eMedinewS
26th October 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

How to prevent getting lifestyle diseases including heart attack

Wild animals do not get heart attack, blood pressure, diabetes or stroke. These are all lifestyle disorders. But they can occur in a lion caged in a zoo, a rabbit in a laboratory or a pet dog in the house.
The biggest challenge, therefore, in cardiology internationally is – how to prevent development of lifestyle diseases including heart attack.

Most lifestyle disorders are linked to abdominal obesity, which is the latest epidemic in the society in the west. It is also becoming an epidemic in urban India and is now gradually shifting to the middle class. It is linked to eating white sugar, white rice, white maida and not exercising.

Traditionally, Indian sages knew that Indians are prone to getting abdominal obesity, therefore, they promoted observing fast at least 80 days in a year which involves one fast every week, one extra fast on Ekadashi and two Navratras of nine days each at the onset of summer and winter. Traditionally, the Indian fast includes not eating cereals on the fast day. Avoiding cereals 80 days in a year does not allow a person to develop metabolic syndrome and insulin resistance, which is responsible for inflammation of arteries and subsequent lifestyle disorders including heart attack and paralysis.

The other challenges at an international level in cardiology involve safer alternatives for surgery and angioplasty. Today, most angioplasties with stenting and bypass surgeries last for 6-10 years. We want such procedures to last lifelong, obviously with control of risk factors. Stents may be needed, which can be resorbed completely.

A large number of patients die because cardiac transplant facilities are not available in many countries, especially the Asian countries. Every country should have all transplant-friendly laws so that any patient who dies in an accident and is brain dead, but has a living heart ends up as a heart living brain dead donor. In India, thousands of patients die every year for want of a heart donor.

Diastolic dysfunction, heart failure and atrial fibrillation are the other new epidemics of the society. In diastolic dysfunction, the heart does not relax properly and leads to breathlessness on exertion. It is again linked to obesity. If not treated in time, it causes enlargement of the left smaller chamber of the heart called left atrium. This leads to atrial fibrillation, where the heart beats are irregularly irregular. This is the commonest cause of paralysis in elderly age group.

Most lifestyle disorders are also linked to eating high salt diet and/or a diet high in transfats. Every country must come out with its policy and guidelines in which they must restrain various restaurants and hotels from using trans fats in their food and limiting the content of salt in their dishes.

They are also challenges for cardiologists. A cardiologist must practice what he preaches. A patient will not listen to the cardiologist if he/she (the cardiologist) is overweight and has abdominal obesity, drinks excessive alcohol or smokes.

Cardiologists internationally also face legal threat. Most of the law suits in the west are filed against cardiologists, especially those linked to the need of putting a stent or doing bypass surgery. Clear cut guidelines should be laid down and impunity should be given to doctors, if they follow those guidelines.

It is a duty of the cardiological association of every country to come out with transparent and standard guidelines in the treatment of heart diseases and when not to put devices in a patient.
Due to lucrative packages, a large number of cardiologists are shifting towards interventional cardiology. Very few people, a time will come, will remain in clinical, preventive or diagnostic cardiology. It will be sad scenario to watch, if it happens.

Young doctors and medical students should devote their life to combat these challenges. They must learn the principles of Vedic philosophy, especially ethical earning. They must follow the principles of counseling as taught by Lord Krishna to Arjuna. Krishna took 18 counseling sessions. In the first, he only listened, in the second he counseled in great detail, from 3 to 17, he gave reasoning at every stage and in the last session, he revised.

The budding doctors must remember that the word ‘Dr.’ as a prefix is given to them as an honour which differentiates them from the society. These prefixes or suffixes are not even available even to Prime Minister or President of India. They must maintain nobility of the medical profession.

In Islam, one of the five pillars mentioned is compulsory charity. The budding doctors should decide at this stage that throughout their life they will involve in doing 10% of charity on a daily basis.

21st MTNL Perfect Health Mela 2014

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

Findings of an EP Wire survey in Europace 2014 Oct;16(10):1521-3 conclude that work-up of ‘lone atrial fibrillation (AF)’ typically includes screening for known risk factors but not genetic testing. The preferred management of paroxysmal lone AF is rhythm control with antiarrhythmic drugs, whereas pulmonary vein isolation only is the first ablation strategy for the majority of patients with symptomatic persistent lone AF. The survey was conducted by the European Heart Rhythm Association Survey, in which 32 European centers, all members of the EHRA electrophysiology (EP) research network participated.

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

  • A New York City physician who recently treated Ebola patients in Guinea as a member of Doctors Without Borders has tested positive for the virus, New York City Mayor Bill De Blasio announced tonight. The 33-year-old physician, identified by Reuters as Craig Spencer, MD, is the fourth person to be diagnosed with Ebola in the United States. He is a fellow in international emergency medicine at New York Presbyterian/Columbia University Medical Center.
  • Human testing of a second investigational Ebola vaccine candidate is under way at the National Institutes of Health’s Clinical Center in Bethesda, Maryland.
  • About 20% of clinicians at various levels of training were unaware of the placement of a central line in their hospitalized patients, according to a study published in the October 21 issue of the Annals of Internal Medicine.
  • The combination of umeclidinium and vilanterol provides greater improvements in lung function as compared to tiotropium monotherapy in patients with COPD, suggests a study published online in Respiratory Medicine.
  • Hemodialysis patients who exercise aerobically have greater health-related quality of life and lower rates of depression symptoms and mortality, suggests a study published in the Clinical Journal of the American Society of Nephrology.

Dr KK Spiritual Blog

Why Spirituality is Happiness Friendly

  1. What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone that is released in the body in response to stress.
  2. Positive thinking produces nearly a 30 percent drop in perception of pain.
  3. Spirituality and the practice of religion is associated with a slower progression of Alzheimer’s disease.
  4. Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12 percent a year.
  5. People who are undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  6. Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  7. Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  8. Spirituality can affect immune-system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  9. Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  10. Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

Inspirational Story

The important things in life

A philosophy professor stood before his class with some items on the table in front of him. When the class began, wordlessly he picked up a very large and empty mayonnaise jar and proceeded to fill it with rocks, about 2 inches in diameter.

He then asked the students if the jar was full. They agreed that it was. So the professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles, of course, rolled into the open areas between the rocks.

He then asked the students again if the jar was full. They agreed it was. The professor picked up a box of sand and poured it into the jar. Of course, the sand filled up the remaining open areas of the jar. He then asked once more if the jar was full. The students responded with a unanimous “Yes.”

“Now,” said the professor, “I want you to recognize that this jar represents your life. The rocks are the important things – your family, your partner, your health, your children – things that if everything else was lost and only they remained, your life would still be full. The pebbles are the other things that matter – like your job, your house, your car. The sand is everything else, the small stuff.”

“If you put the sand into the jar first,” he continued, “there is no room for the pebbles or the rocks. The same goes for your life. If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you. Pay attention to the things that are critical to your happiness. Play with your children. Take your partner out dancing. There will always be time to go to work, clean the house, give a dinner party, or fix the disposal.”

“Take care of the rocks first – the things that really matter. Set your priorities. The rest is just sand.”

Rabies News (Dr A K Gupta)

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

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

Cardiology eMedinewS

  • Authors of a new review have called for more routine use of coronary angiography among patients with resuscitated out-of-hospital cardiac arrest (OHCA), pointing that relying on ECG alone may cost lives. The review and meta-analysis is published in the November 2014 issue of Resuscitation.
  • A study published online October 16 in the Journal of Clinical Endocrinology & Metabolism stated that among men around 60 years old with type 2 diabetes, those with low total plasma testosterone levels had a sixfold higher risk for increased carotid artery intima media thickness (CIMT) and decreased endothelial function, compared to those with normal testosterone.

Pediatrics eMedinewS

  • When an extract from tea leaves and pomegranate is combined with a standard oral rehydration solution, children with diarrhea tend to improve faster, suggests a new study presented at the American Academy of Pediatrics 2014 National Conference and Exhibition.
  • Prenatal exposure to traffic-related air pollution heightens the risk for respiratory disease in otherwise healthy children, suggests a new report published online October 20 in Thorax.

Quote of the Day

  • Knowledge is learning something every day. Wisdom is letting go of something every day. Zen Proverb

IMA NEWS

  1. Karnataka: Even as government doctors announced their plans to resign en masse on October 27 over wage disparity and irregular payment of salaries, Health Minister U.T. Khader and Principal Secretary, Health and Family Welfare, N. Sivasailam said on Thursday the department would not succumb to the “blackmail” tactics of the doctors and “resignations would be accepted if they were submitted”.
  2. AIIMS head to DU VC, top law officer to Medanta boss, all meet RSS chief - Indian Express: RSS chief Mohan Bhagwat met nearly 60 luminaries from the fields of education, health care, law, culture and bureaucracy over lunch earlier this month, seeking their views on RSS and Hindutva and telling them that society and government need to work together to effect change in the country.

    The rare interaction with the RSS sarsanghchalak took place on October 12 at the PHD Chamber of Commerce and Industry in New Delhi. Invitation cards were issued by RSS Delhi prant sanghchalak Kulbhushan Ahuja.

    Those present included AIIMS director Dr M C Misra, UGC chairman Ved Prakash, Delhi University vice-chancellor Dinesh Singh, Guru Gobind Singh Indraprastha University vice-chancellor Anil K Tyagi, additional solicitor general Tushar Mehta, cardiac surgeons Dr Naresh Trehan and Dr K K Aggarwal, mountaineer Santosh Yadav, dancer Sonal Mansingh, former AIIMS director P Venugopal, National Council for Teacher Education chairman Santosh Panda, former Uttar Pradesh DGP Prakash Singh and other retired bureaucrats.

    Copies of Bhagwat’s Vijay Dashmi speech were distributed at the meeting and people present were asked to give their views. While most listened to what Bhagwat said, around a dozen engaged the RSS chief and gave their own suggestions on what the government needed to do.

    Sources privy to the meeting said Bhagwat did not promise anything and said “Sarkar sangh ki nahin hai. Hamare swayamsevak sarkar mein hain. Aapki baat un tak ham pahuncha denge (It is not a RSS government. Our swayamsevaks are in the government. Your suggestions will be conveyed).”
    “Koi bhi badlao sirf sarkar se nahin aa sakta. Sarkar aur samaj ke sahyog se hi badlao aa sakta hai (No change can be effected by a government alone. Change is possible only if the government and society cooperate,” he was quoted as having said.

    When The Indian Express contacted Dr Aggarwal, he said he suggested health sector reform measures like maximising the use of the health budget, elimination of diseases and reduction in time taken for hospitalisation. “We also discussed how health care can be improved by strengthening our ancient values,” he said.

    Dr Trehan said he put forth his ideas of reforms in the health sector to “provide health care to each and every citizen… there was no politics, no religion. It was just an exchange of views”.

    Sonal Mansingh said “RSS is one-of-its-kind organisation, totally dedicated to India” and suggested that “cultural inputs should become part of education”.
    “Until the HRD Ministry was created, separating culture from education, it was an inclusive, holistic system. Young generations were not deprived of important aspects and dimensions of Indian ethos,” Mansingh said.

    Sources said the AIIMS director suggested that the private sector should be encouraged to work in the field of health care to reduce the burden on the public sector. UGC chairman Ved Prakash, the sources said, called for implementation of reports of various commissions.

Wellness Blog

Heart Attack Symptoms in Women and elderly are Different

Winter is the month for heart attacks and the symptoms in women and the elderly may be different,

  • Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in Archives of Internal Medicine, researchers examined 35 years of research that yielded 69 studies and found that 30-37% of women did not have chest discomfort during a heart attack. In contrast, 17-27% of men did not experience chest discomfort.
  • Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.
  • Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome (ACS). They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath, nausea or vomiting, indigestion, loss of appetite, weakness or fatigue, cough, dizziness and palpitations.
  • Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

ePress Release

Stress management programs for heart patients a must

Drugs such as beta-blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India. In premature heart attack, the mean age is 53-54 yrs.

In general, the goal of a stress management program is to reduce the impact in the individual of stressful environmental events and to better regulate the stress response.

Interventions may be considered at several levels:

• Removal or alteration of the stressor
• Change in perception of the stressful event
• Reduction in the physiologic sequelae of stress
• Use of alternative coping strategies

Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg.

Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.

emedipicstoday emedipics

21st Perfect Health Mela 15th October 2014

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

 

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AHA – ACS update new–2

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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

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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 had mandibular respiration
Dr Bad: It is normal in asthma
Dr Good: It is a bad terminal sign
Lesson: Five of the signs that emerged mostly during the last three days of life had both high specificity (i.e., >95% chance that the patient would not die within three days if the symptom was absent) and high positive likelihood ratios, including pulselessness of the radial artery; respiration with mandibular movement; decreased urine output; Cheyne-Stoke breathing and death rattle. However, sensitivity was limited; these signs were present in fewer than 27% of the patients who died (Hui D, dos Santos R, Chisholm G, et al. Clinical signs of impending death in cancer patients. Oncologist 2014;19:681).

Make Sure

Situation: A 28–year-old male presents with increased frequency and occasional blood in urine. Examination of urine shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria and hematuria. Sterile pyuria is the first clue to diagnosis.

eMedinewS Humor

Rice Preference

The young woman really thought she'd been very patient, through a protracted period of dating with no talk of marriage.

One night her steady boyfriend took her to a Chinese restaurant. As he perused the menu, he casually asked her, "So . . . how do you like your rice? Boiled? Steamed? Or fried?"

Without missing a beat, she looked over her menu at him and replied clearly, "Thrown."

Twitter of the Day

Dr KK Aggarwal: TB more dangerous than FLU By Dr k k Aggarwal
Dr Deepak Chopra: If I do not meditate for a few days I become irritable and restless. Is meditation addictive?

eMedi Quiz

All of the following are features of hallucinations except:

1.It is independent of the will of the observer.
2.Sensory organs are not involved.
3.It is as vivid as that in a true sense perception.
4. It occurs in the absence of perceptual stimulus.

Yesterday’s Mind Teaser: All of the following statements regarding bioavailability 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.

Answer for yesterday’s Mind Teaser: 3.Low oral bioavailability always and necessarily mean poor absorption.

Correct answers received from: Dr Poonam Chablani, Dr K V Sarma, Dr Jainendra Upadhyay.

Answer for 24th Oct 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.

Send your answer to email

medicolegal update

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

Giving an opinion on phone has no legal liability

No legal liability will fall upon the doctor as there is no contract between him and the patient. For negligence to be proved there has to be a duty, breach of that duty and resultant damage. In this case there will no breach of duty. Only if the specialist has charged fee for his opinion from the patient (patient can sue) or from the physician (patient and doctor both can sue), he or she is liable. If the fee has been paid by the referring physician, it will be deemed to be paid by the patient.

medicolegal update
  1. Thanks for the news update. Regards: Dr Karuna

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