eMedinewS26th September 2014, Friday

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 & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06); President IMA New Delhi Branch (94–95, 02–04).
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

press release
emedipicstoday emedipics

Health Check Up and CPR 10 Camp at N P CO-DE Sr. Sec School, Naroji Nagar, New Delhi 15th September 2014

Emphasis on medical treatment in Non–ST Elevation Heart Attack

The American Heart Association and American College of Cardiology released an update of their guidelines for unstable angina and non–ST segment elevation myocardial infarction (NSTEMI). Here are some key aspects of the guidelines that you need to know:

A new name: The guideline has changed names since the last comprehensive revision in 2007 and is now called the Guideline for the Management of Patients with Non–ST–Elevation Acute Coronary Syndromes (NSTE–ACS). The change was to emphasize "the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations," the organizations explained in a statement.

No more initial conservative management: Initial conservative management has been replaced with "ischemia–guided strategy" in order to "more clearly convey the physiologic rationale of this approach.

Emphasis on medical treatment: An early invasive strategy in this population for patients with significant coronary artery disease is still generally accepted, according to the guidelines. But the document highlights guideline–directed medical therapy for low–risk patients.

"Guideline–directed medical therapy has not always been optimally utilized and advances in noninvasive testing have the potential to identify patients with NSTE–ACS at low-intermediate risk to distinguish candidates for invasive versus medical therapy.

More on discharge: The update included expanded recommendations for discharge, such as routine medication with dual antiplatelet therapy, education about symptoms, risk modification, cholesterol management, and cardiac rehabilitation referral. (Source: MedPage Today)

 
Self-Assessment-Quiz
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Ajcc
  • Patients reporting memory problems appear to be at increased risk for subsequent mild cognitive impairment (MCI) or dementia, suggests a new study published online September 24 in Neurology.
  • The North American Menopause Society (NAMS) has published clinical care recommendations to address the multiple issues facing women in midlife. The recommendations are published in the October issue of Menopause. The recommendations cover key issues specific to menopause including vasomotor symptoms, osteoporosis, and vulvovaginal health, as well as more general issues related to sexual function, cognition, cardiovascular health, thyroid disease, and cancers.
  • The "laser–Doppler–imager (LDI) flare" may serve as a new method for detecting early small–nerve–fiber changes in people with diabetes, suggest the first year of results from a prospective study presented recently at Neurodiab, the annual meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes.
  • Positron emission tomography combined with fludeoxyglucose F 18 (FDG–PET) seems less accurate for diagnosing lung disease in areas where infectious lung disease is endemic, suggested a new meta–analysis published in the September 24 issue of JAMA. The pooled sensitivity of FDG–PET for diagnosing lung cancer was 89%, and the pooled specificity was 75%. Researchers noted that in the 10 studies reporting endemic disease, the pooled specificity was lower (54%) than in the remaining 60 studies not reporting endemic disease (78%).
  • The US Food and Drug Administration (FDA) has approved apremilast for treating patients with moderate–to–severe plaque psoriasis who are candidates for phototherapy or systemic therapy.
  • Differentiating chikungunya from dengue: Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache. Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis. Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness. Such patients should also be evaluated for other serious conditions, such as malaria, leptospirosis, and other bacterial infections.
  • Antibiotic use was independently associated with a dramatic risk of recurrent Clostridium difficile infection in an out–patient cohort (Aliment Pharmacol Ther. 2014;40(5):518–522). It is important to avoid unnecessary systemic antibiotics in patients with Clostridium difficile infection, and patients with ongoing antibiotic use should be monitored closely for recurrent infection.
  • Recent studies have suggested that gut bacteria play a fundamental role in diseases such as obesity, diabetes and cardiovascular disease. Data are accumulating in animal models and humans suggesting that obesity and type 2 diabetes (T2D) are associated with a profound dysbiosis. Butyrate–producing bacteria such as Roseburia intestinalis and Faecalibacterium prausnitzii concentrations are lower in T2D subjects.

Obesity reduces life expectancy

Other Blogs

On 2nd Navratri Let Go of Your Impure Thoughts

Brahmacharini (Uma or Tapacharini) is worshipped on 2nd day of Navratri as the goddess who performed ‘Tapa’ (penance or continuous efforts) (Brahma – Tapa, Charini – Performer).d

SHE personifies love and loyalty and provides knowledge and wisdom. Those who worship her, attain, Tap (Religious Austerity), Tyagi (Sacrifice), and Vairagya (Asceticism).She is shown to hold Japa mala (rosary beads) in her right hand and Kamandalu in left hand.

This form of Shakti as per Yoga Shastras is present in second gonad chakra (in Allopathy gonad plexus) called Svadhisthana Chakra. The bija sound for the chakra is VAM, which removes attachments. In Ayurveda, the 2nd chakra represents the water element. In mythology ‘white’ represents purity of mind; beaded rosary or japa mala represents continuous efforts (meditation and concentration) and Kamandalu represents acceptance and water in it represents pure thoughts.

Kamandalu also means living an egoless state of mind. Kamandalu is a water pot made from dry pumpkin; it contains nectar and is shown on the ground next to Shiva. The process of making Kamandalu has deep spiritual significance. A ripe pumpkin is plucked from a plant, its fruit is removed and the shell is cleaned to hold the nectar. In the same way, an individual must break away from attachment to the physical world and clean his inner self of egoistic desires in order to experience the bliss of the Self, symbolized by the nectar in the Kamandalu.

Spiritual mantra on the 2nd Navratri

"Purify the mind (white cloths) with continuous efforts (japa mala) by accepting the things and situations as they are (kamandalu) and building humility in the mind (egoless state)"

Quote of the Day
  • Begin challenging your own assumptions. Your assumptions are your windows on the world. Scrub them off every once in awhile, or the light won’t come in. Alan Alda
  • There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle. Albert Einstein
  • Who are you to judge the life I live? I know I’m not perfect –and I don’t live to be–but before you start pointing fingers…make sure you hands are clean! Bob Marley
Inspirational Story

One Step

Foolish people with all their other thoughts, have this one too: They are always getting ready to live, but never living.

Your success will start when you begin to pursue it. To reach your goal or to attain success, you don’t need to know all of the answers in advance. You just need to have a clear idea of what your goal is. Don’t procrastinate when faced with difficult problems. Break your problems into parts, and handle one part at a time.

Develop tendencies toward taking action. You can make something happen right now. Divide your big plan into small steps and take that first step right away. Everyone who ever got where they are had to begin from where they were. Your big opportunity is where you are right now.

A journey of a thousand miles begins with one step. Take it.

CPR 10

Total CPR since 1st November 2012 – 99898 trained

CPR 10 Camp at SKV, C Block, Defence Colony, New Delhi 17th September 2014, Trained 132 Persons
CPR 10 Camp at NP CO-ED Sr Sec School, Nauroji Nagar New Delhi 15th September 2014, Trained 277 Persons

 

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.

Nida, SM Heart Care Foundation Fund, Post CABG

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.

 

IMA News
  1. CBI on Wednesday registered a case against Additional Secretary, Deputy Secretary, a former Assistant Secretary of the Medical Council of India (MCI), besides the Principal of a Kerala–based private medical college and others, for alleged irregularities in the allotment of post–graduate seats in 2012.

    CBI officials said searches were conducted at the residential and official premises of MCI additional secretary Prasanna Raj, deputy secretary Anshu Sethi Bajaj, ex–consultant Madhu Handa and principal of Karakonam, Thiruvananthapuram-based Somervell Medical College, Samson Nessaih.

    It is alleged that the pending application of Dr. Somervell Memorial CSI Medical College located in Thiruvananthapuram, seeking post–graduate seats, was dealt with and processed illegally in the MCI and a letter of permission issued after the last date, March 31, 2012.

    "The deficiencies pointed out by the assessors in their inspection report in 2011 had not been addressed by the medical college. The machines that had to be installed at the college before sending the compliance to the MCI were actually set up after that date. The bank guarantee which was mentioned to have been submitted by the college to the MCI along with the compliance letter was, in fact, not submitted on time," said CBI spokesperson Kanchan Prasad. The CBI probe revealed that the college had not been granted permission for the post–graduate seats in the past because of the same reasons.

    "Undue favours were allegedly extended to the medical college on the part of the MCI officials by ignoring the relevant regulations.

    Necessary permissions were granted which resulted in significant pecuniary benefits to the private medical college. The college Principal, in conspiracy with the accused MCI officials, submitted false information for securing permission and therefore, cheated the MCI," she said. (The Hind)

    eMedinews Comments: The present raid has nothing to do with the present elected team of MCI. It relates to decisions taken when the MCI was under control of central government under Board of Governors. Dr Prasanna Raj the Additional Secretary MCI is already under suspension by the MCI. (Source National Dailies)

  2. In a joint venture of Department of Bio–technology (DBT), Indian Council of Medical Research (ICMR) and Ministry of Health & Family Welfare (MOH & FW), ICMR has taken a lead for promoting "Indigenous diagnostic technologies for diagnosis of TB and MDR/XDR–TB" developed by Indian scientists/companies.

MCI News

The Central Bureau of Investigation on Wednesday carried out searches at the office of the Medical Council of India here and at a medical college in Thiruvananthapuram in connection with alleged corruption in the granting of recognition to the institute in Kerala. CBI sources said that searches were conducted at the residential and official premises of MCI Additional Secretary Prasanna Raj, Deputy Secretary Anshu Sethi Bajaj, ex–consultant Madhu Handa and Principal of Somervell Medical College, Samson Nessaih. It is alleged that the pending application of the college seeking post–graduate seats was processed in an unauthorised manner by MCI, the sources said. They said that the letter of permission to the college was also issued after the due date.

Make Sure

Situation: A patient of pulmonary Koch’s on ATT complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

Dr Good & Dr Bad

Situation: A patient came with tubercular pericarditis
Dr Good: Start steroids
Dr Bad: No steroids are needed
Lesson: The current recommendation is to use corticosteroids for patients with constrictive tuberculous pericarditis and for those felt to be at high risk of developing the condition (i.e., large effusion, high level of pericardial fluid inflammatory cells, or early signs of constriction)

Video Library

MEDICOLEGAL Query

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

Can doctor–couple dispense drugs without license?

Dr P Kamalasanan, a private medical practitioner from Kollam in Kerala was punished last month for dispensing drugs without a license. Additional Sessions Judge, Kollam on August 7 sentenced Dr Kamalasanan of one–day "imprisonment" and also fined him Rs 1.20 lakh on the charges of running a pharmacy without a license from his clinic. Appearing before the court, Dr Kamalasanan reportedly served the sentence by remaining there till the rising of the court.

View1: Under the rules, only a single–doctor clinic is exempted from the process of obtaining a license before dispensing drugs and any clinic run with the help of more than one doctor falls under the category of hospital, for which it is mandatory to obtain a license to dispense medicines.

View 2: The Drugs & Cosmetics Act, 1940 & Rules, is very clear that private clinics, the place where professional activities of registered medical practitioners take place, are exempted from the drug licence. Private clinics are fully protected from harassment of drug controllers.

Clause–5 of Schedule–K of the Drugs and Cosmetics Rules allows a single doctor to stock, prescribe or dispense medicines without having a license; it does mandate a clinic run by more than one doctor to obtain a license.

A doctor cannot dispense medicines on the prescription given by another doctor; neither can a visiting doctor dispense medicines from that clinic. Item 5. Drugs supplied by a registered medical practitioner to his own patient or any drug specified in Schedule C supplied by a registered medical practitioner at the request of another such practitioner if it is specially prepared with reference to the condition and for the use of an individual patient provided the registered medical practitioner is not (a) keeping an open shop or (b) selling across the counter or (c) engaged in the importation, manufacture, distribution or sale of drugs in India to a degree which render him liable to the provisions of Chapter IV of the Act and the rules there under." (Excerpts from a news in IMT)

eMedi Quiz

Granulocytopenia, gingival hyperplasia and facial hirsutism are all possible side effects of one of the following anticonvulsant drugs.

1. Phenytoin.
2. Valproate.
3. Carbamazepine.
4. Phenobarbitone.

Yesterday’s Mind Teaser:
Medullary carcinoma of the thyroid is associated with which of the following syndrome:

1. MEN I.
2. MEN II.
3. Fraumeni syndrome.
4. Hashimoto’s thyroiditis

Answer for yesterday’s Mind Teaser: 2. MEN II.
Correct answers received from:
Najib Khatee, Dr Bitaan Sen & Dr Jayashree Sen, Dr Raghavendra Jayesh, Dr P C Das, Dr Sushma Chawla, Dr Jainendra Upadhyay, Dr Chandresh Jardosh.
Answer for 24th Sept Mind Teaser: 2. Familial polyposis coli.
Correct answers received from:
Daivadheenam Jella, Dr Avtar Krisha.
Send your answer to:
ijcp12@gmail.com

eMedinewS Humor

Overloaded

My wife, a flight attendant for a major airline, watched one day as a passenger overloaded with bags tried to stuff his belongings in the overhead bin of the plane. Finally, she informed him that he would have to check the oversized luggage.

"When I fly other airlines," he said irritably, "I don’t have this problem."

My wife smiled, "When you fly other airlines, I don’t have this problem either."

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

The records are in the form of claims as authenticated by the sender as on the day of approval. The records can be used as part of a personal bio data or institution's achievements.

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 at:
www.ijcpbookofmedicalrecords.com/

Press Release of the Day

Navratra: Time to eat buckwheat flour

Navratra is the time when wheat flour is omitted from the diet and substituted it with buckwheat flour or kuttu ka aata. Buckwheat is not a cereal grain; it is a fruit and hence is a good substitute for Navratra fasts where cereals are prohibited.

  1. The flour is extremely high in protein and is a wonderful substitute for those who are allergic to gluten (found in wheat).
  2. It is good for patients with celiac disease as it is gluten–free.
  3. It contains phytonutrient rutin, which lowers cholesterol and blood pressure.
  4. It is rich in magnesium, vitamin B, iron, calcium, folate, zinc, copper, manganese and phosphorus.
  5. As the buckwheat hulls are hard to chew, traditionally they are soaked for about six hours and then cooked to make them softer and easily digestible.
  6. It also contains alpha–linolenic acid, which increases HDL cholesterol ("good" cholesterol) and controls LDL cholesterol ("bad" cholesterol).
  7. It is a good source of insoluble fiber and prevents occurrences of gallbladder stones. According to the American Journal of Gastroenterology, a 5% increase in the insoluble fiber intake results in a 10% reduced risk of gall–bladder stones.
  8. Kuttu is 75% of complex carbohydrates and 25% of high quality protein, which makes it an ideal food for weight loss.
  9. As the flour is gluten–free, a potato is used to bind the flour together.
  10. The flour tastes different.
  11. Pooris made from kuttu flour are crunchier than the normal wheat flour pooris.
  12. One should not make pooris with hydrogenated oils or vanaspati as it will take away all the medical benefits of buckwheat flour.
  13. Buckwheat flour however is subjected to adulteration.
  14. Mixtures of rye flour, Indian corn flour, wheat flour, and other ground cereals are often used as a substitute for buckwheat.
  15. Being high in fiber and low glycemic index it is good substitute for diabetic patients. The glycemic index for buck wheat is 47 (Low GI foods have a GI value less than 55; medium GI foods have a GI value between 55 and 69 and high GI foods have GI value greater than 70).
  16. The chiro-inositol present in buckwheat has been identified as the diabetes preventing component.
  17. Asthma symptoms can occur in sensitized children when food allergens such as buckwheat are cooked in a confined area. Both acute and late–phase respiratory symptoms are seen.
  18. Eat kuttu ki roti instead of poori or pakodas (fried items) made from kuttu atta (buckwheat flour).
  19. One can also prepare idlis from kuttu atta (buckwheat flour) and dosa from the samak rice (non grain seed)
  20. Food poisoning may occur if flour left over from the previous year is reused.
Wellness Blog

Singhara flour – a favorite Navratre diet

During Navratra fasts, wheat flour should be omitted from diet and be substituted with water chestnut (Singhara) or buckwheat (kuttu) flour, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA. Singhara is not a cereal but a fruit and hence a good substitute for a Navratra fast where cereals are not to be eaten.

  • Singhara flour is prepared from Singhara or Water Chestnut.
  • Singharas are floating aquatic plants, growing in slow–moving water up to 5 meters deep. The plant bears ornately shaped fruits containing a single very large starchy seed.
  • The seeds or nuts are boiled and sold as snacks or eaten raw.
  • The flour is made from dried, ground water chestnuts. The nuts are boiled, peeled, dried then ground into flour. The flour is bright white fine powder; it is actually a starch rather than flour.
  • The flour is primarily used as a thickener.
  • The flour is used as food in Navratra and consumed as phalahar (fruit) diet.
  • It is an excellent source of energy and provides 115 kcals per 100g.
  • The glycemic index for chestnut is 60. Low GI foods have a GI value less than 55; medium GI foods have a GI value between 55 and 69 and high GI foods have GI value greater than 70.
  • Chestnuts are relatively low in net carbs (total carbohydrate minus dietary fiber) and so are included in many low carb diets.
  • Being a gluten–free product, chestnut flour is a cooking option for people with celiac disease or other gluten intolerances or allergies.
  • Chestnuts do not contain the fat that regular nuts have.
  • It contains less carbohydrate than white flour.
  • People with tree nut allergies should avoid chestnut flour as it may cause an allergic reaction.
  • Flour made from chestnuts is typically more difficult to locate in many areas as well as more expensive than white flour.
  • Avoid eating deep fried chestnut flour pooris or paranthas.
  • Do not use trans fats containing vegetables oils to cook bread from chestnut flour.
  • Buy only branded flour as flour left over from the previous year can lead to food poisoning.
  • As per Ayurveda, chestnut flour has cool and buckwheat flour has hot properties.
  • Both chestnut flour and buckwheat flours can be combined.
  • One should eat phalahar once a week and at least 80 days in a year.
Pediatrics eMedinewS
  • In most children whose epilepsy started following a standard vaccination, there appears to be a genetic or structural cause, and about one-third of cases of epilepsy triggered by a vaccine are relatively benign, suggests a new study published online in Pediatrics.
  • Systemic steroids increase the risk of post-tonsillectomy bleeding in children, but not in adults, suggests a new Japanese study published online in JAMA Otolaryngology – Head & Neck Surgery. Researchers noted that the rate of reoperation for hemostasis was significantly higher in the steroid group than in the control group (1.6% vs. 0.9%).
Cardiology eMedinewS
  • Most treatment strategies used to treat acute venous thromboembolism (VTE) appear to be as safe and effective as the currently recommended combination of low-molecular-weight heparin (LMWH) plus a vitamin K antagonist; however, they are not interchangeable, suggests a large network analysis published recently in JAMA.
  • The American Association for Thoracic Surgery (AATS) has issued new guidelines to help prevent the development of atrial fibrillation (AF) during or after surgery and for the clinical management of patients in whom AF or atrial flutter develops. The recommendations are published September 23 in the Journal of Thoracic and Cardiovascular Surgery.
Rabies News (Dr A K Gupta)

What are the common side effects of intra-dermal rabies vaccination?

Cell culture vaccines have proved to be remarkably safe and free of significant adverse events. However, mild symptoms of pain, erythema, irritation or swelling at the intradermal injection sites occur in 3–92% of patients. The most frequent symptom is local irritation in 7–64% of vaccines. Generalized symptoms reported by 3–14% of recipients include headache, fever and influenza–like illness. Transient macular, papular and urticarial rashes are occasionally seen. All these adverse effects are mild, transient and self limiting and rarely call for the use of antihistamines and analgesics.

medicolegal update

Dear Dr KK Aggarwal, very informative newspaper. Regards: Dr KP Mishra

Twitter of the Day

Dr KK Aggarwal: You can reverse heart disease Every cell in the body eventually dies and is replaced by a new cell. Every (cont)
http://bit.ly/17wSWz3 

Dr Deepak Chopra: Brain, body, universe & all our ideas about them exist in consciousness alonehttp://bit.ly/DC_Ananda  #ananda

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