eMedinewS18th February 2014, Tuesday

Dr K K AggarwalPadma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Sr National Vice President, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; 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

How to cut back on added sugar

Many of the "healthy" foods you eat such as energy bars, fruit, and flavored yogurt contain sugar. The first step is to read labels carefully and opt for products that are lower in sugar.

The American Heart Association recommends keeping calories from added sugars under 100 calories a day (24 grams, or 6 teaspoons) for women and under 150 calories (36 grams, or 9 teaspoons) for men.

Giving up juices and soft drinks can be tough, but here are few ways to get started:

  • Make your own. Start with plain sparkling water or tap water. Add a flavoring that strikes your fancy. Here are a few options: an ounce or two of 100% fruit juice; a slice of lemon, lime, orange, or grapefruit; a sprig of fresh mint; a few raspberries.
  • No frills coffee and tea. A small dash of sugar or artificial sweetener and milk is okay, but go easy on the extras like flavored syrups and whipped cream.
  • Transition to "diet" beverages. Sugar–free sodas and other soft drinks can help you transition away from sugar–sweetened beverages. (HealthBeat)

Health budget

1. Health and Family Ministry will get 33,725 crore.
2. Ministry of Health and Family Welfare has delivered new technologies to the people: the JE vaccine, a diagnostic test for Thalassaemia, and a Magnivisualizer for detection of cervical cancer.
3. Ministry of Health and Family Welfare has requested that services provided by cord blood banks are also healthcare services and should be exempt from service tax. I propose to accept the request.
4. Universal health care priority of Government.

Dr K K Aggarwal on Zee TV

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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VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Spiritual prescriptions: Namaskar and Namaste

sprritual blog

We are virtually nobodies, while the Cosmos is the Ultimate Being

While greeting any one in Hindu culture one takes the name of GOD, the supreme Brahma. It reminds us that we are nothing, every thing is GOD.

This traditional greeting of India has a deep spiritual meaning. It signifies non-arrogance or negation of ego.

NAMASKAR is made of three words: NAMAH + OM + KAR

NAMAH means NOT ME. It is a negation of one’s identity and hence of one’s ego or arrogance. It signifies that I am nothing.

OM is the sound of life, the primordial sound of nature. In Vedic language it signifies soul, the spirit or the GOD.

KAR means shape/form of or manifestation of.

OMKAR therefore signifies manifestation of OM, the UNIVERSE, the cosmos, BRAHMA, SHIVA or GOD. OMKAR is omnipresent and omnipotent.

NAMASKAR therefore indicates that I am nothing while OMKAR is everything. IT also gives respect to the one you say Namaskar. That I am nothing and you are GOD. In Vedantic text we are taught to give respect to atithi (atithi devo bhava).

When you bow to say namaskar, try to get angry. You cannot, because the body posture does not allow you to do so. For an angry posture you must have expansion of the chest wall and not the flexion of the chest wall.

Other schools of thought

NAMASKAR= NAM + AS + KAR

NAM is the root form of NAMAH and has the same meaning as NAMAH – NOT ME. (I am nothing).

AS means "To Be" or "To Exist" … a word derived from Astitva which means existence.

KAR means doer or one who makes or creates. For example, KAR can be seen in the words Kalakar, Chitrakar, Karmkar, Charmkar. In the above words, the suffix kar leads to the meaning of one who creates work.

ASKAR therefore means the creator of all that exists, the GOD.

Namaskar therefore has the same meaning: I am nothing every thing is the GOD

Other meanings

1. Some people interpret NAMAH as "I Bow to". Ultimately the deeper meaning remains the same. I bow to GOD. Here you are considering the other person as GOD, which is one of Mahavakyas from Chandogya Upanishad in Sam Veda, "Tat Tyam Asi" (you are that).

2. "I salute the Almighty within you." The true Namaste gesture is accompanied by bowing the head and shoulders slightly. This is a gesture that lessens our sense of ego and self-centeredness, requiring some humility to do it well — whereas shaking hands can be quite an arrogant event.

3. It is a sign of respect and peace

4. I bow to God in you; I love you and I respect you, as there is no one like you."

5. The word ‘Namo’ can be split into ‘Na’ + ‘Mama’ – meaning ‘Not mine’.

6. In AHIRBUDNYA SAMHITA, Siva explains the meaning of Namah in three ways:

• STULA ARTHA: Gross etymological derivation referring to the inherent nature of the Jeeva as Sesha. Bowing the body is acceptance of the greatness of the one bowed to; when done with the eight angas (limbs), it is ‘Sashtanga’ and is the perfect Namas.

• SUKSHMA ARTHA: Subtle meaning as seen in ‘Nirukta’ when it refers to bowing in thought, word and deed with an understanding of the bowing to be a Sadhyopaya (means).

• PARA ARTHA: Supreme meaning derived from the Shastras thus: NA indicating the Upaya; MA indicating its importance and S indicating Bhagavan, the Siddhopaya.( goal )

NAMASTE

Namaste = NAMAH + TE
Namah means Not Me
Te means "they".
The literal meaning of NAMASTE hence is "Not me, they". The word they refer to "GOD".

NAMASTE = that the doer of everything is not me but the Gods.

Other means of greetings

1. RAM–RAM

2. JAI SHRI KRISHNA

3. HARE KRISHNA

4. JAI SHRI RAM

5. JAI SIYA RAM

6. Sikhs say SAT SHRI AKAL, which means that Truth is the God and is timeless.

7. Sikhs also say WAHE GURUJI KA KHALSA, WAHE GURUJI KI FATEH. This is a declaration that the ultimate victory will be of the Guru and his followers.

8. Muslims say KHUDA HAFIZ, which means Khuda is the Protector.

cardiology news

The way to feel good is to do good. The way to feel successful is to take the actions that bring about success.

You cannot truly feel what you do not truly live. Be honest and authentic with yourself, with others, and with life, because anything less is just cheating yourself.

Spend this day being a unique and enthusiastic expression of life’s goodness. See how much of a positive difference you can make, and experience what a genuine, positive feeling you get from doing so.

Seek to add richness to the lives of others and be delighted at how much richness it brings into your own life. Do something good and useful just because it is the right thing to do, and discover how right it feels.

Let go of the tiresome fight to gain advantage, and direct your energy toward appreciating and creating goodness. Move beyond the need to prove yourself and focus instead on improving all of life.

Give more and more of your own unique goodness to those around you, to the world, and to life. And feel the outstanding richness as it grows increasingly abundant for you.

News Around The Globe

  • In a study of 112 obese adults, Australian investigators found that weight loss was associated with a lower amount of cartilage volume loss in the medial tibia and an improvement in knee symptoms, whereas further weight gain had the opposite effect. The findings were published online February 11 in the Annals of Rheumatic Diseases
  • Fixed-dose rituximab therapy can produce durable remission of pemphigus. In a retrospective study, the median disease duration before rituximab therapy was 24 months, and 83% of patients were receiving systemic corticosteroids or immunosuppressive therapies at the time of their first rituximab infusion. All patients showed improvement after rituximab treatment: 74 (80%) had complete remission after the first cycle, and all patients had complete remission by the 4th cycle. There were 56 relapses (61%) after the first cycle, with a median time to relapse of 15 months, the authors reported online February 5th in JAMA Dermatology.
  • Oophorectomy prior to menopause was associated with a greater risk for carotid artery thickening and bone loss more than a decade post menopause. Sara J. Mucowski, MD, of the University of Southern California Keck Medical Center in Los Angeles, and colleagues report in Feb. 14 in Fertility and Sterility that after excluding women who used estrogen or bisphosphonates, women without their ovaries showed a larger rate of bone mineral density decline in the lumbar spine compared with women with intact ovaries, both 5 to 10 years after menopause (–11.2, 95% CI –19.8–minus 2.53, P=0.02) and more than 10 years after menopause (–6.45, 95% CI –14.1–1.24, P=0.08).
  • Vascular endothelial growth factor A (VEGF–A) levels in pancreatic fluid may distinguish serous cystic neoplasms (SCN) from premalignant or malignant pancreatic cysts, according to a prospective study published online February 12 in the Journal of the American College of Surgeons. If the findings are confirmed, use of this biomarker could potentially reduce the costs and risks associated with monitoring and surgical intervention.
  • A new guideline on margins in breast cancer surgery is likely to reduce the re–excision rate for women with early–stage breast cancer who undergo lumpectomy. At present, this re-excision rate is around 20% to 25%, and is considered unacceptably high by experts. The new guideline was developed by the Society of Surgical Oncology (SSO), in conjunction with the American Society of Radiation Oncology, and has been endorsed by the American Society of Clinical Oncology and the American Society of Breast Surgeons. It is available online at www.redjournal.org, www.annsugoncol.org, and jco.ascopubs.org, and will be published in the March print issues of the International Journal of Radiation Oncology * Biology * Physics, the Annals of Surgical Oncology, and the Journal of Clinical Oncology.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

Can RIGs be safely injected into already infected animal bite wounds?

RIGs can be safely injected into already infected animal bite wounds following proper wound cleansing and administration of appropriate antibiotics.

cardiology news

Clot dissolving therapy or angioplasty in early acute heart attacks

Outcomes are comparable between primary removal of clot in heart artery with stent angioplasty and clot dissolving drugs in patients with ST–elevation heart attacks who present early.

Results of STREAM study

  • Stent angioplasty is the best if it can be done within one hour of presentation to the hospital
  • In those who presented within three hours of chest pain and stent angioplasty cannot be done in one hour, there was no difference between the two treatments (stent angioplasty of clot dissolving drugs) in the primary composite end point of major adverse cardiovascular events at 30 days.

Comments: In most non busy cardiac centers, stent angioplasty labs needs to be informed and angiographer called for doing the procedure and that take time. In such cases give clot dissolving drugs.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

The elevated risk of thrombotic events previously seen in mothers in the 6 weeks after childbirth appears to last about twice as long, though the absolute risk remains very low. According to Hooman Kamel, MD, of Weill Cornell Medical College in New York City Consistent with previous research, the rate of ischemic stroke, myocardial infarction (MI), or venous thromboembolism (VTE) was about 10–fold higher in the 6 weeks after delivery compared with the same 6–week period a year later (24.4 versus 2.3 cases per 100,000 deliveries). But a greater risk –– albeit of smaller magnitude –– also was seen from 7 to 12 weeks after delivery (5.6 versus 2.6 cases per 100,000 deliveries, odds ratio 2.2, 95% CI 1.5-3.1). The findings were reported at the International Stroke Conference and published simultaneously online in the New England Journal of Medicine.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

Using bronchiolitis clinical practice guidelines (CPGs) was linked to reduced use of chest X-rays (CXRs), bronchodilators, steroids, and length of stay (LOS) in hospitalized children without affecting 7-day all-cause readmissions, according to a study published online February 17 in Pediatrics.

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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Young age heart care 20–40 years

Most heart attacks occur in patients over the age of 40 but more and more younger men and women are presenting with heart attack. Most cardiologists use an age cut off of 40–45 years to define young patient with heart blockages or acute heart attack. Therefore, anybody who gets a heart attack before 40 in India is considered as a young age heart attack said Padma Shri, Dr. B C Roy National and DST National Science Communication Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India Senior National Vice President, Indian Medical Association. Definite data regarding heart blockages in the young is inadequate. Most data come from autopsy reports of victims of accidents, suicides or homicides.

In the age group of 15–20 years, 2% of the men have been shown to be suffering from advanced coronary blockages. Coronary blockages have been shown to be present in 20% of men and 8% of women at age 30–35 years and out of them 90% of men and 8% of women have coronary blockages in the left artery of more than 40%. In India, we note that heart attack occurs 10 years earlier than in the west.

In the west, upto 10% heart attacks occur in people who are younger than 40 years of age but the same in India will be much higher and can be upto 30–40%. The traditional risk factors are age, high cholesterol, high upper blood pressure and severe smoking. For every six year increase in age, the risk of heart attack increases by 1.63; for over 40 mm rise in cholesterol, the risk factors increase by 1.42, for every 20 mmHg rise in upper blood pressure, the heart attack risk increases by 1.32 and for additional 10 cigarettes smoking in a day, the risk increases by 1.36.

Younger people usually have multiple risk factors. About 90–97% of them will have at least two risk factors. Smoking is most common amongst multiple risk factors in younger patients. It is seen in upto 90% of young heart attack compared to 60% of heart attack patients who are above the age of 45. In India, these factors are much more important as passive smoking gets added to active smoking.

Younger patients with heart attack often have positive family history of premature heart disease. Upto 40% of them will have the history compared to 12% in the patients who are above the age of 45. If a father had a heart attack at the age of 45, it is very likely that the son will have the heart attack at the age of 35 and if not prevented in time.

Abnormal cholesterol levels are common in young patients whose prevalence is same to that of older patients. But in India, diabetic younger people who get heart attack are the ones who have abnormally low good cholesterol levels and abnormal high LDL bad cholesterol levels, high triglycerides and low HDL cholesterol level is typically associated with pot belly obesity, abdominal circumference of 90 cm in men and 80 cm in women. Younger people from BMI point of view may be within normal weight criteria but if one takes the history, they will be found have gained more than 20kg weight in the last two decades. This special group comprises normal weight abdominal obesity.

In young women on oral contraception, the chances of heart attack increase if they smoke. Smoking marijuana also triggers heart attack.

Psychological factors such as anger can be important in development of premature heart disease. Marital disharmony and job dissatisfaction are the two most common stress factors associated with premature heart disease. Trio of anger, aggression and hostility are now upcoming as new risk factors for heart disease in younger people.

Not walking or exercising can lead to insulin resistance which can add to future heart attack. Vitamin D deficiency, which is seen in upto 80% young people, can also add to the process of developing of blockages in the heart vessels.

The clinical presentation of heart attack in younger patients may also differ from that in older patients. High proportion of young heart attack patients may not experience chest pain. Most of the young patients will present with acute coronary syndrome or acute impending heart attack rapidly ending up in acute massive heart attack if left untreated.

Younger patients often will be found with fewer blockages and more clouts. Their angiography may show normal coronary arteries with mild luminary irregularities and single vessel blockage compared to older patients.

Prevention lies in remembering the Formula of 80, which means that one should keep their lower blood pressure, fasting sugar, resting heart rate, abdominal circumference and bad cholesterol levels lower than 80; to achieve this, all young people should walk for 80 minutes a day, brisk walk 80 minutes a week (with more than 80 steps in a minute), not eat cereals 80 days in a year, sunbathe 20–40 minutes a day for 80 days in a year, not take alcohol, if do, less than 80 ml in a day, do 80 cycles of slower and deeper pranayam breathing (4 per minute x 20 minutes) a day and give 80 minutes to oneself.

One cannot give or accept heart attack as a gift as one has to work against the law of the nature for over a decade to get a heart attack. The process of heart blockages usually starts right at the age of 20–25 years; therefore, all prevention must start right in high school or early college levels.

The number one risk factor for younger patients is metabolic syndrome due to insulin resistance which is associated with pot belly obesity, high triglycerides and low LDL good cholesterol levels. It is basically because of eating refined carbohydrates – white sugar, white rice and white maida. If these foods are eaten multiple times in a day for years together, one can end up with insulin resistance with resultant high blood pressure, blood sugar, pot belly obesity and stickier cholesterol, endothelial dysfunction leading to formation of blockages in the heart vessels.

Between the age 30–40, if one has an abdominal circumference of more than 80 cm, he should go for further evaluation including lipid profile, high sensitivity CRP test (if positive, it makes the cholesterol more stickier leading to thickening of the wall of the neck artery).

The first manifestation is seen in the neck artery, which shows thickened wall; this can be detected by a simple ultrasound test. At this stage, it is reversible. All high risk patients who think they can end up with heart attack in young age should also learn and make sure that family members are taught CPR 10 mantra which shows that even after sudden cardiac death, the deceased person can be revived.

The formula can be remembered in English – "To revive a person from sudden cardiac death, 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 by 1 ½” distance continuously with a speed of 10x10 i.e. 100 per minute."

In Hindi it can be remembered as – "Marne ke dus minute ke andar (jitna jaldi utna behtar), kam se kam agle dus minute tak (jitni der tak utna behtar, 10x10=100 ki gati se, apni chhati peetne ke bajaye mare hue aadmi ki chhati peeto."

All high risk patients should be vaccinated for flu and pneumonia as it can reduce the chances of heart attack. Nobody should eat trans fats – vanaspati and dalda, as they can reduce the levels of good HDL cholesterol.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 86664 people since 1st November 2012.

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."

emedipicstoday emedipics

Heart Care Foundation of India trained school children at Mayur Public School, IP Extension in cardiac first aid including how to revive a dead person after sudden cardiac death.

press release

Weight loss may improve sexual health of obese diabetes

vedio of day

today video of the dayHeart disease starts in youth

Cholesterol tips released

Padma Shri & Dr B C Roy National Awardee, Dr KK Aggarwal on Tackling tension headaches

eMedi Quiz

A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys with symptoms of burning, itching, and lacrimation with polygonal raised areas in the palpebral conjunctiva is:

1. Trachoma.
2. Phlyctenular conjunctivitis.
3. Mucopurulent conjunctivitis.
4. Vernal keratoconjunctivitis.

Yesterday’s Mind Teaser: The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X–ray diffraction.

Answer for yesterday’s Mind Teaser: 4. X–ray diffraction.

Correct answers received from:Dr. V.P. Thakral, DR.A.K.GAJJAR, Dr. P. C. Das, Dr. P. C. Das, Dr.K.Raju, Dr Jainendra Upadhyay, DR AYYAVOO ERODE, Dr Ajay Gandhi, Dr Avtar Krishan, Aalia, Dr B K Agarwal, Deepali Chatterjee, DR.Gelivi Sahadevudu,

Answer for 16th February Mind Teaser: 3.Gel filtration chromatography.

Correct answers received from: Dr B K Agarwal, Deepali Chatterjee, Arvind Diwaker, Dr Chandresh Jardosh

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

Talking Clock

While proudly showing off his new apartment to friends late one night, the drunk led the way to his bedroom where there was a big brass gong.

"What’s that big brass gong for?" one of the guests asked.

"Why, that’s the talking clock" the man replied. "Watch", the man said, giving the gong an ear–shattering pound with a hammer.

Suddenly, someone on the other side of the wall screamed, "F’gosh sakes, you idiot, it’s 2am in the blankety–blank morning!"

medicolegal update

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medicolegal update

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

medicolegal update

Sunbeams out of the clouds. Faith out of all my doubt. Terri Guillemets

medicolegal update

Dr KK Aggarwal: Eating refined sugar can cause diabetes http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Why do you stay in prison When the door is so wide open –Rumi

Forthcoming events

Date: Saturday 2PM-Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

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