eMedinewS16th July 2014, Wednesday

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

Do not ignore transient brain dysfunction

Transient ischemic attack or TIA or mini paralysis is a brief episode of neurologic dysfunction caused by lack of blood supply in the focal brain or eye, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction or brain attack

It is a neurological emergency and early recognition can identify patients who may benefit from preventive therapy or from surgery of large vessels such as the carotid artery.

The initial evaluation of suspected TIA and minor non disabling ischemic paralysis includes brain imaging, neurovascular imaging, and a cardiac evaluation. Laboratory testing is helpful in ruling out metabolic and hematologic causes of neurologic symptoms.

TIA or minor non disabling ischemic paralysis is associated with a high early risk of recurrent paralysis. The risk of paralysis in the first two days after TIA is approximately 4 to 10 percent.

Immediate evaluation and intervention after a TIA or minor ischemic reduces the risk of recurrent stroke. Risk factor management is appropriate for all patients. Currently viable strategies include blood pressure reduction, statins, antiplatelet therapy and lifestyle modification, including smoking cessation.

For patients with TIA or ischemic stroke of atherothrombotic, lacunar (small vessel occlusive), or cryptogenic type, antiplatelet agents should be given. For patients with atrial fibrillation and a recent ischemic stroke or TIA, the treatment is blood thinners. For patients with carotid blockages, surgery is needed.

News Around The Globe

  • A new study presented at the Alzheimer’s Association International Conference (AAIC) 2014 has revealed that cataract surgery may reduce the rate of cognitive decline and improve vision, cognition, and quality of life in dementia patients.
  • Individuals who cope with stress with the help of drugs or alcohol or by engaging in self–distraction vs. adopting a head–on approach have increased odds of developing insomnia, suggests a new research published in Sleep.
  • Two new studies have linked impaired olfactory function to elevated brain amyloid and heightened neurodegeneration in cognitively normal adults, as well as progression to Alzheimer’s disease (AD), among patients with mild cognitive impairment (MCI). The findings were presented at the Alzheimer’s Association International Conference (AAIC) 2014.
  • A new study evaluating individual counseling for self–care in patients with diabetes vs. group education has found that the latter is associated with better outcomes. Compared with those attending individual counseling, patients who attended group classes were less likely to visit the emergency room, be hospitalized for hypo- or hyperglycemia, or develop foot ulcers/cellulitis. The findings are published in the Canadian Journal of Public Health.
  • Data from European studies have supported earlier Japanese findings of an increased risk of cholangiocarcinoma in printers and typesetters. The findings, published in Occupational and Environmental Medicine, reported that men had a higher standardized incidence rate (SIR) than women. The highest SIRs were in printers and lithographers.

Rabies News (Dr A K Gupta)

How is RIG life saving?

Administration of anti–rabies vaccine stimulates production of neutralizing antibodies by the patient’s immune system. Protective levels of antibodies (more than 0.5 IU/ml of serum) are seen 7 to 14 days after the initial dose of vaccine (window period). Moreover when the bites are on the head, neck, face & hands, the incubation period will be shorter.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.

Cardiology eMedinewS

  • A new analysis of patients with newly diagnosed coronary heart disease (CHD) has pointed that the benefits of beta–blockers in this setting appear downgraded only to those with a recent MI. The analysis revealed that the use of beta–blockers was associated with an overall 10% lower risk of mortality and an 8% lower risk of death or MI in those with first CHD event, defined as either acute coronary syndrome or coronary revascularization.
  • New results from the 90+ Study have shown that new hypertension after 80 years of age is associated with reduced risk of dementia. The study was presented recently at the Alzheimer’s Association International Conference (AAIC) 2014.

Pediatrics eMedinewS

  • Ultrasonography diagnoses hand bony fractures in pediatric patients with greater than 90% accuracy, reports a study published online in Archives of Disease in Childhood. Ultrasonography results were 91.7% sensitive and 97.6% specific for diagnosing fracture (compared with radiography), with 96.0% positive predictive value and 94.6% negative predictive value.
  • Young athletes who delay anterior cruciate ligament (ACL) surgery seem to be at increased risk for secondary knee injuries, suggests a research presented July 10 at the American Orthopaedic Society for Sports Medicine’s (AOSSM) annual meeting.

Dr K K Spiritual Blog

Prayer for Inner Happiness

Stress is defined as the physical and mental reaction to the interpretation of a known situation. In absence of a known situation there cannot be a stress. One cannot be stressful for a person who has just died in New York in an accident unless he or she is a known person.

There has to be a right, conscious based interpretation of the situation as the same situation can bring happiness to one and stress to the other.

The most important consequence physical or mental of stress, therefore, depends on the right interpretation of the situation.

The interpretation or judgment in the body is governed by chemical reactions and is controlled by the balance of autonomic balance system, which in turn is governed by the interaction of parasympathetic and sympathetic nervous system.

During the phase of acute stress when the sympathetic system is predominant, heart rate and blood pressure rises and a person cannot take correct and decisive decision. He or she is likely to make mistakes, which can often be detrimental to living. Sympathetic mode is basically the mode of flight or fight reactions of the body.

Right conscious–based decisions can only be taken in a state of relaxed mind when the intention is inserted in the field of consciousness. The relaxed mind state of the body is the parasympathetic mode which is healing and is evident by reduction in heart rate, blood pressure and increase in the skin resistance. Most conscious based decisions will be based on truthfulness, will be necessary and will bring happiness to both the persons and the surroundings.

The yogic lifestyle by which a person learns the dos and don’ts of living, does regular practice of correct postures, daily pranayama and practices regular withdrawal from the outer atmosphere, helps in preparing a state of physical and mental body state, which is more receptive for conscious-based decisions. Yoga Sutras of Patanajali included them in his ashtanga yoga as the processes of Yama, Niyama, Asanas, Pranayama and Pratihyar.

Prayers have no value when the mind is not at rest. All of us have participated in hundreds of mourning prayers with two minutes of silence. This prayer has no value if the two minutes of silence is not observed. If prayer is done without it the mind will remain restless and we will keep on thinking these two minutes are not over yet. The process of silence does shift our awareness towards test and parasympathetic state and temporarily we get to be in contact with the memories of the departed soul and we pay homage to him or her.

Today a large number of organizations are teaching the process of meditation but the same cannot be taught unless a person practices procedures by which the mind gets relaxed.

The eight limbs of Patanjali focus in detail about premeditation preparations and once that is learned one can go to the other three limbs which are Dharna, Dhyana and Samadhi.

Yoga asanas are different from exercises. They stimulate and stretch all or one of the seven charkas, autonomic plexuses, and ganglion and there located ductless endocrine glands. Also during a yogasana the mind is in the exercise and not wondering here and there.

While yogic exercises at rest are termed yoga asanas and the same yogic meditative exercises with activity are called traditional Indian dances. Western exercises and dances do not follow the principles of yoga. Many international studies have shown that over one–third of the people during their lifetime pray either for their own illness or for somebody else.

All hospitals should have spirituals areas. The prayer and meditation rooms in a hospital setting invariably will provide an arena which will improve patient-doctor relationship and will reduce the rising disputes amongst them in the country.

Wellness Blog

5 Steps to Lower Alzheimer’s Risk

  • Maintain a healthy weight.
  • Check your waistline.
  • Eat mindfully. Emphasize colorful, vitamin–packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.
  • Exercise regularly. Aim for 2½ to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time.
  • Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure, and blood sugar numbers.

Inspirational Story

Life is all About Choices

Michael is the kind of guy you love to hate. He is always in a good mood and always has something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!"

He was a natural motivator. If an employee was having a bad day, Michael was there telling the employee how to look on the positive side of the situation. Seeing this style really made me curious, so one day I went up to Michael and asked him, "I don’t get it! You can't be a positive person all of the time. How do you do it?"

Michael replied, "Each morning I wake up and say to myself, you have two choices today. You can choose to be in a good mood or … you can choose to be in a bad mood. I choose to be in a good mood." Each time something bad happens, I can choose to be a victim or… I can choose to learn from it. I choose to learn from it.

Every time someone comes to me complaining, I can choose to accept their complaining or… I can point out the positive side of life. I choose the positive side of life. "Yeah, right, it’s not that easy," I protested.

"Yes, it is," Michael said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people affect your mood. You choose to be in a good mood or bad mood. The bottom line: It’s your choice how you live your life."

I reflected on what Michael said. Soon hereafter, I left the Tower Industry to start my own business. We lost touch, but I often thought about him when I made a choice about life instead of reacting to it.

Several years later, I heard that Michael was involved in a serious accident, falling some 60 feet from a communications tower. After 18 hours of surgery and weeks of intensive care, Michael was released from the hospital with rods placed in his back. I saw Michael about six months after the accident.

When I asked him how he was, he replied, "If I were any better, I’d be twins. Want to see my scars?" I declined to see his wounds, but I did ask him what had gone through his mind as the accident took place. "The first thing that went through my mind was the well-being of my soon–to–be born daughter," Michael replied.

"Then, as I lay on the ground, I remembered that I had two choices: I could choose to live or… I could choose to die. I chose to live." "Weren’t you scared? Did you lose consciousness?" I asked.

Michael continued, "… the paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the ER and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read ‘he’s a dead man’. I knew I needed to take action."

"What did you do?" I asked. "Well, there was a big burly nurse shouting questions at me," said Michael. "She asked if I was allergic to anything. ‘Yes, I replied.’ The doctors and nurses stopped working as they waited for my reply. I took a deep breath and yelled, ‘Gravity’." Over their laughter, I told them, "I am choosing to live. Operate on me as if I am alive, not dead!"

Moral of the story: Michael lived, thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything. After all, today is the tomorrow you worried about yesterday.

Life is about the little choices we make every day!

Self-Assessment-Quiz

 

Zee News – Health Wealth Shows

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Cancer Prevention
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Total CPR since 1st November 2012 – 94595 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)

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Health Check Up and CPR 10 Camp at NP Primary School, Kamraj Marg–11th July 2014

press release

Depression linked to paralysis

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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 was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.

eMedinewS Humor

Last year I replaced all the windows in my house with those expensive, double–pane, energy–efficient kind.

Today, I got a call from Home Depot who installed them. He complained that the work had been completed a year ago and I still hadn’t paid for them.

Helloooo … just because I’m blonde doesn’t mean that I am automatically stupid.

So, I told him just what his fast–talking sales guy told me last year… that these windows would pay for themselves in a year. Helloooo…? It’s been a year, so they’re paid for, I told him.

There was only silence at the other end of the line, so I finally hung up. He never called back. I bet he felt like an idiot.

Quote of the Day

It costs nothing to dream, but everything if you don’t. Rita Davenport

Twitter of the Day

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Make the decision to be living in love - with yourself, your life, your whole world #CosmicConsciousness

 

ePress Release

HbA1c should replace blood sugar test for diabetes

A 21–member International Expert Committee (American Diabetic association, the European Association for the Study of Diabetes, and the International Diabetes Federation) has recommended that hemoglobin A1c (HbA1c) should be the mainstay of type 2 diabetes screening and diagnosis, replacing fasting blood glucose level and the oral glucose tolerance test.

This is the first major departure from how we’ve been diagnosing diabetes in the past 30 years 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.

As per the recommendations

  1. HbA1c of 6.5% should be diagnostic for diabetes.
  2. Patients with HbA1c levels between 6.0 and 6.5% should be cautioned that they are in the highest risk group for developing type 2 diabetes.
  3. The risk for developing diabetes is a continuum. Pre diabetes is not a great term to use.
  4. Diabetic retinopathy is the complication we can measure most readily, and HbA1c correlates very closely with diabetic retinopathy. An HbA1c of 6.5% is the level above which you see eye disease and below which you don’t see it.

Although glucose levels have been used to diagnose type 2 diabetes traditionally, using HbA1c has definite advantages. HbA1c reflects the average glucose level over a period of several months, whereas glucose levels only measure one point in time. HbA1c is also a more stable chemical moiety; glucose levels can change with temperature and time. HbA1c testing is also much more convenient for patients and eliminates the need for 8–hour fasting.

eMedi Quiz

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.

Yesterday’s Mind Teaser: An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde-3-phosphate Dehydrogenase.
2.Phosphoglucomutase.
3.Lactate-dehydrogenase.
4.Glucokinase.

Answer for yesterday’s Mind Teaser: 1.Glyceraldehyde–3–phosphate Dehydrogenase.

Correct answers received from: Dr Abbs Vakil, Dr Jayant Gaikwad, Dr Gopal Shinde, Dr K V Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Sasisadan, Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Dr Prakash Khalap.

Answer for 14th July Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorthiazide.

Correct answers received from: Dr Prakash Khalap.

Send your answer to ijcp12@gmail.com

medicolegal update

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medicolegal update

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medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico-legally… SD Bherwal
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