eMedinewS19th March 2014, Wednesday

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, National Vice President Elect, 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);
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Five reasons why cardiologists are sued

Problems with diagnosis –– failing to make one, making the wrong one, or taking too long to get to one are the main reasons why cardiologists are sued, as per Sandeep Mangalmurti, MD, JD, a cardiologist at Bassett Medical Center in Cooperstown, New York.

  • Failure to make a diagnosis, making the wrong diagnosis, or delaying a diagnosis (25%). The primary issue leading to lawsuits in this category is the failure to diagnose myocardial infarction.
  • Improper management of treatment (14%).
  • Improper performance of a treatment or procedure (12%) and improper performance of surgery (11%). It’s inevitable that there are going to be some complications even amongst the most experienced cardiologists. Known risks of interventional procedures or operations are discussed with patients during the consent process ahead of time. But that isn’t enough to head off a potential lawsuit should one occur. That’s because it’s not usually the complication itself that results in a lawsuit, but rather the way it’s handled –– or mishandled –– by the physician.

    In the case of an interventionalist who suspects a retroperitoneal bleed after a procedure, for example, a lawsuit could be waiting if he or she fails to perform imaging or call in a surgeon to evaluate whether a bleed has actually occurred or fails to treat it.
  • Improper medication management (6%). Medications that we need to be aware of as cardiologists from a liability perspective are anticoagulants. Claims are related almost exclusively to bleeding complications. If placing a patient on systemic anticoagulation –– either with warfarin or one of the newer oral anticoagulants one need to be aware of the fact that one is increasing the liability risk.

    Another problematic drug is amiodarone. Multiple lawsuits related to side effects like pulmonary fibrosis often seen years after starting treatment.

Comments

Mistakes and complications will happen, and the key to avoiding lawsuits related to those is a solid line of communication between the patient, the patient’s family, and the treating doctor. Part of that includes fully informing patients and their families about the potential risks that accompany treatments and procedures

Equally important is a sincere effort on the part of the physician to take responsibility for any problems that occur and to try to find solutions. Oftentimes patients and their families will sue because they're frustrated that nobody is owning up to the situation and providing the answers they need.

Remember that no one is perfect, no one is going to get the right diagnosis every time right off the bat, and all of our procedures have complications even in the best of hands and in the most experienced centers, and so those things are going to happen.

But the thing that we do have control over as physicians and healthcare providers is the way that we interact with our patients and the families. This communication can really be the important before the procedure, after the procedure, after the treatment, during the process, the whole thing.

As per Dr Jack Lewin, president and CEO of the Cardiovascular Research Foundation and former CEO of the American College of Cardiology (ACC), fully disclosing risks to patients beforehand and owning a complication or mistake from the start can go a long way toward avoiding lawsuits, pointing to the effects of the University of Michigan’s policy of apologizing and initiating a discussion when something goes wrong.

Other ways to avoid a legal suit are

  1. Being a bit more meticulous about ruling out other potential diagnoses before settling on one
  2. Taking a timely second opinion

    (Source: Medpage Today)

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Zee News – Health Wealth Show

Dr kk Aggarwal on Zee Show

Safe Drugs-Health Wealth Zee News Show
Cancer Prevention–Health Wealth Zee News Show2
Potbelly Obesity–Health Wealth Zee News Show
Cancer Prevention–Health Wealth Zee News Show1
Vitamin D Health Wealth
Pneumonia–Health Wealth Zee News Show
Sudden Cardiac Death
Depression
Can Alcohol be Prescribed as Medicine
Health Wealth: All about Paralysis

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

Why are most temples located in faraway places?

sprritual blog

Most temples represent God or the spirit or the deity located in the temple or mandir situated in an area at the outskirts of the city. A spiritual atmosphere is one that is devoid of pollution and which promotes rajasik or tamasik behavior. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. The inner journey of being in touch with one’s consciousness requires detachment from worldly pleasures and the withdrawal of the five senses of the body

To be in touch with one’s consciousness one needs to bypass the disturbed state of consciousness controlled by emotion, memories and desires, through mind, intellect and ego. This bypass usually requires a prolonged period of persistence and undertaking the inward journey devoid of external stimuli. The parikrama, which means "the path surrounding something", incorporating many long walks helps to detoxify the mind and thus shifts the consciousness from a disturbed state to an undisturbed, calm state.

A long walk not only offers physical benefits but one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The person is often required to walk bare foot on natural ground, inhale pure air and concentrate and listen to the sounds of the nature, birds and trees. This proximity to nature helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode described by lowering of blood pressure and pulse rate. The final happiness invariably comes from within us at the time of final darshan when a person invariably closes his eyes and experiences God within his heart.

Most temples today are being constructed in residential colonies and provide a holy atmosphere to people right at their doorstep. However, they do not have the same spiritual significance and benefits as a temple located at the outskirts of a city.

There is no way a person can go to a temple in the vicinity of his house and detoxify his mind as this can hardly be achieved in minutes unless you are a siddha yogi, and if you are one, you need not go to a temple as the temple is within you.

In Vedic texts, it has been clearly mentioned that to acquire powers and inner happiness, rishi, munis were also required to do tapasya for months and years together. This tells us that spiritual well–being is acquired over an extended period of time as the process of detoxification is a long drawn process. Cars and other vehicles should not be allowed near temples as the basic motive is to have a pollution–free atmosphere and to give time and space for the mind to detoxify.

cardiology news

Words of Wisdom

Words of great wisdom, The Native American Code of Ethics:

  1. Rise with the sun to pray. Pray alone. Pray often. The Great Spirit will listen, if you only speak.
  2. Be tolerant of those who are lost on their path. Ignorance, conceit, anger, jealousy and greed stem from a lost soul. Pray that they will find guidance.
  3. Search for yourself, by yourself. Do not allow others to make your path for you. It is your road and yours alone. Others may walk it with you, but no one can walk it for you.
  4. Treat the guests in your home with much consideration. Serve them the best food, give them the best bed and treat them with respect and honor.
  5. Do not take what is not yours whether from a person, a community, the wilderness or from a culture. If it was not earned or given, it is not yours.
  6. Respect all things that are placed upon this earth – whether it be people or plant.
  7. Honor other people’s thoughts, wishes and words. Never interrupt another or mock or rudely mimic them. Allow each person the right to personal expression.
  8. Never speak of others in a bad way. The negative energy that you put out into the universe will multiply when it returns to you.
  9. All persons make mistakes. And all mistakes can be forgiven.
  10. Bad thoughts cause illness of the mind, body and spirit. Practice optimism.
  11. Nature is not FOR us, it is a PART of us. They are part of your worldly family.
  12. Children are the seeds of our future. Plant love in their hearts and water them with wisdom and life’s lessons. When they are grown, give them space to grow.
  13. Avoid hurting the hearts of others. The poison of your pain will return to you.
  14. Be truthful at all times. Honesty is the test of ones will within this universe.
  15. Keep yourself balanced. Your Mental self, Spiritual self, Emotional self, and Physical self – all need to be strong, pure and healthy. Work out the body to strengthen the mind. Grow rich in spirit to cure emotional ails.
  16. Make conscious decisions as to who you will be and how you will react. Be responsible for your own actions.
  17. Respect the privacy and personal space of others. Do not touch the personal property of others – especially sacred and religious objects. This is forbidden.
  18. Be true to yourself first. You cannot nurture and help others if you cannot nurture and help yourself first.
  19. Respect others religious beliefs. Do not force your belief on others.
  20. Share your good fortune with others. Participate in charity.

News Around The Globe

  • A study presented at the American Academy of Pain Medicine (AAPM) 30th Annual Meeting has reported that a combination of oxytocin and human chorionic gonadotropin (hCG) has the ability to improve pain and enables opioid dose reduction in patients with intractable pain. Nine patients with intractable pain maintained on one or more opioids were simultaneously administered oxytocin and hCG. A 30–40% reduction in the opioid dose was noted in 7 of 9 patients at follow–up, along with decrease in pain intensity.
  • The antipsychotic risperidone or paliperidone (an active metabolite of risperidone) may increase the risk of gynecomastia in older men, reports a study presented recently at the American Association for Geriatric Psychiatry (AAGP) 2014 Annual Meeting. Results of the study revealed that after adjusting for confounding variables, the rate ratio for gynecomastia was significant at 1.69 for current and recent users of risperidone and at 1.69 for users of paliperidone when compared with those who did not take any of the two medications.
  • In a recent genome–wide association study (GWAS) published March 11 in Nature Communications, researchers have identified 2 new risk loci for bipolar disorder and have also confirmed the presence of 3 other genes that may be associated with the illness. One of the 2 identified regions contains the gene that encodes adenylate cyclase 2 (ADCY2), a protein involved in signal transmission within nerve cells and is located on chromosome 5. The other region comprises 2 genes, microRNA 2113 (MIR2113) and POU class 3 homeobox 2 (POU3F2), believed to play a role in neurodevelopmental processes and are located on chromosome 6. The other 3 genes that were confirmed include ankyrin 3 (ANK3), odd Oz/ten–m homologue 4 (ODZ4), and tetratricopeptide repeat and ankyrin repeat (TRANK1).
  • A community–based UK study published online March 17 in Lancet Respiratory Medicine reports that despite 18% of the population being infected in recent outbreaks of seasonal influenza and in the 2009 H1N1 influenza pandemic, only 23% of infections were symptomatic, and only 17% led to medical attention. Most patients did not see a doctor, and many of those who consulted one were often not recognized as having influenza. The study thus points that the burden of the disease is much more than we actually see it.
  • A novel Australian study in PLoS One has reported that performing biopsies only in patients whose duodenal mucosa appears grossly abnormal on endoscopy may not be able to identify the cases of celiac disease. Researchers noted in their study that about 50% of patients with celiac disease identified by biopsy performed during gastrointestinal endoscopy exhibited normal–looking mucosa, and nearly a quarter of them had atypical symptoms. Researchers stressed that patients should never be subjected to an endoscopy without being screened for celiac disease.

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)

What are the common side effects of intra-dermal rabies vaccination?

Cell culture vaccines have proved to be remarkably safe and free of significant adverse events. However, mild symptoms of pain, erythema, irritation or swelling at the intradermal injection sites occur in 3–92% of patients. The most frequent symptom is local irritation in 7–64% of vaccines. Generalized symptoms reported by 3–14% of recipients include headache, fever and influenza–like illness. Transient macular, papular and urticarial rashes are occasionally seen. All these adverse effects are mild, transient and self limiting and rarely call for the use of antihistamines and analgesics.

cardiology news

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

  • Researchers at the National Perinatology Institute, Mexico conducted a randomized, double–blind, placebo–controlled trial at 4 day care centers from April 2011 to June 2012 and reported that daily supplementation with live bacteria could reduce the occurrence and duration of diarrhea and respiratory tract infection (RTI) in preschool children. The supplementation could also lower the costs of treatment. The study is published online March 17 in Pediatrics.
  • There is no doubt about the benefits of breastfeeding; however, a novel study has reported that extended and intensive breastfeeding is associated with a higher risk of cavities in baby’s first teeth. Researchers evaluated babies when they were about 6, 12 and 38 months old. About 40% of children who were breastfed between ages 6 and 24 months had some tooth decay by the end of the study; however, the number was 48% for kids breastfed for more than two years. The study findings are reported in Annals of Epidemiology.
cardiology news

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

  • Omega–3 fatty acid supplements have no benefit in reducing cardiovascular (CVD) risk, reports a recent study published March 17 in JAMA Internal Medicine. It was observed that supplementing the diets of elderly patients with long–chain omega–3 fatty acids did not show any benefit in reducing CVD risk. Approximately five years of supplementation failed to reduce the incidence of CVD mortality, MI, stroke, unstable angina, revascularization, CHF hospitalizations, and resuscitated cardiac arrest.
  • Researchers from the University of Michigan and the Norwegian University of Science and Technology recently reported their findings in Nature Genetics that have revealed a previously unknown gene variation that could make blood lipid levels healthier in humans and reduce risk of heart attacks. Researchers pointed that by looking at the genetic code differently – like by looking for how it affects the way proteins behave – they could find the gene hiding in plain sight in previous searches for cardiovascular risk genes.
cardiology news

Malaria, Dengue, Chikungunya and Filaria are diseases spread by mosquitoes and are totally preventable. Here are a few tips to prevent them.

  • Both malaria and dengue mosquitoes bite during day time.
  • It is the female mosquito which bites.
  • Dengue mosquito takes three meals in a day while malaria mosquito takes one meal in three days.
  • Malaria may infect only one person in the family but dengue will invariably infect multiple members in the family in the same day.
  • Malaria fever often presents with chills and rigors. If the fever presents together with joint and muscle pains, one should suspect Chikungunya.
  • Both dengue and malaria mosquitoes grow in fresh water collected in the house.
  • The filaria mosquito grows in dirty water.
  • There should be no collections of water inside the house for more than a week.
  • Mosquito cycle takes 7–12 days to complete. So, if any utensils or containers that store water are cleaned properly once in a week, there are no chances of mosquito breeding.
  • Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered.
  • If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  • Some mosquitoes can lay eggs in broken tires, broken glasses or any container where water can stay for a week.
  • Using mosquito nets/repellents in the night may not prevent malaria and dengue because these mosquitoes bite during the day time.
  • Both malaria and dengue mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
  • Wearing full sleeves shirt and trousers can prevent mosquito bites.
  • Mosquito repellent can be helpful during the day.
  • If you suspect that you have a fever, which can be malaria or dengue, immediately report to the doctor.
  • There are no vaccines for malaria and dengue.
cardiology news

Total CPR since 1st November 2012 – 88972 trained

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Excess Weight Speeds Up Osteoarthritis

Besides heart disease and diabetes, being overweight or obese can cause rapid deterioration of the cartilage in the knee, leading to osteoarthritis. The chances of rapid cartilage loss increase 11 percent with every one unit increase in body mass index (BMI), 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.

Osteoarthritis is the most common musculoskeletal disorder with major health and socioeconomic impact in our aging society. Osteoarthritis usually progresses slowly, but some patients experience a more rapid progression.

In a report published in the journal Radiology, researchers recruited 336 patients from a major osteoarthritis study. All were overweight and at risk of osteoarthritis, but had minimal or no loss of cartilage in their knees. During 30 months of follow–up, 20.2 percent of the patients showed a slow loss of knee cartilage and 5.8 percent had rapid cartilage loss. The main risk factors for cartilage loss were pre–existing cartilage damage, being overweight or obese, tears or other injury to the cartilage at the knee joint (meniscus), and severe lesions seen on an MRI. Other factors include inflammation of the membrane lining the joints and abnormal build–up of fluid in the joint.

Weight loss is probably the most important factor to slow disease progression. Danger of developing osteoarthritis is another reason to control weight.

Do not let yourself get heavy. People who are heavy are the ones that are getting worse. Keeping your weight down through diet and exercise or weight–loss surgery –– could prevent the need for knee–replacement surgery.

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 88972 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."

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CPR–10 Training Camp at Press Club–8th March 2014

press release

DVT risk starts early, stays long after acute stroke

vedio of day

today video of the dayPadma Shri & Dr B C Roy National Awardee,Dr KK Aggarwal on Tackling tension headaches

Hands only CPR 10 Utsav, 15th December 2013

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

eMedi Quiz

A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Proprioception on the ipsilateral side.

Yesterday’s Mind Teaser: A 64–year–old old hypertensive obese female was undergoing surgery for fracture femur under general anesthesia. Intra operatively her end–tidal carbon–dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2.Hypovolemia.

Correct answers received from: Dr.A.K.Gajjar,Tukaram Pagad,Dr.P.C. Das, drpoonamchablani, Dr.K.Raju, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Daivadheenam Jella, Dr Avtar Krishan, Anil Tandon

Answer for 17th March Mind Teaser: 3.Atracurium.

Correct answers received from: Dr B K Agarwal, Anil Tandon

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

On Trial

After a trial had been going on for three days, Finley, the man accused of committing the crimes, stood up and approached the judge’s bench. "Your Honor, I would like to change my plea from ‘innocent’ to ‘guilty’ of the charges."

The judge angrily banged his fist on the desk. "If you’re guilty, why didn’t you say so in the first place and save this court a lot of time and inconvenience?" he demanded.

Finley looked up wide–eyed and stated, "Well, when the trial started I thought I was innocent, but that was before I heard all the evidence against me."

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation:A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make Sure that each time a patient is given penicillin injection, anti anaphylaxis measures are available.

medicolegal update

Heart tells the eyes "See less, because you see and I suffer lot". Eyes replied, "Feel less because you feel and I cry a lot".

medicolegal update

Dr KK Aggarwal: Soul is the biggest pharmacy in the world – Dr KK Aggarwal http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Your true self is the ground state of the universe http://bit.ly/15QdVeB #Health

medicolegal update
  1. Dear Sir, Very informative newspaper. Regards: Dr Rajni

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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