eMedinewS
18th November 2014, Tuesday

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

Phosphine gas in Zinc Phosphide the Lethal Killer in Chhattisgarh Sterilization Tragedy

New Delhi: After 13 women died in a sterilization programme in Chhattisgarh, a preliminary enquiry has revealed that the drug used during the procedure could have been contaminated with zinc phosphide, widely used as rodenticide and perhaps could be the cause of death of the victims.

Confirming these findings, Commission Bilaspur Division, Sonmani Borah, said traces of zinc phosphide have been found in Ciprocin 500mg tablets, manufactured by Mahawar Pharmaceutical Pvt Ltd. These tablets were distributed to all the women who underwent sterilizations at the three health camps - Takhatpur, Pendra and Marwahi - in Bilaspur district on last Saturday and Monday.

Mahawar Pharma Pvt Ltd's director Ramesh Mahawar and his son Sumit have been arrested under section 420 for cheating, based on a complaint lodged by Food and Drug Administration authorities.

All about Zinc Phosphide

Zinc phosphide can be prepared by the reaction of zinc with phosphorus. Zinc phosphide reacts with water to produce phosphine and zinc hydroxide. Metal phosphides are used as rodenticides.

A mixture of food and zinc phosphide is left where the rodents can eat it. The acid in the digestive system of the rodent reacts with the phosphide to generate the toxic phosphine gas.

Other pesticides similar to zinc phosphide are aluminium phosphide and calcium phosphide.

There is usually only a short interval between ingestion of phosphides and the appearance of systemic toxicity. Phosphine-induced impairment of myocardial contractility and fluid loss leads to circulatory failure, and critically, pulmonary edema supervenes, though whether this is cardiogenic or non-cardiogenic is not always clear.

Metabolic acidosis, or mixed metabolic acidosis and respiratory alkalosis, and acute renal failure are frequent.

Other features include disseminated intravascular coagulation, hepatic necrosis and renal failure. There is conflicting evidence on the occurrence of magnesium disturbances.

There is no antidote to phosphine or metal phosphide poisoning and many patients die despite intensive care. Supportive measures are all that can be offered and should be implemented as required.

News Around The Globe

  • A blood test that measures the ratio of interferon (IFN)-beta to IFN-alpha in patients with rheumatoid arthritis can help predict who will respond to tumor necrosis factor (TNF) inhibitors, suggests a new study presented at the American College of Rheumatology 2014 Annual Meeting.
  • Passers-by guided by 911 dispatchers in performing cardiopulmonary resuscitation (CPR) before first responders reach the scene helped improve survival of people suffering out-of-hospital cardiac arrest, researchers reported in AHA meeting.
  • The US Food and Drug Administration (FDA) has approved alemtuzumab for the treatment of relapsing forms of multiple sclerosis (MS).
  • New findings suggest that the composition of an individual's gut microbiome is influenced not just by environmental exposure but also by the genetics of the host; the microbiome thus affects host metabolism, thereby contributing to obesity. The findings are published in Cell.
  • The combination of prehospital hypoxia and hypotension, each known to heighten mortality in the setting of traumatic brain injury (TBI), has a synergistic negative effect, increasing mortality risk by three or more times than either alone, suggests a new study presented at the American Heart Association 2014 Scientific Sessions Resuscitation Science Symposium.

66th Annual Conference of Cardiological Society of India (CSI) -2014

18th-Nov-CSI

Dr KK Spiritual Blog

The Scientific Aspects of Prayer

It is natural for us to promise or offer to pray for someone who suffers from sickness. So many people believe in the power of prayer that it has now caught the attention of scientists and doctors. Today most hospitals and nursing homes are building prayer rooms for their patients, based on the principle that a relaxed mind is a creative mind. During prayer, a person is in touch with the consciousness, and is able to take correct decisions. Most doctors even write on their prescriptions “I treat He cures”.

Medically it has been proved that the subconscious mind of an unconscious person is listening. Any prayer therefore would be captured by the patient building inner confidence and faith to fight terminal sickness. We have seen the classical example of the effect of mass prayer on a person’s health in the case of Amitabh Bachchan’s illness.

“Praying for health is one of the most common complementary treatments people do on their own,” said Dr Harold G Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center.

About 90% of Americans and almost 100% Indians pray at some point in their lives, and when they’re under stress, such as when they’re sick, they’re even more likely to pray.

More than one-third of the people surveyed in a recent study published in the Archives of Internal Medicine said they often turned to prayer when faced with medical concerns. In a poll involving more than 2,000 Americans, 75% of those who prayed said they prayed for wellness, while 22% said they prayed for specific medical conditions.

Numerous random studies have been conducted on this subject. In one such study, neither the patients nor the healthcare providers had any idea who was being prayed for. The coronary care unit patients didn’t even know there was a study being conducted. And, those praying for the patients had never even met them. The result: While those in the prayer group had about the same length of hospital stay, their overall health was slightly better than the group that didn’t receive special prayers.

“Prayer may be an effective adjunct to standard medical care,” wrote the authors of this 1999 study, also published in the Archives of Internal Medicine. However, a more recent trial from the April 2006 issue of the American Heart Journal suggests that it’s even possible for some harm to come from prayer. In this study, which included 1,800 people scheduled for heart surgery, the group who knew they were receiving prayers developed more complications from the procedure, compared to those who had not been a focus of prayer.

Many patients are reluctant and do not discuss this subject with their doctors. Only 11% patients mention prayer to their doctors. But, doctors are more open to the subject than the patients realize, particularly in serious medical situations. In a study of doctors’ attitudes toward prayer and spiritual behavior, almost 85% of the doctors thought they should be aware of their patients’ spiritual beliefs. Most doctors said they wouldn’t pray with their patients even if they were dying, unless the patient specifically asked the doctor to pray with them. In that case, 77% of the doctors were willing to pray for their patient.

Most people are convinced that prayer helps. Some people are ‘foxhole religious’ types and prayer is almost a reaction or cry to the Universe for help. However, many people do it because they’ve experienced benefit from it in the past.

If a patient wants to pray and feels it might be helpful, there’s no reason he should not. If he believes that prayer might work, then he should use it.

Inspirational Story

The Tale of Two Pebbles

Many years ago in a small Indian village, a farmer had the misfortune of owing a large sum of money to a village moneylender. The moneylender, who was old and ugly, fancied the farmer’s beautiful daughter. So he proposed a bargain. He said he would forgo the farmer’s debt if he could marry his daughter.

Both the farmer and his daughter were horrified by the proposal. So the cunning money-lender suggested that they let providence decide the matter. He told them that he would put a black pebble and a white pebble into an empty money bag. Then the girl would have to pick one pebble from the bag.

If she picked the black pebble, she would become his wife and her father’s debt would be forgiven. If she picked the white pebble she need not marry him and her father’s debt would still be forgiven. If she refused to pick a pebble, her father would be thrown into jail.

They were standing on a pebble strewn path in the farmer’s field. As they talked, the moneylender bent over to pick up two pebbles. As he picked them up, the sharp-eyed girl noticed that he had picked up two black pebbles and put them into the bag. He then asked the girl to pick a pebble from the bag.

Now, imagine that you were standing in the field. What would you have done if you were the girl? If you had to advise her, what would you have told her? Take a moment to ponder this. What would you recommend that the girl do?

The girl put her hand into the moneybag and drew out a pebble. Without looking at it, she fumbled and let it fall onto the pebble-strewn path where it immediately became lost among all the other pebbles.

“Oh, how clumsy of me!” she said. “But never mind, if you look into the bag for the one that is left, you will be able to tell which pebble I picked.” The moneylender dared not admit his dishonesty. The girl changed what seemed an impossible situation into an extremely advantageous one.

Most problems do have a solution, sometimes we just need to think in a different way.

Rabies News (Dr A K Gupta)

Can a rabies patient make a valid will?

A rabies patient can make a valid will.

According to Section 59 in the Indian Succession Act, 1925

Person capable of making will:

  1. Every person of sound mind not being a minor may dispose of his property by will.
  2. A married woman may dispose by will of any property which she could alienate by her own act during her life.
  3. Persons who are deaf or dumb or blind are not thereby incapacitated for making a will if they are able to know what they do by it.
  4. A person who is ordinarily insane may make a will during interval in which he is of sound mind.
  5. No person can make a will while he is in such a state of mind, whether arising from intoxication or from illness or from any other cause that he does not know what he is doing.

Cardiology eMedinewS

  • Continuing a thienopyridine plus aspirin well beyond 1 year cut major adverse cardiovascular risks after drug-eluting stent (DES) implantation in the landmark Dual Antiplatelet Therapy (DAPT) trial. Dual therapy for 30 months cut stent thrombosis rates by a relative 71% compared with aspirin alone after 12 months (rate 0.4% versus 1.4% from months 12 to 30, P<0.001), Laura Mauri, MD, of Brigham and Women's Hospital in Boston, and colleagues found. Prolonged clopidogrel (Plavix) or prasugrel (Effient) cut major adverse cardiovascular and cerebrovascular events by a relative 29% (rate 4.3% versus 5.9% over the same time frame, P<0.001), the researchers reported here at the American Heart Association meeting and simultaneously online in the New England Journal of Medicine.(MedPage)
  • The effectiveness of performing cardiopulmonary resuscitation (CPR) in cardiac arrest cases may have influenced the outcomes in one clinical trial, researchers suggested. Only about 40% of patients in the trial who performed CPR were guideline compliant in delivering proper compression rate, compression depth and compression fraction, said Demetris Yannopoulos, MD, associate professor of medicine at the University of Minnesota, Minneapolis. Yannopoulos suggested that while performing chest compression at a rate of 80 to 120 compressions a minute was within guidelines, the failure to compress to a depth of more than 4-6 cm would make the number of compressions performed moot. Similarly, if the compression fraction was less than 50% it would negate the compression rate and compression depth. All three factors had to be within guidelines (AHA 2005 recommendations or the study parameters) in order to have quality CPR, he said.

Pediatrics eMedinewS

  • In preschool-aged children, a simple test performed in the ophthalmologist's or optometrist's office greatly overestimates the eye's ability to "flex and focus" in order to see small objects clearly, points a study published in the November issue of Optometry and Vision Science, official journal of the American Academy of Optometry.
  • A new study recently presented at the American College of Rheumatology Annual Scientific Meeting linked antibiotic use in children to increased risk of juvenile idiopathic arthritis.

Quote of the Day

  • Wisdom is knowing what to do next, skill is knowing how to do it, and virtue is doing it. David Starr Jordan

Wellness Blog

Tips for getting the rest you need

  • Reserve your bedroom for sleep and intimacy.
  • Banish television, computer, smartphone, tablet, and other diversions from that space.
  • Nap only if necessary.
  • Avoid caffeine after noon, and go light on alcohol.
  • Get regular exercise, but not within three hours of bedtime.
  • Plan a vacation with a light schedule and few obligations.
  • Avoid backsliding into a new debt cycle. Try to go to bed and get up at the same time every day — at the very least, on weekdays. If need be, use weekends to make up for lost sleep.

ePress Release

Even cycling can cause erectile dysfunction?

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hrs a week can cause erectile dysfunction in males. For those who drive cycles for more than 3 hours a week should do so in reclining position and not upright position, 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.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling.

Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than three hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

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21st Perfect Health Mela 18th October 2014

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Weight loss may improve sexual health of obese diabetes

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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

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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: A patient had a break of policy for two days.
Dr. Bad: You will have to go for new policy now.
Dr. Good: Your old policy should be continued.
Lesson: Cumulative bonus provisions are applicable only in respect of continuous insurance without break excepting, however, in exceptional circumstances, the break in period for maximum of seven days is approved as a special case subject to medical examination and explanation of diseases contracted during the break period.

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

eMedinewS Humor

I'll trust you that you paid

A man walks into a bar and has a couple of beers. Once he is done the bartender tells him he owes $9.00.

"But I paid, don't you remember?" says the customer.

"Okay," says the bartender, "If you said you paid, you did."

The man then goes outside and tells the first person he sees that the bartender can't keep track of whether his customers have paid.

The second man then rushes in, orders a beer and later pulls the same stunt.

The barkeep replies, "If you say you paid, I'll take your word for it."

Soon the customer goes into the street, sees an old friend, and tells him how to get free drinks.

The man hurries into the bar and begins to drink high-balls when, suddenly, the bartender leans over sand says, "You know, a funny thing happened in here tonight. Two men were drinking beer, neither paid and both claimed that they did. The next guy who tries that is going to get punched right in the nose."

"Don't bother me with your troubles," the final patron responds. "Just give me my change and I'll be on my way."

Twitter of the Day

Dr KK Aggarwal: Chew a tablet of water soluble aspirin if you suspect heart attack
Dr Deepak Chopra: A God worthy of faith must actually matter. He needs to start performing instead of disappointing

eMedi Quiz

Elements of primary health care include all of the following except:

1. Adequate supply of safe water and basic sanitation.
2. Providing essential drugs.
3. Sound referral system.
4. Health education.

Yesterday’s Mind Teaser: Brocq's phenomenon is analogous to which clinical sigh in psoriasis

a. olfleck's phenomenon
b. auspitz sigh
c.salmon patch
d.candle wax scales

Answer for yesterday’s Mind Teaser: b. auspitz sigh

Correct answers received from: Dr Avtar Krishan.

Answer for 16th November Mind Teaser: 4. Glycosylation.

Correct answers received from: Daivadheenam Jella, Tukaram Pagad, Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr Avtar Krishan, Tukaram Pagad.

Send your answer to email

medicolegal update
  1. Sir, proceed on media, issue legal notice for prematurely telecasting derogatory remarks on laparoscopic surgeon. It is national doctor's issue, it will alert media to be cautious in future. Dr.Sreenivasulu.M.D Aditya NursingHome.H.NO:1/541/135 College road.Adoni.518301
  2. Dear Dr KK, I must say that your comments on Bilaspur case are brilliant. These bring out the real issues. I feel that IMA and AHPI need to aggressively engage the public from time to time and explain the intricacies in medical treatment in simple language. We should be concerned that adverse perception is being allowed to propagate as it suits a class of people including the PRESS. Dr Girdhar Gyani

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