eMedinewS17th September 2014, Wednesday

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 & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06), President IMA New Delhi Branch (94–95, 02–04)
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

News Around The Globe

  • The American Academy of Orthopaedic Surgeons has issued a new, evidence–based Clinical Practice Guideline (CPG) on hip fracture diagnosis and treatment in patients aged >65 years. This CPG includes a strong recommendation for preoperative regional analgesia to achieve pain control without increasing the risk for delirium.
  • A simple antenatal blood test from 11 weeks’ gestation can accurately target anti–D immunoglobulin prophylaxis only to RhD negative women with RhD positive babies, which would reduce unnecessary administration, suggests novel research published online in BMJ.
  • Men with a certain type of baldness may be at a higher risk of developing aggressive prostate cancer, suggests a new analysis from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. The risk was observed particularly in men who had moderate baldness that affected both the front and the crown of their head by age 45 years. The study was published September 15 in the Journal of Clinical Oncology.
  • Some cases of idiopathic pulmonary fibrosis (IPF) may occur as a result of environmental or occupational exposure to asbestos, suggested a new analysis of mortality data in England and Wales. The findings thus suggest that patients with known asbestos exposure, currently excluded from treatment with new IPF drugs, should be considered candidates for these drugs. The data were presented at the European Respiratory Society (ERS) International Congress 2014.
  • Getting enough sleep each night may mean you're less likely to take time off from work due to illness, according to a study that included more than 3,700 people in Finland, aged 30 to 64, and who were followed for an average of seven years. Those who slept less than six hours or more than nine hours a night were much more likely to have extended absences from work due to illness, the investigators found. People with the lowest risk for taking time off from work due to sickness were those who slept between seven and eight hours a night. The researchers even narrowed the ideal amount of nightly sleep for workers down to seven hours, 38 minutes for women, and seven hours, 46 minutes for men, according to the study in the September issue of the journal Sleep.

National News

  • Dr KK Aggarwal to be the chief guest for the Global Healthcare Excellence Awards, 2014 to be presented on September 28, 2014 (Sunday) from 07:30 pm onwards. The other expected guests for the evening are Dr. C.P. Thakur – Former Health Minister, Govt. of India and Dr. Akhil K. Sangla – CEO of Indian Confederation for Healthcare Accreditation.
  • Sai Retina Foundation will be locating a mobile retina van for free eye screening during the Perfect Health Mela to be held between 15th and 19th of October, 2014. Under the "Diabetic Retinopathy Mitigation Project in East and North–east Delhi" the mobile retina van will hold the camp screening activities. All screening, investigations, procedures and treatment will be free of cost for the mela visitors.
  • IMA out–rightly reject the proposed bill to regulate medical fees. Constitution of India guarantees freedom to conduct business under Article 19–g of the Constitution.

IMA News

  1. Indian Medical Association joined hands with NATHEALTH, the healthcare federation of India. Dr N Saini Secretary General and Dr K K Aggarwal incoming Secretary General attended the first meeting held in the city today.
  2. IMA to send doctors to Kashmir flood area: Over 20 doctors were flown to Kashmir by IMA (coordinated by its Delhi State Branch) for relief work.
  3. IMA has appealed to its members to contribute liberality to the "IMA Disaster Relief Fund" at the Headquarters through Demand Draft drawn in favor of "INDIAN MEDICAL ASSOCIATION, HQ’S" payable at New Delhi. Members can also help by contributing in the form of medicines. Volunteer doctors who are interested to serve the affected area on a short notice can contact the IMA HQ, Disaster Management Cell.
  4. IMA has decided to commemorate World Elders Day on 1st October, 2014. All State/Local branches are requested to conduct Special programmes/Meetings on that day.

Rabies News (Dr A K Gupta)

If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.

Cardiology eMedinewS

  • Limiting the length of triple therapy for stent patients who require anticoagulation does not increase the benefit or reduce the risk in this population. The ISAR–TRIPLE investigators compared a 6–week regimen of warfarin, aspirin, and clopidogrel to a 6-month regimen and at 9 months found the incidence of major adverse cardiovascular events (MACE) plus major bleeding was 9.8% in the 6–week group and 8.8% in the 6–month arm. The findings of the trial were reported at the ongoing Transcatheter Cardiovascular Therapeutics meeting.
  • Six months of dual antiplatelet therapy (DAPT) after implantation of a second generation drug–eluting stent (DES) provided as much protection against cardiovascular death, MI, stroke, stent thrombosis, or bleeding as 12 months of DAPT. At 1 year the primary composite endpoint occurred in 4.5% of the patients treated for 6 months versus 3.7% of those treated for 12 months (P=0.469), Antonio Colombo, MD, of San Raffaele Scientific Institute, in Milan, reported at the ongoing Transcatheter Cardiovascular Therapeutics meeting.
  • Early trial results have shown that the Absorb everolimus-eluting bioresorbable scaffold was similar to a metal stent eluting the same drug (Xience) on 1–year outcomes but may have been more effective at reducing angina. Device success, quantitative coronary angiography, and intravascular ultrasound results were similar between the two stent types at that point, Patrick W. Serruys, MD, PhD, of Imperial College in London, and colleagues found in the ABSORB II trial. The findings are reported in The Lancet. The Absorb scaffold is approved in Europe but not yet in the U.S.
  • Evidence for the safety and efficacy of transcatheter aortic valve replacement continues to mount and now 5 year results from PARTNER I also demonstrate durability as reported at the ongoing Transcatheter Cardiovascular Therapeutics meeting.

Pediatrics eMedinewS

  • Vaccinating parents of newborn infants against pertussis provides moderate protection against the infectious disease in young infants, suggests a new study published online September 15 in Pediatrics.
  • The presence of amblyopia during early childhood may lead to impaired visual–auditory speech integration and alterations in speech perception, suggests a study published online September 11 in JAMA Ophthalmology.

Dr K K Spiritual Blog

Should there be a mourning room in the hospital?

In a survey conducted by Heart Care Foundation of India of 400 people from all walks of life, 90% of the people wanted that wishes of the dying person and dead body should be respected in the hospital setting. They said that doctors should be more compassionate and emphatic at the time of declaring a patient dead.

Unless people are expecting a death, death usually comes as a shock to the family members. It is expected that the relatives may be in agony, pain and even anger. Every hospital should have a mourning room where relatives should be made to sit, counseled and death declared.

After death is declared, the treating doctors, nurses and hospital staff must sit with the patient’s relatives, counsel them, tell them about the sequence of what happened before death and also counsel them about how to handle the dead body. People also want to know the cause of death so that similar thing may not happen to another person in the family.

They also want to know if the body is infectious or not and what rituals should not be done if the body is infectious. They also like to know about how to preserve the dead body till cremation.

They may also like to know whether a postmortem is required to know exact cause of death, which can help future family members of the family.

Wellness Blog

Malaria

  • Malaria is transmitted by the bite of a female Anopheles mosquito.
  • The malaria mosquito bites mainly between dusk and dawn. While, the dengue mosquito bites during the day.
  • Malaria can also transmit by blood transfusion by sharing of contaminated needles.
  • Bed nets are good against malaria since major malarial vectors bite during the night.
  • Mosquito’s behavior may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day.
  • Preventive therapy of malaria can be instituted in pregnancy in high risk areas.
  • The malarial mosquito feeds every third day compared to dengue mosquito, which feeds three times a day.
  • Malarial fever presents with chills, especially during afternoon.
  • Spraying of the indoor residential walls and ceiling is effective against mosquitoes.
  • DDT is widely used as indoor residential spraying.
  • DDT should not be applied more than once or twice early in the walls.
  • Mosquito contact with DDT surface would generally save from lethal exposure outside the house.
  • Public must know that spray may require furniture rearrangement. Walls may become streaked with chemical treatment and residual odor from DDT.
  • The other alternative is malathion spray.

Inspirational Story

Look Fear in the Face

Look fear in the face. Be brave and bold. Don’t be scared of the unknown. Accept your own wrong doings as an opportunity to search deep within your soul. This way, you can't blame others for your problems.

Be strong my child, admit defeat and always stand tall with dignity and pride. Allow your tribulations to become your guide for new found wisdom. Don't look back with regret; move forward with positive thoughts about the good and bad.

Be slow to speak and listen openly to what others have to say with respect. Remember you have a choice to make. Live negative or positive; the choice is only dependent upon you. You are sent to this world for a reason; a gift to others and remember always you have a special purpose so never give up but move straight ahead with love, peace, forgiveness, and strength!

ePress Release

Besan or gram flour has health benefits

If you are in doubt that your food may be the cause of your illness, try substituting one food each day. To began with, its best to use besan foods (gram flour) in place of wheat flour foods 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.

People suffering from celiac disease cannot digest a protein called gluten, which is found in barley and wheat flour. This gluten triggers immune system in patients to damage small intestine villi. As a result, patient cannot absorb nutrients from food and remains malnourished, which could lead to anemia, weight loss and fatigue. Celiac disease patients suffer from fat malabsorption.

A gluten–free diet is also recommended for patients with wheat allergy, dermatitis herpetiformis, multiple sclerosis, autoimmune disorders, autism spectrum disorders, ADHD, and some behavioral problems.
Gluten-containing cereals are wheat, barley, rye, oats and triticale. Gluten is also present as a food additive in the form of a flavoring, stabilizing or thickening agent.

In these conditions one should switch over to gluten–free foods. The best alternative is to shift from wheat flour to gram flour (besan)

eMedi Quiz

Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Antimalarial drug halofantrine is more extensively absorbed if taken with food.

Yesterday’s Mind Teaser: All of the following statements regarding bioavailability of a drug are true except:

1. It is the proportion (fraction) of unchanged drug that reaches the systemic circulation.
2. Bioavailability of an orally administered drug can be calculated by comparing the Area under Curve after oral and intravenous administration.
3. Low oral bioavailability always and necessarily means poor absorption.
4. Bioavailability can be determined from plasma concentration or urinary excretion data.

Answer for yesterday’s Mind Teaser: 3. Low oral bioavailability always and necessarily means poor absorption.

Correct answers received from: Chandra Pal, Dr P C Das, Dr K Raju, Raghavendra H Gobbur, Dr Jainendra Upadhyay, Dr Avtar Krishan, Najib Khatee, Dr Rohini Dhillon.

Answer for 13th September Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Dr Rohini Dhillon, Dr Prakash Khalap, Dr P C Das.

Send your answer to ijcp12@gmail.com

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Total CPR since 1st November 2012 – 98440 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."

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To err is human

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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

The Anesthesiologist

Jill received a bill from the hospital for her recent surgery, and was astonished to see a $900 fee for the anesthesiologist. She called his office to demand an explanation.
"Is this some kind of mistake?" Jill asked when she got the doctor on the phone.
"No, not at all," the doctor said calmly.
"Well," said Jill, "that’s awfully costly for knocking someone out."
"Not at all," replied the doctor. "I knock you out for free. The 900 dollars is for bringing you back around."

Quote of the Day

A good book should leave you... slightly exhausted at the end. You live several lives while reading it. William Styron

Twitter of the Day

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer
http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Those who make wise choices in life should wind up happier & more successful @DeepakChopra #CosmicConsciousness

   
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  1. Good points on relaxation therapy, particularly on side effects. One of my friends went into acute psychosis after hypnotherapy in first session!! Dr Suresh Amin MD. IFCAP Consultant Pathologist 25 Alkapuri Society, Vadodara (Guj) 390005

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