eMedinewS
18th December 2014, Thursday

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

Cardiology's Stories of 2014

  1. The Failure of Renal Denervation

    Few negative trials teach us as much as the sham-controlled, prospective, single-blinded, randomized clinical trial of renal denervation called SYMPLICITY-HTN-3.(1)

    The nonsignificant blood pressure reductions in the properly controlled SYMPLICITY HTN-3 trial confirmed the old adage: If something looks unbelievable, it probably is.
     
  2. ARNI: A New Class of Drug for Congestive Heart Failure

    The impressive results of the PARADIGM-HF trial may be the first breakthrough in drug therapy for heart failure in more than two decades.

    Investigators compared the novel combination drug LCZ696 (valsartan/sacubitril) with standard-dose enalapril in a multicenter clinical trial. The idea behind angiotensin-neprilysin inhibition (ARNI) drugs is that the addition of the neprilysin inhibitor (sacubitril) to the angiotensin-receptor blocker (ARB) will help counter the unfavorable vasoconstriction, sodium retention, and negative remodeling seen with neurohormonal activation in heart failure patients.

    The results of PARADIGM-HF were clear. LCZ696 lowered the rate of the primary endpoint, a composite of cardiovascular (CV) death or first hospital admission for heart failure, by 4.7%. The novel drug also lowered the most important endpoint, premature death from any cause, by 2.8%. Functional status and quality-of-life measures favored LCZ696. Renal function remained stable with the study drug.
     
  3. Cardiac Monitoring

    This was a good year for novel cardiac monitoring technologies.

    The CRYSTAL AF trial showed that an implantable loop recorder (ILR) was six times more likely than conventional monitoring to detect atrial fibrillation (AF) in patients who had just suffered ischemic stroke. The majority of ILR-detected cases of AF were asymptomatic. The EMBRACE trial, published alongside CRYSTAL-AF in the same issue of the New England Journal of Medicine, confirmed the value of extended monitoring after cryptogenic stroke or transient ischemic attack. In that study, Canadian researchers detected new AF in one in six patients using 30-day ambulatory ECG recorders.
     
  4. Aspirin Loses Its Mystique

    An analysis of the SPRINT-AF Canadian registry revealed that 40% of AF patients treated with oral anticoagulants were taking antiplatelet drugs without an indication.

    In the absence of recent stent placement, acute coronary syndrome, or the presence of a mechanical valve, there are no data to support combining these classes of drugs.

    In fact, the combination increases the risk of bleeding.

    The matter of aspirin for the primary prevention of CV events was debated this year. In May, the FDA issued a statement concluding that the evidence does not support the use of aspirin for primary prevention. Then, in July, a European Society of Cardiology working group published a position paper (in an American journal, JACC) recommending that aspirin be considered for primary prevention in cases where two or more major CV events were projected per 100 subject-years. Finally, at the American Heart Association (AHA) sessions in November, a Japanese research group presented a trial of 14,464 high-risk patients in which aspirin failed to prevent CV events.
     
  5. Cardioversion Safety Revisited

    Finnish investigators addressed the risk of early (first 48-hours) cardioversion in 2481 patients with new-onset AF who were not taking anticoagulants. They found that shocking the patient earlier (12 hours or less) in the 48-hour window was better.

    On the matter of using new oral anticoagulant (NOAC) drugs before and after cardioversion, two studies brought good news. The X-VeRT trial investigators found that rivaroxaban compared favorably to warfarin in 1504 patients with nonvalvular AF scheduled for either early or late cardioversion. There were no differences in a composite endpoint. Two patients in each group had post procedure strokes.

    Although the small number of events in the X-VeRT trial (a good thing) limited its statistical rigor, a substudy of the ARISTOTLE trial[bolstered the notion that NOACs can be used for cardioversion. In this analysis, ARISTOTLE investigators looked at 743 cardioversions done in 265 patients assigned to apixaban and 275 patients on warfarin. There were no strokes in either group (two patients died in each group).
     
  6. Less Is (Still) More

    In the treatment of patients with out-of-hospital cardiac arrest, basic—not advanced—life support increased the odds of survival.

    And the long-held practice of giving epinephrine was associated with worse neurologic outcomes.

    In cardiac device implantation, the negative findings of the SIMPLE trial disrupted standard practice by showing no significant difference in all-cause mortality with routine vs no defibrillation threshold testing at the time of implant.

    In patients with persistent AF, the STAR-AF-2 trial convincingly demonstrated that additional ablation beyond pulmonary vein isolation did not improve success rates. Less, not more, ablation—even in patients with advanced AF—proved the winner.

    In the surgical treatment of patients with ischemic mitral regurgitation, adding a mitral-valve repair with coronary artery bypass graft (CABG) did not improve left ventricular remodeling, and the extra surgery increased adverse events.

    In a similar vein, patients with severe ischemic mitral regurgitation (MR) referred for cardiac surgery got no benefit from the more complicated repair surgery compared with valve replacement.
     
  7. Guideline Decay

    Cholesterol and blood pressure guidelines were published in 2013, but their effects made news in 2014.

    Dr John Ioannidis (Stanford University) IN February 2014, wrote an editorial in the Journal of the American Medical Association in which he estimated that, based on the new cholesterol treatment guidelines, more than a billion people worldwide could be taking statin drugs.

    He wondered whether the "statinization" of populations "would be one of the greatest achievements or one of the worst disasters of medical history."

    An example of tone change in guidelines came from the 2014 AHA/ACC/HRS AF treatment guidelines, in which the Class I recommendation for beginning anticoagulation says this : "In patients with AF, antithrombotic therapy should be individualized based on shared decision-making after discussion of the absolute and (relative risks) of stroke and bleeding and the patient's values and preferences."
     
  8. The Blind Spot of Cardiology

    Four in five heart attacks are preventable. These were the beautiful findings of Swedish researchers who studied the effects of five modifiable health measures in 20,721 men from 1997 to 2009.

    Women, too, can prevent heart disease. American researchers performed a similar analysis of data from the Women's Health Initiative.

    Perhaps the strongest support that simple lifestyle factors are potent elixirs for health came from data on AF ablation results. In the ARREST-AF trial, a team of scientists from Australia showed that patients enrolled in an aggressive risk-factor modification clinic increased their chance of ablation success fivefold.

News Around The Globe

  • Excessive use of social media such as Facebook can be addictive and is linked to problems with emotion regulation, impulse control, and substance abuse, suggests new research published in the December issue of Addiction.
  • People whose lungs displayed signs of emphysema in computed tomography (CT) scans, even those without airflow obstruction or without chronic obstructive pulmonary disease (COPD), were at greater mortality risk, reported a population-based study published in the December 16 issue of the Annals of Internal Medicine.
  • Simeprevir plus peginterferon and ribavirin is noninferior to telaprevir plus peginterferon and ribavirin for treating previous null or partial responders with chronic hepatitis C virus (HCV) genotype 1 infection, reports the ATTAIN trial published online in The Lancet Infectious Diseases.
  • The low-molecular-weight heparin (LMWH) tinzaparin is better than warfarin at preventing the recurrence of blood clots in a mix of cancer patients, but not significantly so, reports the CATCH trial of 900 patients with active cancer. The results were presented at the American Society of Hematology (ASH) 56th Annual Meeting.
  • Training programs that focus on strengthening the legs and hips and stabilizing the abdomen are the most effective for preventing injury to the anterior cruciate ligament (ACL) in young women, and doing more than one type of exercise is important, reports a new analysis published online in the British Journal of Sports Medicine.

Dr KK Spiritual Blog

How to Eat Less And Stay Healthy?

Vedic science, Ayurveda, Homeopathy, Naturopathy, Allopathy all talk about eating less to stay healthy. Following are the ways to eat less:

  1. The brain gets a signal that you have eaten only after 20 minutes, therefore, chew every bite of food at least 15 times. It not only provides enough hormones for enzymes but also sends signals to the brain. Therefore, the time spent per meal should be 20 minutes.
  2. The taste buds are only on the tip and side of the tongue. If you gulp food, the brain will not get signals. Eating small pieces and chewing them properly also sends the signals through the taste buds.
  3. The size of the fullness of the stomach also decides how much one can eat. The brain gets signal only when the stomach is 100% full. Therefore, one should not overeat and full the stomach to its size. Also if you eat less and over a period of time the size of the stomach will get shrunken.

Inspirational Story

The Challenge

It was decided that we would enter our first sports race or challenge as it was also called. The event was for a really good cause and sounded like a great idea. We would all train accordingly in preparation for the big day. A sixty-mile course consisting of three paddling legs, two cycling segments and two running courses lied ahead. We decided which part of the race each of us would complete and recruited a driver for our team.

We came up with a team name, and so we had the birth of the Warren Street Rat Pack. What we might have lacked in physical ability, we would make up in enthusiasm. We arrived at the starting point adorn with our team t-shirts. We looked like true contenders. My teammates left me at the starting line to run my leg of the challenge and headed off to the next checkpoint.

When it was time for the challenge to begin, I joined the large group of runners at the starting line. I observed some of the runners stretching, some walking in circles nervously and decided to converse with a small group who chattered and laughed non-stop while waiting for the race to begin.

I have never been in a race before; the excitement of taking off swept me away. People lined that streets and were cheering. I stuck with the group of runners until I realized I was completely out of breath and was running at speed that was twice as fast as I had ever gone before.

I managed to finish my leg in the time that I had hoped for, with only two runners finishing behind me. My team cheered me on as if I was the first to cross the line and I felt like a champion. It was time to pass the baton to our next team member who would embark on his first kayak ride since he attended summer camp as a boy.

With the completion of each leg of the race, our team members applauded wildly and acknowledged success for the person who just finished their turn. I am sure the spirit of our team was lifted a bit higher when one our teammates took off with a giant smile while ringing the bell on her three-speed bike. We all followed her in the car for a bit, laughing as we watched her emanating joy with her smile; waving to every person she passed by.

The first place team had long since passed the finish line, the check in points were being dismantled, and the big celebration party had already kicked off when we had one last kayak route to complete. Now on his second kayak ride since attending summer camp as a boy, our finish line team member set off to complete the challenge for our team. We did our best to stay close enough to him, so that he could hear us rooting for him. Our excitement level was high, as we were about to complete our first sports race, or challenge as it was also called.

At last we helped our kayaker to pull the boat ashore after he crossed the finish line. Jumping up and down, hugging one another, offering raised hands welcoming the high-fives, we had finished. The encouragement we gave to each other, the laughter we shared and the way we embraced each part of the journey put us on a winning team, which by the way came in last.

We all agreed to enter the Greenway Challenge together again this year. Although we have considered making some changes in our strategy looking back, perhaps we shouldn't change a thing.

Rabies News (Dr A K Gupta)

If the pet is immunized, do family members need pre-exposure vaccination?

A dog effectively vaccinated against rabies ordinarily will not suffer and transmit rabies. But it is very difficult to say with certainty that a particular dog immunized with specific vaccine is immune against rabies, more so in a rabies–endemic area.

Animal lovers and pet owners are always at high risk of rabies, and therefore, pre–exposure vaccination is recommended for all the family members.

Cardiology eMedinewS

  • A review of studies examining the benefits of yoga suggests that yoga provides significant benefits on cardiovascular risk factors, including LDL cholesterol and systolic blood pressure. Those who practiced asana-based yoga had reduction in LDL-cholesterol levels by 12.1 mg/dL and systolic blood pressure by 5.2 mm Hg as compared to those who did not participate in any physical activity, suggested the review published December 15 in the European Journal of Preventive Cardiology.
  • Among overweight adults without diabetes, selecting foods with a low glycemic index may not add cardiovascular benefit to a heart-healthy diet that is already low in total carbohydrates, nor does this approach improve insulin sensitivity, suggests a new trial published in the December 17 issue of the Journal of the American Medical Association.

Pediatrics eMedinewS

  • The US Food and Drug Administration (FDA) has cleared for marketing the first screening test for severe combined immunodeficiency (SCID) in newborns. The EnLite Neonatal TREC Kit, ascertains the level of T-cell receptor excision circles (TREC DNA) in a few drops of blood obtained from the newborn's heel.
  • Maternal vitamin D deficiency is associated with multisystem long-term health outcomes in offspring, reports a summative review of five substudies published online December 15 in Pediatrics.

Quote of the Day

Act with kindness, but do not expect gratitude. ~ Confucius

Wellness Blog

Heart Patients Beware of Eating Cakes

Food of animal in origin and saturated foods contain cholesterol. 1% rise in cholesterol raises the chances of heart attack by 2%. Heart Patients should therefore avoid eating cakes during the Christmas and New Year Season. They should distribute fruits & dry fruits instead of cakes.

Beware of the term Low or High Cholesterol on the labels

  • Cholesterol Free means less than 2 mg cholesterol and 2 grams or less fat.
  • “Low Cholesterol” means 20 mgs or less cholesterol and 2 grams or less saturated fat.
  • “Fat Free” means less than ½ gram fat;
  • “Low Fat” means 3 grams or less fat;
  • “Reduced Fat” means at least 25% less fat than other brands of same food.

ePress Release

It may be cold outside, but winter needn't be the unhealthiest time of year for you and your family.

Here are five ways to make sure that, even when your body is telling you to hibernate, you can keep healthy and fit, no matter what the weather's like.

1.Eliminate your sleep debt

"On average we sleep six-and-a-half hours a night, much less than the seven to nine hours recommended," which aims to raise awareness of the importance of a good night's sleep for health and wellbeing.

But in winter, we naturally sleep more because of the longer nights. "It's perfectly natural to adopt hibernating habits when the weather turns cold,". "Use the time to catch up."

2. Drink more milk

You are 80% more likely to get a cold in winter, so making sure your immune system is in tip-top condition is important. Milk and dairy products such as cheese, yoghurt and fromage frais are great sources of protein and vitamins A and B12.

They're also an important source of calcium, which helps keep our bones strong. Try to go for semi-skimmed or skimmed milk, rather than full-fat and low-fat yoghurts.

3. Eat more fruit and veg

When it's cold and dark outside, it can be tempting to fill up on unhealthy comfort food, but it's important to ensure you still have a healthy diet and include five portions of fruit and veg a day.

If you find yourself craving a sugary treat, try a juicy clementine or satsuma instead, or sweet dried fruits such as dates or raisins.

Winter vegetables such as carrots, parsnips, swede and turnips can be roasted, mashed or made into soup for a comforting winter meal for the whole family. Explore varieties of fruit and veg that you may not normally eat.

4. Try new activities for the whole family

Don't use the cold winter months as an excuse to stay in and lounge around. Instead, get out with the whole family to try out a new activity – maybe ice skating, or taking a bracing winter walk on the beach or through the park.

Regular exercise helps control your weight, boost your immune system, and is a good way to break the tension that can build if the family is constantly cooped up inside the house.

5. Have a hearty breakfast

Winter is the perfect season for porridge. Eating a warm bowlful on a cold morning isn't just a delicious way to start your day, it also helps boost your intake of starchy foods and fibre.

These give you energy and help you feel fuller for longer, stopping the temptation to snack mid-morning. Oats also contain lots of vital vitamins and minerals.

Make your porridge with semi-skimmed or skimmed milk or water, and don't add sugar or salt. Add a few dried apricots, some raisins, a sliced banana or other fruit for extra flavour and to help you hit your 5 A DAY target.

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

ACE inhibitors better ARBs in new meta–analysis in hypertensives

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: A patient wanted to know if his pre-hospital bills are covered under claim.
Dr. Bad: They are not covered.
Dr. Good: They are covered.
Lesson: All expenses incurred related to the diseases upto 30 days prior to hospitalization are covered under Mediclaim.

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully.
Lasson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.

eMedinewS Humor

At a Car Dealership:

"The best way to get back on your feet – miss a car payment."

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots by Dr k k Aggarwal
Dr Deepak Chopra: A God worthy of faith must actually matter. He needs to start performing instead of disappointing

eMedi Quiz

The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

1. Transitional
2. Stratified squamous
3. Stratified cuboidal.
4. Stratified columnar.

Yesterday’s Mind Teaser: A 30 year old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1.Medial rectus and superior division of oculmotor nerve.
2.Inferior oblique and inferior division of oculomotor nerve.
3.Lateral rectuas and abducent nerve.
4.Superior rectus and trochlear nerve.

Answer for yesterday’s Mind Teaser: 3.Lateral rectuas and abducent nerve.

Correct answers received from: Dr Rakesh Sharma Nohar, Raju Kuppusamy, Dr Avtar Krishan, Dr Poonam Chablani, Dr Jainendra Upadhyay, Sunita Kalra.

Answer for 16th December Mind Teaser: 3.Pain sensation on the contralateral side.

Correct answers received from: Raju Kuppusamy, Dr Avtar Krishan, Dr Rakesh Sharma Nohar, R Krishnamoorthy, Tukaram Pagad, Dr Bitaan Sen & Dr Jayashree Sen, Dr K V Sarma, Dr Jainendra Upadhyay.

Send your answer to email

medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

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