eMedinewS21st September 2013, Saturday

Dr K K Aggarwal Padma 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
www.facebook.com/Dr KKAggarwal

Common Orthopedics Surgery Practices That Should Stop

American Academy of Orthopaedic Surgeons made the following 5 evidence–based recommendations:

  1. Avoid performing routine postoperative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
  2. Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for longterm relief.
  3. Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
  4. Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
  5. Don’t use post–operative splinting of the wrist after carpal tunnel release for long-term relief.

….Read More

Common Surgery Practices That Should Stop

American College of Surgeons recommended the following 5 recommendations:

  1. Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
  2. Avoid the routine use of ‘whole–body’ diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.
  3. Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.
  4. Avoid admission or preoperative chest x–rays for ambulatory patients with unremarkable history and physical exam.
  5. Don’t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

….Read More

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."


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

Ringtone – CPR 10 Mantra English

sprritual blog Etiquettes must be taught in schools

In India we are not taught etiquettes at school level and we end up learning them by making mistakes. Here are a few that I learnt over the period of time.

1. One of my patients got upset because I sat on his bed with my knee on the bed.
2. One of my seniors got upset, when he saw me coming to a meeting without a tie.
3. My boss’s brother–in–law fired me once when he saw that my socks did not match with my clothes.
4. In my first encounter my boss smiled when he saw me seeking a job with a khadi cloth bag, wearing chappals and wearing khadi clothes.
5. When I went to see the girl for my marriage proposal, the girl’s family were upset after seeing that my sandals did not match my clothes.
6. One of my patients got upset when I leaked information about blood pressure reading to his wife.
7. One of my patients walked out of my cabin when he saw me picking up a mobile to listen to a call during a consultation.
8. One of my patients got upset in OPD when he was not attended by my resident on time. My resident was late as he had been awake the whole night for serious patients. The patient said that it was not his concern. He could not be neglected if he was given a time.
9. My senior got upset when I made my wife sit in the front seat and made him sit in the back seat of my car.
10. An executive walked out before signing a deal after he found my hand shake not warm enough.
11. I saw a spiritual guru asking a person who had come from a long distance to go because she found his aura was not good.
12. One of the senior IAS officers got upset when unintentionally a protocol was broken and his junior was made to inaugurate an event when he was also present.
13. I can never forget my college days when people used to tease me as baniya.
14. I can never forgive a person who to defame someone puts false allegations linked to financial irregularities or character assassination.
15. I got upset with a patient when he called me at 2 am for a regular appointment, He thought that all doctors do not sleep before 2 am.

cardiology news

Be a Good Friend

One day, when I was a freshman in high school, I saw a kid from my class was walking home from school. His name was Kyle. It looked like he was carrying all of his books. I thought to myself, "Why would anyone bring home all his books on a Friday? He must really be a nerd."

I had quite a weekend planned (parties and a football game with my friends tomorrow afternoon) so I shrugged my shoulders and went on. As I was walking, I saw a bunch of kids running toward him. They ran at him, knocking all his books out of his arms and tripping him so he landed in the dirt. His glasses went flying, and I saw them land in the grass about ten feet from him. He looked up and I saw this terrible sadness in his eyes

My heart went out to him. So, I jogged over to him as he crawled around looking for his glasses, and I saw a tear in his eye. As I handed him his glasses, I said, "Those guys are jerks. They really should get lives." He looked at me and said, "Hey thanks!" There was a big smile on his face. It was one of those smiles that showed real gratitude.

I helped him to pick up his books, and asked him where he lived. As it turned out, he lived near me, so I asked him why I had never seen him before. He said he had gone to private school until now. I had never hung out with a private school kid before. We talked all the way home, and I carried some of his books. He turned out to be a pretty cool kid.

I asked him if he wanted to play a little football with my friends, he said yes. We hung out all weekend and the more I got to know Kyle, the more I liked him, and my friends thought the same of him. Monday morning came and there was Kyle with the huge stack of books again. I stopped him and said, "Boy, you are gonna really build some serious muscles with this pile of books everyday!"

He just laughed and handed me half the books. Over the next four years, Kyle and I became best friends. When we were seniors we began to think about college. Kyle decided on Georgetown and I was going to Duke. I knew that we would always be friends, that the miles would never be a problem. He was going to be a doctor and I was going for business on a football scholarship.

Kyle was valedictorian of our class. I teased him all the time about being a nerd. He had to prepare a speech for graduation. I was so glad it wasn’t me having to get up there and speak. Graduation day, I saw Kyle. He looked great. He was one of those guys that really found himself during high school.

He filled out and actually looked good in glasses. He had more dates than I had and all the girls loved him. Boy, sometimes I was jealous! Today was one of those days. I could see that he was nervous about his speech. So, I smacked him on the back and said, "Hey, big guy, you’ll be great!" He looked at me with one of those looks (the really grateful one) and smiled. "Thanks!" he said. As he started his speech, he cleared his throat, and began:

"Graduation is a time to thank those who helped you make it through those tough years. Your parents, your teachers, your siblings, maybe a coach…but mostly your friends… I am here to tell all of you that being a friend to someone is the best gift you can give them. I am going to tell you a story."

I just looked at my friend with disbelief as he told the story of the first day we met. He had planned to kill himself over the weekend. He talked of how he had cleaned out his locker so his mom wouldn’t have to do it later and was carrying his stuff home.

He looked hard at me and gave me a little smile. "Thankfully, I was saved. My friend saved me from doing the unspeakable." I heard the gasp go through the crowd as this handsome, popular boy told us all about his weakest moment.

I saw his Mom and dad looking at me and smiling that same grateful smile. Not until that moment did I realize its depth. Never underestimate the power of your actions. With one small gesture you can change a person’s life. For better or for worse. God puts us all in each other’s lives to impact one another in some way.

News Around The Globe

5th Dil Ka Darbar

Date: Sunday, 29th September 2013, Venue: Constitution club of India, Rafi Marg, Time: 8 AM to 6 PM

Programme: A non stop question answer–session between all top cardiologists of the NCR region and the public.

The focus of the discussions will be prevention of heart diseases in women and young men. Special discussion will be held on Sex and Heart Diseases. Practical training will also be given to people on Hands–only Cardiopulmonary Resuscitation. Another focus of the discussion will be the launch of the Project Dhadkan (Palpitations) and Project Murmur (Congenital and valvular heart diseases in children).

Entry free…

  • Results from a new study in the September 19 issue of the New England Journal of Medicine show that some women with stress urinary incontinence may fare better if they skip physiotherapy and go directly to midurethral sling surgery. In a head–to–head trial of the 2 approaches, 90.8% of women assigned to surgery reported improvement a year later compared with 64.4% of those assigned to physiotherapy.
  • About one patient in seven can expect to be readmitted within 30 days of discharge following major surgery, as reported by Ashish Jha, MD, and colleagues at the Harvard School of Public Health in the Sept. 19 issue of the New England Journal of Medicine. But rates of 30-day readmission were better in hospitals with a high surgical volume or with lower surgical mortality rates. Good adherence to surgical process measures, on the other hand, had very little effect.
  • Postmenopausal women with diabetes had two to three times the risk of dying over an average of 10 years of follow–up than those without diabetes, regardless of race or ethnicity, as per analysis of data from the Women’s Health Initiative (WHI) reported online in the American Journal of Epidemiology. Among white women, the hazard ratio for all-cause mortality on an adjusted analysis for those with diabetes was 2.2, while among blacks it was 2.11. Similar risks also were seen for Hispanic women as well as for those of Asian ancestry.
  • The often–deadly coronavirus circulating in the Middle East, dubbed MERS–CoV, is genetically diverse with at least three lineages circulating in the Saudi Arabian capital of Riyadh. And the virus has probably jumped from animals to humans more than once, according to Ziad Memish, MD, Saudi Arabia’s Deputy Minister for Public Health, and colleagues. The findings ––– from analysis of 21 MERS–CoV genome sequences, the largest number to date –– also suggest the virus was circulating long before the first case was recognized. The study is reported online in The Lancet.
  • According to a top UN official, the global AIDS epidemic could be over by 2030 because of progress made in treatment and control of the disease as reported in The Economic Times, 20 Sep, 2013. Luis Loures, a deputy executive director of UNAIDS, the UN agency leading the fight against HIV/AIDS said, "I think that 2030 is a viable target to say that we have reached the end of the epidemic. HIV will continue existing as a case here or there but not at the epidemic level we have today." According to UNAIDS, the annual incidence of new infections has fallen 20 per cent over the past decade, and in 25 countries, including 13 in sub–Saharan Africa, it has fallen by 50 per cent. Over the past two years, the number of people who have obtained treatment for HIV has increased by 60 per cent. The challenge is now for the most vulnerable groups, like homosexual males, sex workers and drug users who do not seek treatment for fear of being stigmatized or criminally prosecuted. If we do not succeed in controlling the epidemic among these groups, AIDS will stay with us," he warned.

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Rabies News (Dr. A K Gupta)

Can rabies be transmitted to a dog that has eaten the flesh of a dead rabid cow or buffalo?

Yes. The rabies virus after multiplying in the brain spreads to other organs of the body like the heart, muscles, skin, etc. So the dog can definitely get infected because the virus can spread through oral mucous membrane.

cardiology news
  • Introduction of digoxin therapy in patients with new systolic heart failure was associated with a significant 72% jump in all–cause mortality but no effect on HF–hospitalization risk in a community–based cohort study, in both women and men and regardless of whether patients were also taking beta–blockers. This analysis and other recent studies provide "no good evidence that digoxin improves outcomes" and suggest that "it’s associated, at least theoretically, with different types of harm," according to Dr Alan S Go (Kaiser Permanente Northern California, Oakland). The use of digoxin should be reevaluated to determine "whether or not it is really helping patients with heart failure."
  • Data from a large clinical registry reported online in Journal of the American College of Cardiology: Cardiovascular Interventions show that an updated model of bleeding risk after percutaneous coronary intervention (PCI) identified more than twice as many bleeding incidents as reported in studies of earlier models,. An expanded definition of bleeding led to an overall bleeding rate of 5.8%, compared with 2.4% in a previous analysis of the National Cardiovascular Data Registry (NCDR) CathPCI Registry. The definition of bleeding was amended to include any of the following events if it occurred within 72 hours of PCI or before hospital discharge:
    • Site–reported arterial access–site bleeding, including external or a hematoma >10 cm for femoral access, >5 cm for brachial access, or >2 cm for radial access
    • Intracranial hemorrhage
    • Cardiac tamponade
    • Post–procedure hemoglobin decrease of 3 g/dL in patients with pre–procedure hemoglobin level ≤16 g/dL
    • Post–procedure nonbypass surgery–related blood transfusion for patients with pre–procedure hemoglobin level ≥8 g/dL

Valvular Heart Disease News

Patient with large vegetations are at high risk of complications.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • Pediatricians should have a high index of suspicion when evaluating patients for myasthenia. Despite pediatric myasthenia being a rare condition, the autoimmune form is a treatable condition. The most common type is juvenile myasthenia gravis (JMG), which is characterized by fluctuating skeletal muscle weakness that improves with rest. JMG occurs when patients make antibodies to neuromuscular junction proteins, most commonly the acetylcholine receptors. Other types include congenital myasthenic syndromes (CMS) and transient neonatal myasthenia gravis.
  • According to a study published online June 21 in the American Journal of Obstetrics & Gynecology, home deliveries were 10 times more likely to result in an Apgar score of 0 than hospital deliveries. There was a nearly 4–fold greater risk for neonatal seizure or serious neurologic dysfunction among home births.
cardiology news

Ethics principles

The previous edition of the American College of Physicians’ (ACP’s) Ethics Manual was published in 2005. The current publication updates this manual, with important new recommendations regarding the use of medical information and physician reimbursement practices.

  • Beneficence: the duty to promote good and act in the best interest of the patient and society; nonmaleficence: the duty to do no harm to patients; respect for patient autonomy; and justice: the equitable distribution of life–enhancing opportunities afforded by healthcare.
  • Face–to–face patient care is still encouraged above all, although other means of communication can be used to augment patient care. However, the act of writing prescriptions based solely on telephone conversations or the results of questionnaires with patients unknown to the physician is not an acceptable standard of care.
  • In the absence of a preexisting relationship, the physician is not morally bound to provide care for a patient unless it is an emergency or there are no other physicians available to see the patient.
  • In the rare case when the physician decides to end the relationship with a patient, the patient should be notified in writing and the physician should arrange for the appropriate transfer of care.
  • The physician is not obliged to provide secrecy in cases when a person close to the patient divulges information and asks that the patient not be informed of the disclosure.
  • Physicians should disclose errors made in the process of care to patients.
  • Patient competence to make clinical decisions can be difficult to assess, and should be evaluated for a specific decision at the time of that choice.
  • When a surrogate makes a medical decision for a patient, the physician should try to ensure that this decision fits with the patient’s beliefs and wishes, not what the surrogate may choose for herself or himself. Problematic cases can be referred to a hospital ethics committee.
  • If a physician refuses to provide reproductive services on moral grounds, he or she is still obliged to discuss all options or refer the patient appropriately.
  • In a catastrophic disaster, the moral guidelines of autonomy and beneficence may have to cede to utility, fairness, and stewardship.
  • Providing medical care to individuals with whom the physician already has a nonprofessional relationship, such as friends and coworkers, is discouraged.
  • Physicians who use social media should take care not to blur social and professional boundaries.
  • An order not to intubate a patient should be accompanied by a complete do–not–resuscitate order.
  • The ACP does not support the practice of physician–assisted suicide or euthanasia.
  • Physicians should disclose potential financial conflicts of interest with patients. They should not refer patients to treatment centers in which they have invested money, but do not provide direct care.
  • The practice of selling products out of the physician office is discouraged. Such products should meet urgent needs of patients, which would not apply to products such as supplements or cosmetic aids.
  • Physicians should not be involved in interrogations. The participation of physicians in the execution of prisoners, except to pronounce death, is considered unethical.
  • Physicians should not participate in strikes that reduce patient access to care.

(Ann Intern Med. 2012;156:73–104)

cardiology news

Total CPR since 1st November 2012 – 63400 trained

CPR Classes 63400

Media advocacy through Print Media

sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping
sprritual blog Media Press Clipping Media Press Clipping Media Press Clipping

29th August: Veer Arjun

Media advocacy through Web Media

When Constipation May be a Serious Problem 30th August

NETLOG, FREEPRESS RELEASE, PRLOG, FREEPRESSINDEX , AFRICANNEWSWIRE

TB more dangerous than FLU 29th August

NETLOG, FREEPRESS RELEASE, PRLOG, AFRICANNEWSWIRE

Air pollution can raise blood pressure

Breathing polluted air for even two hours can boost blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog, Dr. K K Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela.

In susceptible patients this small increase may actually be able to trigger a heart attack or stroke. In the study, which appeared in a recent issue of the journal Hypertension, researchers tested 83 people as they breathed levels of air pollution similar to those in an urban city near a roadway. The air pollution caused diastolic pressure –– the lower number in a blood pressure reading –– to rise within two hours. Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity.

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 63400 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."

today emedipics

Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal Live on Headlines Today

press release

Ayurvedic doctors to perform eye surgeries

today video of the dayDr KK Aggarwal Birthday 5th September

Cultural Evening at IMA

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

An older adult patient is discharged from the hospital with nortriptyline for neuropathic pain. Which statement indicates the patient’s need for additional education?

1. "I will chew sugarless gum and mints."
2. "I will drink carbonated beverages."
3. "I will take my medication at breakfast."
4. "I will use a humidifier at bedtime."

Yesterday’s Mind Teaser: A 35–year–old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient’s behavior:

1. Is an emotional reaction to the anticipated pain.
2. Is in anticipation of future pain.
3. Is more indicative of the need for pain medication than the pain rating.
4. May be in conflict with the pain rating, and accepts the report of pain.

Answer for yesterday’s Mind Teaser: (4) May be in conflict with the pain rating, and accepts the report of pain.

Correct answers received from: DR MONICA GANDHI NEE MENOCHA, DR ARPAN GANDHI, Prabha Sanghi, dr ajay Gandhi, Dr kanta jain, daivadheenam, Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Chandresh Jardosh, Dr.K.Raju, Dr Avtar Krishan

Answer for 19th September Mind Teaser: d) Location, quality, and onset

Correct answers received from: Dr Deepali Chatterjee, DR ABBAS VAKIL, Dr. P. C. Das, Dr.A.K.GAJJAR

Send your answer to ijcp12@gmail.com




medicolegal update

Click on the image to enlarge

medicolegal update

Death on Vacation

During their vacation and while they were visiting Jerusalam, George’s mother–in–law died. With death certificate in hand, George went to the American Consulate Office to make arrangements to send the body back to the States for proper burial.

The Consul, after hearing of the death of the mother–in–law told George that the sending of a body back to the States for burial is very, very expensive. It could cost as much as $5,000.00. The Consul continues, in most cases the person responsible for the remains normally decides to bury the body here. This would only cost $150.00.

George thinks for some time and answers, "I don’t care how much it will cost to send the body back; that’s what I want to do."

The Consul, after hearing this, says, "You must have loved your mother-in-law very much considering the difference in price." "No, it’s not that," says George. "You see, I know of a case from many years ago of a person that was buried here in Jerusalem. On the third day he rose from the dead! I just can't take that chance."

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

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.

medicolegal update

A blind person asked Swami Vivekanand: "Can there be anything worse than losing eyesight?" He replied: "Yes, losing your vision!"

medicolegal update

Dr KK Aggarwal: Dr K K Aggarwal: Relaxation during work http://bit.ly/15Lvpwx #Health

Dr Deepak Chopra: Why compare yourself with others? No one in the entire world can do a better job of being you than you.

medicolegal update

Sir, Very well written. Especially in Medical field, where students are constantly compared with each other, an inferiority complex may be prevalent in students from their MBBS days. Further, the same attitude remains prevalent while choosing specialization branches. I request your good self to add upon an article to choose specialization branch (MD/MS) based on passion and not by trend/money. Best regards, Dr Jitendra Ingole, MD Internal Medicine.

Forthcoming Events

29thSeptember–Dil Ka Darbar at Constitution Club of India,New Delhi

20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India

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medicolegal update


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