emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma 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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

 

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–7 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

15th September 2012, Saturday

Longer CPR efforts may improve survival chances

A new study published online Tuesday in The Lancet looked into the duration of cardiopulmonary resuscitation in hospitals. The study suggests that many doctors may be giving up too soon in their efforts to resuscitate their patients.

The study found that patients have a better chance of surviving in hospitals that persist with CPR for just nine minutes longer, on average, than hospitals where efforts are halted earlier.

The findings challenge conventional medical thinking, which holds that prolonged resuscitation for hospitalized patients is usually futile because when patients do survive, they often suffer permanent neurological damage.

Patients who survived prolonged CPR and left the hospital fared as well as those who were quickly resuscitated.

The findings suggest that prolonging resuscitation efforts by 10 or 15 minutes might improve outcomes.

On average, hospitals spent 20 minutes on attempted resuscitation before a patient was declared dead. But hospitals that tried longest (those whose efforts averaged 25 minutes) had a 12–percent higher chance of patient response than those whose efforts (average 16 minutes) were shortest.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
    Constipation Update

How does fiber help in the management of constipation?

Fiber increases stool bulk, which causes colonic distention and promotes stool propulsion. A daily fiber intake of 20 to 25 g/day is generally recommended. The effects of fiber on bowel movements may take several weeks. Bloating and flatulence is a common problem with increased fiber intake.

For comments and archives

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Longer CPR efforts may improve survival chances

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

A non–stop Interaction between Patients and Cardiologists

A press conference was organized by Heart Care Foundation of India to announce about forthcoming 4th Dil Ka Darbar at Talkatora Stadium on Sunday, 23rd September, 2012 in association with World Fellowship of Religions.

 
Dr K K Aggarwal
 
    National News

Biological E Ltd, Hyderabad launches JEEV – Inactivated Japanese Encephalitis Vaccine

Hyderabad: 13 September 2012: Biological E Ltd, one of the leading Indian Vaccine manufacturers based at Hyderabad announced the launch of its latest vaccine – Inactivated Japanese Encephalitis Vaccine which is to be marketed under the brand name "JEEV. Japanese Encephalitis (JE) is a deadly viral disease afflicting major areas around the world and is the leading cause of AES – acute encephalitic syndrome. There were more than 8000 confirmed cases recorded in India in 2011 with over 1100 deaths. There is no specific treatment available for JE and vaccination is the most effective weapon against the disease. Inactivated vaccines are considered to have a better safety profile as compared to live vaccines. There is no other vaccine available to private doctors in India currently.

Dr. Vijay Kumar Datla, Chairman & Managing Director of Biological E. said, "With the launch of JEEV, the indigenous vaccine with excellent safety profile and proven efficacy in Indian subjects is now available to Doctors for prevention of Japanese Encephalitis in Children and Adults." The vaccine will be a safe and effective weapon against JE which is known for high mortality (up to 35%–40%) and high morbidity where up to 50% of all survivors end up with physical and mental disabilities after surviving the disease.

For comments and archives

World Sepsis Day observed for the first time

MUMBAI: Global and Indian medical community joined hands to observe World Sepsis Day on Thursday. This is the first time a day has been designated to raise awareness about Sepsis, which is coming to be recognised as one of the deadliest killers globally. Globally, an estimated 18 million cases of sepsis occurs each year. Sepsis is a serious medical condition that is triggered by any infection and can prove to be fatal if not intervened in time. Doctors from the Indian Society of Critical Care Medicine (ISCCM) have joined hands with Global Sepsis Alliance (GSA) to undertake awareness programmes. Dr Pravin Amin, council member of World Federation of Society of Intensive and Critical Care Medicine said, "While sepsis is one of the most serious medical conditions, there’s a tremendously low awareness among people and this includes even medical professionals not to mention the common man. Through WSD initiatives we aim to fill this gap that exists today." Amin explained how sepsis remains the primary cause of death from infection despite advances in modern medicine. Sepsis is often misunderstood by the public as ‘blood–poisoning’. "Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multiple organ failure, and death, especially if not recognized early and treated promptly," he said. Between one third and one half of patients with sepsis die. Every hour, about 36 people die from sepsis. Sepsis causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined, say global studies. (Source: TOI, Sep 13, 2012)

For comments and archives

4th Dil Ka Darbar

September 23, 2012, 9:00 AM–6:00 PM , Tal Katora Indoor Stadium, Connaught Place, New Delhi

A non stop question answer–session between all top cardiologists of the NCR region and the public.

My Profession My Concern

Quality standards for any clinical establishment

Hospital Compare, a quality tool provided by Medicare, currently provides performance data on 31 process measures in 5 clinical areas. These measures are adapted from JCI under "core measure set". (Heart attack, Heart failure, Pneumonia, Surgical care and Children’s asthma care)

Quality Measures related to heart failure

  • Evaluation of left ventricular systolic function: The percentage of heart failure patients with documentation that an evaluation of the left ventricular systolic (LVS) function was performed before arrival, during hospitalization, or is planned for after discharge. US National average performance is 98 percent.
  • Angiotensin–converting enzyme (ACE) inhibitor or angiotensin receptor (ARB) for left ventricular systolic dysfunction: The percentage of heart failure patients with left ventricular systolic dysfunction and without contraindications who are prescribed an ACE inhibitor or an ARB at hospital discharge. US National average performance is 95 percent.
  • Discharge instructions: The percentage of heart failure patients discharged home with written instructions or educational material given to patient or care giver addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen. US National average performance is 89 percent.
  • Smoking cessation advice/counseling: The percentage of heart failure patients with a history of smoking cigarettes who are given smoking cessation advice or counseling during a hospital stay. US National average performance is 99 percent.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

When should surgery be avoided in chronic mitral regurgitation?

Asymptomatic patients with severe chronic MR and normal LV systolic function (defined as LV ejection fraction (LVEF) ≥60 percent and LV end–systolic dimension <40 mm) are usually followed and managed conservatively.

(Experts: Dr Bhabha Nanda Das and Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr K S Dagar, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Non–pharma, in–home therapies decrease dementia symptoms

Nonpharmacological interventions administered in a home setting can significantly lower the severity and frequency of behavioral and psychological symptoms in patients with dementia, new research suggests. In addition, the metaanalysis showed that the interventions also improved reactions by the caregivers to these often stress–inducing symptoms. (Source: Medscape)

For comments and archives

Zapping renal nerves helps HTN, saves money

Catheter–based renal denervation to relieve drug–resistant hypertension appears to add significant clinical benefit in a cost–effective manner, according to a modeling prediction. (Source: Medpage Today)

For comments and archives

Symptom–based treatment of asthma appears effective

Symptom–based adjustment (SBA) of inhaled corticosteroids appears to be as effective as the use of physicians’ assessment–based adjustment (PABA) and biomarker–based adjustment (BBA). Physicians can thus be assured that SBA of inhaled corticosteroids dose is likely appropriate for most patients with mild to moderate asthma. William J. Calhoun, MD, from the University of Texas Medical Branch in Galveston, and colleagues published the results of the Best Adjustment Strategy for Asthma in the Long Term (BASALT) trial in the September 11 issue of JAMA. The study analyzed adults with mild to persistent asthma controlled with low–dose corticosteroid therapy.(Source: Medscape)

For comments and archives

No QoL hit with long–term finasteride

Long–term treatment with the 5 alpha–reductase inhibitor finasteride (Proscar, Propecia) did not adversely affect men’s health–related quality of life, a new analysis of a large randomized trial showed. (Source: Medpage Today)

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Poor hygiene habits may lead to Typhoid fever

@DeepakChopra: The politics of fear is the real danger to humanity

 
    Spiritual Update

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

Meaningful Coincidences: Synchronicity

If you meet someone you haven’t met for a long time, stop and talk to him or her. Remain aware of a message from the Universe that they might be carrying for you. Follow the coincidence through, and you’ll be amazed to find where it takes you.

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How will my doctor diagnose hydrosalpinx?

There are three ways that your doctor can check if you have hydrosalpinx.

  • X–ray procedure: The doctor will inject a special liquid into your uterus and then take an x–ray (called a hysterosalpingogram or HSG) to see where the liquid goes. If your fallopian tubes are open, the liquid will flow out of the ends of the tube. If the tubes are blocked, the liquid will be trapped and your doctor will be able to tell that you have a hydrosalpinx.
  • Surgery: Your doctor will make a small opening in your belly and insert a special telescope or laparoscope. During this surgery, the doctor can look at your fallopian tubes to see if they are blocked. Usually the doctor inserts a dye through the vagina into the uterus and fallopian tubes to confirm that the dye passes through the ends of the tubes.
  • Ultrasound: Your doctor may do an ultrasound to look at your fallopian tubes.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

What about Rh – positive and Rh – negative?

A patient with Rh–negative blood cannot be given Rh–positive blood as the antigen-antibody reactions will result in severe consequences.

In the females who have Rh negative with their husbands being Rh–positive, the first child with Rh–positive may be normal, subsequently she may not conceive or may have repeated abortions. There may be intra uterine fetal death. If the child born is alive, it will suffer from a fatal disease called "erythroblastosis fetalis." Now mothers can be given an injection of anti–D within 24 hours of the delivery of an Rh–positive child and thus protect the next baby from this catastrophe.

For comments and archives

 
    An Inspirational Story (Ms Ritu Sinha)

One Step

Foolish people with all their other thoughts, have this one too: They are always getting ready to live, but never living.

Your success will start when you begin to pursue it. To reach your goal or to attain success, you don’t need to know all of the answers in advance. You just need to have a clear idea of what your goal is. Don’t procrastinate when faced with difficult problems. Break your problems into parts, and handle one part at a time.

Develop tendencies toward taking action. You can make something happen right now. Divide your big plan into small steps and take that first step right away. Everyone who ever got where they are had to begin where they were. Your big opportunity is where you are right now.

A journey of a thousand miles begins with one step. Take it.

For comments and archives

 
  Cardiology eMedinewS

HIV docs may be missing signs of heart disease Read More

Heart Societies refine CRT guidance Read More

 
  Pediatric eMedinewS

Harder exercise tied to lower heart risk in kids Read More

Bedtime strategies for baby are safe Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with positive malaria came with severe thrombocytopenia.
Dr Bad: This is classical malaria.
Dr Good: Also look for dengue.
Lesson: Malaria and dengue may co exist in the same patient.

For comments and archives

Make Sure

Situation: A patient of pulmonary Koch’s on ATT complains of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

For comments and archives

 
  Quote of the Day (Dr GM Singh)

Begin challenging your own assumptions. Your assumptions are your windows on the world. Scrub them off every once in awhile, or the light won’t come in. Alan Alda

 
    Ophthalmology Update

(Dr S K Verma, Consultant Ophthalmologist, New Delhi)

Hearing impaired may see sound through glasses

Scientists from the Korea Advanced Institute of Science and Technology have developed glasses that allow a hearing impaired person to see when a loud sound is made and give an indication of where from it came. An array of seven microphones, mounted on frame of glasses, pinpoints the location of such sounds and relays that directional information to the wearer through a set of LEDs embedded inside the frame. The prototype requires the user to carry a laptop in a backpack to process the signal. The lead researcher Yang Hann Kim has stressed that the device is a first iteration that will be miniaturized over the next few year. (Courtesy – TOI, Sep 6, 2012)

 
    Legal Question of the Day (Dr M C Gupta)

Q. A woman was admitted in the special ward of a private hospital for delivery. As per hospital rules, three days admission is a must for delivery patients. This rule was not told to the patient in advance. The patient sought to be discharged after 24 hours of delivery. The hospital insisted on payment for 3 days regardless of the lesser duration of stay. It offered to shift the patient to general ward for the remaining 2 days if they did not want to pay the charges for special ward. The offer was not accepted. The patient stayed in special ward for 3 days. There was a hot dispute about the 3–days bill at the time of discharge. What are your comments?

Ans. My comments are as follows:

  1. It was the hospital’s fault in not displaying clearly the rule about 3–day minimum hospitalisation. As per rules applicable, hospitals have to display the charges at the reception counter.
  2. It was the hospital’s fault in not telling about the charges in writing when taking consent at the time of admission.
  3. It was the hospital’s fault in forcibly and illegally keeping the patient in the hospital when discharge was sought. If the patient was not fit to be discharged, she should still have been discharged after obtaining properly documented discharge consent.
  4. It was the hospital’s fault in not obtaining sufficient advance payment before admitting her to the special ward. Advance deposit should have been taken from the patient and daily bill should have been issued for payment. In case of non–payment, the patient should have been shifted to general ward without waiting for consent for such shifting. No consent for shifting a patient from one bed to another is needed. If there is physical obstruction to such shifting, the police should have been informed. However, this was not needed because discharge from the hospital was sought.
  5. This case is a classic example of doctors’ ignorance and carelessness about laws and legal principles. Every private hospital/nursing home must have on its staff an administrator and a legal advisor on suitable terms and conditions. If they are not prepared to take their assistance, it is their choice but, then, they should be prepared to suffer the consequences.

For comments and archives

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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Serum lactate dehydrogenase

Lactate dehydrogenase (LDH or LD) is an enzyme found in almost all body tissues, but only in a small amount in the blood. LDH is found in the bloodstream when cells are damaged. Because of this, LDH test can be used as a general marker of cell damage. Level of LDH may be measured either as a total LDH or as LDH isoenzymes. Elevated levels of LDH may be seen with:

  • Cerebrovascular accident (CVA, stroke)
  • Drugs: anesthetics, aspirin, narcotics, procainamides, alcohol
  • Hemolytic anemia
  • Pernicious anemia (megaloblastic anemia)
  • Infectious mononucleosis (Mono)
  • Intestinal and pulmonary infarction
  • Kidney disease
  • Liver disease
  • Muscular dystrophy
  • Pancreatitis
  • Lymphoma or other cancers
 
    Mind Teaser

Read this…………………

Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse’s priority should be

A. Placing her in a Trendelenburg position
B. Putting several warm blankets on her
C. Monitoring her hourly urine output
D. Assessing her VS especially her RR

Yesterday’s Mind Teaser: A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of

A. Hypervolemia, hypokalemia, and hypernatremia.
B. Hypervolemia, hyperkalemia, and hypernatremia.
C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
D. Hypovolemia, no fluctuation in serum sodium and potassium levels.

Answer for Yesterday’s Mind Teaser: C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.

Correct answers received from: Prabha Sanghi, Dr Parimal Shah, YJ Vasavada, Dr (Maj. Gen.) Anil Bairaria, Dr BB Aggarwal, Dr K Raju, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Kanta Jain, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Answer for 13th September Mind Teaser: C. Low residue diet
Correct answers received from: Prabha Sanghi.

Send your answer to ijcp12@gmail.com

 
    Fitness Update (Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Teen dies after playing basketball

A Michigan teen collapsed Tuesday while playing basketball at a Life Time Fitness center and later died at a nearby hospital.

Bryson Salem, 18, collapsed at 5 p.m. Tuesday at the Life Time in the Detroit suburb of Commerce Township, MI, according to the Oakland County (MI) Medical Examiner’s Office as reported by the Detroit Free Press. Salem was taken to Henry Ford West Bloomfield Hospital, where he was pronounced dead at 6:17 p.m., the newspaper reported. "Our heartfelt condolences, thoughts and prayers go out to the family in light of this tragedy," Jason Thunstrom, vice president of public relations and corporate communications at Life Time Fitness, Chanhassen, MN, said today in a statement to Club Industry. "As you can imagine, it is weighing heavily on our team at this time."

Salem’s father told the newspaper his son had recently undergone a check–up and had no pre–existing medical conditions. An autopsy is pending. Visitation will take place today, and the funeral will be Thursday.

Salem, a Commerce Township native, graduated from Walled Lake Western High School and was a freshman at the University of Detroit studying pre–dentistry, according to the Free Press. "Just pray for him, that’s all," his father told the newspaper this morning

 
    Laugh a While (Dr GM Singh)

Some answers

  1. Antibody – One who hates his body
  2. Artery – Study of Fine Paintings
  3. Bacteria – Back door of a Cafeteria
  4. Coma – Punctuation Mark
  5. Gallbladder – Bladder of a Girl
  6. Genes – Blue Denim
  7. Labour Pain – Hurt at Work
  8. Liposuction – A French Kiss
  9. Ultrasound – Radical Sound
  10. Cardiology – Advanced Study of Playing Cards
 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is minimally conscious state?

Minimally conscious state is distinguished from vegetative state by the partial preservation of conscious awareness.

  • Some patients with severe alteration in consciousness have neurological findings that do not meet criteria for vegetative state (VS).
  • These patients demonstrate some behavioral evidence of conscious awareness but remain unable to reproduce this behavior consistently the condition referred here as the minimally conscious state (MCS).
  • To make the diagnosis of MCS, limited but clearly discernible evidence of self or environmental awareness must be demonstrated on a reproducible or sustained basis by one or more of behaviors like verbal yes/no responses regardless of accuracy, purposeful behavior, including movements or emotional behaviors that occur in relation to relevant environmental stimuli and are not due to reflexive activity.
  • Some examples of qualifying purposeful behavior include: appropriate smiling or crying in response to the emotional but not to neutral topics, vocalizations or gestures that occur in direct response to the linguistic content, reaching for objects.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Vegetarian diet and Soya Products help reduce BP

Ingestion of a vegetarian diet may reduce systolic blood pressure by 5 mmHg. A 5 mm reduction in blood pressure may reduce the risk of heart disease by 21%. This was stated by Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Dil Ka Darbar to be held on 23rd September 2012 at Talkatora Stadium.

One major feature of a vegetarian diet that may affect blood pressure is the amount of dietary fiber; with an increased amount being associated with decreased systemic pressures. Multiple meta–analyses have shown benefits with dietary fiber intake on blood pressure.
Vegetarians, in general, have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. Experts postulate that a typical vegetarian’s diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, vitamin C and vitamin A, all of which may have a favorable influence on blood pressure.
More significant reductions were observed in older (greater than 40 years) and hypertensive individuals.

Soya is good for high blood pressure because it is naturally high in potassium and low in sodium. Potassium and sodium are electrolytes, and a high–potassium, low–sodium diet promotes a healthy blood pressure.

Soya can be good for high blood pressure when you eat it as an alternative protein source to unhealthy meats. Soya–based meat substitutes, such as veggie burgers, veggie bacon and meatless cold cuts, can be higher in fiber and lower in sodium than animal-based meat products. They can lower your risk for heart disease because they are lower in saturated fat. However, soya does not contain the long–chain omega–3 fatty acids that are found in fatty fish and shellfish; these may lower your blood pressure, according to the Linus Pauling Institute.

Even though soya is low in unhealthy saturated fat, some soya products are high in total fat and calories, and as a result will contribute to weight gain if you eat too much. Losing weight if you are overweight, or maintaining your current weight if you are already at a healthy weight, improves your chances of lowering your high blood pressure.

 
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