eMedinewS18th August 2014, Monday

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

CT not required in appendicitis

When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required.

Compared with a straight–to–surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre–operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

News Around The Globe

  • A new study published in the Lancet has stated that being overweight or obese may increase the risk of developing 10 of the most common cancers. Researchers noted that every 5 kg/m2 increase in BMI was associated with a higher risk of cancers of the womb (62% increased risk), gallbladder (31% increased risk), kidney (25% increased risk), cervix (10% increased risk), thyroid (9% increased risk), and leukemia (9% increased risk).
  • A large, prospective, multicenter study has revealed that the likelihood of incident type 2 diabetes is lower in people who have high plasma levels of odd-chain saturated fatty acids obtained from dairy fats, compared with people who did not have these biomarkers. The study was published online in Lancet Diabetes & Endocrinology.
  • A 4–protein biomarker panel could improve the diagnosis of esophageal cancer, suggests new research published online in Cancer. The panel might also help guide treatment for those with the disease.
  • High–dose influenza vaccine provides better protection against influenza when compared with standard–dose vaccine among persons aged 65 years and older, suggests a new study published in the August 14 issue of the New England Journal of Medicine.
  • A new research has suggested that despite numerous regimens being effective for preventing active tuberculosis in patients with latent disease, those containing rifamycin are shorter and may be preferable for some patients. The findings were published online August 12 in the Annals of Internal Medicine.

Rabies News (Dr A K Gupta)

Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier.

Cardiology eMedinewS

  • The better warfarin anticoagulation is managed over the long–term in patients with atrial fibrillation (AF), the lower their later risk of dementia, suggests a retrospective single–center study published August 8 in Heart Rhythm.
  • Adults with disabilities are more likely to have hypertension than those without, and they represent an important subpopulation to target blood pressure–lowering interventions, reported researchers from the Centers for Disease Control and Prevention (CDC) in an article published in the August 14 issue of Preventing Chronic Disease.

Pediatrics eMedinewS

  • A new study has revealed that higher doses of folic acid during pregnancy and throughout life may have long–term negative effects. Researchers noted that the higher doses of folic acid altered offspring’s brain development and behavior in ways that are found in neurodevelopmental disorders. The research is published in PLoS One.
  • A South African study has found no evidence that delayed administration of the bacillus Calmette–Guérin (BCG) vaccination for tuberculosis (TB) affects immune responses to the vaccine. Researchers noted that the immunogenicity of BCG vaccination in HIV–exposed, uninfected infants was not compromised when delayed until 8 weeks of age, and resulted in robust BCG–specific T cell responses at 14 weeks of age. The study was published online August 8 in the Journal of Infectious Diseases.

Dr K K Spiritual Blog

Should doctors detach themselves?

In dealing with patients, the traditional Patient–Doctor relationship model has been that doctor should remain cool, calm and collected at all times.

The doctor’s approach needs to be strictly scientific, logical, objective, methodical precise and dispassionate. This has been the model since the era of William Osler, the father of modern medicine. The term used is imperturbability, which means coolness and presence of mind under all circumstances.

Osler said a rare and precious gift to doctor is right of detachment. The right of detachment insulates the doctors and protects them from powerful emotions that patients display in their presence like anger, frustration, grief, rage and bewilderment. It also insulates patients from the rolling emotions that doctors may at times feel towards them.

However, a detached attitude also insulates doctors from empathizing with patients. A detached doctor may talk in a language that is over patient’s head.

Detachment is not like a light switch that you can turn on and off to suit the situation. Detachment as a practice cannot be in isolation if it becomes your personal style of distracting from the world, it may not be just for the patients but also from your colleague, family friends and even yourself.

I recall when I joined by hospital, the first lesson given to me by my boss was not to get unduly attached with patients. As part of etiquettes, we were taught not to socialize with patients. Even today the new American Guidelines talk that doctors should not socialize with their patients on social media including Facebook. Even doctors are human beings and their personal life should not be known to the patients. As far as lawsuits are concerned, it is equally true that known patients file a lawsuit much more than unknown people because over a period of time they know your weakness. One should learn to empathize with the patients and yet be detached from its results. Doctors who follow Bhagawad Gita understand this concept very well.

Wellness Blog

Honey excellent for Cough

A spoonful of honey can quieten children’s’ night time cough and help them — and their parents — sleep better.

When compared to the cough syrup ingredient dextromethorphan or no treatment, honey came out on top. As per a study from Archives of Paediatrics and Adolescent Medicine, the results are so strong that it can be said that honey is better than no treatment and dextromethorphan was not. There is currently no proven effective treatment for cough due to an upper respiratory infection like the common cold. While dextromethorphan is widely used, there is no evidence that it works, and it carries risks.

Honey is used around the world as a home remedy for cough, and might provide a safe, effective alternative to cough medicine. To investigate, the researchers compared buckwheat honey, a honey–flavoured dextromethorphan preparation, and no treatment in 105 children who had sought treatment for night time coughs due to colds. Among the three groups, children given honey had the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality may be soothing to the throat, while its high antioxidant content could also be a factor. Honey also has antimicrobial effects. Honey is not recommended for infants younger below one year of age because of the risk of botulism spores.

Inspirational Story

Kindness with Class

We had just finished thirteen miles of hiking in the Smokey Mountains. We were tired and our muscles ached as we made our way back to New England. The cramped car ride to the airport followed by a two hour flight left our legs in worse condition than they were when we first came off the mountain we just climbed.

When I heard that two seats in first class on our next flight were available for a small upgrade fee, I jumped at the opportunity. We agreed to blow our budgets and paid the fee to upgrade our tickets. Our spirits lifted immediately. At least we would end our adventure in comfort and style.

Our travel has always been arranged on a budget, so flying first class was a new experience for us. As we boarded the plane, we felt as if we were part of an elite group. We took our seats and were happy to join the other few passengers who could fly in such luxury. It was almost as if we had a sense of pride to be sitting with the group of people that surrounded us.

As we chatted away about hiking, waterfalls and bears, I could hear people around us talking about busy schedules and business meetings. It wasn't long before I realized that these people were accustomed to flying in luxury. They are important people I thought to myself.

We noticed that the stewardess was working non–stop to ensure the comfort of the first class passengers. She could not walk by a seat without receiving an order. I thought about how much she must love her job as she smiled kindly at each person while attending to their needs.

As the stewardess walked by our seats near the end of the flight, I looked at her and said, "Thank you and I hope you have a great night". She stopped at our seats with a look of disbelief on her face, bent down, looked at me and said, "Excuse me". I repeated my words and she smiled in a rather funny way, almost as if I had asked her a question that she did not know how to answer.

After a few moments the stewardess walked back to our seats. She asked us what company we were traveling for. "I can tell you work with the public," she said. "Why do you think so?" I asked. She answered very quietly "because you are the only passenger here to say thank you or stop to say something nice to me tonight and I really appreciate your kindness."

The sense of belonging to the elite group of people in first class disappeared as we heard her words. Our seats in luxury offered us more than a comfortable ride. We were reminded that without kindness, we would be flying in no class.

ePress Release

Drugs as Good as Angioplasty for Stable Heart Disease

Aggressive drug therapy is just as good as angioplasty for patients with stable heart blockages, 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.

There has been a belief amongst cardiologists that all patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery.

Patients with stable heart disease make up about three–quarters of all the patients who undergo angioplasty and receive stents.

Quoting the results of Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, Dr. Aggarwal said that optimal drug therapy, when combined with lifestyle changes, has equal results as that of angioplasty and optimal medical therapy combined.

The study published in the New England Journal of Medicine randomly assigned 2,300 patients with stable but significant heart disease to one of two treatment regimens. The first group received drug therapy alone, while the second group received the drug therapy plus angioplasty.

Follow up showed that 19% in the angioplasty group had died or had a heart attack, compared to 18.5% in the group that only received drug treatment. The only benefit of angioplasty was that it reduced chest pain over the long–term compared with drug therapy alone. About 30% of the patients who received drug therapy alone did eventually undergo angioplasty because their symptoms could not be managed with drugs alone.

In addition, about 21% of the patients who received stents needed to have another procedure. Although angioplasty was better at relieving symptoms, it wasn’t better in preventing death or heart attack.

Drug therapy for patients with stable heart disease should be tried as first–line treatment. Angioplasty should be reserved for patients who have continuing symptoms.

eMedi Quiz

Prevalence of HIV infection in India is:

a.1.8 million
b.2.3 million
c.4.5 million
d.6.7 million

Yesterday’s Mind Teaser: Bacitracin acts on:

1. Cell wall
2. Cell membrane.
3. Nucleic acid.
4. Ribosome.

Answer for yesterday’s Mind Teaser: 1. Cell wall

Correct answers received from: Dr.K.Raju, Dr.Bitaan Sen & Dr.Jayashree Sen, Daivadheenam Jella, Dr Jainendra Upadhyay, dr poonam chablani, Dr Pankaj Agarwal Dr Avtar Krishan, Dr.G.Sampath

Answer for 17th August Mind Teaser: 1. Hydatid cyst of liver.

Correct answers received from: Dr poonam chablani, Dr Prakash Khalap, Yogesh Porwal

Send your answer to ijcp12@gmail.com

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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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Health Check Up and CPR 10 Camp at NP CO–ED Sr Sec School, Tilak Marg on 8th August 2014

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Exercise impact on the knee

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IJCP Book of Medical Records

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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 with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my God! Why was the full initial course of penicillin not given?
Lesson: Make sure that patients with acute rheumatic fever are initiated on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.

eMedinewS Humor

Experiment on a Dog

Some scientists decided to do the following experiments on a dog.

For the first experiment, they cut one of the dog’s legs off, and then they told the dog to walk. The dog got up and walked, so they learned that a dog could walk with just three legs.

For the second experiment, they cut off a second leg from the dog, and then they told the dog once more to walk. The dog was still able to walk with only two legs.

For the third experiment, they cut off yet another leg from the dog and once more they told the dog to walk. However, the dog wasn’t able to walk with only one leg.

As a result of these three experiments, the scientists wrote in their final report that the dog had lost its hearing after having three legs cut off.

Quote of the Day

A creative man is motivated by the desire to achieve, not by the desire to beat others. Ayn Rand

Twitter of the Day

Dr KK Aggarwal: TB more dangerous than FLU By Dr k k Aggarwal http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Happiness and oneness help form the core of abundance http://bit.ly/DC_Ananda #ananda

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  1. Dear Sir, Thanks for the information: Regards, Dr Kanishk
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