eMedinewS21st July 2014, Monday

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

Neck Artery Wall Thickness and Plaque Area – a new test to diagnose early heart diseases

Treadmill, stress echocardiography, Thallium and Angiography do not detect early blockages. Treadmill can miss blockages up to 70%; stress echocardiography up to 60%, angiography upto 40%.

Most heart attacks occur because of a plaque rupture in patients with blockages of less than 50%. If the blockage is more than 70% the patient usually presents with heart pain and not massive heart attack.

The only way to detect heart blockages before they cause symptoms or are detected in conventional tests is to measure the wall thickness of the neck artery or the leg artery. Normally, the wall thickness is less than 0.5mm. If the wall thickness is more than 0.75mm, it is suggestive of underlying heart blockages and if it is more than 1mm, it is suggestive of blockages in all three arteries of the heart.

Any thickness of more than 1mm is called a plaque and plaque area calculated by high resolution ultrasound is a new marker for heart blockages, progression as well as regression.

If the artery wall is thick in both the neck and the leg arteries, it is very likely that the patient will also have blockages in the arteries of the heart.

All high risk individuals, therefore, should have their neck and leg artery wall thickness checkup done. Only 2% of patients with blockages in all three arteries of the heart have a neck artery wall thickness of less than 1mm and 94% of patients with a neck artery wall thickness of more than 1.15mm will have multiple blockages in the heart.

News Around The Globe

  • A report published online in Clinical Infectious Diseases has revealed that among patients on long–term voriconazole therapy, high plasma fluoride levels and skeletal pain are highly suggestive of periostitis.
  • A regimen of negative shoulder movements and stretching may present a long–term treatment for chronic subacromial shoulder pain and reduce the need for surgery, suggests a new study published online in the British Journal of Sports Medicine.
  • Certolizumab, a monoclonal antibody against TNF–alpha, seems effective in patients with rheumatoid arthritis (RA) that no longer responds to other anti–TNF therapies, suggested a recent small trial published online in the Annals of the Rheumatic Diseases.
  • Regular use of fish oil supplements is associated with a significant reduction in cognitive decline and brain atrophy in older adults, suggests a new study published online in the journal Alzheimer’s & Dementia.
  • A new study published in Stroke has reported that women who were sexually abused in childhood may be more likely to have higher thickening of the inner lining of the arteries in middle age, an early indication of atherosclerosis.

Rabies News (Dr A K Gupta)

How should the animal causing the bite be handled?

It is important to establish whether the biting animal is healthy or diseased, bearing in mind that a rabid animal excretes the virus in its saliva not just throughout the illness but also several days before the appearance of the first signs. An unknown animal, which has disappeared, must be considered as rabid and full course of PEP must be given. Cats and dogs, which can be identified, must be kept under observation. The risk of rabies can be considered as slight if the animal shows no sign of disease after 5 days, and non–existent if the animal is still healthy on the 10th day (The European Standards recommend an observation period of 15 days).

All wild animals, and those domestic animals suspected of having rabies must be put down and the rabies diagnosis must be carried out in the laboratory.

If it is proven that the animal is not rabid, only then the anti–rabies treatment may be halted.

Cardiology eMedinewS

  • A new meta–analysis has suggested that medical therapy plus revascularization with PCI using newer–generation drug–eluting stents (DES) improves survival better than an initial strategy of optimal medical therapy (OMT) only. No such advantage was seen for PCI using either bare–metal stents or early–generation DES. The report has been published in BMJ.
  • A study published online July 16 in JAMA has pointed that patients who had an ischemic stroke within 3 months before undergoing elective noncardiac surgery were at relatively high risk for cardiovascular events and mortality but the risks stabilized after 9 months. Thus, patients who have sustained a stroke should wait for 9 months before having elective surgery.

Pediatrics eMedinewS

  • A reconstruction technique involving regional nerve transfers and nerve grafts has been suggested by researchers at the Hospital for Sick Children and the University of Toronto that can restore sensation in children with corneal anesthesia. The report is published online in JAMA Ophthalmology.
  • A new research has shown that using a computerized decision aid to help automate developmental surveillance and screening (DSS) at well–child visits helps more children being screened and leads to earlier diagnoses for those with developmental delay. The findings are published in JAMA Pediatrics.

Dr K K Spiritual Blog

You look at people the same way as you are

Honest people look at everybody as honest and dishonest people regard everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with you personal experience. I recall one of the doctors saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he did not take into consideration the doctors who did not approach him.

Wellness Blog

Smell check, scratch and sniff, a new test for Parkinson’s disease

Olfactory dysfunction presenting as odor detection, discrimination, and identification is a common finding in patients with early non vascular Parkinson’s disease.

As per a study of 2,267 men published in the Annals of Neurology, an impaired sense of smell could be an early indicator of Parkinson’s disease, occurring up to four years before motor skill problems appear.

In the study decreased odor identification was associated with older age, smoking, more coffee consumption, less frequent bowel movements, lower cognitive function and excessive daytime sleepiness, but even after adjusting for these factors, those with the lowest odor identification scores had a five time greater risk of developing Parkinson’s disease than those with the highest scores.

Nerve loss and the formation of Lewy bodies –– abnormal clumps of proteins inside nerve cells that are thought to be a marker of the disease –– are known to take place in the olfactory structures of patients with the disease.

An impaired sense of smell could also be caused by impaired sniffing, which may be another motor symptom of Parkinson’s.

Early indicators of Parkinson’s disease are olfactory abnormality, constipation and sleep disturbances.

Besides Parkinson’s disease, obesity, diabetes, hypertension, malnutrition, Alzheimer’s disease, multiple sclerosis and Korsakoff’s psychosis are all accompanied or signaled by smell disorders.

Inspirational Story

If and When Planted

How is "if and when" planted? The short stories below are examples of planting "if and when":

Karen, one of my coworkers was stressed about where she was living. She hated the apartment she was in and complained every day about it. One day over coffee, I asked her why she didn’t look for another apartment – it seemed like an easy solution to me. Karen’s reply to this was, "I will look for another apartment when I come back from vacation."

Sam hated his job. He dreaded getting up in the morning. He hated the work he was doing and it started to take a toll on him. He had a love for photography and was currently taking a two–year course to obtain his certificate. Every night he complained about his work. After listening to his complaints for a month, I asked him why he didn’t finish his course and start a small business doing photography on the weekends. His reply, "if only I had more time to finish my course. When I finish my course I will start a business."

Sarah had saved all her life and now was retired and living comfortably. The house she bought had a dishwasher in it; however, the dishwasher was old and didn’t work. She hated doing dishes, and every time we visited with her she complained about doing the dishes. One night, I asked her, "Why don’t you buy a new dishwasher Sarah." Her reply, "I have been thinking about it, if they would only come on sale I would."

Larry worked for a company that allowed early retirement. Larry had both the years of service and his age, which allowed him to retire, but at a reduced pension. He was having difficulty coping with all the changes that were being made in his work. He had a couple of mild attacks, not a heart attack but similar to one. He called me and we talked for hours. I was worried about the stress of his job and the effects it was having on his health. "Why don’t you retire Harry? Do something that you have always wanted to do," I asked. Harry’s reply to my question was, "If only I was older then I would get my full pension." I got bolder in my conversation with him, "But Harry, you have your house paid off, you have no bills, the kids are grown up. You could sell your house and downsize, it really is not worth your health is it? Harry then said, "When the summer comes maybe I will."

All of these stories have the same theme running through them. There is a proverb that says it all: If and when were planted, and nothing grew."

Now a year later, Karen is still living in the apartment she hates! Sam is still complaining about his job and still has not finished his course! Sarah is still washing dishes! Larry is still working and his health is not what it used to be!

The sad part of all of these stories is that all of these people had a lot of stress in their lives that they could have taken action to reduce. But, all of them defeated themselves by thinking "if" or "when". Life is too short for "if’s and when’s".

The next time you are in a stressful situation and you find yourself saying or thinking – "if or when" – remember the saying, "If and when were planted and nothing grew!" Change your thinking and take action, so that you can reduce your stress right now.

ePress Release

Even cycling can cause erectile dysfunction?

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who cycle for more than 3 hours a week should do so in a reclining position and not upright position, 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.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling.

Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling–induced impotence is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than three hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

Self-Assessment-Quiz

 

Zee News – Health Wealth Shows

Alcohol
Cancer Prevention
Depression
Paralysis
Pneumonia
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Vitiligo
Fluid Intake

 

Total CPR since 1st November 2012 – 94595 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

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

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

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at NP Primary School, Rama Krishna Marg–16th July 2014

press release

Healthcare worker fatigue and patient safety

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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 acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

eMedinewS Humor

If a lion is chasing you

Teacher: If a lion is chasing you, what would you do?
Student: I’d climb a tree.
Teacher: if the lion climbs a tree?
Student: I will jump in the lake and swim.
Teacher: if the lion also jumps in the water and swims after you?
Student: Teacher, are you on my side or on the lion’s?

Quote of the Day

Permanence, perseverance and persistence in spite of all obstacles, discouragement, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak. Thomas Carlyle

Twitter of the Day

Dr KK Aggarwal: Smoking may dull taste buds By Dr k k Aggarwal http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Many obstacles to manifesting healthy relationships can be overcome by improving our communication with one another http://tinyurl.com/njbfuua

 

eMedi Quiz

Appropriate teledematology tool to screen (active survey) a dermatology case of public health importance like leprosy is:

a. Mobile teledermatology
b. Videoconference
c. Store and forward teledermatology
d. Online discussion group

Yesterday’s Mind Teaser: Follow up care for a leg ulcer is documented with which of the following teledematology tool?

a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. Online discussion group

Answer for yesterday’s Mind Teaser: b. Mobile teledermatology

Correct answers received from: Kala Sarma, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.Chandresh Jardosh, Dr Avtar Krishan, Dr Ajay Gandhi, Dr.K.V.Sarma

Answer for 19th July Mind Teaser: d. All of the above

Correct answers received from: Dr Chandresh Jardosh, Daivadheenam Jella, Dr Avtar Krishan, Dr Prakash Khalap, Dr Avtar Krishan, dr poonam chablani, Dr.Jayashree Sen & Dr.Bitaan Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

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medicolegal update

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  1. Dear Sir, Thanks for the news: Regards: Dr Soni
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