eMedinewS15th June 2014,Sunday

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

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Who can write Specialist as a suffix?

Recently, a State Medical Council took a couple of decisions under which an MD Medicine cannot write Physician & Cardiologist and an MBBS cannot write Physician & Gynecologist.

This is a matter which needs to be debated and I feel that the Indian Medical Association should come out with clear–cut guidelines to be followed by its members.

Following are my personal views:

  1. MCI Regulation 7.20, it states – "a physician shall not claim to be a specialist unless he has special qualification in that branch." The Ethics regulation were framed in 2002, therefore, this clause is applicable to only those who have passed MBBS or a PG degree after 2002. Before that there was no such clause. Therefore, a doctor MD medicine practicing as a cardiologist is free to do so.

    The above clause only says "unless he has special qualification in that branch". Nowhere does it mention that this special qualification should be MCI recognized or this special qualification could be DM or MCH. The words "special qualification" can mean even an experience, diploma or a certificate.

    In an RTI Ref. no. 4898, MCI has answered a query on application dated 23.02.2014 received in the Council Office on 28.02.2014. The RTI refers to the decision of Ethics Committee in its meeting on 19/20 April 2004 which is reproduced below:

    Q 1: A person having qualification of MBBS can perform i) caesarean surgery, ii) hysterectomy and iii) other general surgery procedures.

    Clarification: A physician shall not claim to be a specialist unless he has special qualification in the branch. The special qualification means degree/diploma in the concerned specialty, however this provision does not debar a doctor having proper documented/certified adequate training/exposure in an institution recognized by MCI thereby gaining/competency and experience to work in any particular discipline/branch where.
  2. Regulation 7.20 should be read with Ethics Regulation 1.4.1 which states, "physicians who display as suffix to their names only recognized medical degrees or such certificates/diplomas and membership/honours which confer professional knowledge or recognized any exemplary qualification/achievement." The word "Dr." is a prefix and whatever is written after the name of a doctor, including degrees and qualifications and specializations is a suffix. As per this clause, a person can display as suffix recognized medical degree or even a certificate or diploma which confers medical professionally knowledge or membership or honours which confer professional knowledge. He can also suffix a certificate, diploma, membership or honour which recognize any exemplary qualification or achievements.
  3. If MCI Ethics Regulations 1.4.2 is read with 7.20, then MBBS who has done six months residency in medicine and six months residency in surgery can easily practice and right as physician & surgeon.
  4. Today in the era of NABH accreditation, privileges are defined for every practitioner with experience. These privileges can be redefined by Indian Medical Association or adopted from international scenario. For example, all three can be cardiologists: an MBBS, MD or DM but all three of them will have different privileges as regards who can perform an angioplasty.

Obituary

With profound grief we would like to inform that Dr. SS Rastogi (Endocrinologist/Diabetes specialist) has passed away. His prayer meeting (Chautha) is on Sunday June 15th from 4:00 to 5:00 PM at

Satsang Bhawan, R 814 B, New Rajinder Nagar, New Delhi – 110060

Thank you, Dr. Sharad Rastogi, MD, MBA (Dr. SS Rastogi’s son) 9811114121

News Around The Globe

  • A new study published in Occupational & Environmental Medicine has pointed that hairdressers using permanent hair dye and hair waving products appear to be exposed to carcinogenic aromatic amines. Their blood levels of certain carcinogens appear to be associated with the frequency with which they apply treatments, including hair dyes and permanent waves.
  • A new study presented at the European League Against Rheumatism (EULAR) Congress 2014 has shown that sarilumab plus methotrexate bring about better clinical, radiographic, and functional responses in patients with moderate to severe rheumatoid arthritis (RA), as compared to methotrexate alone.
  • Patients with knee osteoarthritis (OA) can attain significant benefits and avoid physical function limitations just by walking more, reports a study published in Arthritis Care & Research. Researchers noted that walking an additional 1000 steps each day was associated with a 16% to 18% reduction in incident functional limitation 2 years later.
  • Use of selective serotonin reuptake inhibitors (SSRIs) for depression is not associated with cerebral microbleeds, reported Dutch researchers in an online report published in Stroke.
  • Italian researchers have identified 4 microRNA (miRNA) biomarkers that are significantly decreased in patients with Alzheimer’s disease (AD) compared with controls. Three of these were also decreased in cerebrospinal fluid (CSF), thereby pointing that circulating miRNAs, along with other biomarkers, can serve as noninvasive indicators of AD. The findings were presented at the 24th Meeting of the European

Rabies News (Dr A K Gupta)

A previously immunized person is bitten again. What is the re–exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory–confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to overtreat than undertreat.

Cardiology eMedinewS

  • Parity appears to have a nonlinear association with cardiovascular events with the minimum incidence in women with two births, a slightly higher incidence in nulliparas and primiparas, and a dramatically higher prevalence in women with higher parity, reported a study published online in Hypertension. Parity appeared to be associated with lower carotid artery distensibility.
  • The first drug–eluting balloon (DEB) to go before a panel of advisors to the US Food and Drug Administration has received a unanimous vote of support. The FDA’s Circulatory System Devices panel members have voted in favor of recommending approval of the Lutonix drug–coated balloon PTA catheter. The system elutes paclitaxel during balloon inflation and is intended for use in the femoropopliteal arteries.

Pediatrics eMedinewS

  • A new study from Europe has revealed that very young children with type 1 diabetes possibly lack the gut microbes that are responsible for producing a beneficial metabolite from food, called butyrate, which protects the gut from inflammation. It was noted that healthy children had a higher abundance of Clostridium clusters IV and XIVa compared to children with type 1 diabetes. The study appears online June 12 in Diabetologia.
  • Children with severe asthma have increased odds of having reduced lung function during middle age, than their counterparts who have only mild wheeze, reports a study published in the June issue of the Journal of Allergy & Clinical Immunology. Severe asthma in childhood was associated with approximately a 12–fold risk that a 50–year–old would have current asthma; those with hay fever in childhood had a 2–fold risk of being asthmatic adults.

Dr K K Spiritual Blog

Spiritual prescription: Meditation vs Concentration

Meditation is not concentration. Concentration is holding the mind to something within or outside the body. On the other hand, meditation is an unbroken flow of thoughts towards the object of concentration. It can be called prolonged concentration. Meditation is like pouring of oil from one vessel to another in a steady unbroken stream.

Samadhi or absorption is when the object of concentration and the mind of the perceiver becomes one. When Concentration, Meditation and Samadhi are brought to bear upon one subject, it is called Samyam.

According to Yoga Sutras of Patanjali, (3.1–3.6), meditation needs to be learnt and applied step by step. The practice starts by sitting straight with erect spine, preferably in Padmasana (one can also sit on the chair) and concentrate on the breathing or on a primordial sound given by the teacher.

When the mind can be made to flow uninterruptedly towards the same object for 12 seconds, one is said to have learnt the process of concentration.

  • When the mind can continue in that concentration for 12 times (12 seconds × 12 i.e. 2 minutes 24 seconds), one is said to be practicing meditation.
  • When the mind can continue in that concentration for 12 times (12 minutes 24 seconds × 12 i.e. 28 minutes 48 seconds), one is said to be in Samadhi.
  • And if this lower Samadhi can be maintained for 12 times, i.e., for 5 hours 45 minutes and 36 seconds, one is said to be in Nirvikalpa Samadhi.

The mind becomes one–pointed when similar thought waves arise in succession without any gap between them. One should remember that during meditation, the object of concentration may change in form, time and rhythm.

The whole process of meditation, therefore, varies from person to person and day to day. During meditation some may only concentrate, some may actually meditate and some may go into Samadhi. Most of us wander from concentration to meditation.

Once in meditation or Samadhi, by fixing the mind on various structures, internal or external, one can achieve siddhi powers. For e.g., by concentrating on the tip of nose one can acquire better smelling powers; by concentrating on the tip of the tongue, one can acquire supranormal tasting powers; by concentrating on the middle part of the tongue, one can acquire supranormal powers of sensation; by concentrating on the root of the tongue, one can acquire supra normal hearing; and by concentrating on palate one can acquire supra natural colour perceptions. With experience, one can concentrate upon any object of any size, from the atom to the infinity.

Just as pure crystal takes colour from the object nearest to it, the mind when cleared of thoughts achieves identity with the object of concentration.

Primordial sound (beej mantra) meditation is based on the principle that the initial one–point concentration on a particular sound (seed) over a period of time becomes seedless or thoughtless (yoga sutras of Patanjali 1.51).

Swami Vivekananda co–related it with Raj Yoga and said that our average span of attention on a particular object is only around three seconds. He said that if one is able to increase this attention span and concentration at an object of our choice for 12 seconds then we are practicing Patanjali’s sixth stage of yoga or ‘dharana’, which translates as contemplation. And if we can further increase our concentration ability to 12 × 12 seconds or for 144 seconds, then we have reached the mental plateau of meditation or ‘dhayana’. Swami Vivekananda further went on to attribute values to the exalted state of samadhi or transcendental conscious mental state which in value is termed as arising from a meditative or concentration span of 12 × 12 × 12 seconds, which is 30 minutes or half an hour.

Vedanta describes it in terms of units. It says that if you can concentrate 12 seconds on a subject uninterruptedly, it becomes one unit of concentration; 12 such units of concentration make one unit of meditation; 12 units of meditation lead to the first stage of samadhi and 12 units of this samadhi lead to the highest samadhi, the supreme realization of Atman. Dharana is concentration; Dhyana is meditation and Samadhi is trance.

Patanjali called them as ‘Matra: If you are able to sit, withdraw the mind and fix it upon a focal point within (it may be gross, subtle or anything), and are able to keep the mind fixed like that for a period of twelve Matras – a Matra is approximately a moment or a second – it is counted as ‘one concentration’. It says "If you can keep the mind steady without moving, without any contrary thoughts coming in, and without moving away from the object of concentration for a period of twelve Matras, it is regarded as ‘one Dharana or one concentration". He further says that one should go on practicing this Dharana for days and weeks and months so that it becomes longer and longer. By continuous practice, if one is able to keep the mind focused upon one single point without moving here or there, for 144 seconds (a period of twelve Dharanas), then the person is called Dhyani or a Dhyana Yogi.

The Yoga Sutra of Patanjali (3.6) clearly says that meditation must be learnt in stages. It calls for repeated practice of meditation. The three basic components of meditation are: The subject of meditation, the center of consciousness at which the mind is held, and the method employed to guide the mind to concentration.

The subject of meditation may be the non–dual all–pervading Self, any specific aspect of the divine, or any divine incarnation. The center of consciousness may be at the heart, or between the eyebrows, or at the crown of the head. The method employed to invoke concentration may be any of the following: Japa, or repetition of a sacred word; discrimination between the real and the unreal; dispassion, which is knowing the evil effect of sense–enjoyment; pranayama, or control of breath and ceremonial observances.

But regularity is most important. One can start with looking at any object – flame, idol, or picture for 12 seconds with total concentration and without blinking eyelids (concentration). And then one practices 12 concentrations to make one meditation. The proper meditation thus need not last more than 2 minutes 24 seconds.

Wellness Blog

Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.

  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or ulcerative colitis (UC).
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of UC was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non–significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD.
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD.
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.

Zee News – Health Wealth Shows

Alcohol
Cancer Prevention
Depression
Paralysis
Pneumonia
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Vitiligo
Fluid Intake

 

Total CPR since 1st November 2012 – 88972 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

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

Health Check Up Camp at Gitarattan Jindal Public School Sect–7 Rohini, 12th May 2014

press release

Monitoring LFT in a patient on statins

video of day video of day

 

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 :

 

Make Sure

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

eMedinewS Humor

Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

Quote of the Day

Chance favors those in motion. James Austin

 

Twitter of the Day

Dr KK Aggarwal: Diabetes and heart patients beware during Navratri fasts http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Recurrent anxiety can have a devastating toll on all aspects of our life. How to deal with anxiety? http://bit.ly/DC_Ananda #ananda

 

Forth Comming Event

Announcement

Call for Free Registration

4th annual conference Zoonosis 2014
Sunday 6th July 10am–2 pm followed by Lunch

Venue; Indian Medical Association HQs, IMA House, ITO New Delhi

Objective: To discuss about prevention of diseases communicable
from animals to human.

Who can take part: Medical Practitioners,Veterinary Practitioners, Animal Owners/Breeders, NGOworking with animal care etc.

Experts will be from Veterinary/Medical sectors

All participants will be given certificate of participation.

Organizers: Heart Care Foundation
of India, Millennium India Education
Foundation,CAR (Ministry of Agriculture Govt.of India,

Register at :
rawat.vandana89@gmail.com/
drkakroo@gmail.com
or Call: Vandana 9891673085/Dr Kakroo 9810301261

 

Inspirational Story

Competing wth Others

I was jogging one day and I noticed a person in front of me, about one–fourth of a mile. I could tell he was running a little slower than me and I thought, good, I shall try to catch him. I had about a mile to go my path before I needed to turn off. So I started running faster and faster. Every block, I was gaining on him just a little bit. After just a few minutes I was only about 100 yards behind him, so I really picked up the pace and push myself. You would have thought I was running in the last leg of London Olympic competition. I was determined to catch him. Finally, I did it! I caught and passed him by. On the inside I felt so good.

"I beat him" of course, he didn’t even know we were racing. After I passed him, I realized I had been so focused on competing against him that I had missed my turn. I had gone nearly six blocks past it. I had to turn around and go all back. Isn’t that what happens in life when we focus on competing with co–workers, neighbors, friends, family, trying to outdo them or trying to prove that we are more successful or more important? We spend our time and energy running after them and we miss out on our own paths to our God given destinies.

The problem with unhealthy competition is that it’s a never ending cycle. There will always be somebody ahead of you, someone with better job, nicer car, more money in the bank, more education, better behaved children, etc. But realize that "You can be the best that you can be, you are not competing with no one."

Some people are insecure because they pay too much attention to what others are doing, where others are going, wearing and driving.

Take what God has given you, the height, weight and personality. Dress well and wear it proudly! You’ll be blessed by it. Stay focused and live a healthy life. There’s no competition in DESTINY, run your own RACE and wish others WELL!

ePress Release

Can diabetes be prevented?

Adhering to the Mediterranean diet, which is rich in fruits and vegetables and low in animal products, may protect one against developing type 2 diabetes 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.

The diet emphasizes olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and deemphasizes meat and dairy products. It is a healthy eating plan that seems to help in the prevention of heart disease.

In the study published in the British Medical Journal, researchers tracked the diets of 13,380 Spanish university graduates with no history of diabetes. Participants filled out a 136–item food questionnaire, which measured their entire diet (including their intake of fats), their cooking methods and their use of dietary supplements. During an average of 4.4 years of follow–up, the team found that people who adhered to a Mediterranean diet had a lower risk of developing type 2 diabetes. In fact, those who stuck very closely to the diet reduced their risk by 83 percent.

Moreover, the people who tended to stick closest to the diet were those with factors that put them at the highest risk for developing diabetes, such as being older, having a family history of diabetes and being an ex–smoker. These people were expected to have a higher rate of diabetes, but when they adhered to the Mediterranean diet this was not the case.

Type 2 diabetes is typically brought on by poor eating habits, too much weight and too little exercise.

One key factor that might be responsible for the protective effect of the Mediterranean diet is its emphasis on olive oil for cooking, frying, putting on bread and mixing in salad dressings.

Tips to prevent diabetes

  • Eat less
  • Omit refined carbohydrates (white sugar, white rice and white maida)
  • Use olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and reduce meat and dairy products.

eMedi Quiz

A 2–month–old baby with acute icteric viral hepatitis like illness slips into encephalopathy after 48 hours. The mother is a known hepatitis B carrier. Mother’s hepatitis B virus serological profile is most likely to be:

1. HBsAg positive only
2. HbsAg and HBeAg positive
3. HBsAg and HBe antibody positive
4. HBV DNA positive

Yesterday’s Mind Teaser: Bacitracin acts on:

1. Cell wall
2. Cell membrane
3. Nucleic acid
4. Ribosome

Answer for yesterday’s Mind Teaser: 1. Cell wall

Correct answers received from: Dr Jayant Gaikwad, Dr Sushma Chawla, Dr Pankaj AgarwalDr Jainendra Upadhyay, Anil Tandon, Dr.Chandresh Jardosh, Arvind Diwaker, Daivadheenam Jella, Dr B R Bhatnagar, Dr Bitaan Sen & Dr Jayashree Sen, Dr poonam chablani, Dr Prakash Khalap.

Answer for 13th June Mind Teaser: 1. Hydatid cyst of liver

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

Send your answer to ijcp12@gmail.com

medicolegal update

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medicolegal update

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medicolegal update
  1. It is really nice to see your newspaper every morning for which you really deserve my heartiest congratulations. Please keep it up. Please do write more about diastolic heart failure, particularly its management. Also write on ‘An update on fatigue’, a very common symptom but sometimes by missing it one may do much more harm to the patient. Dr OP Agarwal, M.D.,Ph.D.,D.Sc.,F.A.C.P.(USA).,F.A.C.C.(USA) Senior Advisor in Cardiology
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