eMedinewS20th September 2014, Saturday

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 & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06); President IMA New Delhi Branch (94–95, 02–04).
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Gut microbes linked to diabetes: Artificial sweeteners update

The artificial sweeteners aspartame, sucralose, and saccharin cause blood glucose abnormalities in mice and some humans, as per an article published online September 17 in Nature.

The changes in glucose tolerance seem to be driven by the microbiome and can be reproduced in germ-free mice by giving them gut microbes from a person who has consumed the sweeteners, said Eran Elinav, MD, PhD, from the Department of Immunology at the Weizmann Institute of Science, Rehovot, Israel.

The investigators began with experiments in mice, giving each animal 1 of 3 artificial sweeteners in its water: aspartame, sucralose, or saccharin. Because commercial preparations of these sweeteners also contain some glucose, researchers used glucose, fructose, or plain water for the control mice to ensure it was the artificial sweetener and not any added sugar that was responsible for the effect. "To our surprise, we found they all induced a blood sugar disturbance even compared to mice who drank sugary water," Dr. Elinav said. This effect occurred on both a normal diet of rat chow (P < 0.001) and a high–fat diet in which 60% of calories came from fat (P < 0.03).

Because these artificial sweeteners are not digested or absorbed by the human body, gut microbes were responsible for the results. They administered antibiotics to the mice: one group received ciprofloxacin and metronidazole, a broad–spectrum approach focusing on gram-negative bacteria, and another group received vancomycin, aimed against gram–positive bacteria. Both treatments, when given for 4 weeks, eliminated the differences in glucose tolerance between sweetener–fed mice and controls.

The symptoms could also be triggered by a microbial transplant. Microbes from mice who had been drinking saccharin were transplanted via feces into germ-free mice and caused the recipients to show impaired glucose tolerance, whereas microbes from mice who had been drinking glucose did not (P < 0.03). The researchers also cultured bacteria from mice who were not eating sweeteners and added saccharin to the growth media. These bacteria were then transplanted into germ–free mice, resulting in impaired glucose tolerance compared with mice that received a control culture (P < .002). (Medscape Daily)

News Around The Globe

21st MTNL Perfect Health Mela Programme Brouchure

GAPIO Awards

  1. GAPIO Life Time Achievement Award
    1. Dr. Sandip Mukerjee– Dr. B.C. Roy National Award winner, Honorary Surgeon to the President of India since 1973 to 2002 from H.E. Shri Fakruddin Ali Ahmed to H.E. Shri K.R. Narayan and Eminent Teacher.
    2. Dr. Sudhir Parikh – Padma Shri Awardee 2010, Ellis Island Medal of Honor the highest civilian honor for U.S. immigrants, Pravasi Bharatiya Samman 2006.
  2. GAPIO Emerging Young Leaders Award
    1. Dr. Govindaiah Yatheesh from Bangalore, Karnataka
  3. GAPIO Service Excellence Award
    1. Dr. Abhijat Sheth from Ahmedabad, Gujarat
    2. Dr. Arvind Gupta from Bilaspur, Chhattisgarh
    3. Dr. Balreddy from Hyderabad, Andhra Pradesh
    4. Dr. Biraj Mohan Mishra from Bhubaneswar, Orissa
    5. Dr. Dilip Gadhavi from Ahmedabad, Gujarat
    6. Dr. Jagadish Cacodcar from Goa
    7. Dr. Manisha Bobade from Pune, Maharashtra
    8. Dr. Naresh Anamalla from Karimnagar, Andhra Pradesh
    9. Dr. Harinder Sidhu and Marketing Team from Apollo Delhi
    10. Dr. Meenakshi from Aragonda, Chittoor, Andhra Pradesh
    11. Dr. Shylashree from Mysore
    12. Dr. D Sharma from Apollo Noida
    13. Dr. Bajrang Patel from Apollo Delhi
    14. Dr. A. K. Tandon from Apollo Delhi
  • Depression and illness: Chicken or egg? When depression strikes, doctors usually probe what’s going on in the mind and brain first. But it’s also important to check what’s going on in the body, since certain medical problems are linked to mood disturbances. In fact, medical illnesses — and medication side effects — may be behind nearly 10% to 15% of all cases of depression.
  • According to results of a retrospective study, the presence of five or more cerebral microbleeds was associated with an increased mortality risk from all–cause (HR 1.99, P=0.040) and ischemic stroke (HR 3.39, P=0.007) after adjusting for age, sex, and other significant risk factors for stroke death, wrote Tae–Jin Song, MD, of Yonsei University College of Medicine in Seoul, and colleagues.
  • An FDA advisory committee handed a potential setback to proponents of "low–T" treatment by overwhelmingly recommending a tightening of label indications for testosterone and renewed efforts to curb off–label use.
  • Eating a diet high in salt may increase the risk of rheumatoid arthritis among smokers, suggests a new study. Smokers were more than twice as likely as subjects with a low–salt diet to develop the condition. The study was published online in Rheumatology.
  • The US Food and Drug Administration (FDA) has approved dulaglutide, as a once–weekly injection for the treatment of type 2 diabetes. The approval was based on 6 clinical trials involving a total of 3342 patients who received the drug.

IMA NEWS

Self–regulatory code for doctors, hospitals soon

Rema Nagarajan, TNN. A new self regulatory code of conduct for doctors and hospitals, in the process of being formulated, could hold investors and members on the boards of medical establishments responsible for unethical practices in the establishment such as giving cuts to doctors and diagnostic facilities or taking bribes from pharmaceutical companies.

The Indian Medical Association (IMA) and the Association of Hospital Providers of India (AHPI) have constituted a joint committee to formulate the code.

The effort to draw up a code is the initiative of the newly-elected office bearers of the IMA, who will be taking over on December 28. With the health ministry looking into the issue of corruption in healthcare, the IMA and AHPI decided that before the government comes out with a law to regulate the health sector, they should come out with a code for their members to follow.

"Later, the government can adopt this code into the regulatory law it drafts and notify it," said Dr K K Aggarwal, who will be taking over as the general secretary of the IMA in December along with the new president Dr Marthanda Pillai.

"The Medical Council of India is in the process of amending its code of medical ethics. I am a member of the ethics committee. The IMA–AHPI five–member joint committee will be interpreting the MCI’s rules to make it clear for physicians and to document what is not unethical. When a doctor is in trouble he/she approaches the IMA for help, but if the doctor has violated the code, the IMA will not support the person. Often, the entire community of doctors is maligned because of a few black sheep. We will be defining what we mean by ‘black sheep’," explained Dr Aggarwal.

He added that the code would be applicable in 12,000 hospitals in the country, which are members of AHPI. Dr Aggarwal has been trying to get NATHEALTH, the association of mostly corporate hospitals including the Max, Apollo and Fortis groups, to join the effort.

"Currently, there is no code of conduct for hospitals as MCI does not cover hospitals directly, only indirectly through the doctors working there. So, if a corporate hospital forces a doctor to do some unethical work and the doctor does so because he/she has no option, what can be done? Who can the doctor complain to? IMA alone cannot do it as it only deals with doctors and so it has to rope in a body that controls hospitals. Just as the courts had held the directors of AMRI hospital (in Kolkata) responsible for the fire that had broken out, investors and directors of hospitals ought to be held responsible for unethical practices in the hospital," said Dr Aggarwal.

The joint committee is expected to finish drafting the code within the next two months. It will also deal with issues related to digital and tele healthcare, such as email or phone consultations, video conferencing, whether doctors having their own websites amount to advertising and so on.

Editor’s comments: Had a meeting with AHPI on this issue and this came out as a part of discussion. Later Dr N Saini the present Secretary General IMA also arranged a meeting of stake holders with AHPI and a joint committee was formed to proceed in the matter. During NAT-Health meeting also I suggested that the draft should be rectified by IMA, IMA Hospital Board of India, AHPI and NATHealth so that it’s a win–win situation for everyone. Once ready the draft should be on the websites of all stake holders to get responses by the members. Once cleared by the respective bodies, it may be ready for implementation…a process, which may take 3–6 months. The present IMA team may be able to expedite it to get it cleared from the central council meeting on December 27th this year.

Quote from NATHEALTH
NATHEALTH is a unique Healthcare Institution which has got large/medium/small hospitals & nursing homes, Technology Providers (both Device and Equipment companies), Diagnostic Services providers as well as companies from Health Insurance, Healthcare Publishers, Health IT, Healthcare Education and other segments on a single collaborative platform to help in improving quality and access in Healthcare. NATHEALTH strongly believes in and supports any positive activity for improving Ethics in Healthcare…NATHEALTH will be very happy to explore working with IMA on developing self–regulatory code of conduct…"

Anjan Bose,Secretary General,NATHEALTH (Healthcare Federation of India)

Rabies News (Dr A K Gupta)

What is "paralytic form" of rabies in animals?

Paralytic or dumb rabies refers to animals in which the behavioral changes are minimal or absent and the disease is manifested mainly by paralysis. This is first manifested by paralysis of the throat and masseter muscles, often with profuse salivation and inability to swallow. Dropping of lower jaw is common in dogs. The animals are not vicious and rarely attempt to bite. The paralysis progresses rapidly to all parts of the body leading to coma and death follows in a few hours.

Cardiology eMedinewS

  • Left ventricular ejection fraction (LVEF) increased and symptoms improved considerably in patients initially with atrial fibrillation (AF) and LVEF <35% with severe heart failure who underwent catheter ablation for their arrhythmia, reported a small single–center series with follow–ups averaging 27 months. The data were presented at the Heart Failure Society of America (HFSA) 18th Annual Scientific Meeting.
  • A real–world comparison of clopidogrel vs. prasugrel in about 12000 acute coronary syndrome (ACS) patients undergoing PCI revealed no significant differences in the rate of major adverse cardiovascular events (MACE) between the two antiplatelet agents, suggested a new study presented at the TCT 2014.

Pediatrics eMedinewS

  • Moderate to vigorous aerobic exercise in the morning could possibly reduce the symptoms of attention–deficit/hyperactivity disorder (ADHD) in young children at risk for the illness, suggests a new study published online in the Journal of Abnormal Child Psychology.
  • Newborns exposed to azithromycin in the first 6 weeks of life have a significantly increased risk of developing hypertrophic pyloric stenosis, suggests a new study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).

Dr K K Spiritual Blog

Lessons Learnt In Medical Practice

  • One day I asked one of my patients whether you smoke or not. He said, "Kabhi kabhi cigarette peeta hoon." I wrote on my file he smokes occasionally. His wife got upset and asked me to ask him, "What does he mean by ‘Kabhi kabhi peeta hoon’?" When asked he said that he does not smoke all the time "kabhi kabhi to ghante nikal jate hain aur me nahi pita" (Sometimes its hours that I do not smoke)
  • One day a patient came to me after three months and said, "Doc three months back I had fever and you had told me not to take any bath. All this while, I was busy and could not come to you. Can I take a bath now?"
  • Chod diya. A patient came with his wife and the wife asked me to ask the patient, "Cigarette Chod do". I also counseled and said, "Cigarette Chod do." A few weeks later, he said, "Chod diya." There are four meanings of Chod diya:
    • Biwi ko Chod diya
    • Doctor ko Chod diya
    • Dono ko Chod diya
    • Cigarette ko Chod diya
  • After an echo test, one of my patients asked a technician, "Can I eat?" and my technician told, "You can eat after one hour." A few minutes later, the patient came to me and asked me the same question without telling me that he had already asked my technician. I said, "You can eat." He said, "Your technician said after one hour." I was in an embarrassing position. I said to make it light, "He asked you not to eat for one hour and not for the patient."
  • One of my patients said that he never drinks more than three pegs. His wife said, "Don’t believe in him. After three pegs he does not remember how many pegs he drinks."
  • There are funny examples of cigarette smoking:
    • Smokers do not grow old (as they die in young age)
    • Smokers do not get a second heart attack (most die in the first attack)
    • Smoking cures cancer (most smoke–related lung cancers have only six months life)
    • Thieves do not come into the smoker’s house as he coughs throughout the night.
    • Smokers’ brothers do not fight for property (their property has already gone to hospitals for treatment of smoking–related disorders)
    • Smoker’s wife does not suspect him (smoking leads to impotence).

Wellness Blog

Can cardiac death occur after a blunt injury?

The postmortem report of Delhi police constable Subhash Tomar who died at RML Hospital in Delhi during the anti–rape protests in New Delhi in December 2012 reportedly stated that the cardiac arrest was precipitated by blunt injuries to his neck and chest.

Constable Tomar probably died of a heart attack. Whether or not he sustained some injuries from the protesting crowd, it cannot be denied that he was received in hospital in a state of cardiac arrest. He was revived for some time but ultimately succumbed to the consequences of cardiac arrest.

So can blunt injury precipitate sudden cardiac death? Commotio cordis is an event, which occurs as a result of a blunt, non–penetrating and often innocent–appearing blow to the chest wall directly over the heart. This induces instantaneous ventricular fibrillation leading to sudden cardiac arrest. The person collapses and stops breathing. It becomes crucial to act fast. Immediate cardiopulmonary resuscitation (CPR) and if available, use of automated external defibrillator (AED) will help revive the patient. If not, the outcomes are tragic with sudden cardiac death.

This incident is a reminder of the fact that all of us need to learn CPR and act in time. A successful resuscitation is only possible if it is done by bystanders within 10 minutes of death, earlier the better.

Remember the CPR mantra "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 victim effectively and continuously with a speed of 10x10 i.e. 100 per minute."

Inspirational Story

Brotherhood

Ram received an automobile from his brother as birthday present. One day when Ram came out of his office, he saw a street urchin walking around the shiny new car, admiring it.

"Is this your car?" He asked. Ram nodded, "My brother presented me on my birthday." The boy was astounded. "You mean your brother gave it to you and it didn’t cost you nothing? Boy, I wish…" He hesitated.

Of course Ram knew what he was going to wish for. He was going to wish he had a brother like his brother but what the lad said jarred Ram all the way down to his heels."I wish," the boy went on, "that I could be a brother like that." Ram looked at the boy in astonishment, and then impulsively he added, "Would you like to take a ride in my automobile?"

"Oh yes, I’d love that." After a short ride, the boy turned and with his eyes aglow, said, "Would you mind driving in front of my house?" Ram smiled a little. He thought he knew what the lad wanted. He wanted to show his neighbors that he could ride home in a big automobile. But Ram was wrong again.

"Will you stop where those two steps are?" The boy asked. He ran up the steps. Then in a little while Ram heard him coming back, but he was not coming fast. He was carrying his little crippled brother. He sat him down on the bottom step, then sort of squeezed up against him and pointed to the car.

"There he is, brother. Like I told you upstairs, his brother gave it to him and it didn’t cost him a penny. Some day I’m going to give you one just like it then you can see for yourself all the pretty things in the shop windows that I’ve been trying to tell you about."

Ram got out and lifted the crippled boy to the front seat of his car. The shining–eyed older brother climbed in beside him and the three of them began a memorable ride.

Self-Assessment-Quiz

 

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Zee News – Health Wealth Shows

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Total CPR since 1st November 2012 – 98440 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

CPR 10 Videos

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

Exciting events to pave way for the 21st MTNL Perfect Health Mela, a one of its kind initiative by the Heart Care Foundation of India

press release

Daily aspirin to prevent heart disease may increase risk of GI or cerebral bleeding

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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 :

 

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high?
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

eMedinewS Humor

Work Motivators

  • The beatings will continue until morale improves.
  • Never underestimate the power of very stupid people in large groups.
  • We waste time, so you don’t have to.
  • Hang in there, retirement is only 30 years away!
  • Go the extra mile. It makes your boss look like an incompetent slacker.
  • A snooze button is a poor substitute for no alarm clock at all.
  • When the going gets tough, the tough take a coffee break.
  • Indecision is the key to flexibility.
  • Succeed in spite of management.
  • Aim Low, Reach Your Goals, Avoid Disappointment.

Quote of the Day

Only those who dare to fail greatly can ever achieve greatly. Robert F. Kennedy

Twitter of the Day

Dr KK Aggarwal: Just as a wave is a movement of the whole ocean, you are the energy of the cosmos. Don't underestimate your power.
Dr Deepak Chopra: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://tinyurl.com/mwjtqc

   

ePress Release

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management together with empirical treatment is unsuccessful or those who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity. This was stated by 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

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight, and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food, which makes the food pipe valve lax. Examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

eMedi Quiz

The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Yesterday’s Mind Teaser: All of the following are features of hallucinations, except:

1. It is independent of the will of the observer.
2. Sensory organs are not involved.
3. It is as vivid as that in a true sense perception.
4. It occurs in the absence of perceptual stimulus.

Answer for yesterday’s Mind Teaser: absorption.

Correct answers received from: Tukaram Pagad, Daivadheenam Jella, Dr Avtar Krishan

Answer for 18th September Mind Teaser: 3.Low oral bioavailability always and necessarily means poor

Correct answers received from: Richa, Kanishk.

Send your answer to ijcp12@gmail.com

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  1. Dear Sir, Very informative news. Regards: Dr Shella

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