eMedinewS20th August 2014, Wednesday

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

Is Caffeine Good For The Health?

  1. Caffeine is the most consumed stimulant in the world,
  2. It is consumed in the form of coffee and tea.
  3. At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  4. Short term benefits include mental alertness and improved athletic performance.
  5. Short term adverse effects including headache, anxiety, tremors, and insomnia.
  6. Long term adverse affects include generalized anxiety disorder and substance abuse disorders.
  7. Long–term benefits are dose–dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout. Both caffeinated and decaffeinated coffee are also associated with a lower risk of type 2 diabetes.
  8. Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long–term risk factor for myocardial disease.
  9. Most studies show a modest inverse relationship between coffee consumption and all–cause mortality.
  10. Caffeine withdrawal is a well–documented clinical syndrome with headache being the most common symptom. (Source uptodate)

News Around The Globe

  • The Dyspnea Index (DI) reliably determines quality of life in adolescents with exercise–induced paradoxical vocal fold motion (PVFM), suggests a new study published online in JAMA Otolaryngology – Head & Neck Surgery.
  • A large population–based study has shown that a significant proportion of older people in the United States continue to undergo cancer screening, even though they are unlikely to benefit from it. The study results are published online August 18 in JAMA Internal Medicine.
  • An Indian research has revealed that intralesional Mycobacterium w vaccine may be as effective as imiquimod cream for treating anogenital warts. About 59% patients in the imiquimod group showed complete clearance of their lesions, compared with 67% in the Mw group, the researchers reported in JAMA Dermatology.
  • Individuals with the highest vs. the lowest levels of interleukin–6 (IL–6) in childhood have a two-fold increased risk for depression and psychotic experiences in adolescence, reported a study published online in JAMA Psychiatry.
  • A study conducted in older adults over a two–year period revealed that religious participation was correlated with better mood. Researchers noted that older adults who often attended religious services were less likely to report symptoms of depression. Additionally, those with signs of depression at the start of the study were less likely to be depressed if they engaged in frequent private prayer. The findings were published in the Gerontologist.

Rabies News (Dr A K Gupta)

  • Study of passive immunity in the prevention of rabies discusses the advances in passive immunoprophylaxis, most notably the shift from the recommended polyclonal human or equine immunoglobulin to monoclonal antibody therapies. The first rabies–specific monoclonal antibodies are undergoing clinical trials, so passive immunization might finally become an accessible, affordable, and routinely used part of global health practices for rabies.
  • A report on use of a reduced (4–dose) vaccine schedule for post exposure prophylaxis to prevent human rabies summarized new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for post exposure prophylaxis (PEP) to prevent human rabies.
  • Human rabies can be very effectively prevented, and animal control is an important component in reducing the public health risk to humans. Dog rabies can be eliminated by well established control methods and routine dog rabies vaccination programs.

Cardiology eMedinewS

  • A meta–analysis of 11 trials has suggested that while deciding on an initial treatment strategy for hypertension, the focus should be the patient’s total CVD risk, rather than the blood pressure (BP) levels alone. The study was published in the August 16 issue of the Lancet.
  • A new analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial recently revealed that the lipid–lowering therapy works just as well in women as in men. Data suggested that fenofibrate was effective and safe in women and, in particular, in women with dyslipidemia (high triglycerides, low HDL cholesterol). The findings have been published online August 18 in Diabetologia.

Pediatrics eMedinewS

  • The use of growth hormone for the treatment of short stature or growth hormone deficiency in childhood could possibly increase the long–term the risk for stroke in young adulthood, hemorrhagic strokes in particular, suggests a study published online in Neurology.
  • A new editorial in the August issue of Childhood Obesity recommends that pediatricians must act earlier and more aggressively to address weight problems in their patients, otherwise more young people will join the ranks of the severely obese.

Dr K K Spiritual Blog

Relieve Stress by Changing the Interpretation

Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body the yogic way in such a way that stress does not affect the body.

Every situation has two sides. Change of interpretation means looking at the other side of the situation. It is something like half glass of water, which can be interpreted as half empty or half full.

Studies have shown that anger, hostility and aggression are the new risk factors for heart disease. It has been shown that even recall of anger can precipitate a heart attack.

Many studies have shown that in front of unconscious patients in ICU when doctors talk positive their outcome is better than those in whose presence if doctors talk negative.

The best way to practice spiritual medicine is to experience silence in the thoughts, speech and action. Simply walking in the nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. He said that 20 minutes of meditation provides the same physiological parameters as that of seven hours of deep sleep.

Wellness Blog

First Aid in Burns

  1. Patients with severe thermal burns are at significant risk of death and major morbidity.
  2. Look for evidence of respiratory distress and smoke inhalation injury, a common cause of death in the acute burn victim.
  3. Laryngeal edema can develop suddenly and unexpectedly.
  4. Burn depth and size determine fluid resuscitation and the need for transfer.
  5. Vascular collapse from burn shock is a critical component.
  6. Rapid, aggressive fluid resuscitation to reconstitute intravascular volume and maintain end–organ perfusion is crucial.
  7. The fluid requirement during the initial 24 hours of treatment is 4 mL/kg of body weight for each percent of TBSA burned, given IV. Superficial burns are excluded from this calculation. One–half of the calculated fluid need is given in the first eight hours, and the remaining half is given over the subsequent 16 hours.
  8. Monitor urine output is important
  9. Hourly urine output should be maintained at 0.5 mL/kg in adults.
  10. Carbon monoxide and cyanide – Burn patients may be exposed to carbon monoxide, requiring immediate treatment with high–flow oxygen.
  11. Cool and clean wounds, but avoid inducing hypothermia.
  12. Remove any jewelry and any hot or burned clothing and obvious debris not densely adherent to the skin.
  13. Irrigation with cool water may be used.
  14. Topical antibiotics are applied to all non superficial burns.
  15. Give opioids (morphine) to treat pain and give tetanus prophylaxis.

Inspirational Story

The Rebellion against the Stomach

Once a man had a dream in which his hands and feet and mouth and brain all began to rebel against his stomach.

"You good–for–nothing sluggard!" the hands said. "We work all day long, sawing and hammering and lifting and carrying. By evening we’re covered with blisters and scratches, and our joints ache, and we’re covered with dirt. And meanwhile you just sit there, hogging all the food."

"We agree!" cried the feet. "Think how sore we get, walking back and forth all day long. And you just stuff yourself full, you greedy pig, so that you’re that much heavier to carry about."

"That’s right!" whined the mouth. "Where do you think all that food you love comes form? I’m the one who has to chew it all up, and as soon as I’m finished you suck it all down for yourself. Do you call that fair?"

"And what about me?" called the brain. "Do you think it’s easy being up here, having to think about where your next meal is going to come from? And yet I get nothing at all for my pains." And one by one the parts of the body joined the complaint against the stomach, which didn’t say anything at all.

"I have an idea," the brain finally announced. "Let’s all rebel against the lazy belly, and stop working for it." "Superb idea!" all the other members and organs agreed. "We’ll teach you how important we are, you pig. Then maybe you'll do a little work of your own."

So they all stopped working. The hands refused to do lifting and carrying. The feet refused to walk. The mouth promised not to chew or swallow a single bite. And the brain swore it wouldn’t come up with any more bright ideas. At first the stomach growled a bit, as it always did when it was hungry. But after a while it was quiet.

Then, to the dreaming man’s surprise, he found he could not walk. He could not grasp anything in his hand. He could not even open his mouth. And he suddenly began to feel rather ill. The dream seemed to go on for several days. As each day passed, the man felt worse and worse. "This rebellion had better not last much longer," he thought to himself, "or I’ll starve."

Meanwhile, the hands and feet and mouth and brain just lay there, getting weaker and weaker. At first they roused themselves just enough to taunt the stomach every once in a while, but before long they didn't even have the energy for that.

Finally the man heard a faint voice coming from the direction of his feet. "It could be that we were wrong," they were saying. "We suppose the stomach might have been working in own way all along." "I was just thinking the same thing," murmured the brain. "It’s true that he's been getting all the food. But it seems he's been sending most of it right back to us."

"We might as well admit our error," the mouth said. "The stomach has just as much work to do as the hands and feet and brain and teeth." "Then let’s get back to work," they cried together. And at that the man woke up.

To his relief, he discovered his feet could walk again. His hands could grasp, his mouth could chew, and his brain could now think clearly. He began to feel much better.

"Well, there’s a lesson for me," he thought as he filled his stomach at breakfast. "Either we all work together, or nothing works at all."

ePress Release

Practice monogamy to prolong life

Extramarital affairs are not safe for heart patients as they are usually done with much younger partner at unusual time, circumstances, situation, and place, 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.

Extramarital affairs can put strain on the heart, increase pulse rate and cause heart attack. They also involve indiscriminate use of Viagra–like drugs, which may be harmful to the heart if underlying serious blockages are present and the person is not accustomed with normal sexual life. Dr. Aggarwal said that there is a rule of thumb: If a person can walk 2 kms or climb 2 flights of stairs without symptoms, then he or she is cardiac safe to enter into marital relationship.

eMedi Quiz

For the calculation of positive predictive value of a screening test, the denominator is comprised of:

1. True positives + False negatives.
2. False positives + True negatives.
3. True positives + False positives.
4. True positives + True negatives.

Yesterday’s Mind Teaser: Chi–square test is used to measure the degree of:

1. Causal relationship between exposure and effect.
2. Association between two variables.
3. Correlation between two variables.
4. Agreement between two observations.

Answer for yesterday’s Mind Teaser: 4. Agreement between two observations.

Correct answers received from: Smriti Aggarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan.

Answer for 19th August Mind Teaser: 2. Stroke

Correct answers received from: Kala Sarma, Dr R S Gulati, Dr Prakash Khalap.

Send your answer to ijcp12@gmail.com

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Make Sure

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to evaluate the patient thoroughly and only moderately tap the ascitic fluid since overenthusiastic tapping can be life–threatening.

eMedinewS Humor

The Absent–Minded Professor

An absent-minded professor was moving to a new house further along the same street. His wife knew that he was prone to forgetting things and so she wrote down the new address on a piece of paper he went off to college. She handed him the paper and the key to the new house and reminded him not to go back the old address.

That morning, one of his student asked him a complex question and the professor wrote the answer down on the back of the slip of paper. This student asked whether he could keep the paper.

Forgetting what was on the other side, the professor said, "Certainly."

In the evening, he returned out of habit to the old house, tried the key and could not get in. Realizing his mistake, he search in his pockets for the slip of paper with the new address, but off course there was no sign of it. So he wandered along the street and the stop the first personable–looking lad whom he saw.

"Excuse me, I’m professor Galbraith. You would not happen to know where I live, would you?"

Quote of the Day

You’ve got to get up every morning with determination if you’re going to go to bed with satisfaction. George Lorimer

Twitter of the Day

Dr KK Aggarwal: Birth defects linked to mother’s use of cold medicines. http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: True abundance is the experience in which all our needs are easily met & our desires spontaneously fulfilled http://bit.ly/DC_Ananda

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