eMedinewS21st January 2014, Tuesday

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);
For updates follow at
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ASH/ISH Issue Separate Hypertension Guidelines From JNC 8, Hinting at Discord

Tuesday, on the eve of yesterday’s long–awaited release of guidelines from the JNC 8 panel in the Journal of the American Medical Association (JAMA), the American Society of Hypertension and the International Society of Hypertension released their own clinical practice guidelines.

While the focus of their document is on "managing hypertension in the community," the guidance nonetheless carries some echoes of the JNC 8 document, but several key differences as well.

Meanwhile, the ACC/AHA issued their "scientific advisory" on managing high BP last month, and the European Society of Hypertension released their own guidance earlier this year.

Similarities and Differences

Both the JNC–8 (JAMA) guidelines, as well as the ASH/ISH guidelines, provide a treatment algorithm table, but physicians examining these side by side will notice some confusing differences.

Recommendations on thresholds for initiating therapy in both documents advocate a somewhat "losser" approach in certain groups (including the <140/90–mm–Hg target in patients with diabetes or chronic kidney disease), but the guidelines diverge on other issues.

For one, the start–treatment threshold of >150/90 mm Hg applies to patients 80 years or older in the ASH/ISH guidelines, as opposed to 60 years or older in JNC 8. The ASH/ISH document also suggests different drugs from the JNC 8 recommendations for initial therapy, depending on the patients’ race, age, and blood–pressure level. While JNC 8 stated that an ACE inhibitor, angiotensin–receptor blocker (ARB), calcium channel blocker (CCB), or thiazide–type diuretic were all reasonable initial choices in nonblack patients, the ASH/ISH guidelines recommend an ACE inhibitor or ARB for nonblack patients under age 60 and a CCB or thiazide in nonblack patients over 60.

Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

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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Why do we put on Tilak on the forehead?

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The Tilak is a mark of auspiciousness and invokes a feeling of respect in the wearer and others. It is recognized as a religious mark. Its form and color vary according to one’s caste, religious sect or the form of worship of the person in question.

Tilak is applied on the forehead with sandal paste, sacred ash or kumkum, a red turmeric powder. In a wedding, a Kumkum tilak is applied on the forehead of both the bride and groom.

In earlier times, the four castes (based on varna or color) – Brahmana, Kshatriya, Vaishya and Sudra – applied marks differently. The Brahmin applied a white chandan mark signifying purity, as his profession was of a priestly or academic nature. The Kshatriya applied a red kumkum mark signifying valor as he belonged to the warrior race. The Vaishya wore a yellow kesar or turmeric mark signifying prosperity as he was a businessman or trader devoted to creation of wealth. The Sudra applied a black bhasma, kasturi or charcoal mark signifying service as he supported the work of the other three castes.

Also, Vishnu worshippers apply a chandan (sandalwood) tilak of the shape of "U", Shiva worshippers, a Tripundra (of the shape of "º") of bhasma; Devi worshippers a red dot of kumkum and so on. The tilak is applied in the spot between the eyebrows, which is the seat of memory and thought. It is known as the Aajna Chakra in the language of Yoga.

The Tilak is applied with the prayer – "May I remember the Lord. May this pious feeling pervade all my activities. May I be righteous in my deeds." Even when we temporarily forget this prayerful attitude, the mark on another reminds us of our resolve. The tilak is thus a blessing of the Lord and a protection against wrong tendencies and forces.

The entire body emanates energy in the form of electromagnetic waves – the forehead and the spot between the eyebrows especially so. That is why worry generates heat and causes a headache. The tilak cools the forehead, protects the wearer and prevents energy loss. Sometimes the entire forehead is covered with chandan or bhasma.

Using plastic reusable "stick bindis" is not very beneficial, even though it serves the purpose of decoration.

The devotees of Siva apply sacred ashes (Bhasma) on the forehead
The devotees of Vishnu apply sandal paste (Chandan)
The worshippers of Devi or Shakti apply Kumkum.

The scriptures say:

"A forehead without a Tilak, a woman without a husband, a Mantra the meaning of which is not known while doing Japa (recitation), the head that does not bend before holy personages, a heart without mercy, a body devoid of health, a custom without purity,… – all these are worthy of condemnation. They exist for name’s sake only."

cardiology news

The last cab ride

A true story by Kent Nerburn

Twenty years ago, I drove a cab for a living. One time I arrived in the middle of the night for a pick up at a building that was dark except for a single light in a ground floor window.

Under these circumstances, many drivers would just honk once or twice, wait a minute, and then drive away. But I had seen too many impoverished people who depended on taxis as their only means of transportation. Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself. So I walked to the door and knocked. "Just a minute," answered a frail, elderly voice.

I could hear something being dragged across the floor. After a long pause, the door opened. A small woman in her 80s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase.

The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

"Would you carry my bag out to the car?" she said. I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness. "It’s nothing," I told her. "I just try to treat my passengers the way I would want my mother treated." "Oh, you’re such a good boy," she said. When we got in the cab, she gave me an address, then asked, "Could you drive through downtown?"

"It’s not the shortest way," I answered quickly. "Oh, I don’t mind," she said. "I’m in no hurry. I’m on my way to a hospice." I looked in the rear view mirror. Her eyes were glistening. "I don’t have any family left," she continued. "The doctor says I don’t have very long." I quietly reached over and shut off the meter. "What route would you like me to take?" I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing. As the first hint of sun was creasing the horizon, she suddenly said, "I’m tired. Let’s go now." We drove in silence to the address she had given me.

It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

"How much do I owe you?" she asked, reaching into her purse. "Nothing," I said. "You have to make a living," she answered. "There are other passengers." Almost without thinking, I bent and gave her a hug. She held onto me tightly. "You gave an old woman a little moment of joy," she said. "Thank you." I squeezed her hand, then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn’t pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away? On a quick review, I don’t think that I have done anything more important in my life. We’re conditioned to think that our lives revolve around great moments. But great moments often catch us unaware—beautifully wrapped in what others may consider a small one.

News Around The Globe

News

  • Chronic damage in the small intestine is a risk factor for hip fracture in patients with celiac disease (CD), according to a cohort study published online January 16 in the Journal of Clinical Endocrinology & Metabolism.
  • Neoadjuvant chemoradiation with an oral agent worked just as well as infusional therapy for patients with stage II and III rectal cancer, as per results of a randomized trial reported at the Gastrointestinal Cancers Symposium.
  • Extensively drug–resistant tuberculosis (XDR–TB) appears to be spreading in South Africa, fueled by patients who are discharged despite failing therapy. In a prospective cohort of patients with XDR–TB in The Lancet, about 40% were eventually discharged into the community and of those, almost half had failed treatment and remained alive and contagious for a median of 19.8 months.
  • More than 90% of patients with neuroendocrine tumors had objective responses or stable disease when treated with an off–the–shelf chemotherapy doublet. In a study presented at the Gastrointestinal Cancers Symposium (GiCS), the combination of capecitabine (Xeloda) and temozolomide (Temodar) led to a median progression–free survival of almost 2 years among 28 patients, including more than 40 months in the subgroup of patients with pituitary tumors.
  • Women with early–stage invasive breast cancer who undergo breast–conserving therapy (BCT) have a higher rate of disease–specific survival than those who undergo mastectomy, according to an analysis published online January 15 in JAMA Surgery.

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)

Can a rabies patient make a valid will?

A rabies patient can make a valid will.

According to Section 59 in the Indian Succession Act, 1925

Person capable of making will:–

  1. Every person of sound mind not being a minor may dispose of his property by will.
  2. A married woman may dispose by will of any property which she could alienate by her own act during her life.
  3. Persons who are deaf or dumb or blind are not thereby incapacitated for making a will if they are able to know what they do by it.
  4. A person who is ordinarily insane may make a will during interval in which he is of sound mind.
  5. No person can make a will while he is in such a state of mind, whether arising from intoxication or from illness or from any other cause that he does not know what he is doing.
cardiology news

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

  • Dr Yoshihiro Kokubo of National Cerebral and Cardiovascular Center, Osaka, Japan suggests in a review article that lifestyle modifications are the cornerstone of hypertension prevention, but not all changes work for all populations. Physicians should note that because of differences in genes, diet, and lifestyle, the contributions of blood pressure to stroke are different for Westerners and East Asians. The article is published online January 13, 2014 in Hypertension.
cardiology news

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

  • A prospective study of 6090 children from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) in the January issue of the British Journal of Psychiatry showed that less than adequate maternal weight gain during pregnancy and being born first were significantly associated with Tourette syndrome in the offspring by the age of 13 or 14 years.
  • In a new meta–analysis of studies published online January 14 in BMJ, maternal antidepressant use has been linked to a low but statistically significant increased risk for persistent pulmonary hypertension (PPH) in newborns exposed to the drugs in late pregnancy.
cardiology news

Walnuts Good for Semen

The daily addition of 75 g of whole–shelled walnuts to a typical Western–style diet appears to have positive effects on the vitality, morphology and motility of sperm in healthy men, according to the findings of a randomized, parallel, 2–group, dietary intervention trial by Wendie A. Robbins, PhD, from the University of California, Los Angeles. The study is published in August 15 in Biology of Reproduction.

cardiology news

Total CPR since 1st November 2012 – 84500 trained

Media advocacy through Web Media

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Drinking Coffee Prevents Parkinson’s disease

Nicotine present in the tobacco has been used for its medicinal value for quite sometime for diseases like Parkinson’s disease and ulcerative colitis. A study from University of Miami School of Medicine, USA, now has shown that people from families prone to Parkinson’s disease are less likely to develop the disease if they drink coffee on a regular basis.

Padamshri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Sr National Vice President IMA, commenting on the study said that both coffee and nicotine have a link with dopamine in the brain. Dopamine is a chemical that decreases in patients with Parkinson’s disease.

It is possible that people who are going to have Parkinson’s disease have lower levels of dopamine. Those with low levels of dopamine may be more likely to enjoy caffeine.

Parkinson’s disease is caused when brain cells that produce dopamine die. The disease is progressive, affecting about one percent of people older than 65.

Symptoms start out with shaking and can progress to paralysis. There is no cure, although a number of drugs can make symptoms better for a time.

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 84500 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 cum Health Check up Camp at Punjab Kesari Varisht Nagrik 16th December 2013

press release

Weight loss may improve sexual health of obese diabetes

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

Which of the heart valve is most likely to be involved by infective endocarditis following a septic abortion?

1. Aortic valve.
2. Tricuspid valve.
3. Pulmonary valve.
4. Mitral valve.

Yesterday’s Mind Teaser: A 2–month–old baby with acute icteric viral hepatitis like illness slips into encephalopathy after 48 hours. The mother is a known hepatitis B carrier. Mother’s hepatitis B virus serological profile is most likely to be:

1. HBsAg positive only.
2. HbsAg and HBeAg positive.
3. HBsAg and HBe antibody positive.
4. HBV DNA positive.

Answer for yesterday’s Mind Teaser: 2. HbsAg and HBeAg positive.

Correct answers received from: Raghavendra Singh, Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay, Tukaram Pagad, Dr Chandresh Jardosh, Lalithdevraj.

Answer for 19th January Mind Teaser: 4. Howell–Jolly bodies.

Correct answers received from: Anil Laddha, Dr Chandresh  Jardosh, Sangeetha Raja,
Dr B K Agarwal, Lalithdevraj, Dr K Raju.

Send your answer to ijcp12@gmail.com

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medicolegal update

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That’s What we Practice (Joke)

A dad walks into a market with his young son. The kid is holding a Ruppe coin.

Suddenly, the boy starts choking and gasping for breath.

The dad realizes the boy has swallowed the coin and starts panicking, shouting for help.

A well dressed, attractive, but serious looking woman in a blue business suit is sitting at a Tea stall in the market reading her newspaper and sipping a cup of Tea.

At the sound of the commotion, she looks up, puts her Tea cup down on the saucer, neatly folds the newspaper, places it on the counter, gets up from her seat and makes her way, unhurried, across the market.

Reaching the boy, the woman carefully takes hold of the boy's balls and starts to squeeze, gently at first and then ever more firmly. After a few seconds the boy convulses violently and coughs up the coin, which the woman deftly catches in her free hand. Releasing the boy, she hands the coin to the father and walks back to her seat in the Tea stall without saying a word.

As soon as he is sure that his son has suffered no lasting ill effects, the father rushes over to the woman and starts thanking her saying, "I’ve never seen anybody do anything like that before, it was fantastic. Are you a doctor?"

"No," the woman replied, "I work for the Income Tax Dept."

medicolegal update

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medicolegal update

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

medicolegal update

One resolution I have made, and try always to keep, is this: To rise above the little things. John Burroughs

medicolegal update

Dr KK Aggarwal: Stress may increase smoking habits http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: What keeps life fascinating is the constant creativity of the soul.

medicolegal update
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