eMedinewS
22nd December 2014, Monday

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, 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

Paying high MBBS admission fee is not linked to producing dishonest doctors

It is often an argument that paying a capitation fee for MBBS admission will produce a dishonest doctor. The activist says that they will have to recover the cost of capitation fee.

But it is not a reality. One does not buy a Mercedes car, travel in first class, buy a house in posh colony to grab money.

It is true that when the capitation fee is high for those seats only the rich will go and students from this class of the society will have enough money to build corporate practice which will be costly like any other corporate set ups.

Corporate culture of medical practice is not the need of hour in the country as still 80% of the people still lives in rural areas. We still need healers and not western cultured doctors.

Today the ethics of doctors and corporate culture are different

  1. For doctors there are MCI ethics regulations but for corporate culture they do not come under MCI
  2. Corporate culture today are not under any medical regulations
  3. Doctors are not suppose to hire agents or touts but all corporate establishments have marketing departments.
  4. A doctor can be prosecuted under a criminal complaint but a company cannot.
  5. A doctors is not allowed to give rebates and commissions but to a corporate medical establishment there is no bar
  6. A doctor can not advertise but for a medical establishment there is no bar
  7. If an estimate give is for 50,000 and bill comes to 150,000 the corporate culture is not blamed. The one who is blamed is the treating doctor.

(The author Dr K K Aggarwal is Senior National Vice President Indian Medical Association and President Heart Care Foundation of India)

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45th Indian Society of Nephrology Conference, Kolkata, 18th to 21st December 2014

Dr Tiny Nair

An Interview with: Dr M Shreelatha, Calicut

What are the major reasons why CKD patients commonly suffer from renal anemia?

Anemia is very common in patients with chronic kidney disease. There are several causes of anemia in patients with CKD. The most common are iron deficiency and deficiency of erythropoietin (EPO).

Use of IV iron is the cornerstone in the management of CKD patients undergoing dialysis. Has ferric carboxymaltose (available as Ferinject) been proven to be as effective as other IV iron in hemodialysis patients?

Yes, the use of ferric carboxymaltose in hemodialysis patients has been demonstrated to be as effective as other forms of IV iron.

How can IV iron reduce the requirement of erythropoietin stimulating agents in CKD patients?

Erythropoietin stimulating agents are the most important cause of EPO resistance/hyporesponsiveness in patients with iron deficiency. This increases the associated morbidity and mortality. The use of ferric carboxymaltose reduces the need for erythropoietin stimulating agents as was demonstrated in the FIND-CKD trial.

Is ferric carboxymaltose is superior to iron sucrose in hemodialysis patients?

The use of ferric carboxymaltose and iron sucrose are equal in efficacy in hemodialysis patients, but ferric carboxymaltose has better safety and ease of administration.

What are the major advantages of ferric carboxymaltose in CKD patients over other IV formulations?

Ferric carboxymaltose can be administered by IV bolus dose; also, it can be more frequently administered.

Many CKD patients also suffer from CHF as comorbidity. Has the safety of ferric carboxymaltose been studied in CHF patients?

I am not aware of any such studies. But, theoretically, ferric carboxymaltose should be superior to iron-sucrose because it does not require extra water for administration.

How frequently do we need to administer ferric carboxymaltose in CKD patients?

Ferric carboxymaltose is administered total 1 g as bolus and then 100 mg monthly.

What are the major adverse events one can expect while administering ferric carboxymaltose?

We have observed no significant side effects in our study conducted with ferric carboxymaltose in my department in comparison with iron sucrose.

News Around The Globe

  • People with blood type O are less likely to develop type 2 diabetes than those with other blood groups, suggests a new large, prospective epidemiological study from France published online in Diabetologia.
  • The European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) has recommended approval of dalbavancin 500 mg for acute bacterial skin and skin structure infections (ABSSSI) in adults.
  • Neither lipid levels nor statin use appears to affect the incidence of proliferative diabetic retinopathy and macular edema, suggests a new study published online in JAMA Ophthalmology.
  • The development of musculoskeletal and vasomotor symptoms while receiving adjuvant aromatase inhibitor treatment for breast cancer does not influence relapse-free survival (RFS), suggest results from the NCIC Clinical Trials Group MA.27 trial. The report is published online in the Journal of Clinical Oncology.
  • Nitisinone decreases homogentisic acid (HGA) in patients with alkaptonuria (AKU) effectively and safely, suggests a new study published online in Annals of the Rheumatic Diseases.

Dr KK Spiritual Blog

Spiritual Prescriptions - Controlling the Inner Noise

Yoga Sutras of Patanjali define yoga as restraint of the mental states (Chapter 1.2). In the state of total restrain, the mind is devoid of any external object and is in its true self or the consciousness. To control the mind many Vedic scholars have given their own formulas.

Being in touch with one’s own consciousness requires restraining of the mind, intellect and ego on one hand and the triad of rajas, tamas and satwa on the other hand. Every action leads to a memory, which in turn leads to a desire and with this a vicious cycle starts.

The mental turmoil of thoughts can be equated to the internal noise and the external desires and objects to an external noise.

The process of withdrawing from the external noise with an aim to start a journey inwards the silent field of awareness bypassing the internal noise is called pratihaara by Yoga Sutras of Patanjali. It involves living in a satwik atmosphere based on the dos and don’ts learnt over a period of time or as told by the scriptures.

To control inner noise based thoughts we either need to neutralize negative thoughts by cultivating opposite thoughts or kill the origin of negative thoughts.

Not allowing thoughts to occur has been one of the strategies mentioned by the scholars. One of them has been neti-neti by Yagnayakya.

The other method is to pass through these inner thoughts and not get disturbed by it and that is what the process of meditation is. This can be equated to a situation where two people are talking in an atmosphere of loud external noise. For proper communication one will have to concentrate on each others voice for long till the external noise ceases to disturb. In meditation, one concentrates on the object of concentration to such an extent that the noisy thoughts cease to bother or exist.

One of the ways mentioned by Adi Shankaracharya in Bhaja Govindam and by Yoga Sutras of Patanjali (Chapter 2.35) is that whenever one is surrounded by evil or negative thoughts one should meditate open the contrary thoughts. For example, if one is getting evil desires after seeing bare breasts of a young lady, one can think that these very breasts gave me an opportunity to drink milk when I was born.

Similarly when one is feeling greedy, one can think of donating something to somebody. Deepak Chopra in his book Seven Laws of Spiritual Success talks in detail about the importance of giving and sharing. He says one should never visit his friends or relations empty handed. One should always carry some gift of nature, which if nothing is available can be a simple smile, compliment or a flower. By repeatedly indulging into positive behavior and thoughts, you can reduce the internal noise, which helps in making the process of meditation or conscious living a simpler one.

Washing out negative thoughts is another way mentioned by many Vedic scholars. Three minutes writing is one such exercise which anybody can do. Just before sleep anybody can do three minutes writing where you can write down all your emotions and then discard the paper. Another exercise is to reward or punish one self at bed time for the activities done during the day by either patting or slapping yourself.

Inspirational Story

The Cocoon

A man found a cocoon of a butterfly, and he brought it home. One day, a small opening appeared in the cocoon.

The man sat and watched the cocoon for several hours as the butterfly struggled to force its body through that little hole. Then it seemed to stop making progress. It appeared as if the butterfly had gotten as far as it could, and it could go no farther.

The man decided to help the butterfly in its struggle. He took a pair of scissors and snipped off the remaining bit of the co coon and the butterfly emerged easily.

As the butterfly emerged, the man was surprised. It had a swollen body and small, shriveled wings. He continued to watch the butterfly expecting that, at any moment, the wings would dry out, enlarge, and expand to support the swollen body. He knew that in time the body would contract, and the butterfly would be able to fly but neither happened!

In fact, the butterfly spends the rest of its life crawling around with a swollen body and shriveled wings. What the man, in his kindness and haste, did not understand was that the restricting cocoon and the struggle were required for the butterfly to be able to fly.

The butterfly must push its way through the tiny opening to force the fluid from its body and wings. Only by struggling through the opening can the butterfly's wings be ready for flight once it emerges from the cocoon.

Sometimes struggles are exactly what we need in our life. If our Higher Power allowed us to go through life without any obstacles, it would cripple us. We would not be as strong as what we could have been and we could never fly!

Spread your wings and prepare to fly, for you have become a butterfly... Fly abandonedly into the sun!

Rabies News (Dr A K Gupta)

What precautions should be taken while vaccinating by the ID route?

  • The ID injections must be administered by staff trained in this technique.
  • The Vaccine vials must be stored at +2°C to + 8°C after reconstitution.
  • The total content should be used as soon as possible, but at least within 8 hours.
  • The 0.1 ml. ID administration of cell–culture vaccine should create a wheal of at least 5 mm diameter with "peau de orange" appearance.
  • If ID dose is given subcutaneously then there is a possibility of poor immune response due to low antigen load. This may be life–threatening.

Cardiology eMedinewS

  • Successful transcatheter treatment of a leaky valve following valve-replacement surgery is associated with a significant reduction in mortality and improvements in functional class, suggests a new review published online in the Canadian Journal of Cardiology.
  • Prasugrel treatment should be delayed until after a decision is made about revascularization in patients undergoing percutaneous coronary intervention (PCI) for non-ST-elevation myocardial infarction (NSTEMI), suggest the results from the ACCOAST-PCI study. The study is published in the December 23 issue of the Journal of the American College of Cardiology.

Pediatrics eMedinewS

  • New flooring in the living environment of pregnant women significantly increases the risk of infants to suffer from respiratory diseases in their first year of life, reports a new study published in Environment International.
  • A new study, published in Pediatrics, suggests that delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life.
emedipicstoday emedipics

Health Check Up and CPR 10 Camp at GB S School, Khan Pur, New Delhi, on 27th November 2014

nova nova video of day
press release

Obesity reduces life expectancy

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 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)

 

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 :

 

Dr Good and Dr Bad

Situation: A patient with Mediclaim for the last seven years came for executive checkup.
Dr. Bad: You will have to pay from your pocket.
Dr. Good: You can claim it from Mediclaim.
Lesson: In addition to cumulative bonus, the insured shall be entitled for a reimbursement of the cost of medical checkup once at the end of block of every four underwriting years provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount of 1% of the total amount of the average sum insured during the block of four claim free underwriting years.

Make Sure

Situation: An asthmatic patient became worse after receiving a painkiller.
Reaction: Oh my God! Why was he not put on a leukotriene receptor antagonist?
Lesson: Make sure that a patient with asthma is not given aspirin or he is put on a leukotriene receptor antagonist (zafirlukast or montelukast).

eMedinewS Humor

Listening

The teacher, during an English lesson, asked her students: "Now tell me, what do you call a person who keeps on talking when people are no longer interested?"
Little Johnny, in the back row, raised his hand. "Yes, Johnny," said the teacher "A teacher!"

Twitter of the Day

Dr KK Aggarwal: Poly Diet and Poly Drugs by Dr k k Aggarwal
Dr Deepak Chopra: Love that has the power of vulnerability & surrender is invincible

Quote of the Day

Many people love in themselves what they hate in others. E. F. Schumacher

Wellness Blog

Is caffeine good for the health?

  1. Caffeine is the most consumed stimulant in the world.
  2. It is consumed in the form of coffee and tea.
  3. At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  4. Short term benefits include mental alertness and improved athletic performance.
  5. Short-term adverse effects including headache, anxiety, tremors and insomnia.
  6. Long-term adverse affects include generalized anxiety disorder and substance abuse disorders.
  7. Long-term benefits are dose-dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout. Both caffeinated and decaffeinated coffees are also associated with a lower risk of type 2 diabetes.
  8. Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long-term risk factor for myocardial disease.
  9. Most studies show a modest inverse relationship between coffee consumption and all-cause mortality.
  10. Caffeine withdrawal is a well-documented clinical syndrome with headache being the most common symptom. (Source: Uptodate)

ePress Release

Padma Shri Awardee Dr K K Aggarwal Receives Orator of the Year 2014 Award by St Mathew's School 

Recognizing outstanding contribution in the field of social work St. Mathew’s Senior Secondary School New Delhi honored Dr. K K Aggarwal with the Orator of the year Award 2014 in New Delhi on its Foundation Day.
 
An eminent cardiologist, President of Heart Care Foundation of India and the Senior National Vice President Indian Medical Association, Dr Aggarwal has also worked extensively towards helping the lower sections of the society.
 
Commenting on the occasion, Dr Aggarwal, Sr. National Vice President of the Indian Medical Association and the President of the Heart Care Foundation of India said, “I am honored to receive such a prestigious award from the St. Mathew’s Sr. Sec. School. Every individual has a right to live a healthy life and keeping this mind we started the Heart Care Foundation of India and till date have continued to help many patients live a healthy and normal life. The trust recognized my efforts towards the society and it gives me immense happiness and encouragement to keep doing the same throughout life.”
 
Dr Aggarwal is the recipient of three National Awards, namely the Padma Shri for brilliance in medicine, Dr. BC Roy award for excellence in socio-medical awareness and DST National Award for Outstanding Efforts in Science & Technology Communication. DR Aggarwal is also Limca Book of Record holder in CPR 10.

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: In a patient with a tumor in Superior medistinum compressing the superior vena cava, all the following venis would serve as alternate pathways forthe blood to return to the right atrium, except:

1.Lateral thoracic vein.
2.Internal thoracic vein.
3.Hemiazygos vein.
4.Vertebral venous plexus.

Answer for yesterday’s Mind Teaser: 4.Vertebral venous plexus.

Correct answers received from: Dr.K.Raju, Dr Jainendra Upadhyay, Dr Rakesh Sharma, Dr Avtar Krishan,  Manoj –Bhatt, Dr Jainendra Upadhyay

Answer for 20th December Mind Teaser: 2.Propionyl CoA.

Correct answers received from: Dr Rakesh Sharma Nohar, Dr Avtar Krishan.

Send your answer to email

medicolegal update
  1. Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal

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