eMedinewS
15th December 2014, Monday

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

12 Steps to tackle Heartburn

  • Eat smaller meals, but more often.
  • Eat in a slow, relaxed manner.
  • Remain upright after meals.
  • Avoid late–night eating (last meal three hours before sleep)
  • Don’t exercise immediately after meals.
  • Tilt your torso with a bed wedge.
  • Stay away from carbonated beverages.
  • Find the foods that trigger your symptoms and avoid them (fatty foods, spicy foods, tomatoes, garlic, milk, coffee, tea, cola, peppermint, and chocolate.)
  • Chew sugarless gum after a meal which promotes salivation and neutralizes acid.
  • Check your drugs that can loosen the lower esophageal sphincter (LES) or cause acid reflux or inflammation of the esophagus.
  • Lose weight if you need to.
  • Avoid hurry, worry and curry.

NATIONAL NEWS

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

Extracorporeal Shockwave Myocardial Revascularization (G Muralidharan, Chennai)

Patients with advanced CAD pose a major challenge for the cardiologist and cardiac surgeon. They have often been through several “re-do” coronary bypass procedures and multiple PCIs. Surgical and interventional options for these patients typically have been exhausted or will result in only partial revascularization. So, the options available to them are the use of multiple antianginal medications, reduced activity, exertion, and stress level, and significant alteration and limitation of lifestyle.

New approaches such as therapeutic angiogenesis offer hope for these patients. Therapeutic angiogenesis induces the growth and development of new vasculature in zones of severe ischemia in the myocardium, which are viewed to act as collaterals, perfusing ischemic territories unapproachable by macro procedures such as angioplasty and bypass surgery. Strategies adopted for this are local injection of naked DNA or viral vectors coding for various angiogenic growth factors (e.g., VEGF and FGF). These have been examined in animals and humans, as have local injections of actual growth factor proteins such as VEGF, FGF, and IGF. Local delivery of endothelial cells and bone marrow-derived precursor stem cells are other approaches being studied. However, they have significant limitations in terms of rapid translation into clinically useable therapies in the near term.

Injury-induced angiogenesis is another long studied strategy. While not referred to directly in the literature by this term, many studies have emerged over the years using variants of this approach. However, long term effect was not demonstrated.

A new Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy couples the ability of “Low Intensity Shock Waves” to induce angiogenesis and is becoming a new alternative in the treatment of these patients. This new technology is launched in India by name Cardiospec.

Reversible ischemic regions, no longer approachable or treatable by exiting invasive methods are being targeted and treated with ESMR. Short and long term results have shown the ability of this new therapy to increase local perfusion, reduce symptoms, improvement in CCS class, nitrates intake, reduction in re-hospitalization/visit to the doctor’s office and thereby significant improvement in overall quality of life of patients.

News Around The Globe

  • A novel class of synthetic hallucinogens, being sold as a cheaper, more readily available LSD substitute, or even as LSD itself, is emerging as a particularly fatal drug, especially for young males, suggests new research presented at the American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting.
  • Results from the large international Suppression of Ovarian Function Trial (SOFT) are practice changing for the adjuvant treatment of premenopausal women with early-stage hormone receptor (HR)-positive breast cancer, and state that ovarian suppression with endocrine therapy has striking benefits for some of these patients. The results, presented at the San Antonio Breast Cancer Symposium (SABCS) 2014, have led to a new algorithm for the adjuvant treatment of premenopausal women with HR-positive breast cancer.
  • Low levels of oxygen saturation during sleep and reduced durations of slow-wave sleep are both associated with more brain pathology characteristic of dementia, points a new study published online December 10 in Neurology.
  • Drug clearance is not normal in patients with chronic kidney disease (CKD), even for drugs that are only minimally cleared by the kidneys, and it varies by mode of dialysis, suggests a new study published in the American Journal of Kidney Diseases.
  • Allergens modified by carbamylation so that they can be absorbed by the oral mucosa and given as sublingual immunotherapy may be effective in patients with rhinoconjunctivitis and allergic asthma caused by cat allergies, suggests a cross-sectional survey presented at the World Allergy Organization International Scientific Conference and Congress of the Brazilian Association of Allergy and Immunology.

Dr KK Spiritual Blog

Bhoot, Pret and Pishach

In mythology, ‘Bhoot’ means the memories of known people whose unfulfilled desires keep on disturbing us. ‘Pret’ means the memories of unknown people whose unfulfilled desires keep coming to our mind during sleep and disturbing us. These unfulfilled desires of unknown people are instances that we may have forgotten but still reach us through the cloud internet. When these memories start disturbing our day to day life, they are defined as Pishach.

Pret, Pishach and Bhoot are seen only by some people and not everyone. That means that their attachment will only be with those with whom their unfulfilled desires were linked to.

This attachment disorder where the unfulfilled desires of the diseased person keep on coming to our mind during day time, night and in our dreams can be understood by a computer IT model used by porn sites.

People who own porn sites develop software by which a specific program can get transferred to our computer and whenever we open these sites the program file gets embedded in our computer in a secret location in such a way that whenever we open the computer, the specific program will appear on the desktop or will become the preferred sites whenever we open the internet. The specific site only will automatically open even if we do not wish to open it.

These files are difficult to delete unless the computer is reformatted or an experienced IT professional is able to delete these files.

The attachment disorders and the unfulfilled desires of the deceased persons can be compared to this technology and can be explained why those thoughts keep on coming in our mind. Not only the thoughts, even the images of people keep coming into mind and they are difficult to get deleted.

Inspirational Story

Determining Your True Path

A master was strolling through a field of wheat when a disciple came up to him and asked, "I can’t tell which is the true path. What’s the secret?"

"What does that ring on your right hand mean?" asked the master. "My father gave it to me before dying." "Well, give it to me." The disciple obeyed, and the master tossed the ring into the middle of the field of wheat.

"Now what?" shouted the disciple.

"Now I have to stop doing everything I was doing to look for the ring! It’s important to me!"

"When you find it, remember this: You yourself answered the question you asked me. That is how you tell the true path: It is more important than all the rest."

Rabies News (Dr A K Gupta)

What are monoclonal antibodies?

Monoclonal antibodies (mAb) are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.

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, suggest the findings from the Atherosclerosis Risk in Communities (ARIC) study. Waist-to-hip ratio was directly associated with SCD, while measures of body-mass index (BMI) and waist circumference were indirectly associated with SCD. The findings were published online in Heart.
  • A new study published online in Hypertension states that systolic blood pressure levels tend to be higher in subjects drinking a beverage from bisphenol A (BPA) containing cans as compared to when they drank the same beverage from glass bottles.

Pediatrics eMedinewS

  • For infants at high risk for atopic dermatitis, the daily application of a common moisturizer leads to fewer skin problems, including eczema, by 32 weeks of age, suggests a new study published in the Journal of Allergy and Clinical Immunology.
  • Two promising models that could help pinpoint which children are at highest risk for subclinical seizures and should be prioritized for receiving continuous EEG monitoring (CEEG) were discussed at a press briefing during the American Epilepsy Society (AES) 68th Annual Meeting.

Quote of the Day

  • Life has no limitations, except the ones you make. Les Brown

Wellness Blog

Nine Modifiable Risk Factors for Heart Attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, lack of adequate fruits and vegetables in diet and sedentary lifestyle. These account for over 90 percent of the population–attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years it begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. The Heart Care Foundation of India recommends walking 80 minutes in a day and with a speed of 80 steps per minute.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at GB S School, Khan Pur, New Delhi, on 27th November 2014

video of day
press release

Red flag arthritis

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: Embolization occurs in how many patient of DVT? (JR to SR).
Dr Bad: Rare!
Dr Good: Common!
Lesson: Embolization occurs in about 50% of patients with proximal vein DVT.

Make Sure

Situation: A 7–month–old infant presented with grunting respiration, fever, anorexia and irritability. On chest x–ray, pneumatoceles was present.
Reaction: Oh my God! Why did you not start erythromycin immediately?
Lesson: Make sure to remember that erythromycin is an effective drug for Staphylococcal acquired pneumonia.

eMedinewS Humor

Marriage is like old bed room slippers. They are well worn and have lost their appeal, but you don’t want to replace them with a new pair because they are too cosy and comfortable.

Twitter of the Day

Dr KK Aggarwal: Keep your BP lower than 120/80 mmHg
Dr Deepak Chopra: A universe of rational laws that can be understood by rational minds can only have its source in a rational Being

ePress Release

Diabetics should not smoke

The health hazards of cigarette smoking in the general population are well known. In patients with diabetes mellitus, smoking considerably increases the risk for both macrovascular (cholesterol deposition) and microvascular (eye, kidney involvement) disease, 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.

Smoking is an independent risk factor for all-cause mortality, largely due to cardiovascular disease.
There is a dose-response relationship between current smoking status and risk of coronary disease in women with diabetes. The risk is 1.7 and 2.68 for 1 to 14 and >15 cigarettes per day, respectively. The risk returns to baseline in those who had stopped smoking for more than 10 years.

The risk of mortality in diabetic women also increases with the number of cigarettes smoked per day. The risk is 1.4 and 2.1 for 1-14 and >35 cigarettes/day, respectively. The risk decreases substantially 10 years after quitting smoking.

Smoking is associated with increases in the serum concentrations of total cholesterol and very-low-density lipoprotein cholesterol, a decrease in serum high-density-lipoprotein cholesterol levels, and a greater degree of insulin resistance. Smokers, via an uncertain mechanism, have poorer glycemic control.

In patients with type 1 diabetes, smoking is independently associated with an increase in urinary albumin excretion and nonproliferative retinopathy. The degree of albuminuria falls to the level of nonsmokers if smoking is discontinued.

Smokers with either type 1 or type 2 diabetes are at increased risk for neuropathy, an effect that persists even after adjusting for glycemic control.

Smoking is associated with an increased risk of end-stage renal disease and with decreased survival once dialysis is commenced.

eMedi Quiz

A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1.Fat embolism.
2.Hypovolemia.
3.Bronchospasm.
4.Myocardial infarction.

Yesterday’s Mind Teaser: 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.

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

Correct answers received from: Srinivas Subudhi, veeranna gowda, Dr Poonam Chablani, Dr Rakesh Sharma, Dr Avtar Krishan, Tukaram Pagad,

Answer for 13th December Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct answers received from: Dr Jainendra Upadhyay

Send your answer to email

medicolegal update

(Contributed by Dr MC Gupta, Advocate)

Q. What should the hospital/doctors do when the attendants of an unconscious patient with tracheostomy tube, IV lines, Ryle’s tube and indwelling catheter demand that all these be removed at their own risk and responsibility?

Ans.

  • A doctor’s duty is to save, not to take life. Taking life is homicide. Removal of these gadgets will be tantamount to an attempt to take life which also is a criminal act.
  • A doctor is supposed to give or withhold or withdraw or change treatment as per principles of medicine and not as per the orders of a layman or even the patient himself. A doctor who acts otherwise will be guilty of misconduct/negligence.
  • If the act of removing the appliances is done by the doctors or the hospital staff, the risk and responsibility are to be faced by the person doing the act. The relatives cannot be made responsible for the acts of the hospital staff.
  • Even if the relatives make a written request to the hospital to withdraw treatment/appliances, such written request has no meaning in law. Consent for treatment or its stoppage has to come from the patient or his authorised representative.
  • If the authorised representative makes a written request to the doctors to stop treatment when the result of stopping treatment might result in death, the doctors should not act upon the request because euthanasia is not allowed by law. In such a situation, the hospital should contact its advocate for necessary guidance.
medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)