eMedinewS
23rd November 2014, Sunday

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

Flu in children

  • The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestation of respiratory tract illness – sore throat, sough and nasal discharge.
  • All the above features may not be present in children.
  • Flu sometimes may last for more than a week in children.
  • Ear discharge, development into asthma and pneumonia are common complications in children.
  • Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph.
  • During winter, flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat.
  • Fever is present in over 95% of cases, often more than 39oC.
  • Cough is present in over 77% patients.
  • Nasal discharge is present in more than 78% patients.
  • Headache is present in more than 26% patients.
  • Muscle pain is present in more than 71 % patients.
  • Incubation period is 1-4 days with high transmissibility.
  • The treatment is often symptomatic.
  • Cough hygiene should be practiced.

News Around The Globe

  • Genetically low vitamin D concentrations are associated with deaths due to cancer and other causes but not cardiovascular disease mortality, a new study finds published in November 18 in the BMJ by Dr Shoaib Afzal (Copenhagen University Hospital, Denmark)
  • Bypass surgery may be the preferred option for coronary revascularization in patients with diabetes, especially when long-term survival is anticipated, according to results of a systematic review and meta-analysis. Dr. James M. Brophy from McGill University Medical Center and the Royal Victoria Hospital in Montreal, Quebec, Canada.
  • Guiding principles for the care of people with or at risk for diabetes has been produced by the federally funded National Diabetes Education Program (NDEP), cosponsored by the National Institutes of Health and Centers for Disease Control and Prevention. The Alzheimer's disease (AD) drug memantine (Namenda, Forest Laboratories, Inc), a medication that blocks N-methyl-D-aspartate (NMDA) receptors, may also decrease binge eating behaviors.
  • The proportion of patients experiencing a rapid decline in estimated glomerular filtration rate (eGFR) can be reduced significantly with niacin, as can all-cause mortality, suggest the results of an observational study presented at Kidney Week 2014.
  • A study presented at the American Academy of Optometry 2014 Annual Meeting revealed that blinking exercises can help decrease partial blinking and improve meibomian gland function and symptoms in patients with evaporative dry eye.

66th Annual Conference of Cardiological Society of India (CSI) -2014

Overall

Dr KK Spiritual Blog

Is time and place of death pre-defined?

Some gurus teach that the time and place of death is predefined and some do not. I personally feel that life and respiration are predefined and not day and time of death.

It is something like - water in a sponge will become empty when every drop of water comes out but it does not matter how much time it takes to come out. It is therefore possible to postpone or prolong the fulfillment of Prarabhdha Karma and postpone death.

As per the Karma theory, unless our Prarabdha Karmas (decided at the time of death and birth) are enjoyed and fulfilled, one cannot die. But once the Prarabhdha Karmas are fulfilled, death is inevitable.
Another unanswered question is ‘can Prarabdha karma be modified’? Fate or destiny may not change, which means one may not be able to prolong the quantity of life but can definitely change the quality of life. The quality of life can be changed by modifying Agami (present Karmas).

Sanchit Karmas can be burnt with the file of knowledge about self. Prarabdha Karmas have to be experienced and Agami Karma can be neutralized by positive and negative Karmas to Zero in the present life.

The last few Prarabdha Karma experienced can thus be slowed down by the net positive result of their Agami karmas.

Inspirational Story

A Touch of Heaven

It had been a very disheartening day. The doctors had given us the worst of news. Our daughter, who had just completed her first brain surgery to remove a tumor and was going through radiation treatments, was now officially given a two percent chance of survival as this type of cancer had no cure.

My wife and I decided to take our daughter to lunch before continuing our afternoon conversations. We went to a local restaurant where we sat in silence waiting for the waitress. Our daughter Molly wouldn't hear of such sadness or silence so she played happily with crayons and paper while we sat and stared at the floor.

I noticed a very elderly couple sitting a few booths away, they too in silence never speaking a word. I couldn't help but wonder what challenges they had faced in their life and if they ever faced such terrible news about a child of theirs.

We eventually ordered our lunch and still sitting in silence we ate what we could. At some point I became intrigued by the old couple and I watched them more intently with each passing minute. I thought to myself that they hadn't yet spoken to each other and I wondered if it was the peace they were enjoying or the food or maybe both. However, at some point I lost interest and put my focus back on my lunch.

Molly was still talking away and enjoying her meal and her mom and I both listened and tried to be happy in her presence but it wasn't going very well. All of a sudden I saw this hand come out of nowhere. It was huge and I could tell that it had been afflicted with arthritis. The knuckles were swollen and the fingers were crooked and off center. I couldn't take my eyes of that hand. The hand drifted down and landed on my daughter's tiny six year old hand and as it did I looked up; it was the old woman who had been sitting with the old man in silence eating their lunch.

I looked into her eyes and she spoke, but not to me. She looked at my daughter and simply whispered, "If I could do more for you I would." And then she smiled and moved away to join her husband who had moved towards the door.

I heard a "Hey look, a whole dollar." Molly spoke with excitement as she discovered that the old lady had placed a crumpled one dollar bill on the back of her hand. I looked down and saw the dollar bill and quickly realized that it had been left behind by the old lady. I looked up to thank her, but she was gone. I sat stunned, not sure what had just happened and then I looked over at my wife. In almost unison, we broke out into a smile. The sadness of the day had been wiped out by the crippled hand and generous touch of an old lady. The dollar, although exciting to Molly, was not what made us smile or begin to feel differently, it was the offer from an old lady who felt our hurt and our suffering. The crippled hand symbolized a healing touch and made us realize that we did not have to fight this battle alone; that others cared and wanted to help. We felt uplifted and soon our day filled with more happy thoughts as we spent the rest of our lunch planning the next day at home with fun filled activities for everyone.

I will never forget that crippled arthritic hand that taught us such an important lesson. One does not have to go through life facing hardships all alone; the world is full of compassionate and understanding people. Even those that are suffering from their own afflictions have much to give to each other.

The hand that covered Molly's on that day still covers it. And although Molly is no longer with me, I can see her holding hands with that old lady now, both hands perfect and both faces filled with smiles and laughter. And though Heaven has these two perfect angels now, the lessons that they both taught me will remain forever in my heart.

Rabies News (Dr A K Gupta)

What are the factors responsible for rabies transmission in man from rabid animals?

  • Rabies is most commonly transmitted to humans via the bite of a rabies-infected animal.
  • Humans usually contract rabies through bite wounds from rabid animals (bite exposure) because the rabies virus is highly concentrated in the saliva of infected animals.
  • The amount of virus reaching the lesion is also a factor in transmission; for example, when a bite has to penetrate clothing, the saliva may be retained in the fabric and be prevented from entering the wound.
  • It can also be transmitted through non-bite exposure, although this rarely occurs. Airborne infections, such as inhaling an aerosol of infected animal brain tissue in virus laboratories, or of contaminated air in bat-inhabited caves, have been reported.
  • Iatrogenic rabies cases have occurred in patients who received cornea, kidney, liver, or blood vessel graft transplantation from donors who had undiagnosed rabies.
  • To date, the only medically verified cases of human-to-human rabies transmission are the cases infected through organ transplantation from undiagnosed rabies patients

Potential non-bite modes of transmission include contamination of a pre-existing wound, contact of mucous membrane or respiratory tract with the saliva of an infected animal, exposure to aerosolized rabies virus in the laboratory (or from bats), or via organ transplantation from an infected donor.

Cardiology eMedinewS

  • Results from six Phase 3 ODYSSEY trials have shown that alirocumab significantly reduces low-density lipoprotein cholesterol (LDL-C). The data were presented at the American Heart Association (AHA) Scientific Sessions 2014.
  • Digoxin was associated with a 71% higher risk of death and a 63% higher risk of hospitalization among adults with diagnosed atrial fibrillation and no evidence of heart failure, reported a Kaiser Permanente study published online in Circulation: Arrhythmia and Electrophysiology.

Pediatrics eMedinewS

  • Umbilical cord blood from unrelated donors can stop the progression of the neurodegenerative disease Hurler syndrome if performed before the affected child is 9 months old, suggests a Children's Hospital of Pittsburgh of UPMC study that appears online in Annals of Neurology.
  • The rate of juvenile-onset systemic lupus erythematosus (JSLE) is increased in children with atopic dermatitis (AD), suggests a population-based cohort study published in Lupus.

Quote of the Day

  • We are accountable only to ourselves for what happens to us in our lives. Mildred Newman

Wellness Blog

How to recognize cardiac arrest

  • Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.
  • As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”
  • If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.
  • Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.
  • Remember even well-trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.
  • After assessing responsiveness, health care providers should quickly check the patient’s pulse.
  • While doing so, it is reasonable to visually assess the patient’s respirations.
  • It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.
  • The key point is not to delay CPR.
emedipicstoday emedipics

21st Perfect Health Mela 18th October 2014

Self-Assessment-Quiz

 

expert_choice
press release

Vitamin D intake associated with reduced risk for Crohn's disease

video of day

Other Blogs

Video Library

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 Chikungunya was found to have high ESR.
Dr. Bad: It may not be Chikungunya.
Dr. Good: It is Chikungunya.
Lesson: High ESR is seen in Chikungunya.

Make Sure

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that each time a patient is given penicillin injection, anti anaphylaxis measures are available.

eMedinewS Humor

Blonde Stop

A Police car pulled alongside a speeding car on the motorway.

Glancing at the car he was astonished to see that the blonde behind the wheel was knitting!

Realizing that she was oblivious to his flashing lights and siren, the cop rolled down his window and shouted "Pullover!"

The blonde rolled down her window and yelled back "No, it's a scarf!"

Twitter of the Day

Dr KK Aggarwal: Effective pranayam is a respiratory rate of 4 breaths per min
Dr Deepak Chopra: Blind faith and blind unbelief have other things in common. They both refuse to be tested

ePress Release

The first Indian Ebola patient can be a potential cure for a future patient

The use of whole blood or serum from convalescent Ebola virus disease survivors is being used for the treatment of affected patients.
The World Health Organization has issued interim guidance for the collection and administration of convalescent whole blood or plasma for treatment of Ebola virus disease (EVD).

“The patient who is currently undergoing convalescence from Ebola should be persuaded to donate blood or plasma for a future patient”, said Padma Shri, National Science Communication and Dr. B C Roy National Awardee Dr. KK Aggarwal President Heart Care Foundation of India and Senior National Vice President Indian Medical Association.

Giving his valuable insights on the deadly virus Dr. Aggarwal said, "While there is no proven treatment available for Ebola virus disease, whole blood collected from patients in the convalescent phase of infection has been used as an empirical treatment with promising results in a small group of cases with Ebola virus disease and the concept that this treatment could be efficacious is biologically plausible, as convalescent plasma has been used successfully for the treatment of a variety of infectious agents".

WHO guidelines cover all aspects of this procedure. Patients who have recovered from EVD and been discharged from Ebola treatment centers or units could be potential donors for convalescent whole blood or plasma from 28 days after their day of discharge.
Only those EVD patients who have been discharged according to the WHO criteria as clinically asymptomatic and have twice tested negative for EBOV RNA by molecular techniques, should be considered as potential donors. The two samples for EBOV RNA testing should be taken at least 48 hours apart, and the test results should be negative on each sample.

Donated convalescent whole blood should be stored between +2 degree and +6 degree (never frozen) preferably in a separate blood bank refrigerator dedicated to convalescent whole blood or plasma units, fitted with a temperature monitoring system and alarm. Plasma separated from whole blood donations or collected by apheresis may be stored as ‘Liquid Plasma’ between +2 degree and six degree in blood bank refrigerators for up to 40 days. Alternatively, it may be frozen either within 8 hours of collection as ‘Fresh Frozen Plasma’ or within 18-24 hours of collection as ‘Plasma Frozen within 24 hours’ and stored for up to 12 months at or below -18 degree.

Only patients with confirmed EVD preferably in its early stages should be considered for transfusion, as an empirical treatment for EVD. ABO and RhD matched blood or plasma units that need to be selected for transfusion.

eMedi Quiz

Mummification refers to:

1. Hardening of muscles after death.
2. Colliquative putrefaction.
3. Saponification of subcutaneous fat.
4. Dessication of a dead body.

Yesterday’s Mind Teaser: Acantholysis is characteristic of:

1. Pemphigus vulgaris.
2. Pemphigoid.
3. Erythema multiforme.
4. Dermatitis hepetiformis.

Answer for yesterday’s Mind Teaser: 1. Pemphigus vulgaris.

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

Answer for 21st November Mind Teaser: 1. The gain in weight of young animals per unit weight of protein-consumed.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Poonam Chablani, Dr Rakesh Sharma.

Send your answer to email

medicolegal update

(Contributed by Dr MC Gupta, Advocate)

Q. Is a gynecologist, who has undergone USG training at a FOGSI accredited center, legally competent to perform USG at her clinic for infertility treatment?

A.

  • In terms of Rule 3 (3) (1) (b) of the PC & PNDT Rules, 1996, the person performing the US examination should be "A sonologist, Imaging specialist, Radiologist, or Registered Medical Practitioner having postgraduate degree or diploma or six months training or one year experience in sonography or image scanning".
  • As per MCI, "Ultrasonography can be undertaken by a specialist who possesses postgraduate qualification in the specialty of Radio–Diagnosis. However, specialist doctor in their speciality can also undertake Ultrasonography for the purpose of certification subject to the condition that he/she has undergone orientation training in the ultrasonography in the department of Radio–diagnosis in a recognized medical institution under recognized medical teacher for a minimum period of 6 months wherein he has not only observed the procedure of Ultrasonography but also has undergone hands on training to enable him to practice in the field of Ultrasonography for the diagnostic purposes pertaining to his/her speciality." (MCI Executive Committee dated 27.4.2009).
  • The combined effect of the two provisions above is as follows: a. "A postgraduate qualification in radiology" entitles one to perform sonography both for the purpose of the PNDT Act or otherwise. (Note - With regard to the preamble of the PNDT Act, performing USG for the purpose of the PNDT Act would mean performing USG in women in relation to conception). b. "Six months training or one year experience in sonography or image scanning" entitles one to perform sonography for the purpose of the PNDT Act. c. "Orientation training in ultrasonography in the department of Radio-diagnosis in a recognized medical institution under recognized medical teacher for a minimum period of 6 months (wherein he has not only observed the procedure of Ultrasonography but also has undergone hands on training to enable him to practice in the field of Ultrasonography for the diagnostic purposes pertaining to his/her speciality)" entitles a specialist to undertake Ultrasonography for the purpose of certification related to the specialty.
  • In view of the foregoing, a gynecologist performing USG in relation to infertility would be deemed to do so in relation to conception. Her case would be covered by ‘b’ above. She would be legally competent for performing USG if her USG training at a FOGSI accredited centre was for a period of six months.
medicolegal update
  1. Dear Dr. KK Aggarwal, Sir, Hearty Congratulations on being awarded the title of 'Honorary Professor in Bioethics, SRM Medical College Hospital & Research Center, Kttankulathur'. May god bless you many more titles. Parvesh Sablok

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