emedinews
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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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  Editorial …

20th August 2011, Saturday

The science behind birth of Krishna: Krishna Janmashtami

Krishna represents Brahman or God consciousnesses. Krishna avatar is synonymous with self–realization. Normally desires and negative thoughts core our consciousness with ignorance. The journey to self–realization involves removal or shedding of this ignorance which can only be done by the eight spiritual principles as described by the Yoga Sutras of Patanjali. These include: Yama (self control); Niyama (self–discipline), Asanas (bodily postures); Pranayama (control of breath), Pratyahara (one pointed), Dhyana (contemplation) and Samadhi (self–realization).

Ignorance can be symbolized by a Prison, which represents darkness; narrow–minded approach (small entry gate) and limitedness to everything (small room). The chains in the prison denote the bondages of lust, greed, desires and ego.

The birth of Krishna in the prison means ‘self–realization out of ignorance’. It can only be acquired by adhering to the eight principles of Ashtanga Yoga with Tapas (Abhyasa) or hard work. Krishna, born, as the eighth child of Devaki, represents tapas of the eight limbs of yoga. The self–realization can only occur after the seven steps have been successfully negotiated and the mind is purified during the process.

In the state of Samadhi, there is spontaneous birth of the self. In this state (sama = equal; dhi = intelligence), one controls equality and balances himself between the good and the bad.

The symbolization is that, as Krishna was born, the chains that bound his father fell off; the doors that had been bolted flew open and the prison guards immediately went into sleep. And the father, Vasudeva, took Krishna and went to Gokul, after placing Krishna in a basket and walking across the Yamuna river, where at the same time Yashoda, consort of Nanda, had given birth to a female child.

The ‘chains’ here stand for the bondage to the external world and the five senses. A self realized person is free of these bondages. The opening of gates symbolizes control over lust, desire, greed and attachments. Sleeping of the guard symbolizes, that in a self–realized state, one is totally cut off from the world. Everything else perishes and one gets detached.

The thunderstorm, the rain, and the fire, all represent the internal turmoil of uncontrolled desires and hatred. The moment Krishna’s feet touch the turbulent water, everything settles. The spiritual lesson is that by turning inwards and towards one’s pure consciousness any turbulent state of mind can be controlled.

While acquiring all that, one must control the ego and keep the desires inwards and not have ego egocentric desires. Controlling the ego is depicted as a snake sitting over the basket and guarding Lord Krishna.

The baby girl born at Gokul represents the Mayashakti, which was killed by Kansa (the ego of the body).

It is easy to control one’s desires and attachments, but controlling the Ego is the most difficult. This is illustrated by the fact that at the time of birth of Krishna, Kansa was still alive. It took many years for Krishna (self realized state) to kill the ego (Kansa).

Acquiring a state of self–realization should not be the ultimate goal in life. After self–realization, if the ego is not controlled, one can misuse one’s spiritual powers. The ultimate aim in life should then be to kill the ego, which is what Krishna ultimately did.

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  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Additional tests may not always be
necessary for diagnosis

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issues

Delegates participated in large numbers in the recently concluded National Conference on Insight on
Medico Legal Issues
.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

(Dr GM Singh)

Colleges charging capitation fee to be fined Rs. 1 crore

A parliamentary panel has recommended slapping Rs 1 crore fine on technical and medical education institutions collecting capitation fee from students.
In its report on Prohibition of Unfair Practices in Technical Educational Institutions, Medical Educational Institutions and Universities Bill, 2010, the panel, headed by parliamentarian Oscar Fernandes, said compared to the heavy capitation fee charged for seats in medical colleges, a smaller penalty will not be a deterrent.

The parliamentary standing committee, however, underlined that a major and minor violation cannot be treated on par and uniform penalty for all offences was against the principle of natural justice.

It favoured penalties in proportion to the severity of the offence, asking the government to fix the quantum of penalty on a case–to–case basis.
The proposed law provides for a maximum penalty of Rs 50 lakh on erring technical, medical institutions and universities.

While recognising the need for specifying a minimum penalty, the panel said that all violations under the Act should be treated as serious as they affect the interests of students and may put their future at stake. On confiscating the capitation fee collected, the committee recommended that the Government take a cue from various state laws and decide whether the confiscated amount should be forfeited to the government or returned to the payer, as different states had different rules in this regard.

It also recommended a specific provision to cover minority educational institutions without violating their rights under Article 30. "The present provisions can lead to an interpretation whereby any instance of unfair practice by a minority educational institution may not be acted upon. It needs to be ensured that interests of all students, including those studying in minority institutions, are safeguarded," the panel stressed.

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Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

Coronary calcium better than CRP to stratify risk

Among asymptomatic individuals with normal LDL cholesterol levels and elevated high–sensitivity C–reactive protein (hsCRP), measuring the burden of calcium in the coronary arteries with cardiac CT appears to stratify the risk of cardiovascular disease, researchers found. (Source: Medpage Today)

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Cervical screening guidelines ignored

Many physicians recommend the HPV and Papanicolaou co–tests for cervical cancer screening on an annual basis, despite guidelines that call for re–screening every three years, researchers said. National survey data show that about 51% of providers ordered the co–test, but in clinical vignettes, only about 14% recommended re–screening in three years for women with normal results, Katherine Roland, MPH, of the Centers for Disease Control and Prevention in Atlanta, and colleagues reported online in the American Journal of Obstetrics & Gynecology.

(Source: Medpage Today)

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Additional tests may not always be necessary for diagnosis

According to a study in the Aug. 8/22 issue of the Archives of Internal Medicine

  1. A physical exam and patient’s history are the two most important tools for diagnosis, being sufficient for a correct diagnosis in around 60 percent of the time
  2. Addition of routine tests results in 90 percent of correct diagnoses.
  3. Only in 10% we need special tests.

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  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

You can prevent sarcopenia lifelong

Loss of skeletal muscle mass and function with aging is called sarcopenia. It includes loss of muscle quantity and quality, loss of motor neurons that enable muscles to contract, loss of strength and especially muscle power, and a steep decline in muscle repair and recovery. In addition, there is a progressive increase in oxidative stress, chronic inflammation, and pain. Because muscles supply the immune system with the glutamine required to make immune cells, loss of muscle also causes a loss of immune function. By complex effects, including a decline of oxygen to the brain because of reduced muscle contraction, sarcopenia is also linked to death of brain cells and loss of cognition and memory with age. Frequently, being overweight masks the appearance of sarcopenia, and only adds to the problem. Since 1989, when it was first measured accurately, sarcopenia has grown to epidemic proportions in the US and Canada. In otherwise healthy people over 40, it can be as high as one in every four tested. Researchers on aging generally agree that it is a self–inflicted outcome that is almost 100 percent preventable.

The Right Protein: Here are the two simple steps to prevent sarcopenia lifelong: First, you have to have sufficient high–quality protein in your diet to maintain lean muscle. Because muscle protein synthesis becomes less efficient with age, only first–class protein will do it. Numerous studies, the latest just published in the American Journal of Clinical Nutrition in May 2011, show that whey protein is the best.

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  Twitter of the Day

@DrKKAggarwal: Dr KK’s Formula: One can not live more tan 3 minutes without oxygen, 3 days without water and 3 weeks without food.

@DeepakChopra: #CosmicConsciousness In being is all knowingness

 
    Dr KK Answers

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

Can a patient with respiratory infection fly?

  1. Active or contagious respiratory infections (eg, TB, Pneumonia) are a contraindication to air travel, until there is objective evidence of effective treatment (i.e., negative cultures) and the patient is clinically stable.
  2. A sore throat, upper respiratory infection, cold, can cause blockage of the Eustachian tube making it difficult to equilibrate the air pressure in the middle ear during descent. This can lead to a number of problems including pain, vertigo, and tympanic membrane rupture.
  3. Patients with sore throat who cannot avoid flying may benefit from an oral decongestant (pseudoephedrine) and a nasal spray containing a vasoconstrictor used 30 minutes before descent.
  4. Patients should avoid alcoholic beverages and drink plenty of fluids to ensure hydration and to keep secretions thin and easier to clear.

For comments and archives

 
    Spiritual Update

The science behind Anna movement based on Gandhigiri

Gandhigiri always works, whether it was Mahatma Gandhi, the movie "Lago Raho Munnabhai" or the Gandhian Anna. The Gandhian principles were so framed that they always united the common man. The four basic principles Gandhi taught were of Satya (truthfulness); Ahimsa (non violence); Sarvodaya (welfare…

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

The secret

A woman named Vicki once knew a young person at church named Susan. Susan always seemed effervescent and happy, although Vicki knew she had faced struggles in her life. Her long–awaited marriage had quickly ended in divorce. She had struggled to get a grip on her single life. She hadn’t chosen it, but she decided she would live it with utmost enjoyment and satisfaction. Susan was active in Sunday school, in the choir, as a leader of the junior high girls’ group, and in the church renewal movement. Vicki enjoyed knowing Susan. Susan’s whole face seemed to smile.

One day Vicki asked Susan, "How is it that you are always so happy, you have so much energy, and you never seem to get down?" With her eyes smiling, Susan said, "I know the Secret!" "What secret is that, what are you talking about?" Vicki asked. Susan replied, "I’ll tell you all about it, but you have to promise to share the Secret with others." Vicki agreed, "Okay, now what is it?"

The Secret is this:

"I have learned there is little I can do in my life that will make me truly happy. I must depend on God to make me happy and meet my needs. When a need arises in my life, I have to trust God to supply according to HIS riches. I have learned most of the time I don't need half of what I think I do. HE has never let me down."

Since I learned that Secret I am happy.

Vicki’s first thought was, that’s too simple! But upon reflecting over her own life she recalled how she thought a bigger house would make her happy–but it didn’t! She thought a better–paying job would make her happy –but it hadn’t. When did she realize her greatest happiness? Sitting on the floor with her grandchildren, playing games, eating pizza or reading a story, a simple gift from God. Susan knew the secret, Vicki learned the secret, and now you know it too!

We can’t depend on people to make us happy. Only GOD in His wisdom can do that. Trust HIM!

And now the Secret is passed on to you!

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    Gastro Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

Can weight loss surgery be recommended in adolescents with morbid obesity?

Adjustable gastric banding (AGB) is one of two established surgical interventions to address severe obesity in adolescents. A randomized trial of 50 adolescents compared AGB with a supervised lifestyle intervention. During the 2–year follow–up period, the patients in the AGB group lost an average of 34.6 kg, as compared with 3.0 kg in the lifestyle group. Of note, almost 30% of the patients undergoing AGB required revisional procedures.

(Ref: O’Brien, PE, Sawyer, SM, Laurie, C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 2010; 303:519).

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Chloride

Increased: Diarrhea, renal tubular acidosis, mineralocorticoid deficiency, hyperalimentation, medications (acetazolamide, ammonium chloride).

Decreased: Mineralocorticoid excess, vomiting, diabetes mellitus with ketoacidosis

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    IJCP Special

Dr Good Dr Bad

Situation: An obese patient came with BMI of more than 40.
Dr Bad: Go for surgery.
Dr Good: First try diet, exercise and drug therapy.
Lesson: Obesity surgery is indicated in patient with BMI more than 40 who have failed diet and exercise with or without drugs.

For comments and archives

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

For comments and archives

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  Quote of the Day

(Dr Chandresh Jardosh)

The sea is common for all, but some people take pearls, some take fish and some come out with just wet legs! World is common for all. but we get what we try for.

 
  IDIOMS

(Ms Ritu Sinha)

Elvis has left the building: The show has come to an end. It’s all over.

 
  G P Pearls

(Dr Pawan Gupta)

Salmeterol usage increases exacerbations and death rates.

For comments and archives

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

If needed the doctor must perform CPR even in patients with injury chest

  • When a person is in need of CPR, it means that the person is in cardiac arrest i.e. they are unconscious, not moving, not breathing normally.
  • If the person is awake, is breathing normally and therefore does not appear to need CPR, chest compressions and CPR may further damage the already damaged chest and complicate the victim’s injuries. As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR should be initiated regardless of the injuries of the patient.
  • If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
  • This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. These injuries must be recorded in clinical sheet.
  • This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.

For comments and archives

 
  Rabies Update

(Dr.A.K.Gupta, Author of "RABIES – the worst death")

Can we apply local antibiotics or antimicrobial agents on the site of bite?

After cleansing of the bite wounds, local antimicrobial agents can be applied.

What is a street virus?

Street virus is a type of rabies virus which is virulent, having a long and variable incubation period of about 3 weeks to 3 months.

For comments and archives

 
    Mind Teaser

Read this…………………

Which of the following catheter materials is most suited for long-term use is?

1. Latex
2.Silicone
3. Rubber
4. Polyurethane

Yesterday’s Mind Teaser: What is VLP?

a. Very large particle
b. Very long peptide
c. Virus–like particle
d. Virus–like protein

Answer for Yesterday’s Mind Teaser: c. Virus–like particle

Correct answers received from: Dr Neelam Ohri, Dr Deepali chatterjee, Dr K Raju, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Neelam Nath, Dr Anil Bairaria.

Answer for 18th August Mind Teaser: 2. Primary repair
Correct answers received from: Dr K V Sarma, Dr Anupam, Dr Sheetal, Dr Prachi, Dr Somil, Dr Piyush.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr Chandresh Jardosh)

A sign in a dentist waiting room:

"God gives us a set of teeth twice…,

The third has to be paid for…";–)

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name

Indication

DCI Approval Date

Diclofenac Cholestyramine 145.6 mg corresponding to 75mg Diclofenac Sodium Capsules.

For the treatment of acute arthritis (including attacks of gout), chronic arthritis especially rheumatoid arthritis (chronic polyarthritis), ankylosing spondylitis (Morbus Bechterew) and other inflammatory, rheumatoid syndromes of vertebral column.

19.05.11

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Breaking the fast should be slow

Anna is on fast as are many others all over India. Not only fasting but even re–feeding can be dangerous after a fast.

Once acetone appears in the urine, the fast must be broken slowly else one can end up with re–feeding syndrome which can even be fatal said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Facts about hunger strike of Satygraha

  1. Most hunger strikers do not wish to die as per the medical literature.
  2. Many doctors who graduated before 1990 may not be aware about the guidelines as regards hunger strikers. The first declaration of World Medical Assembly was adopted in 1991, revised in 1992 and then again revised in 2006. It is called the ‘WMA Declaration of Malta on Hunger Strikers’. It describes the duties of a doctor and guidelines for the management of hunger strikers. As per the WMA Declaration, all physicians are bound by Medical Ethics even when not providing therapy. They must try to prevent coercion or maltreatment of detainees and must protest if it occurs. It is the duty of the physicians to take the hunger striker in confidence in isolation and find out his or her intention before and during the fast.
  3. The Rough formula of 3 is that one cannot live for three minutes without air, three days without water and three weeks without food. But this formula is for healthy muscular and fatty people. When you fast you can stay healthy for long if you have good muscles and have good fat content.
  4. There are three phases of fast: The 1st phase is conversion of stored glycogen into energy and lasts a few days. The 2nd phase is burning of fat into energy. Acetone appears in the urine in this phase, which lasts as long as body fat is up to 10% in females and 7% in males. At this time there will be a strong urge to eat. If one does not eat at this time, the 3rd phase will start, when proteins start breaking down leading to starvation effects which can be fatal due the kidney failure and heart irregularity.
  5. The basic aim of breaking any fast is to prevent occurrence of re-feeding syndrome, a metabolic complication that occurs when nutritional support is given to severely malnourished patients or to someone recovering from prolonged fast or hunger strike. Any individual who has had negligible nutrient intake for 5 consecutive days is at risk. It occurs within four days of starting to feed. Patients who weigh less than 70 percent of ideal body weight or lose weight rapidly are at greatest risk for the syndrome.

During prolonged fasting the body conserves muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source. The liver decreases its rate of gluconeogenesis thus conserving muscle and protein. Many intracellular minerals become severely depleted during this period, although serum levels may remain normal. Insulin secretion is suppressed and glucagon secretion is increased.

During re-feeding, the metabolism shifts from a catabolic to an anabolic state. Insulin is released on carbohydrate intake resulting in increased glycogen, fat and protein synthesis. Insulin release triggers cellular uptake of potassium, phosphate, and magnesium which are already depleted and the stores rapidly become used up.

When the serum concentrations of these electrolytes are reduced, serious complications, such as irregular heart beat can occur. Patients can also develop fluid and electrolyte imbalance, low phosphate levels, neurologic, lung, heart, neuromuscular, and blood related complications. Irregular heart rhythm is the most common cause of death with other significant risks including confusion, coma and convulsions and cardiac failure.

The diagnostic feature is presence of low phosphate, potassium, magnesium, vitamin B1 levels and fluid overload with edema feet. Low phosphate levels are the essential criteria for diagnosis.

If the refeeding syndrome occurs, doctors should immediately slow nutritional replenishment and correct low levels of phosphates, potassium and magnesium while monitoring the cardiovascular system. In patients at risk of re–feeding syndrome, nutritional support is initially delivered at a maximum of 10 kcal/kg/day and raised gradually to full needs within a week. In extreme cases this energy intake is limited to 5 kcal/kg/day.

Before and during the first 10 days of feeding, it is important to give 200-300 mg oral thiamine a day, 1–2 vitamin B complex tablets three times a day or intravenous vitamin B, and a balanced multivitamin and mineral supplement each day.

One should monitor and supplement oral, enteral, or intravenous potassium, phosphate and magnesium in such patients. On average, patients should receive 2–4 mmol/kg/day potassium, 0.3–0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium.

Moderately to severely ill patients with marked edema or a serum phosphorous <2 mg/dL should be hospitalized to intravenously correct electrolyte deficiencies.

Sugarcane juice is the best juice to break the fast. Unrefined sugarcane contains many minerals and nutrients including phosphorus, calcium, iron, magnesium and potassium. Pure sugar cane has 11 calories per teaspoon.

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    Readers Response
  1. Dear Sir, Formula of three for hunger strike and Satyagraha is really very informative. Regards Dr Prachi
 
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.

...more

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