eMedinewS
19th November 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, 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

Elderly should Beware of Commonly Prescribed Group of Drugs

Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anti-cholinergic drugs used to treat acid reflux, Parkinson's disease and urinary incontinence may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.
Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.

News Around The Globe

  • Patients who were chronically over-anticoagulated, defined as having an International Normalized Ratio (INR) greater than 3 more than 25% of the time, had a 5.8% risk of developing dementia during a median of 4 years, reported T. Jared Bunch, MD, of Intermountain Health System in Salt Lake City, and colleagues.
  • Clinicians know the recommendations regarding when and when not to prescribe antibiotics, but they do not always follow them, according to in-depth interviews with 36 physicians, nurse practitioners (NPs), and physician assistants (PAs). Guillermo Sanchez, MPH, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues report the results of their interview-based study in an article published online November 13 in Emerging Infectious Diseases.
  • NIH-sponsored study identifies superior drug regimen for preventing mother-to-child HIV transmission: For HIV-infected women in good immune health, taking a three-drug regimen during pregnancy prevents mother-to-child HIV transmission more effectively than taking one drug during pregnancy, another during labor and two more after giving birth, an international clinical trial has found. The ongoing PROMISE (Promoting Maternal-Infant Survival Everywhere) study also has found that one triple-drug regimen for preventing mother-to-child transmission may be safer than another for women and their babies. These findings provide further support for World Health Organization guidelines for preventing mother-to-child HIV transmission, according to the researchers. The findings were reported on Nov. 4, 2014 during a scheduled interim review of the PROMISE study data by an independent data and safety monitoring board (DSMB). (NIH)
  • For patients with osteoarthritis, a formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, developed with SoluMatrix fine-particle technology, improves health-related quality of life, physical function, and pain, suggests a phase 3 open-label study. The findings were presented at the American College of Rheumatology 2014 Annual Meeting.
  • A novel genetic test based on a prostate cancer's unique genetic fingerprint can accurately predict disease recurrence in men undergoing local treatment and can distinguish those who will require additional systemic therapy from those who will not, suggests a new study published online in the Lancet Oncology.

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

19th-Nov-CSI

IMA News

Over 1.27 crore suffer from atrial fibrillation: DC | SHASHI BHUSHAN | November 17, 2014, 06.11 am IST: NEW DELHI: The number of “atrial fibrillation” patients is increasing in the country. In 2013 alone, over 1.27 crore people suffered from atrial fibrillation, an increase by 40 lakhs from 2012 and 60 lakhs from 2011.

Atrial fibrillation is the number one cause of paralysis in the elderly. Indian Medical Association (IMA) will be launching a national programme for control atrial fibrillation.

The disease is classified as new onset, paroxysmal, persistent, long standing persistent or permanent. In India, the increasing incidence of potbelly obesity and chronic heavy alcohol use is directly linked to the increase in incidence of atrial fibrillation.

Date related to atrial fibrillation was released in Asia Pacific Heart Rhythm Society (APHRS) conference held recently in the capital.

President of the Heart Care Foundation of India (HCFI) and Secretary General Elect of the Indian Medical Association (IMA), Dr K.K. Aggarwal said, “Medically, all patients with atrial fibrillation need sequential echocardiography and permanent blood thinners unless contraindicated. In the absence of a reversible cause, atrial fibrillation is always recurrent. If not treated, atrial fibrillation can lead to paralysis, an increased heart rate linked low pumping action of the heart and distressing symptoms”.

Concerned with the rising number of atrial fibrillation patients, the IMA has decided to launch national program for control of atrial fibrillation and stroke.

The IMA’s national program for control of atrial fibrillation and stroke will focus on creating awareness about the magnitude of problem in the country and sensitizing the family physicians in early recognition of atrial fibrillation.

“Campaign focus on creating awareness about control of risk factors so that atrial fibrillation does not occur, sensitising the government and the industry to make available cost effective blood thinners to prevent stroke,” added Dr Aggarwal.

Director Cardiology at Saket City Hospital, Dr Mohan Nair said that according to the latest APHRS white book, there are only 27 doctors in the country who can ablate atrial fibrillation. “There are only 20 atrial fibrillation centers in the country,” added Dr Nair.

Atrial fibrillation sees sharp rise: Nov 17, 2014 - SHASHI BHUSHAN | Asian Age: New Delhi: The number of “atrial fibrillation,” abnormal heart rhythm, patients are increasing in the country. In 2013 alone, over 1.27 crore people suffered from atrial fibrillation, an increase of 40 lakh compared to 2012 and 60 lakh compared to 2011. Atrial fibrillation is the main cause of paralysis in the elderly. The Indian Medical Association will launch a national programme for control of atrial fibrillation.

The disease is classified as new onset, paroxysmal, persistent, long-standing persistent or permanent. In India, the increasing incidence of potbelly obesity and chronic heavy alcohol use is directly linked to the increase in the incidence of atrial fibrillation.

“Medically, all patients with atrial fibrillation need sequential echocardiography and permanent blood thinners unless contra-indicated. In the absence of a reversible cause, atrial fibrillation is always recurrent. If not treated, atrial fibrillation can lead to paralysis, an increased heart rate linked to low pumping action of the heart and distressing symptoms,” according to Dr K.K. Aggarwal, IMA secretary-general-elect and Heart Care Foundation of India president.

Worried about the rising number of patients with the condition, the IMA has decided to launch a national programme for control of atrial fibrillation and strokes. The IMA’s national programme for control of atrial fibrillation and strokes will focus on creating awareness about the magnitude of problem in the country and to sensitise the general physicians to ensure early recognition of atrial fibrillation.

“Campaign focus on creating awareness about control of risk factors so that atrial fibrillation does not occur, sensitising the government and the industry to make available cost effective blood thinners to prevent stroke,” added Dr Aggarwal.

According to the latest Asia-Pacific Heart Rhythm Society white book, there are only 27 doctors in the country who can ablate atrial fibrillation, Dr Mohan Nair, director, cardiology, at Saket City Hospital, said.

“Only 2 doctors were added to the group from 2011-12 and 7 from 2012-13. There are only 20 atrial fibrillation centres in the country and no new centre was added between 2012-13. This indicates the urgent need for raising awareness about the prevention, treatment and rehabilitation from the disease condition,” added Dr Nair.

The IMA campaign will also focus on promoting training and availability of more ablation centres and physicians in the country.

The campaign will also work to make cardiologists, neurologists and physicians work together to control atrial fibrillation and its complications.

MCI News

300 doctors under Medical Council of India lens over graft charge
Rema Nagarajan,TNN | Nov 18, 2014, 12.59 AM IST: 300 doctors from across the country have been summoned to Delhi to answer questions on an anonymous complaint that they had been bribed by a pharmaceutical firm.

The Medical Council of India has summoned about 300 doctors from across the country to Delhi to answer questions on an anonymous complaint that they had been bribed by a pharmaceutical firm. About 100 of these doctors appeared before MCI's ethics committee on Monday.

According to the complaint, the Ahmedabad-based pharma company has been paying doctors lakhs of rupees as well as gifting them cars and flats and sponsoring family foreign trips in return for prescribing its medicines even though cheaper alternatives from better known companies are available.

Of the 150 doctors summoned to appear at the last meeting of the ethics committee, 109 appeared. The rest were summoned on Monday. "About 135 are left and they have been asked to appear at the next meeting of the committee in December. According to the rules, they have to be given three chances," explained Dr KK Aggarwal, a member of the panel.

The letter asking doctors to appear before the committee on Monday said: "Please bring your ITR, bank statement for the last three years, passport in original, as well as a set of photocopies of the said documents." The letter also warned that "in case you fail to appear on the above said date and time, the ethics committee will proceed for ex parte decision against you on the basis of available records in the council office".

That had about 100 doctors thronging MCI's office. They were asked to give a response in writing. While many submitted their responses and documents immediately, others chose to wait and talk to their lawyers. "The letter sent to us with a copy of the complaint did not include the details of the charges against us though the complaint did mention that it included details of charges against each doctor. Without knowing the exact allegation against us, how can we be expected to respond?" said a doctor.

Dr Ajay Kumar, who chaired Monday's meeting, said, "They have a week to respond. We did not want to reveal the exact allegations against them in the letters. But when they appeared today, the complaint against them was read out. Now they know the content of the complaint and they have been given a proforma to fill as response."

The anonymous complaint was received by the department of pharmaceuticals in August. "The vigilance division of the department was of the view that since it involved such a large number of doctors, it ought to be examined in detail. So, they sent it to MCI in the first week of September, though anonymous complaints are usually disregarded," said Dr Aggarwal.

According to the complaint, one of the ways in which the firm would bribe doctors would be by paying lakhs of rupees for running advertisements on a TV installed in their clinics. The letter gave the name of each doctor with his or her address and the bribe given to him or her.

It alleged that the doctors were violating basic norms and claimed that the turnover of the company had grown from zero to Rs 400 crore in just five years. The letter alleged that company's brands were priced 15% to 30% higher than those of well-established companies like Cipla, Ranbaxy, Sun, Aristo, Alkem, Zydus and Cadila but still doctors were prescribing its products as the company "was buying doctors by way of offering various means of bribes".

The complainant claimed that the firm was adding the cost of bribes to its products, forcing the patient to pay up. The complainant sought an I-T probe since doctors who allegedly accepted these bribes were evading income tax.
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21st Perfect Health Mela 18th October 2014

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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

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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 with skin diseases needed circumcision and wanted to know whether Mediclaim would cover it.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Circumcision is excluded unless it is necessary for treatment of a disease.

Make Sure

Situation: A terminally ill patient who developed bed sores was prescribed only systemic antibiotics.
Reaction: Also change the position of the patient frequently and keep the skin clean and dry.
Lesson: Make sure that good nursing care and maintenance of skin hygiene is advised first to patients with bed sores, along with topical antibiotics.

eMedinewS Humor

Civil Servant

Three boys are in the schoolyard bragging of how great their fathers are. The first one says, "Well, my father runs the fastest. He can fire an arrow, and start to run, I tell you, he gets there before the arrow".

The second one says, "Ha! You think that's fast! My father is a hunter. He can shoot his gun and be there before the bullet".

The third one listens to the other two and shakes his head. He then says, "You two know nothing about fast. My father is a civil servant. He stops working at 4:30 and he is home by 3:45!!"

Twitter of the Day

Dr KK Aggarwal: Avoid routine refined carbohydrate
Dr Deepak Chopra: A God worthy of faith must actually matter. He needs to start performing instead of disappointing

Dr KK Spiritual Blog

How to Be Happy and Healthy

Somebody once asked Lord Buddha, “After meditating for years, I have not been able to gain anything.” Then Lord Buddha asked, “Did you lose anything?” The disciple said, “Yes, I lost my anger, desires, expectations and ego.” Buddha smiled and said, “That is what your gain is by meditating.”

To be happy, one must learn to let go the following:

  • One should let go of the desires. In Amarnath Ki Yatra, Lord Shiva firstly let go of the Bull, which represents the sexual desires. In Hanuman ki Lanka yatra, desires are represented by Samhiki, a creature who used to catch birds by their shadow. Hanuman killed the desires. So, it is possible to kill your desires. Again in Ramayana, desires are linked to Rajsik mind and in mythology, Meghnath represents the Rajsik mind. Meghnath was killed by Lakshman, the determined mind. Therefore, one should let go of the desires by killing them by focused concentration of the mind on the desires.
  • Let go of your expectations. In Amarnath Ki Yatra, the second thing which Lord Shiva discarded was the moon, which in mythology symbolizes letting go of expectations.
  • Let go of your ego. In mythology, ego represents Kansa in Krishna era and Ravana in Rama era. Both were killed by Krishna and Rama respectively, who symbolize the consciousness. Ego can never be killed by the mind and can only be killed by the consciousness (conscious-based decisions).
  • Ego is also represented by Sheshnaag and we have Lord Shiva and Lord Vishnu both having a Sheshnaag each with a mouth downwards indicating the importance of controlling one’s ego.
  • One should let go of his or her ego but also remember never to hurt somebody’s ego. Hurting somebody’s ego in terms of allegations of sexual misconduct, financial corruption or abusing one’s caste is never forgotten and carries serious implications.
  • In Hanuman Ki Lanka Yatra, ego is represented by Sursa; Hanuman managed her by humility and not by counter ego. In Naag Panchami also, we worship Naag, the ego, by folded hands and by offering milk.
  • Let go of your inaction. One should learn to live in the present. In Hanuman Ki Lanka Yatra, Hanuman first meets Menak Mountain, which indicates destination to rest. One should never do that and willfully divert his or her mind towards action.
  • Let go of your attachments. Let go of your attachments to your close relatives and the worldly desires. In Amarnath Ki Yatra, Lord Shiva first leaves Bull (desires), moon (expectations), sheshnaag (ego) and then he gives up Ganesha and worldly desires (five elements). In mythology, this is practiced as detached attachment and in Bhagavad Gita is equated to Lotus. In Islam, detached attachment is practiced in the form of Bakra Eid.
  • Let go of your habit of criticizing, complaining and condemning people. One should always practice non-violent communication and speak which is truth, necessary and kind. One should not criticize, condemn or complain about people, situation and events. Wayne Dyer said, “The highest form of ignorance is when you reject something you do not know anything about.”
  • Most of us often condemn people without knowing their capabilities and label them as unmatchable to us. One should also let go habit of gossiping as it is a form of violent communication.
  • Let go of your habit of blaming others: One should learn to take the responsibilities and people believe in team work. Good leader is the one who learns to be responsible in life.
  • Let go of your need to be always right: It is a form of ego. Remember, in arguments either you can win arguments or relationships. Always try to win relationship and not arguments.
  • Let go of your need to control situations, events and people: Learn to accept people as they are. The world is won by those who let this habit go.
  • Let go of your habit and the need to impress others: This is also a type of ego where we always seek appreciation.
  • Give up your belief that you cannot do it: Remember ‘IMPOSSIBLE’ is ‘I M POSSIBLE’. A belief is not an idea held by the mind but it is an idea that holds the mind. (Elli Roselle).
  • Give up your resistance to change: Remember change is the only constant which will happen and always welcome it. Joseph Campbell once said that one should follow one’s bliss and will open doors to your where there are only walls.
  • Let go of your fear and all negative thoughts: Remember, the mind is a superb instrument if used rightly. It becomes very destructive if used badly. (Eckhart Tolle).
  • Let go of your habit of giving excuses.
  • Let go of always being in the past.

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)

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

  • In high-risk patients, adding ezetimibe to statin therapy reduced LDL cholesterol by an average of 17 mg/dL and reduced cardiovascular events compared with statin therapy alone. That finding from the 18,000-patient IMPROVE-IT trial marks the first time that adding a nonstatin lipid-lowering therapy to a statin demonstrated a clinical benefit, Christopher Cannon, MD, of Brigham and Women's Hospital said. (MedPage Today)
  • Patients developing inpatient-onset ST-elevation myocardial infarction (STEMI) had more than threefold greater in-hospital mortality as compared to those with outpatient-onset STEMI, suggested an analysis published in the November 19 issue of JAMA.

Pediatrics eMedinewS

  • Energy drinks can be poisonous for young children, a study of poison control center calls found.
  • Training teachers to promote structured play among kindergarteners leads to improved reading, vocabulary and math scores that persist into first grade, suggests a new study published online in PLOS ONE.

Quote of the Day

  • A question that sometimes drives me hazy: am I or are the others crazy? Albert Einstein

Wellness Blog

Why is My Nose Bleeding?

Nosebleed is a common problem, occurring in up to 60 percent of the general population and is often because of a respiratory illness or dry conditions. Nasal drying is common in the hot summer months because of the extreme temperature and dry air due to use of air conditioners.

Here are some typical reasons for nosebleeds:

  • Nasal allergies
  • Blowing your nose too hard or trying to remove something from inside the nose
  • A result of “popping” the ear
  • Nasal exposure to chemicals
  • Frequent sneezing or having an upper respiratory infection
  • Use of nasal spray or a blood-thinning drug, such as aspirin
  • Inhaling air that is extremely dry or cold
  • Having recent surgery on the nose or elsewhere on the face
  • Breaking the nose or a similar injury
  • Uncontrolled blood pressure

Bleeding can be controlled by direct pressure i.e. compression of the nostrils rasping the alae distally so all mucosal surfaces are opposed. Direct pressure should be applied continuously for at least five minutes, and for up to 20 minutes. The patient should be encouraged not to check for active bleeding. Patients who are properly instructed may control their bleeding while the evaluation gets underway.

Other maneuvers include bending forward at the waist while sitting up (to avoid swallowing blood), placing a plug of cotton wool or gauze into the bleeding nostril (sometimes coated with antibiotic ointment), expectorating out blood that accumulates in the pharynx and a cold compress applied to the bridge of the nose.

These maneuvers also should be taught to high-risk patients for use at home. Many ENT specialists recommend initial treatment with two puffs of oxymetazoline to hasten hemostasis.

ePress Release

Now two blood thinners for 30 months after a heart stent

A report published in New England Journal of Medicine by Dr. M. Mauri of Brigham and Women’s Hospital, Boston has shown that one should continue two blood thinners for at least 30 months after stents are placed in the heart arteries. The recommendation up till now was for one year.

Commenting on the study Padma Shri, Dr B C Roy National and National Science Communication Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association said the results of DAPT

Trial have now clarified that all patients with drug eluting stents must continue two blood thinners for at least 30 months.

A group of doctors has recently suggested that two blood thinners should only be given for 6 months instead of one year. Only patients at very high risk for bleeding or patients with liver disease should receive two blood thinners for 6 months.

eMedi Quiz

A measure of location which divides the distribution in the ratio of 3:1 is:

1. Median.
2. First quartile.
3. Third quartile.
4. Mode.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 3. Sound referral system.

Correct answers received from: Tukaram Pagad, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr K V Sarma.

Answer for 17th November Mind Teaser: b. Auspitz’s sign.

Correct answers received from: Dr Avtar Krishan, Tukaram Pagad, Dr Poonam Chablani.

Send your answer to email

medicolegal update
  1. Exercise-A Prescription,wow,what an informative and useful for one and all. Thanks for it dear Dr K.K. Regards: Dr VK

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