eMedinewS22nd August 2014, Friday

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

Alternative Therapies Lower BP

A group of experts has reviewed all the existing studies and concluded that indeed there are alternative treatments for lowering blood pressure – with aerobic exercise leading the pack as far as strong evidence goes.

Other alternative treatments – namely isometric handgrip and dynamic resistance exercises and guided breathing –– also got high grades when it came to reducing high blood pressure in some patients, according to a scientific statement from the American Heart Association published online in the journal Hypertension.

"The evidence is not as strong for transcendental meditation and acupuncture, but they may help as well," said co–senior author Sanjay Rajagopalan, MD, professor of cardiovascular medicine at Ohio State University School of Medicine in Columbus.

For the report, an expert panel headed by the University of Michigan’s Robert D. Brook, MD, reviewed 1,000 studies published from 2006 to 2011. They divided the studies into three major classes of alternative treatments: behavioral therapies, noninvasive procedures and devices, and exercise. The panel did not review dietary and herbal treatments.

Based on the level of evidence, they gave each an "A," "B," or "C" recommendation –– with "A" being the highest –– for implementation into clinical practice.

The panel found:

  • Exercise–based regimens did the best overall, with dynamic aerobic exercises getting an "A" class of recommendation, with a level of evidence of I, the highest possible.
  • Dynamic resistance exercises got a "B" and isometric handgrip exercises got a "C" grade, with levels of evidence of IIA and IIB, respectively.
  • Still, 4 weeks of isometric hand grip exercises resulted in some of the most impressive improvements in several studies –– a 10% drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely uncontrolled hypertension (180/110 mm Hg or higher).
  • As for noninvasive procedures or devices, device–guided breathing got a "B" with a level of evidence of II. Device–guided slow breathing proved most effective in lowering blood pressure when performed for 15–minute sessions three to four times a week.
  • Acupuncture also got a "B," but its level of evidence was III, meaning no benefit.
  • Among behavioral techniques, transcendental meditation and biofeedback both received "B" grades, with IIBs for levels of evidence. Yoga got a C, with level of evidence of III, or no benefit, as did other meditation techniques.
  • The alternative approaches that work reduce systolic blood pressure by only 2 to 10 mm Hg; whereas standard doses of a blood pressure–lowering drug reduce systolic blood pressure by about 10 to 15 mm Hg.
  • Alternative approaches are best for patients with blood pressure levels over 120/80 mm Hg who can’t tolerate or don’t respond well to standard medications.

News Around The Globe

  • Infection with Giardia may triple the risk for irritable bowel syndrome (IBS) and chronic fatigue (CF) even years after infection, suggests a prospective study published online in the journal Clinical Infectious Diseases.
  • The US Food and Drug Administration (FDA) has approved fluticasone furoate inhalation powder as maintenance treatment for asthma in patients aged 12 years and older. The FDA approved two doses, 100 and 200 μg, to be administered once daily.
  • A simple test evaluating involuntary eye movements may help determine attention–deficit/hyperactive disorder (ADHD) in an individual and may also predict whether stimulant medication will be an effective treatment, suggests new research published in the August issue of Vision Research.
  • Combination treatment with psychotherapy and antidepressant medication (ADM) could optimize the rates of recovery in patients with severe, nonchronic major depressive disorder (MDD), suggests a large–scale, multicenter, randomized clinical trial published online August 20 in JAMA Psychiatry.
  • A UK study, published online August 19 in the BMJ, supports the public–health benefits of actively commuting to work, including lower body mass index (BMI) and body–fat composition, in comparison to taking the car. Researchers noted that men who used public transport or who walked or cycled to work had BMI scores 1.10 and 0.97 points lower, respectively, than men who used private transport.

Rabies News (Dr A K Gupta)

Is age of the biting dog important in transmission of rabies?

No. Neither the age nor the breed or sex of the dog is important in transmission of rabies.

Cardiology eMedinewS

  • A new joint statement from the American Heart Association (AHA) and the American Diabetes Association (ADA) looks into the current state of knowledge about cardiovascular disease in type 1 diabetes and finds it lacking. The statement is published online in both Circulation and Diabetes Care.
  • Directional atherectomy appears effective for lower extremities revascularization in claudication or critical limb ischemia (CLI), suggest 12-month results from the DEFINITIVE LE study. The findings are published in the August issue of JACC: Cardiovascular Interventions.

Pediatrics eMedinewS

  • A recent study has shown that children with sickle cell anemia and asymptomatic neurologic injury at 58% lower risk to suffer a repeat cerebral infarction while undergoing regular blood transfusions. The study is published in the August 21 issue of the New England Journal of Medicine.
  • New research suggests that the strong effect of minor infections on risk of stroke in children appears to be short lived. Researchers noted that the risk is highest during the 3 days following a doctor’s visit for an infection, after which it rapidly decreases. The study is published online August 20 in Neurology.

Dr K K Spiritual Blog

Identify seven types of mothers and give them mother’s day gift

As per Vedic literature "&a;tma–mata guroh patni, brahmani raja–patnika, dhenur dhatri tatha prthvi, saptaita matarah smrtah,” there are seven types of mothers.

  1. Atma mata: The mother who gave me birth
  2. Guru patni: The wife of my teachers, guru or master
  3. Brahmni: The wife of our Brahmin to whom we call for our religious functions
  4. Raja Patni: President’s wife
  5. Dhenur : Cow
  6. Dhatri: Anyone who has helped in my growing (sister, ayah or domestic help, grandmother, nurse, gynecologist)
  7. Prithvi: Mother earth

The possible gifts are

  • Non materialistic: Appreciation, care, love, affection, time, compliments.
  • Materialistic gifts.
    • Vitamin D sachets, once per month, 12 sachets.
    • One year supply of iron folic acid, weekly one tablet.
    • One year supply of calcium supplements.
    • Four tablets of albendazole, to be taken one every three months.
    • Pneumonia vaccine once five years or once for life if mother above 65.
    • Flu vaccine once a year.
    • Typhoid vaccine once in three years.
    • Round trip for pilgrimage tour.
    • Sumer supply of Sattu, jaggery, fruits or dry fruits.
    • Filter for safe water supply.

Wellness Blog

Eating junk food: It’s in the brain

When it comes to eating junk food one may blame the brain. Addiction is a disease and the same has been proved by a study.

Two areas of the brain have to work together to give the self–control to reject unhealthy foods. California Institute of Technology researchers used MRI to scan the brains of volunteers as they looked at photos of dozens of types of foods and decided which ones they’d like to eat. They found significant differences in the brain activity between people who had self–control in terms of making food choices and those with no self–control.

An area of the brain called the ventromedial prefrontal cortex is involved in all value–based decisions. When ventromedial prefrontal cortex activity decreases, a person will probably reject an item, whereas increased activity means they’ll probably choose it.

The study published in the issue of Science found that in people with no self–control, the ventromedial prefrontal cortex seemed to take into consideration only the taste of a food.

In people with good self–control another area of the brain called dorsolateral prefrontal cortex becomes active and modulates the basic value signals so that the self–controllers also incorporate health considerations into their decisions.

The study showed that ventromedial prefrontal cortex is active during every decision and that the DLPFC is more active when a person is using self–control.

Inspirational Story

Diff between Man and Woman

Let’s say a guy named Fred is attracted to a woman named Martha. He asks her out to a movie; she accepts; they have a pretty good time. A few nights later he asks her out to dinner, and again they enjoy themselves. They continue to see each other regularly, and after a while neither one of them is seeing anybody else.

And then, one evening when they're driving home, a thought occurs to Martha, and, without really thinking, she says it aloud: "Do you realize that, as of tonight, we’ve been seeing each other for exactly six months?"

And then, there is silence in the car.

To Martha, it seems like a very loud silence. She thinks to herself: I wonder if it bothers him that I said that. Maybe he’s been feeling confined by our relationship; maybe he thinks I'm trying to push him into some kind of obligation that he doesn't want, or isn't sure of.

And Fred is thinking: Gosh. Six months.

And Martha is thinking: But, hey, I'm not so sure I want this kind of relationship either. Sometimes I wish I had a little more space, so I’d have time to think about whether I really want us to keep going the way we are, moving steadily towards, I mean, where are we going? Are we just going to keep seeing each other at this level of intimacy? Are we heading toward marriage? Toward children? Toward a lifetime together? Am I ready for that level of commitment? Do I really even know this person?

And Fred is thinking: …so that means it was…let’s see…February when we started going out, which was right after I had the car at the dealer’s, which means…lemme check the odometer…Whoa! I am way overdue for an oil change here.

And Martha is thinking: He’s upset. I can see it on his face. Maybe I’m reading this completely wrong. Maybe he wants more from our relationship, more intimacy, more commitment; maybe he has sensed – even before I sensed it – that I was feeling some reservations. Yes, I bet that’s it. That’s why he’s so reluctant to say anything about his own feelings. He’s afraid of being rejected.

And Fred is thinking: And I'm gonna have them look at the transmission again. I don’t care what those morons say, it’s still not shifting right. And they better not try to blame it on the cold weather this time. What cold weather? It's 87 degrees out, and this thing is shifting like a garbage truck, and I paid those incompetent thieves $600.

And Martha is thinking: He’s angry. And I don’t blame him. I’d be angry, too. I feel so guilty, putting him through this, but I can’t help the way I feel. I’m just not sure.

And Fred is thinking: They’ll probably say it’s only a 90–day warranty…scumballs.

And Martha is thinking: Maybe I’m just too idealistic, waiting for a knight to come riding up on his white horse, when I’m sitting right next to a perfectly good person, a person I enjoy being with, a person I truly do care about, a person who seems to truly care about me. A person who is in pain because of my self–centred, schoolgirl romantic fantasy.

And Fred is thinking: Warranty? They want a warranty? I’ll give them a warranty. I’ll take their warranty and stick it right up their…

"Fred," Martha says aloud.

"What?" says Fred, startled.

"Please don’t torture yourself like this," she says, her eyes beginning to brim with tears. "Maybe I should never have…oh dear, I feel so…"(She breaks down, sobbing.)

"What?" says Fred.

"I’m such a fool," Martha sobs. "I mean, I know there’s no knight. I really know that. It’s silly. There’s no knight, and there’s no horse."

"There’s no horse?" says Fred.

"You think I'm a fool, don’t you?" Martha says.

"No!" says Fred, glad to finally know the correct answer.

"It’s just that…it’s that I…I need some time," Martha says.

(There is a 15–second pause while Fred, thinking as fast as he can, tries to come up with a safe response. Finally he comes up with one that he thinks might work.)

"Yes," he says. (Martha, deeply moved, touches his hand.)

"Oh, Fred, do you really feel that way?" she says.

"What way?" says Fred.

"That way about time," says Martha.

"Oh," says Fred. "Yes." (Martha turns to face him and gazes deeply into his eyes, causing him to become very nervous about what she might say next, especially if it involves a horse. At last she speaks.)

"Thank you, Fred," she says.

"Thank you," says Fred.

Then he takes her home, and she lies on her bed, a conflicted, tortured soul, and weeps until dawn, whereas when Fred gets back to his place, he opens a bag of Doritos, turns on the TV, and immediately becomes deeply involved in a rerun of a college basketball game between two South Dakota junior colleges that he has never heard of. A tiny voice in the far recesses of his mind tells him that something major was going on back there in the car, but he is pretty sure there is no way he would ever understand what, and so he figures it’s better if he doesn’t think about it.

The next day Martha will call her closest friend, or perhaps two of them, and they will talk about this situation for six straight hours. In painstaking detail, they will analyse everything she said and everything he said, going over it time and time again, exploring every word, expression, and gesture for nuances of meaning, considering every possible ramification.

They will continue to discuss this subject, off and on, for weeks, maybe months, never reaching any definite conclusions, but never getting bored with it either.

Meanwhile, Fred, while playing racquetball one day with a mutual friend of his and Martha’s, will pause just before serving, frown, and say: "Norm, did Martha ever own a horse?"

And that’s the difference between men and women.

Self-Assessment-Quiz

 

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Zee News – Health Wealth Shows

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Total CPR since 1st November 2012 – 96458 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."

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CPR 10 Videos

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Health Check Up and CPR 10 Camp at NP Primary School Kaka Nagar on 11th August 2014

press release

PPIs may be associated with a higher risk for clostridium difficile–associated diarrhea

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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 was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of National Registry of Myocardial Infarction 2 (NRMI–2) trial suggest that this intervention is much better than thrombolytic therapy in such patients.

eMedinewS Humor

Salesman to Policeman

A salesman, tired of his job, gave it up to become a policeman.

Several months later, a friend asked him how he liked his new role.

"Well," he replied, "the pay is good and the hours aren’t bad, but what I like best is that the customer is always wrong."

Quote of the Day

If we would see the color of our future, we must look for it in our present; if we would gaze on the star of our destiny, we must look for it in our hearts. Canon Farrar

Twitter of the Day

Dr KK Aggarwal: Preventing electrical deaths in monsoon http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: The path to joy is a return to wholeness. Here are my Eight Secrets to Free Your Spirit and Find Joy http://bit.ly/DC_Ananda

ePress Release

Vegetarian diet and Soya Products help reduce BP

Ingestion of a vegetarian diet may reduce systolic blood pressure by 5 mmHg. A 5 mm reduction in blood pressure may reduce the risk of heart disease by 21%. This was stated by 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.

One major feature of a vegetarian diet that may affect blood pressure is the amount of dietary fiber; with an increased amount being associated with decreased systemic pressures. Multiple meta–analyses have shown benefits with dietary fiber intake on blood pressure.

Vegetarians, in general, have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. Experts postulate that a typical vegetarian’s diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, vitamin C and vitamin A, all of which may have a favorable influence on blood pressure.

More significant reductions were observed in older (greater than 40 years) and hypertensive individuals.

Soya is good for high blood pressure because it is naturally high in potassium and low in sodium. Potassium and sodium are electrolytes, and a high–potassium, low–sodium diet promotes a healthy blood pressure.

Soya can be good for high blood pressure when you eat it as an alternative protein source to unhealthy meats. Soya–based meat substitutes, such as veggie burgers, veggie bacon and meatless cold cuts, can be higher in fiber and lower in sodium than animal-based meat products. They can lower your risk for heart disease because they are lower in saturated fat. However, soya does not contain the long–chain omega–3 fatty acids that are found in fatty fish and shellfish; these may lower your blood pressure, according to the Linus Pauling Institute.

Even though soya is low in unhealthy saturated fat, some soya products are high in total fat and calories, and as a result will contribute to weight gain if you eat too much. Losing weight if you are overweight, or maintaining your current weight if you are already at a healthy weight, improves your chances of lowering your high blood pressure.

eMedi Quiz

The syndromic management of urethral discharge includes treatment of:

1. Neisseria gonorrhoeae and herpes genitalis.
2. Chalamydia trachomatis and herpes genitalis.
3. Neisseria gonorrhoeae and Chlamydia trachomatis.
4. Syphilis and chancroid.

Yesterday’s Mind Teaser: The Vitamin A supplement administered in Prevention of nutritional blindness in children programme" contains:

1. 25,000 i.u./ml.
2. 1 lakh i.u./m.l.
3. 3 lakh i.u./m.l.
4. 5 lakh i.u./m.l.

Answer for yesterday’s Mind Teaser: 2. 1 lakh i.u./m.l.

Correct answers received from: Dr P C Das, Dr K V Sarma, Daivadheenam Jella, Dr Chandresh Jardosh, Smriti Aggarwal, Dr Avtar Krishan, Dr Deepali Chatterjee, Arvind Diwaker.

Answer for 22nd August Mind Teaser: 3. True positives+ False positives

Correct answers received from: Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Smriti Aggarwal, Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Deepak Ambli, Dr Pankaj Agarwal, Dr Jayashree Sen, Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Thanks for the information: Regards, Dr Kanishk

Forthcoming Events

Seeking media opportunity: Dr. KK Aggarwal giving an oration on spirituality and health in Pune

Dr. KK Aggarwal is giving an oration on Spirituality and Health in Pune. His talking points would include:

  1. Health and Spirituality
  2. Modern Medicine vs Spirituality
  3. Medical Negligence and ethics a doctor must follow during his practice
  4. Reversal of heart disease

Dr. KK Aggarwal is the only doctor in the country to receive all three National awards, namely the Padma Shri, Dr.B C Roy National Award and DST National Science and Communication Award. A spiritual orator and writer, Dr. KK Aggarwal is an expert in the field of scientific healthcare communication.

A member of the Ethics Committee of the Medical Council of India, Dr. Aggarwal is also well versed with topics such as ethical guidelines every medical practitioner must follow, medical negligence, article 21 and a person’s right to universal healthcare.

Venue: SKN Medical College S.No. 49/1, Westerly Bypass Road, Narhe (Ambegaon), Pune – 411 041.

Date: Friday, 22nd August 2014
Oration Time: 2:00 pm onwards

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