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  From the Desk of Editor–in–Chief
Dr KK 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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

23rd January 2013, Wednesday

Beware of fatty liver

Fatty liver is present in up to 30% of population, up to 60% in patients who are at risk for heart disease and in up to 90% of obese persons.

  • Nonalcoholic fatty liver disease (NAFLD) means presence of hepatic steatosis (fatty liver), when no other causes for secondary hepatic fat accumulation (heavy alcohol consumption) are present.
  • NAFLD, if not treated, may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis.
  • NAFLD is subdivided into
    o Nonalcoholic fatty liver (NAFL) or simple fatty liver with no liver inflammation.
    o Nonalcoholic steatohepatitis (NASH) or fatty liver with liver inflammation
  • Patients with NAFLD may have mild or moderate elevations in SGOT and SGPT levels (liver enzymes).
  • Normal SGOT and SGPT levels, however, do not exclude NAFLD.
  • When elevated, the SGOT and SGPT levels are typically 2 to 5 times the upper limit of normal.
  • In acute viral hepatitis, the SGOT/SGPT ratio is less than 1 (unlike alcoholic fatty liver disease, which typically has a ratio greater than 2)
  • The degree of SGOT and SGPT elevation does not predict the degree of liver inflammation or fibrosis, and a normal SGOT, SGPT levels does not exclude clinically important histologic injury.
  • The alkaline phosphatase may be elevated to 2 to 3 times the upper limit of normal.
  • Serum albumin and bilirubin levels are typically within the normal range, but may be abnormal in patients who have developed cirrhosis. When cirrhosis sets in, one may have prolonged prothrombin time and cytopenias.
  • A serum ferritin greater than 1.5 times the upper limit of normal in patients with NAFLD may mean presence of inflammation.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What are the alarm symptoms in constipation?

Alarm symptoms include rectal bleeding, hemoccult positive stools, obstructive symptoms, recent onset of constipation, weight loss, a change in stool caliber. The presence of these symptoms calls for more extensive evaluation.

 
Dr K K Aggarwal
    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

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

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A CPR 10 training camp was conducted at Modern Era Convent School, Janakpuri by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Vice President Elect IMA

 
Dr K K Aggarwal
    National News

Free Checkup Camp at Lajpat Nagar

To commemorate Republic Day, Heart Care Foundation of India along with Sevakram Naturopathy Centre, Lajpat Bhavan is organizing a free Heart Checkup Camp on 27th January, Sunday at Lajpat Nagar, Near Vikram Hotel.

The Camp will focus on disease of the Heart Valve. A team led by Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, alongwith other valvular experts from the city will conduct the camp.

Giving the details Dr Aggarwal said that 1% of the population suffers form valvular heart disease and if deducted in time it can be treated and corrected.

The camp will be open from 10 AM to 2 PM.

Be Human Stop Child Abuse

Dear Colleague,

Greetings from Team India Medical Association for CMAAO meet.

Indian Medical Association will be hosting the 49th CMAAO Council Meeting on the subject “Be Human Stop Child Abuse” from 12th to 14th September, 2013, at Hotel Shangri-La, Ashoka Road, New Delhi.

We have created a facebook page on the theme. It can be seen on the following link:

www.facebook.com/BeHumanStopChildAbuse

Kindly join this page by liking it.

About CMAAO

CMAAO is a Confederation of Medical Associations of Asia and Oceania. The associated countries are : Australian Medical Association; Bangladesh Medical Association; Cambodian Medical Association; The Hong Kong Medical Association; Indian Medical Association; Indonesian Medical Association; Japan Medical Association; Korean Medical Association; Macau Medical Association; Malaysian Medical Association; Myanmar Medical Association; Nepal Medical Association; New Zealand Medical Association; Philippine Medical Association; Singapore Medical Association; Sri Lanka Medical Association; Taiwan Medical Association and The Medical Association of Thailand. The secretariat of the CMAAO is in Tokyo under Japan Medical Association.

Pune Municipal Corporation to overhaul system to curb mosquito-breeding

PUNE: The Pune Municipal Corporation (PMC) has designed a microplanning system to curb mosquito-borne infections, such as dengue, malaria and chikungunya, in view of the increasing number of cases of such diseases in the last few months. Anti-mosquito measures were last overhauled in 2003, when a massive spurt in dengue cases was reported in the city. From recruiting manpower to setting up a testing laboratory, the new system envisages microplanning and allotting specific responsibilities to ward medical officers and zonal medical officers to prevent mosquito breeding. Dengue fever has infected over 1,000 people and claimed over 16 lives in the city since August last year. "Microplanning is more in tune with requirement of the city's population, which has increased considerably over the last 10 years, and the projected pace of population growth in coming years. The 'zero mosquito' goal, which forms the basis of this planning, needs clearly demarcated responsibilities at ward and zonal level to increase accountability," said S T Pardeshi, medical officer of health, Pune Municipal Corporation (PMC). (Source: TOI, Jan 22, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

Bicuspid aortic valve is also associated with coarctation of the aorta.

(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)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Cancer drug controls tumors in rare disorder

A rare genetic disorder that causes noncancerous kidney tumors can be controlled with everolimus (Afinitor), researchers reported. (Source: Medpage Today)

LVAD guidelines seek to bridge evidence gap

New guidelines for use of left ventricular assist devices (LVADs) aim to bolster best practices by focusing on patient selection, preparation, inpatient management, and long-term care. (Source: Medpage Today)

3D imaging boosts breast cancer detection

Breast cancer detection increased by 27% when three-dimensional mammography was combined with conventional breast imaging, investigators reported. (Source: Medpage Today)

CDC: Flu hitting harder, too early to tell if it's peaking

Influenza is hitting the nation harder than it did at this point last year, but it could be peaking in some parts of the country, the Centers for Disease Control and Prevention (CDC) announced. (Source: Medscape)

SCCT policy statement recommends CT prior to TAVI/TAVR procedures

The Society of Cardiovascular Computed Tomography (SCCT) has issued a consensus statement on the use of CT imaging before transcatheter aortic-valve implantation (TAVI)/transcatheter aortic-valve replacement (TAVR), highlighting the importance of the imaging modality for patients receiving the catheter-based aortic valve. (Source: Medscape)

Flu-fighting foods

Beyond the flu shot, and avoiding physical contact like handshakes, one can also build up their immune system with foods.

  • Proteins is lean meat, poultry, seafood, eggs, beans and soy products can boost immunity
  • Vitamin A protects from infections and is present in colorful carrots, kale, spinach, sweet potatoes, and red bell peppers.
  • Vitamin C boosts immunity and is present in citrus fruits.
  • Vitamin E in nuts works as an antioxidant neutralizing free radicals. Throw in some almonds or sunflower seeds for a little healthy Zinc. Other sources are lean beef, crab, black eye peas and tofu! [Source Medline Plus]
 
    Twitter of the Day

@DrKKAggarwal:Chat with Dr KK: Dr HK Chopra: Nirvana is eternal happiness, with desire which is selfless. Krodh - manage (cont) http://tl.gd/kp09uh

@DrKKAggarwal: Using drugs to cope with your emotional pain & depression? Our Vancouver Treatment Center can help http://bit.ly/CTC_Prog

 
    Spiritual Update

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

Doctors are for patients’ safety

Properly documented medical doctors are for doctor’s safety was the concluding remarks of the JCI team who recently concluded their inspection at Moolchand Medcity.

For comments and archives

    Be Human Stop Child Abuse (Team IMA for CMAAO)

Medical neglect in a child

In addition to refusal to seek or delay in seeking medical care, medical neglect also includes lack of adherence to health care recommendations.

Lack of adherence can be due to lack of education, motivation, resources, or understanding.

American Academy of Pediatrics recommends that physicians respect parental religious beliefs and the role of parents in rearing their children, and seek to make collaborative decisions with families whenever possible.

BUT if the physician believes that parental religious convictions interfere with appropriate medical care that is likely to prevent substantial harm, suffering, or death, the doctor should request court authorization to override parental authority.

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the causes of hirsutism?

  • Polycystic ovarian syndrome or PCOS is a form of hyperandrogenism in which hormonal imbalances cause the ovaries to overproduce androgens. It is a common cause of hirsutism and is frequently associated with irregular or absent ovulation and infertility. Multiple small cysts develop in the ovaries, hence the term polycystic. These small cysts are actually immature ovarian follicles that failed to mature and ovulate. Menstrual periods may become irregular or cease due to lack of ovulation.
  • Unexplained hirsutism: Some women have hair follicles that are abnormally sensitive to androgens. Androgen levels are normal and menstrual periods occur regularly in these patients. This tendency to develop hirsutism is genetic but the cause is not known.
  • Non–classic adrenal hyperplasia: The most common abnormality of the adrenal glands that can result in hirsutism is an inherited disorder called non–classic adrenal hyperplasia (NCAH), which causes the adrenal glands to overproduce androgens. Like PCOS, NCAH is associated with irregular menstrual cycles. NCAH is a genetic disorder most commonly seen in certain ethnic groups including Ashkenazi Jews, Eskimos, and French–Canadians. Elevation of the hormone 17a–hydroxyprogesterone is characteristic of NCAH.
  • HAIR–AN syndrome (Hyperandrogenism, Insulin Resistance, Acanthosis Nigricans): Some women are born with insulin resistance, a severe defect in the ability of insulin to control blood sugar levels. To compensate, the pancreas produce ovulation. Insulin resistance may lead to diabetes mellitus, high blood pressure, heart disease, and excessive growth and darkening of the skin (acanthosis nigricans), which generally occurs around the neck and crease areas of the skin.
 
    Tat Tvam Asi………and the Life Continues……

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity, Gurgaon)

Is it safe to donate a part of our liver?

Most people think that we have only one liver so how can we donate it? We have nearly 70% extra liver and a healthy liver is the only organ which regenerates. Fortunately there are two lobes of the liver – right and left and each lobe is further divided into segments. Each lobe has separate arterial, venous and ductal (bile duct) supply. Therefore we could donate one part of our liver – right, left or left lateral.

 
    An Inspirational Story

A Promise is a Promise

A man’s wife called him, “How long will you be poring over that newspaper? Will you come here and make your darling daughter eat her food?” he tossed the paper away and rushed to the scene.

His only daughter Sindu, looked frightened, tears were welling up in her eyes, in front of her was a bowl filled to its brim with Curd Rice.

Sindu is a nice child, quite intelligent for her age, she has just turned eight; she particularly detested Curd Rice. His mother and his wife are orthodox and believe firmly in the ‘cooling effects’ of Curd Rice! He cleared his throat, and picked up the bowl. “Sindu, darling, why don’t you take a few mouthfuls of this Curd Rice?

Just for Dad’s sake, dear? And, if you don’t, your Mom will shout at me.”He could sense his wife’s scowl behind his back. Sindu softened a bit, and wiped her tears with the back of her hands.

“OK, Dad. I will eat – not just a few mouthfuls, but the whole lot of this. But, you should…” Sindu hesitated, “Dad, if I eat this entire curd Rice, will you give me whatever I ask for?”

"Oh sure, darling’.“Promise?” “Promise.”

He covered the pink soft hand extended by his daughter with mine and clinched the deal.

“Ask Mom also to give a similar promise”, his daughter insisted, his wife slapped her hand on Sindu’s, muttering, “Promise”, without any emotion.

Now he became a bit anxious. “Sindu dear, you shouldn’t insist on getting a computer or any such expensive items, Dad does not have that kind of money right now. OK?”

“No, Dad. I do not want anything expensive.”

Slowly and painfully, she finished eating the whole quantity, he was silently angry with his wife and his mother for forcing my child to eat something that she detested.

After the ordeal was through, Sindu came to him with her eyes wide with expectation, all our attention was on her.

“Dad, I want to have my hair shaved off, this Sunday!’ was her demand.

“Atrocious!” shouted her wife, “A girl child having her hair shaved off? Impossible!”

“Never in our family!” her mother rasped. “She has been watching too much television, our culture is getting totally spoiled with these TV programs!”

“Sindu darling, why don’t you ask for something else? We will be sad seeing you with a clean-shaven head.”

“No, Dad. I do not want anything else”, Sindu said with finality.

“Please, Sindu, why don’t you try to understand our feelings?” he tried to plead with her.

“Dad, you saw how difficult it was for me to eat that Curd Rice.” Sindu was in tears. “And you promised to grant me whatever I ask for, now, you are going back on your words.

Was it not you who told me the story of King Harishchandra, and its moral that we should honor our promises no matter what?”

It was time for him to call the shots. “Our promise must be kept.”

“Are you out your mind?” chorused his mother and wife.

“No. If we go back on our promises, she will never learn to honor her own, Sindu, your wish will be fulfilled.”

With her head clean-shaven, Sindu had a round-face, and her eyes looked big and beautiful. On Monday morning, he dropped her at her school. It was a sight to watch his hairless Sindu walking towards her classroom. She turned around and waved, he waved back with a smile.

Just then, a boy alighted from a car, and shouted, “Sinduja, please wait for me!”

What struck me was the hairless head of that boy. Maybe, that is the in-stuff, he thought.

“Sir, your daughter Sinduja is great indeed!”

Without introducing herself, a lady got out of the car and continued.

“That boy who is walking along with your daughter is my son Harish. He is suffering from leukemia.” She paused to muffle her sobs. “Harish could not attend school for the whole of the last month. He lost all his hair due to the side effects of the chemotherapy.

He refused to come back to school fearing the unintentional but cruel teasing of the schoolmates. Sinduja visited him last week and promised him that she would take care of the teasing issue.

But, I never imagined she would sacrifice her lovely hair for the sake of my son! Sir, you and your wife are blessed to have such a noble soul as your daughter.”

He stood transfixed and then, wept. He said “My little Angel, you are teaching me how selfless real love is!”

For comments and archives

 
    Cardiology eMedinewS

Global impact: ECHO screening for rheumatic heart disease Read More

Devices for stroke Read More

 
    Pediatric eMedinewS

Appendectomy with same day discharge Read More

Diagnostic imaging and negative appendectomy rates Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with CKD wanted a cardiology reference.
Dr Bad: It’s not needed.
Dr Good: You should get it done.
Lesson: Chronic renal dysfunction alone is an independent risk factor for the development of coronary artery disease, and for more severe coronary heart disease.

Make Sure

Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson: Make sure that all foreigners are diagnosed to be suffering from travelers’ diarrhea even if there is one single loose motion.

 
  Quote of the Day (Dr GM Singh)

The will to win means nothing if you haven’t the will to prepare. Juma Ikangaa

 
    Mind Teaser

Read this…………………

Which action will best help reduce anxiety in a 64-year-old patient who has been hospitalized for suspected peptic ulcer disease?

A. Ask all members of the team to reassure the patient about the quality of care provided in the hospital.
B. Assign the patient to a room with a talkative, optimistic roommate.
C. Explain to the patient what will happen during the hospitalization.
D. Visit the patient frequently and get the patient to talk about pleasant future plans.

Yesterday’s Mind Teaser: Dennis receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis is probably experiencing:

A. An anaphylactic transfusion reaction
B. An allergic transfusion reaction
C. A hemolytic transfusion reaction
D. A pyrogenic transfusion reaction

Answer for yesterday’s Mind Teaser: C. A hemolytic transfusion reaction

Correct answers received from: Dr B K Agarwal, Prabha Sanghi, Dr. Arvind Khanijo, Dr. Bharat Bhushan Aggarwal, Rajiv Kohli, drjella, Dr.K.V.Sarma, DR SHAGUFTA MOIN, Dr Kanta Jain, Dr.(Maj. Gen.) Anil Bairaria,, Dr. P. C. Das, Arpan Gandhi, dr deepali chatterjee, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Avtar Krishan

Answer for 21st January Mind Teaser: D. “Does it help you to joke about your illness?”

Correct answers received from: Arpan Gandhi, dr deepali chatterjee, Dr Avtar Krishan, Dr Prabodh Kumar Gupta Dr.K.V.Sarma, Dr.RAGHAVENDRA JAYESH

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

"One of the most difficult things in the world is to convince a woman that even a bargain costs money. " Edgar Watson Howe

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Doctor and care of the terminally ill

The duty of the physician is to heal and, where possible, relieve suffering and act to protect the best interests of his patients. There shall be no exception to this principle even in the case of incurable disease or malformation. This principle does not preclude application of the following rules:

  • The physician may relieve suffering of a terminally ill patient by withholding treatment with the consent of the patient or his immediate family if unable to express his will.
  • Withholding of treatment does not free the physician from his obligation to assist the dying person and give him the necessary medicaments to mitigate the terminal phase of his illness.
  • The physician shall refrain from employing any extraordinary means, which would prove of no benefit for the patient.
  • The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
  • These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

For comments and archives

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    Public Forum

(Press Release for use by the newspapers)

CPR 10 training at School at Janakpuri

Conducting a CPR 10 training camp at Modern Era Convent School, Janakpuri, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Vice President Elect IMA said that in last 2 ½ months at least two lives have been saved by public who has learnt Cardiopulmonary Resuscitation.

Dr. Aggarwal said that 50 people die every day in Delhi of a cardiac illness and 5-6 lives should be saved every day if general public learns CPR. He said that Heart Care Foundation of India plans to train one lakh people within this year.

Over 1200 school children were trained in CPR which is based on the mantra – “within 10 minutes of sudden cardiac death (earlier the better) for the next 10 minutes (longer the better) compress the centre of the chest of the victim with a speed of 10 x 10 i.e. 100.”

Addressing the gathering Mrs K.G. Modi, Principal of the school said that as a good Samaritan, it is the duty of every teacher to learn CPR and in turn train parents and school children so that every child learns that CPR 10 training is not only for organization but is also for each and every person and family.

 
    Readers Responses

Dear Dr KK, This is about your article on 'Claims of Cure' etc. and the Reader's response of Dr Tuli. While your argument goes in favor of negating false claims that mislead people, reply from Dr Tuli is not far from truth. I have two small observations.

  • How is it that in the last few years, big full size advertisements on 'Educational Institutes' and "Hospitals", "Medicines" etc. are on both TV and Newspapers. The biggest issue is Ethical. It is to be seen beyond INFORMATION, often they claim. They are fortified with statements like Largest, Biggest, Best, so on...
  • The drug companies fail or deliberately ignore the wisdom and the values in the other systems. Any system becomes acceptable only when systematically analyzed, TRUE, but why are such attempts not made for so many systems of Indian origin (AYUSH)?
  • There is an unseen monopoly by the western dominated Pharma companies, which try to snub ideas and products of other origin.
  • I feel sad further when I find that the so-called research institutes do not probe with enthusiasm.
  • The practitioners of Modern medicine do not talk with experts or participate in the interactive meetings of other systems of cure.

Unless the Government establishes a Centre for Medical Research in Indian and Allied Sciences, the interactive center should embrace other scholars with equal respect and openness. Regards, Prof KS Ratnakar, Director, Global Medical Education & Research, Global Hospitals, Hyderabad.

 
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