eMedinewS
21st February 2014,Friday

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
www.twitter.com/DrKKAggarwal
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Clinicians Should Aggressively Treat Unhealthy Lifestyles

Health care providers should treat unhealthy behaviors as aggressively as they treat hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create "interprofessional practices" to connect patients with behavior-change specialists.

They must implement five As when caring for patients

  1. Assess a patient’s risk behaviors for heart disease
  2. Advise change, such as weight loss or exercise
  3. Agree on an action plan
  4. Assist with treatment
  5. Arrange for follow–up care.
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."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Why should we eat seasonal fruits and vegetables?

sprritual blog

God will grow only those fruits and vegetables, which are necessary in that season in that particular location. For example, during summer, the body requires more liquids and regular flushing of the kidney because of extreme heat so that dehydration does not damage kidney. To prevent this, nature produces vegetables and fruits in this season that are juicier and increase urination.

All summer fruits like mango, lichi, watermelon, musk melon, wood apple (bel), etc. are juicy fruits. All vegetables grown in summer such as bottle gourd (ghiya), snake gourd (torai), apple gourd (tinda) grow on creepers and they all have a mild diuretic action.

In summer, where the humidity is not so high like in Delhi, one need not take coconut water, which is only required as a treatment of humidity–related diseases. Therefore, nature grows coconuts only in the coastal areas.

cardiology news

An Inspirational Story about Faith

In the abyss between life and death resides only faith. Experts call this abyss "Motherhood."

Lying on a cold, hard bed only six months along with my first child, I faced the frightening implications of this truth. My body shook uncontrollably as abject terror clutched at me. My only lifeline was my husband’s hand clutching mine over the abyss as love for life – mine and the tiny, still–unseen child’s – burned deep in our hearts. One after another after another the nurses piled the bloody sheets into the corner until the doctor pronounced those fateful words, "The baby's coming."

Only then, with control slipping past me into a haze of drugs and fear, did I make that one, final leap – the leap from control to faith – the leap from childlessness into motherhood. My next recollection was my husband’s hand once again holding mine as he said the words that officially changed my life, "We have a little girl."

The images of the next two months blurred together as ups and downs alternated at break-neck speed. One minute spent holding my two-pound and yet weightless daughter in my arms versus the next three weeks spent holding only tiny fingers through the isolate window–waiting for the next opportunity to take my baby out of the incubator again.

The drugs, powerful enough to keep her safe from infection, again and again blew through her small veins while all I could do was watch, pray, and hang onto the faith that somehow we would get through this. If we could just make it to the next horizon, through the next transfusion and the next round of drugs, then I could live again. Until then survival was my only goal.

In the darkness of a soul in crisis, my prayers became much deeper. No longer were they for selfish requests. Now they were centered wholly on the tiny baby God had entrusted to my care. The Lord has said, "Cast your burden upon the Lord, and He shall sustain you" (Psalms 55:22), and during those long days, that was what kept me going.

As good as that sounds, however, reality was that my only real positives at the time were formed by the negatives. "It’s not pneumonia." "It’s not an infection." "We won’t have to put the IV in her head–this time." The struggle to live was being waged not only by the tiny baby lying helplessly in the incubator, but by her mother’s spirit as well. Fear laced every call to the hospital, every question, every conversation. But always the faith remained. Somehow we would make it. Somehow God sustained me somehow. Then in one faltered heartbeat the negatives became negatives again, and I faced a test of faith more terrifying than my own journey through the abyss – my baby’s journey to the edge of the River Jordan. All her veins had been blown, and a new IV would have to go in her head – all the other options had been exhausted.

In utter desperation my husband and I left the hospital, and on a rain–soaked highway with the amber glow of the streetlights flashing above me, I reached a place that I never even knew existed – the place where faith no longer resides.

"Why?" I asked the darkness around me. "Why?" But God has promised, "I will never leave you, nor forsake you" (Hebrews 13:5), and I am here to tell you, He does send messengers to help when you ask. Truth is, mine was sitting right by my side – exactly where he had been through the whole ordeal. Slowly my husband reached over, took my hand, and spoke the words that I would cling to not only for this one night but for the rest of eternity. "She’s going to be okay. You've just got to have faith."

Every day for the next five years that faith has been tested over and over again. Every time I let my baby-big girl, now-off at play school. Every time my second daughter lets go of my hand and walks off on her own. Every time one child or the other screams in pain or in fear at two o’clock in the morning – the words come back to me, "She's going to be okay. You’ve just got to have faith."
In the days to come, the phrase will only become more powerful. During the long nights when the girls fail to call and on the days when they experience their own grieve, the words will be there to help me through. Time and again as I hold my children for one brief moment and then release them into the abyss, the words will be there.

Through school, best friends, boyfriends, first dates, first heartbreaks, in partnership with God and my husband, I will remain the rock on which these two girls can build their lives. Until someday in some beautiful sunlit church, I will watch from a front pew as they stand before God and pledge themselves to another forever. Then as they turn, kiss me, and walk away into their own lives, the words will again be there. "She’s going to be okay. You’ve just got to have faith."

The day will come of course when the abyss will stretch before me again "when Christ, who is our life, shall appear, then shall you also appear with Him in glory" (Colossians 3:4).

In some darkened room on another cold, hard bed I will step toward the abyss to make my final journey home. However, this time I will have not one but three sets of hands to hold onto. Then, looki will be there, but a greater understanding will hold me also.ng up into the eyes of the two beautiful women my daughters have become, the sadness at our imminent parting

Beyond a doubt, I know that as I slip from the darkness of this world into the light beyond, I will hear that voice one more time: "They're going to be okay. You’ve just got to have faith."

News Around The Globe

  • Most women with low–risk pregnancy should be allowed to spend more time in the first stage of labor to avoid unnecessary cesareans, according to new joint guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal–Fetal Medicine (SMFM), published in the March issue of Obstetrics & Gynecology.
  • A study from Taiwan reported online in Annals of the Rheumatic Diseases has found that among the myriad potentially debilitating complications faced by patients with systemic sclerosis is an increased risk of osteoporotic fractures. Compared with age– and sex–matched controls, patients with systemic sclerosis had an incidence rate ratio (IRR) of osteoporotic fractures of 1.69. In addition, their IRRs were 1.78 (95% CI 1.30–2.39, P<0.001) for vertebral fracture and 1.89 (95% CI 1.05–3.22, P=0.026) for hip fracture.
  • The FDA has approved droxidopa (Northera) for the treatment of neurogenic orthostatic hypotension, a rare disease that results in a drop in blood pressure when patients try to stand up. The drug was passed up for approval 2 years ago when the FDA asked for more data from an additional clinical trial.
  • A high neutrophil–lymphocyte ratio (NLR) predicts a poor response to anticoagulation and other adverse outcomes in lung cancer patients with venous thromboembolism (VTE). In the study in Lung Cancer, more patients in the high NLR group had stage IV non–small cell lung cancer (NSCLC), CNS metastasis, and cancer progression at the time of VTE onset compared with patients in the low NLR group, whereas risk factors for VTE did not differ between the groups. Resolution of VTE was less likely among patients with high NLR (42.4% vs. 76.2% of patients with low NLR) and among patients with NSCLC (55.7% vs. 86.7% of patients with SCLC) or low albumin (45.2% vs. 72.7% of patients with high albumin).
  • A home–based exercise program modestly improved physical function at 6 months in patients who completed standard rehabilitation after hip fracture, according to findings of a randomized clinical trial published in the February 19 issue of JAMA.

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 is "window period"?

It is the time taken by the anti-rabies vaccine to produce protective levels of antibodies in the patient. The window period is of 7–14 days.

cardiology news

Energy drinks may put heart at risk for sudden death

Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death.

In a meta–analysis by Sachin A. Shah at University of the Pacific in Stockton, Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms.

In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks.

Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life–threatening arrhythmias.

Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle and AMP have three times the amount of caffeine as colas. A 16–oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as 5 cans of soda.

cardiology news

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

  • Patients who had bacteremia –mainly urinary-tract infections, pneumonia, or sepsis –when admitted to hospital were much more likely to have an MI or stroke within 30 days, compared with healthy controls or patients hospitalized for other reasons. The research suggests that "bacteremia (a severe and acute infection) should be considered a risk factor for MI and stroke, but only for a short period of time after onset of infection," and it hints that infection with Staphylococcus aureus may confer a particularly high risk. The study was published online February 12, 2014 in Circulation.
  • Transcatheter aortic valve implantation (TAVI) improved survival and physical function compared with medical management in elderly patients with aortic stenosis, but its impact on psychological well–being seemed to be modest. An analysis of findings from 62 studies in patients with a mean age of 73 to 93 revealed a clinically relevant decrease in New York Heart Association (NYHA) class 6 to 11 months after the procedure and at 12 to 23 months. The study is reported in the Annals of Internal Medicine.
cardiology news

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

Genetic differences in how infants respond to food may play a role in obesity risk, according to two studies. The first study found that among newborn sets of twins, the twin with higher responsiveness to food and lower satiety gained more weight than the twin who was more easily sated. The second study found that infants with a higher genetic risk score –ndash; based on findings from earlier genome-wide association studies (GWAS) ––had reduced satiety and higher body mass index (BMI) than those with a lower risk profile. Both studies were published online in JAMA Pediatrics.

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

X–ray can be normal in Pneumonia

A chest X–ray can be normal in the first 24 hours of pneumonia, 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.

Pneumonia can be community–acquired or hospital–acquired. Community–acquired pneumonia is pneumonia that is acquired in the community in a person without a history of contact with a patient or a health care worker and can be treated by simple antibiotics.

But if a person develops pneumonia in 48 hours after getting admitted to hospital or after 48 hours of endotracheal intubation it is called hospital acquired pneumonia. This pneumonia needs treatment with combination of costly antibiotics.

HCAP is healthcare–associated pneumonia that occurs in a non hospitalized patient but with extensive healthcare contact. Public must avoid visits to the hospitals to avoid this as once the pneumonia develops, it requires costly and aggressive antibiotics. One should suspect HCAP if the patient in the last one month has received any intravenous therapy; has been going to a doctor for a wound care; has received intravenous chemotherapy; has visited a hospital setting or a hemodialysis clinic. It should also be suspected if the person was admitted to a hospital with acute care facilities in the last 3 months.

Uncomplicated community–acquired pneumonia (CAP) can be treated in a clinic as it has low mortality but patients with CAP who require admission have 37% mortality.

High-risk community-acquired pneumonia patients can be remembered by the formula CURB 65:

  • C stands for confusion (anoxia)
  • U stands for Urea more than 20 (pre renal azotemia)
  • R stands for respiratory rate more than 30 per minute (due to low oxygen)
  • B stands for low blood pressure – systolic less than 90 and diastolic less than 60 (due to CO2 retention)

Any patient of community–acquired pneumonia who does not respond within 72 hours should be treated as high-risk patient. Pneumonia patients have low mortality if they have received pneumonia/flu vaccination in the past.

Community–acquired pneumonia treatment can be treated only on the basis of clinical features and a chest X–ray. But in healthcare–associated pneumonia, sputum culture examination is required.

Do not treat X-ray, breathlessness or cough as they may persist for a long period of time after treatment.

Cough in pneumonia may last for a week and x–ray may take 4 weeks to clear in normal individuals and 12 weeks in the elderly.

Repeat x–ray after one week of discharge is not necessary. However follow up x–ray is required at 8 to 12 weeks to document resolution of pneumonia and to exclude underlying malignancy.

For simple health care–associated pneumonia where multidrug resistance is not suspected: Treat with IV 2 g of ceftriaxone or Levofloxacin 750 mg daily or ampicillin–sulbactam 3 g intravenous every six hours. The best bet is to give 750 mg Levofloxacin every day.

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 86664 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."

emedipicstoday emedipics

Congratulations Dr S Arul Rhaj for receiving the best doctor award from the govt. of Tamil Nadu. He is the first one to get this new state award.
Dr. K. Vijayakumar,
Immediate Past National President

press release

Red flag arthritis

vedio of day

today video of the dayHands only CPR 10 Utsav, 15th December 2013

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

Padma Shri & Dr B C Roy National Awardee, Dr KK Aggarwal on Tackling tension headaches

eMedi Quiz

A 20–year–old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:

1. Macular edema.
2. Sympathetic ophthalmia.
3. Optic nerve avulsion.
4. Delayed vitreous hemorrhage.

Yesterday’s Mind Teaser: A patient using contact lens develops corneal infection. Laboratory diagnosis of acanthamoeba keratitis was established. The following is the best drug for treatment:
1. Propamidine.
2. Neosporine.
3. Ketoconazole
4. Polyhexamethylene biguanide.

Answer for yesterday’s Mind Teaser: 1. Propamidine.

Correct answers received from: Dr,Bitaan Sen & Dr.Jayashree Sen,Dr.K.Raju,Dr Jainendra Upadhyay,Dr.K.Raju, Dr Jainendra Upadhyay, Dr.K.Raju, Dr Chandresh Jardosh, Dr.K.Raju, DR Ayyavoo Erode, Anil Tandon, Sangeetha Raja, Dr Ajay Gandhi,

Answer for 19th February Mind Teaser:4. Gluconeogenesis.

Correct answers received from: Dr.K.Raju, Anil Tandon, Dr Avtar

Send your answer to ijcp12@gmail.com

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centralbank
medicolegal update

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medical querymedical query

medicolegal update
medicolegal update

????

The next day, TV news reported that 100 million was taken from the bank. The robbers counted and counted and counted, but they could only count 20 million. The robbers were very angry and complained "We risked our lives and only took 20 million; the bank manager took 80 million with a snap of his fingers. It looks like it is better to be educated to be a thief!"

This is called "Knowledge is worth as much as gold!"

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

medicolegal update

Egotism is the anesthetic that dulls the pain of stupidity. Frank Leahy

medicolegal update

Dr KK Aggarwal: : Obesity is a disease By Dr k k Aggarwalhttp://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Every experience of love, bliss, belonging, inspiration & insight provides a stepping stone back to your true self http://bit.ly/WAHF_Am #WAYHF

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

medicolegal update
  1. Dear Sir,very informative news. Regards: Dr Kartar

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

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