eMedinewS
25th October 2014, Saturday

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

Viagra for LVH

For patients with left ventricular hypertrophy (LVH), long-term of use of phosphodiesterase type-5 (PDE-5) inhibitors (sildenafil) can also improve measures of cardiac performance. As per Dr Elisa Gianetta (Sapienza University of Roma, Italy), the ideal target population to benefit from PDE-5 inhibition is patients with heart failure and LVH. Their conclusions are based on a meta-analysis of 24 studies with 1622 individuals, of which 954 were treated with PDE-5 inhibitors and 772 with placebo. Their results are published October 19, 2014 in the journal BMC Medicine.

The researchers suggest that PDE-5 inhibitors "could be reasonably offered to men with cardiac hypertrophy and early-stage heart failure." Given that the drugs were tested in men, there is a need for additional studies in women, as well as a long-term study focusing on cardiovascular outcomes, they add.

21st MTNL Perfect Health Mela 2014

7th Asia-Pacific Heart Rhythm Scientific Session New Delhi, India

In a study by Cristina Fornengo and colleagues, septal E/e' ratio =11 and AF duration >90 days predicted recurrence of atrial fibrillation at 3 months in patients with symptomatic persistent AF and LA dilation. The study findings are published online in the journal Eur Heart J Cardiovasc Imaging. 2014 Oct 1.

Dr. Mohan Nair
Chairman, Organizing Committee of the 7th Asia Pacific Heart Rhythm Society's  (APHRS) Scientific Sessions, being organized simultaneously at the Taj Palace Hotel and ITC Maurya in New Delhi from October 29th to November 1st, 2014.

Be a part of the discussions regarding Arrhythmia Management with global experts at the 7thAsia Pacific Heart Rhythm Society Meeting from October 29th – November 1st at New Delhi.

As a special offer for all eMedinews readers, we have decided to waive off the registration fees for the conference. To register yourself, please click on the following link

https://podio.com/webforms/9727986/708939

News Around The Globe

  • For the first time, Australian doctors have transplanted a heart that had stopped beating in what they say is a paradigm shift for organ donation: Victor Chang Institute executive director Professor Bob Graham said a newly developed technique would save 20 to 30 per cent more lives. The doctors at Sydney's St Vincent's Hospital transplanted a heart that had stopped beating for twenty minutes. The heart was resuscitated with a new console and injected with a preservation solution that was developed by researchers at the hospital and the Victor Chang Cardiac Research after 12 years of work. Professor Graham told the ABC's The World Today program that most hearts were donated by patients who were brain dead but kept alive using a ventilator, which meant their hearts were still beating when they were transplanted.
  • Doctor gets ebola infection: A doctor recently back from West Africa is in isolation in New York City's Bellevue Hospital after testing positive for Ebola. A second test to confirm the result will be done at the CDC's labs in Atlanta, the agency said in a statement late Thursday night. The doctor, Craig Spencer, MD, had returned from Guinea Oct. 17 and had passed through the enhanced screening protocol in place at JFK airport. He had no fever or symptoms during his trip or at the time of arrival, the CDC said. A person’s body mass index (BMI) does not always correspond with body fat percentage or metabolic health, according to a study presented here at the 25th Annual Meeting of the North American Menopause Society (NAMS).
  • The biggest viral disease outbreak has nothing to do with Ebola. It is Chikungunya virus, and it is sweeping the Americas. The primary symptoms are fever and polyarthralgia. "Chikungunya, in the Makonde language of Tanzania and northern Mozambique, means that which bends over or dries up," said Lyle Petersen, MD, from the US Centers for Disease Control and Prevention (CDC) in Fort Collins, Colorado. Unlike the Dengue virus, where most infections are asymptomatic, 72% to 97% of people infected with the Chikungunya virus develop clinical symptoms. The incubation period is usually 3 to 7 days, with a range of 1 to 12 days, Dr Petersen reported at IDWeek 2014.
  • Treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) with rifaximin was associated with significant symptomatic improvements, and treatment could be successfully repeated if patients relapsed. In an open-label study known as TARGET 3 that included 2,579 patients, a total of 42% of patients responded to 2 weeks of treatment according to the FDA's stringent criteria of at least a 30% reduction in pain and a 50% or greater decrease in the number of days with scores or 6 (loose) or 7 (watery) on the Bristol Stool Scale, according to Anthony Lembo, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, and colleagues. Among those initial responders, 36% never relapsed over 18 to 22 weeks of follow-up, which was "very important," co-author Mark Pimentel, MD said at the American College of Gastroenterology meeting.(Medpage)
  • Two short treatment regimens for tuberculosis failed to match the standard 6 months of therapy in efficacy. Both experimental regimens substituted a fourth-generation fluoroquinolone antibiotic for one of the drugs used in standard treatment, according to separate reports in the Oct. 23 issue of the New England Journal of Medicine.
  • WHO released data that the incidence of TB is falling globally, although -- owing to better information gathering -- the actual numbers are about half a million cases higher than previously thought. The U.N. agency said its data confirm that incidence of the disease is declining at about 1.5% a year and the mortality rate has dropped 45% since 1990. But because of more accurate data collection, the WHO said it now estimated that about 9 million people developed TB in 2013 and 1.5 million people died from the disease. The agency estimated that 37 million lives were saved between 2000 and 2013 through effective diagnosis and treatment. "However, given that most deaths from TB are preventable, the death toll from the disease is still unacceptably high," the WHO said in its Global Tuberculosis Report 2014.

Dr KK Spiritual Blog

Vedic Science behind running post- traumatic stress disorder?

Post-traumatic stress disorder or PTSD is a stress disorder, which lasts for up to 2 weeks if handled properly and for months or years if not handled after an acute stress. It can be a serious disorder.

The acute stress after the death of somebody very close will be called acute traumatic stress and the condition as PTSD.

The reference to grieving people mourning a death can be found in the Vedic literature. There is custom that the grieved partner is made to weep till she or he is overwhelmed with emotions. In fact, all relatives and friends participate in the exercise, depending upon their respective closeness to the deceased.

Most relatives join in the antim yatra and after that the grieved person is made to sit for 90 minutes every day as a part of the ceremony which either ends on chautha or tervi where again everybody known gather together to end the ceremony. Thereafter, normal activities of life are resumed.

In some sections of the society there is also a custom of shaving the head or doing ‘daan’ of hairs and or wearing white clothes.

There is a scientific explanation behind these customs?

The plausible explanation are many and are based on the observation that a grieving person may go into depression which if not treated properly may last for months together, or even forever.

Inspirational Story

Soar like an Eagle

Did you know that an eagle knows when a storm is approaching long before it breaks? The eagle will fly to some high spot and wait for the winds to come.

When the storm hits, it sets its wings so that the wind will pick it up and lift it above the storm. While the storm rages below, the eagle is soaring above it. The eagle does not escape the storm. It simply uses the storm to lift it higher. It rises on the winds that bring the storm.

When the storms of life come upon us, like the eagle, we can rise above them and ride the winds of the storm that bring sickness, tragedy, failure, and disappointment into our lives.

What is your greatest challenge right now? Jot it down. And then let it lift you higher.

Rabies News (Dr A K Gupta)

Is it essential to perform skin sensitivity test prior to the administration of ERIG?

Majority of reactions to ERIG result from complement activation and are not IgE mediated and will not be predicted by skin testing.

The recent WHO recommendation states that there are no scientific grounds for performing a skin test prior to the administration of ERIG, because testing does not predict reactions and ERIG should be given whatever the result of the test.

However, skin test is mandatory to avoid any possible litigation under Consumer Protection Act (COPRA) in India.

Cardiology eMedinewS

  • Heart Rate May Predict Survival, Brain Function in Comatose Cardiac Arrest Survivors: Acute Cardiovascular Care 2014, the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC): “When we talk to relatives and friends immediately after a cardiac arrest we often tell them that we're not able to say much about the prognosis for their Dad, Mom, friend, etc, for the next 3 to 4 days,” said Jakob Hartvig Thomsen, MD, Copenhagen University Hospital, Copenhagen, Denmark. “This is incredibly distressing and loved ones are desperate for more information.”“Therapeutic hypothermia is used in comatose survivors of OHCA to protect them from brain damage,” he said. “Current recommendations say that prognostication should not be made until 72 hours after hypothermia when patients have returned to normothermia and the sedation has worn off. The prognostic tools presently available are not reliable until after this 72-hour period.” “During hypothermia some patients lower their heart rate,” he added. “We hypothesised that this is a normal physiological reaction and that these patients may have less severe brain injury after their arrest and therefore lower mortality.” “Patients with sinus bradycardia during therapeutic hypothermia had a 50-60% lower mortality rate at 180 days than those with no sinus bradycardia,” said Dr. Thomsen. “We also found that sinus bradycardia was directly associated with a better neurological status 180 days after the arrest.” SOURCE: European Society of Cardiology.
  • An independent appraisal committee for the UK's National Institute for Health and Care Excellence (NICE) is supporting the use of rivaroxaban as part of a secondary-prevention strategy in acute coronary syndrome (ACS) patients. The NICE appraisal committee states that rivaroxaban 2.5 mg twice daily with aspirin alone or aspirin plus clopidogrel or ticlopidine is an option for biomarker-confirmed ACS patients without a prior history of stroke or transient ischemic attack.

Pediatrics eMedinewS

  • Epilepsy surgery may add several years to the life expectancy of children with refractory epilepsy who are deemed suitable surgical candidates, and it may also improve their quality of life compared with continuing medical therapy only, suggested a new study presented at the 43rd Annual Child Neurology Society Meeting.
  • Drinking milk produced from sources other than cows may increase the risk for low levels of serum vitamin D in young children compared with drinking cow's milk, suggests a study published online October 20 in the Canadian Medical Association Journal.

Quote of the Day

  • A hug is a great gift - one size fits all, and it's easy to exchange.

IMA NEWS

  • Thiruvananthapuram: The National Initiative for Safe Sounds (NISS) in association with Indian Medical Association (IMA) will provide for free these instruments to measure noise pollution to all police stations in the capital district in addition to tahsildars with the aim of curbing noise pollution.

    The move comes in the wake of the draft Noise Pollution Control order 2014 issued by the district administration based on Section 143 of Criminal Code of Procedure and Section 80 of Kerala Police Act, set to come into effect here from November 1 onwards.

    ‘’Under the rule, the maximum noise level must not cross 75 decibels while the sound levels now being emitted from loudspeakers range from 100 to 110 decibels. The sound meters are imported pieces with each piece costing Rs 12,000. Within two months, all police stations in Thiruvananthapuram city will be supplied with sound meters’’ said Dr C John Panicker, ENT surgeon and NISS state president.

    In Thiruvananthapuram district, control rooms will be opened at seven centres namely, the district Collectorate, taluk offices at Thiruvananthapuram, Neyyattinkara, Kattakkada, Nedumangad, Chirayinkeezhu and Varkala where public can complain about noise pollution.

    According to the order, individuals, group of people, religious institutions, cultural institutions and organisations have to obtain registration centres for operating loudspeakers from the centres in the taluk control rooms before November 1. There are also mandatory noise limits prescribed for specific places which should not be violated.

    ‘’When the police receive complaints about noise pollution from loudspeaker use, the noise level can be checked on the spot with the aid of Sound Level Meters and quick action taken. Initially, warnings will be given to violators and if continuous violation is found, there is provision to seize the loudspeakers,’’ said Thiruvananthapuram City Police Commissioner H Venkatesh. 4
  • Nagpur: Dr Manoj Singrakhiya accused of negligence as his patience loses life, Wife complains to IMA: According to the aggrieved wife Shalini Balinge’s complaint to IMA, the deceased Gangadhar Balinge, who resides in Amravati, was not in good health for some days and so, was referred by his doctors in Amravati to Dr Manoj Singrakhiya, who runs a hospital named Shanta Spine in Ramdaspeth. The couple came to Shanta Spine on September 8. After his check-up, Dr Singrakhiya advised surgery for ‘blocked veins at four places in the neck’. He told the couple that the operation would be performed in the morning and by evening, the patient would be discharged. The doctor told the couple that the operation would cost 1 lakh, of which the hospital would take Rs 90,000. This cost was to cover the expenses for surgery, medicines, accommodation, check-ups, nursing, etc. The patient’s wife was asked to only take care of their food.

    According to the doctor’s advice, the patient was hospitalised in the night. The following day, he was taken to operation theatre at 8.30 am. It was said that the operation would be over in half an hour. However, the patient was not brought out even by 3 pm.4

    Meanwhile, whenever Shalini Balinge enquired about her husband’s health, she was told that the patient is under anaesthesia and would be brought out soon. At around 3.30 pm, Dr Singrakhiya called the patient’s wife to his chamber and told her, “The patient suffered a lot of blood loss and his heart had stopped functioning. He is undergoing treatment inside.”

    Thereafter for two hours, the doctor did not give any update to the patient’s relative. At 5 pm, Shalini Balinge was told that the patient would have to be shifted to Aditya Hospital. The patient was in an unconscious and critical state when he was shifted out of Shanta Spine. On September 22, he passed away. Seeking justice from IMA’s Nagpur branch, the patient has raised suspicion about the doctor’s role and approach in the entire case. The IMA has forwarded the complaint against Dr Singrakhiya to its grievance redressal cell. Head of the cell, Dr Ashok Adhao is investigating the case based on the complaint. He has issued a show cause notice to the doctors concerned seeking their explanation. Both the complainant and the doctors concerned would be given hearing. Thereafter, a team of experts from IMA would conduct investigation following which a suitable action would be taken. 4 Dr Sanjay Deshpande, president, IMA (Nagpur)

Wellness Blog

Children and adolescents with congenital heart disease should avoid body piercing

Children and teenagers with congenital heart disease should be strongly discouraged from getting a tattoo or piercing their ears or other body parts, because it could lead to a potentially deadly infection of the heart called endocarditis

Infective endocarditis occurs when bacteria or fungi attach on the valves of the heart and begin to grow. If left untreated, it can lead to a fatal destruction of heart muscle.

Most people are not aware that they should talk to their doctor before tattooing or piercing their body.

Body art in the form of tattoos and piercing has become increasingly popular among children and teenagers.

Most experts today strongly discourage all forms of body art. For those who cannot be dissuaded, the recommendation is to give antibiotics prior to tattooing or piercing, “with strong advice for prompt treatment of any signs of subsequent infection”.

ePress Release

Do not ignore early morning chest pain

Do not ignore early morning chest pain as most fatal heart attacks occur early in the morning. In a message, 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 said that most heart attacks occur in the first three hours of getting up, more during full moon period and during winter.

A heart attack can present with chest pain, discomfort, heaviness or burning in the center of the chest, which is diffuse in nature and never localized and lasts for more than 30 minutes.

A discomfort, which lasts less than 30 seconds and which can be pinpointed with a finger, can be ignored as a non-cardiac chest pain. A burning in the chest occurring at 2 O’clock in the night may be due to acidity but any acidity occurring for the first time in life after the age of 40 years, should be considered cardiac in origin unless proved otherwise. Similarly, any breathlessness appearing for the first time in life after the age of 40 years is cardiac in origin unless proved otherwise.

Chewing a tablet of aspirin at the onset of cardiac chest pain can reduce chances of cardiac death by 22%.

All patients with chest pain should be promptly taken to the nearest cardiac hospital as timely clot dissolving therapy or clot removing angioplasty can practically cure a patient. The life saving window to reach hospital is within three hours.

Elaborating further he said that the three investigations required for evaluation of a chest pain should be available in the set up of every doctor who handles such patients and these include ViScope, an audio-visual auscultation device, ECG machine to diagnose an acute heart attack and echocardiography machine for early detection of heart attack.

ECG can often detect abnormal sounds in first six hours of heart attack but with a ViScope it is always possible to detect abnormal sounds during chest pain. Angiography is the gold-standard investigation if a patient with chest pain comes within three hours as it can help removing the clot by primary angioplasty.

eMedi Quiz

All of the following statements regarding bio availability of a drug are true except:

1. It is the proportion (fraction) of unchanged drug that reaches the systemic circulation.
2. Bioavailability of an orally administered drug can be calculated by comparing the Area Under Curve (0- ) after oral and intravenous (iv) administration.
3.Low oral bioavailability always and necessarily means poor absorption.
4.Bioavailability can be determined from plasma concentration or urinary excretion data.

Yesterday’s Mind Teaser: Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Answer for yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr K V Sarma, Dr Jainendra Upadhyay, Dr Avtar Krishan.

Answer for 22nd Oct Mind Teaser: 2. pKa

Correct answers received from: Dr Avtar Krishan.

Send your answer to email

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21st Perfect Health Mela 15th October 2014

21st MTNL Perfect Health Mela 2014
Self-Assessment-Quiz

 

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Zee News – Health Wealth Shows

Alcohol

press release

Hospital Noise Not Health-Friendly

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MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

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 – 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."

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: An elderly patient after IV ondansetron 16 mg dose developed irregular heart rhythm.
Dr Bad: It cannot be due to the drug.
Dr Good: It is due to the drug.
Lesson: ECG interval changes, including prolongation of the QTc interval, are a class effect of the first-generation serotonin antagonists, including ondansetron; potentially fatal cardiac arrhythmias may result. QTc prolongation occurs in a dose-dependent manner, and is expected to be greater with faster rate of infusion and larger doses for IV administration. The current recommendation is to limit single IV doses to no more than 16 mg. Canadian guidelines place additional dosing restrictions on IV ondansetron to mitigate the risk of QT prolongation, particularly in older adults, in whom the initial dose should not exceed 8 mg (Source: healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2014/39943a-eng.php (Accessed on June 16, 2014).

Make Sure

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh my God, why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they travel to mountains.

eMedinewS Humor

Final Countdown

A man hasn't been feeling well, so he goes to his doctor for a complete checkup. Afterward, the doctor comes out with the results.

"I'm afraid I have some very bad news," the doctor says. "You're dying, and you don't have much time left."

"Oh, that's terrible!" says the man. "Give it to me straight, Doc. How long have I got?"

"Ten," the doctor says sadly.

"Ten?" the man asks. "Ten what? Months? Weeks? What?"

"Nine..."

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots

Dr Deepak Chopra: We are born with everything we need to fulfill our every desire

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Not disclosing the names of doctors in the surgical team may be deficiency of service

Recently, the Kerala State Consumer Disputes Redressal Commission presiding members M.K. Abdulla Sona and A. Radha directed the Travancore-Cochin Medical Councils-Kerala (TCMC-K) to instruct all doctors to display their medical council registration numbers on their signboards and quote the register numbers in all prescriptions and all case sheets. The commission said that using the registration number in the doctors’ prescriptions, case-sheets and signboards would help patients to get all information about the doctor including their competency and possessed the required qualifications.

The commission said that the patient/consumer has the right to know the details of each doctor who accompanied the leader of the surgical team, including the anaesthesiologist. Any denial of this would be considered a deficiency of service and an unfair trade practice under the provisions of the Consumer Protection Act.

medicolegal update
  1. Dear Sir, Wishing you a very happy Diwali. Regards: Dr Kirti

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