases??
  • Randomized data needed in primary PCI population.

Ulnar Artery Cannulation: Tips and Tricks (Dr RK Gokhroo, Ajmer)

  • Ulnar artery cannulation is as comfortable as radial artery cannulation.
  • With experience, it’s not snakes and ladders, but only ladders all the way: Learning curve of ulnar artery cannulation did not differ much when compared to radial artery
  • Ulnar’s VInTEx SCore (Volume of pulse; INability to palpate ulnar artery comfortably; Tortuosity; Experience of operator<50 for radial/ulnar artery cannulation; Sex category: Female; Calcified vessel) of =3 is simple bed side score for predicting success of ulnar artery cannulation.
  • Bless radial for future: Always consider ulnar artery first if ulnar’s VInTEC score favors.
  • Rest Assured! : PTCA via ulnar route is as comfortable and as successful as radial route.

News Around The Globe

  • Air pollution should be viewed as one of several major modifiable risk factors in the prevention and management of cardiovascular disease, contends a European Society of Cardiology (ESC) position paper published online December 9, 2014 in the European Heart Journal, with lead author Dr David Newby (University of Edinburgh, Scotland). According to Dr Robert Storey (University of Sheffield, UK), air-pollution exposure should be part of the conversation with patients, who are often anxious to reduce their (CVD) risk in any way possible. We hope that our advice will help stimulate debate about improving cardiovascular health globally.
  • Subjective memory symptoms might be an early indicator of stroke risk, especially in highly educated people, suggests a new study published online in Stroke on December 11.
  • The US Food and Drug Administration (FDA) has expanded the indication of ramucirumab to include the treatment of metastatic non-small cell lung cancer (NSCLC). The approval is based on findings from the phase 3 REVEL trial.
  • Medical comorbidities are linked to poor semen quality, suggesting that current health condition and genetic factors affect sperm production, report the findings of a cross-sectional study published online December 9 in Fertility and Sterility.
  • Weight loss surgery may decrease the frequency and severity of lower urinary tract symptoms, suggest two new studies published online December 8 in BJU International.

IMA News

HC relief to docs: Clinics not under Shops & Est Act

By Ravikiran Deshmukh: Mid Day: Bringing relief to doctors running their clinics in the city, the Bombay High Court has ruled that no provisions of the Bombay Shops and Commercial Establishment Act, 1948, would be applied for running a medical practice.

The bench, comprising Justice V M Kanade and Justice P D Kode, was hearing a petition filed by a doctor from Malabar Hill. The court struck down the provision of the Act as ultra vires (beyond the legal power), and declared it to be inapplicable for medical professionals and their clinics.

The BMC had initiated criminal prosecution against several doctors of the city for failure to get their clinics registered under the Shops and Establishment Act. Many doctors pleaded guilty and paid the fine before the magistrate.

Dr Kavita Tilwani, a consultant gynaecologist and obstetrician, had approached the HC challenging the BMC’s criminal proceedings, allegedly in violation of the Act. She disputed the applicability and constitutional validity of the Act, calling it ‘an abuse of the process of law’.

Tilwani claimed that by running her medical practice, she was not carrying out any sort of business or commercial activity in her clinic, and treating it at par with a business or commercial activity was violating Articles 14 and 19(1) of the Constitution (right to equality and to practise any profession or occupation).

Dr KK Spiritual Blog

Debts in Mythology

It is said that there are three debts which everybody has to pay in his or her lifetime. In Vedic language, they are called Dev Rin, Pitra Rin and Rishi Rin.

In medical language, the body consists of soul, physical body, mind, intellect and ego. The soul is given to us by God or Devtas (Dev Rin), the physical body by our parents (Pitra Rin) and the mind, intellect and ego by our Gurus (Rishi Rin).

In terms of computer language, if I see my body as a computer, then my body as a computer is made by my parents; operating software and my inner internet represent the soul or consciousness given by the Devtas and the application softwares i.e. Word, Excel and Power point, which we learn over a period of time are given to us by our Gurus. Therefore, we have to pay all these three debts while we are still alive.

Inspirational Story

Keep Your Dream

I have a friend named Monty Roberts who owns a horse ranch in San Ysidro. He has let me use his house to put on fund-raising events to raise money for youth at risk programs.

The last time I was there he introduced me by saying, “I want to tell you why I let Jack use my horse. It all goes back to a story about a young man who was the son of an itinerant horse trainer who would go from stable to stable, race track to race track, farm to farm and ranch to ranch, training horses. As a result, the boy’s high school career was continually interrupted. When he was a senior, he was asked to write a paper about what he wanted to be and do when he grew up.

“That night he wrote a seven-page paper describing his goal of someday owning a horse ranch. He wrote about his dream in great detail and he even drew a diagram of a 200-acre ranch, showing the location of all the buildings, the stables and the track. Then he drew a detailed floor plan for a 4,000-square-foot house that would sit on a 200-acre dream ranch.

“He put a great deal of his heart into the project and the next day he handed it in to his teacher. Two days later he received his paper back. On the front page was a large red F with a note that read, `See me after class.’ “The boy with the dream went to see the teacher after class and asked, `Why did I receive an F?’

“The teacher said, `This is an unrealistic dream for a young boy like you. You have no money. You come from an itinerant family. You have no resources. Owning a horse ranch requires a lot of money. You have to buy the land. You have to pay for the original breeding stock and later you’ll have to pay large stud fees. There’s no way you could ever do it.’ Then the teacher added, `if you will rewrite this paper with a more realistic goal, I will reconsider your grade.’

“The boy went home and thought about it long and hard. He asked his father what he should do. His father said, `Look, son, you have to make up your own mind on this. However, I think it is a very important decision for you.’ “Finally, after sitting with it for a week, the boy turned in the same paper, making no changes at all.

He stated, “You can keep the F and I’ll keep my dream.”

Monty then turned to the assembled group and said, “I tell you this story because you are sitting in my 4,000-square-foot house in the middle of my 200-acre horse ranch. I still have that school paper framed over the fireplace.” He added, “The best part of the story is that two summers ago that same schoolteacher brought 30 kids to camp out on my ranch for a week.” When the teacher was leaving, he said, “Look, Monty, I can tell you this now. When I was your teacher, I was something of a dream stealer. During those years I stole a lot of kids’ dreams. Fortunately you had enough gumption not to give up on yours.”

“Don’t let anyone steal your dreams. Follow your heart, no matter what.”

Rabies News (Dr A K Gupta)

What is the "potency" of rabies vaccine?

WHO recommends that the vaccine potency should be at least 2.5 IU per dose. The potency is the capacity of the vaccine to induce immune response.

Cardiology eMedinewS

  • Routine measures of obesity are significantly associated with an increased risk of sudden cardiac death (SCD) among middle-aged citizens who do not smoke, findings from the Atherosclerosis Risk in Communities (ARIC) study indicate. However, only the waist-to-hip ratio, an index of reflecting both subcutaneous and intra-abdominal fat, was directly associated with SCD, while measures of body-mass index (BMI) and waist circumference were indirectly associated with SCD, apparently via effects on traditional CVD risk factors. The study was published online November 19, 2014 in Heart.
  • In compliant patients with true-resistant hypertension, renal denervation does not appear to reduce blood pressure more than intensified drug treatment and it is not ready to be used routinely yet, suggests new research from the Czech Republic published online in Hypertension.
emedipicstoday emedipics

Health Check Up and CPR 10 Camp at G B Sr. Sec. School No-1, Khanpur, New Delhi on 5th December 2014

video of day
press release

Weight loss may improve sexual health of obese diabetes

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 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in ventricles or cisterns.

Make Sure

Situation: An 18–year– old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

eMedinewS Humor

History of Telecommunication

After having dug to a depth of 10 feet last year, Italian scientists found traces of copper wire dating back 100 years and came to the conclusion, that their ancestors already had a telephone network more than 100 years ago.

Not to be outdone by the Italians, in the weeks that followed, a Chinese archaeologist dug to a depth of 20 feet, and shortly after, a story in the China Daily read: ‘Chinese archaeologists, finding traces of 200 year old copper wire, have concluded their ancestors already had an advanced high–tech communications network a hundred years earlier than the Italian’s.

One week later, the Punjab Times, a local newspaper in India, reported the following: After digging as deep as 30 feet in his pasture near Amritsar, in the Indian state of Punjab, Dugdeep Singh, a self–taught archaeologist, reported that he found absolutely nothing. Dugdeep has therefore concluded that 300 years ago, India had already gone wireless.

Twitter of the Day

Dr KK Aggarwal: Eating transfat increases bad LDL cholesterol and reduces good HDL Cholesterol
Dr Deepak Chopra: The world is as we are. What we see we become. Choose your seeing wisely.

Pediatrics eMedinewS

  • Children whose mothers were exposed to higher levels of phthalates, common chemicals in consumer products, in late pregnancy tend to score lower than other kids on intelligence tests at age seven, reported a new study published online December 10 in PLOS ONE.
  • Toddlers who sleep in the same bed as their parents may be at increased risk of developing asthma, suggests a new study published in the European Respiratory Journal. Study authors noted that bed-sharing at 24 months was associated with increased risk of wheezing between the ages of 3 and 6 years old, and toddlers who bed-shared at this age were also at higher risk of being diagnosed with asthma at age 6.

Quote of the Day

  • It is good to have an end to journey toward; but it is the journey that matters, in the end. Ursula K. LeGuin

Wellness Blog

Guidelines about Eating

Malnutrition and wrong dietary habits have been identified as major risk factors for ill health, including heart attacks. Most people below the poverty line suffer from malnutrition due to lack of calories, proteins and vitamins in their food. In the affluent society, overeating or eating wrong food results in over nutrition, a form of malnutrition leading to heart blockages. In this context Heart Care Foundation of India has formulated some guidelines about eating (as below).

These include:

  • Eat only when you are hungry.
  • Do not eat for pleasure, social obligations or emotional satisfaction.
  • Eat at a slow pace
  • Eat less; dinner less than lunch.
  • Take small mouthfuls each time, chew each morsel well, swallow it and only then take the next morsel.
  • Do not eat while watching television, driving a car or watching sports events. The mind is absorbed in these activities and one does not know what and how much one has eaten.
  • Do not talk while eating and never enter into heated arguments. The stomach has ears and can listen to your conversation. It will accordingly send signals to the mind and heart.
  • Plan and decide in advance what and how much food you will be eating.
  • Use low fat or skimmed mild dairy products. For cooking, use oils which are liquid at room temperature.
  • Do not take red meat and if you are a non–vegetarian, you may take poultry meat or fish.

ePress Release

Winter Asthma

Any breathlessness after the age of 40, appearing for the first time in winter, is cardiac asthma unless proved otherwise. Such patients should immediately get their blood pressure checked, which if found high needs immediate medical attention. First-onset breathlessness can also be an indication of angina or heart attack, 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. However, winter asthma or acute exacerbation of winter COPD (chronic bronchitis) is more common.

Asthma is reversible airway obstruction and COPD is irreversible airway obstruction. Sudden exposure to cold, humidity, pollution at lower levels in atmosphere can precipitate asthma in susceptible individuals. Winter is the time to increase the dose of asthma medicines.

If a person can speak a full sentence, the asthma attack is mild; if a person speaks broken sentences, the asthma attack is moderate and if the person is able to speak only words then the asthma attack is severe. Severe attack of asthma needs immediate hospitalization.

An attack of asthma is due to inflammation, narrowing and collection of fluid in the windpipe and needs medicines to widen the windpipe and reduce the inflammation.

The need of asthma medicines can be intermittent and/or permanent. The ‘Formula of 2’ becomes handy in such situations. A person who consumes more than two canisters of inhalers in a year or consumes asthma medicines more than twice in the night time in a month or more than twice in a day in a week, then he or she needs continuous asthma and anti inflammatory medicines. Inhalers are the best choices.

eMedi Quiz

At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1.Pancuronium.
2.Gallamine.
3.Atracurium.
4.Vecuronium.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct answers received from: Dr K Raju, Dr Rakesh Sharma, Dr Avtar Krishan, Dr Poonam Chablani, Tukaram Pagad, Dr KV Sarma.

Answer for 12th December Mind Teaser: 1.Criterion validity.

Correct answers received from: Tukaram Pagad, Dr KV Sarma.
Send your answer to email

medicolegal update

(Contributed by Dr MC Gupta, Advocate)

Q. On what grounds can the CEA 2010, be challenged?

Ans. The main grounds are as follows:

  • The Act has been made under Article 47 of the Constitution but there is no relation between this Article and the purpose of the Act.
  • The Act places unreasonable restrictions up on the fundamental right of the medical practitioners to practice their profession within the meaning of Article 19(1)(g).
  • The Act defines and provides adjudication for ‘emergency medical condition’ and ‘stabilisation’, which are medical concepts that should not be interfered by the courts.
  • The Act mandates giving emergency medical treatment without providing for a mechanism for compensation for the services rendered.
  • Solo practitioners are not, cannot and should not be treated as an establishment. They are already covered by the MCI Regulations. There is no parallel Act for other professionals who are covered by their own professional councils.
  • Medical treatment, including emergency treatment and standards for the same cannot be different for civil and defence establishments. There is no rational basis for exempting the armed forces from the purview of the Act.
  • The Act provides for a dismally low representation of modern medicine/allopathic doctors in the National and State Councils.
  • There is no provision for representation of the private sector in the National Council as envisaged in Sec 3 of the Act.
  • The District Registering Authority, having vast discretionary powers to impose heavy punishment, must have a legal expert as a member to avoid administrative arbitrariness.
  • Section 12 (1) (ii) of the Act takes away the freedom of the owner of the establishment to employ the number and type of personnel as he may think appropriate and thereby violates his fundamental right to run his establishment as he deems appropriate.
  • Too much power has been vested in the District Authority under various sections including Section 49.
medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

eMedinewS Special

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