eMedinewS
27th December 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

15 Game-Changing Wireless Devices to Improve Patient Care

  1. An ECG in your pocket: The device, a one-lead ECG, attaches to a smartphone and records accurate ECGs and heart rate in 30 seconds.
  2. Monitoring inpatients when you're not in the hospital: The new device can retrieve and display a patient's temperature, blood pressure, CT scans, ultrasounds, labs, radiographs, medications, and more—including electronic health record (EHR) notes—on a doctor's tablet or smartphone.
  3. Checking all your diabetic patients at once: A new device connects over 30 nonwireless glucometers to patient smartphones, transforming them into wireless devices that enable syncing of blood glucose readings, integrate food and lifestyle data, and allow for real-time connection between patients and providers.
  4. A foolproof medication compliance monitor: A sensor, which costs less than a penny, is placed on a pill. It gets activated by stomach juices when it's ingested. A digital signal is then sent to a monitor worn on the patient's arm." This records the medication taken, ingestion time, heart rate, body temperature, body position, and rest and activity patterns.
  5. A symptom tracker for patients with asthma or COPD: A device that fits onto an inhaler and wirelessly syncs with a smartphone app to record trending data.
  6. An advance in insulin administration and glucose monitoring: A noninvasive, wireless monitoring system for people with diabetes. A pen-like skin preparation device administers insulin via pain-free transdermal skin permeation rather than a needle. A biosensor is then placed on the administration site, much like a Band-Aid; it wirelessly transmits the patient's blood glucose level every minute to a remote monitor, which tracks glucose levels and rate of glucose change. Visual and audible alarms are triggered if levels move beyond the target range.
  7. Precise monitoring of cardiac patients with frequent symptoms: The new device including a wearable peel-and-stick sensor and a wireless transmitter is designed for patients with frequent symptoms that require short-term cardiac monitoring for up to 30 days.
  8. A scale that measures much more than your weight: A Bluetooth device monitors fat mass, lean mass, and body mass index with FDA-cleared bioelectrical impedance analysis. It also monitors your pulse (with an accompanying blood pressure cuff), records your standing heart rate history, and measures temperature and carbon dioxide to assess air quality. A companion smartphone app tracks running, weight loss, activity and calorie levels, and cardiovascular fitness.
  9. A smart way to monitor cardiac patients: This wireless device has been designed to continuously monitor a patient's heart rate, R-R interval, respiration rate, ECG, activity level, position, and posture while in the hospital, in transition, or at home. A wireless module snaps into a holder held in place on a patient's chest by two disposable standard ECG electrodes, making it easy for patients to stay remotely connected to a care team without cumbersome wires or hard-to-use devices. Vital signs, updated every minute, can be monitored in a special Web portal.
  10. A wireless system to improve seniors' health and wellness: This tablet-like device improves quality of life for nursing home residents or enables elderly patients to remain at home. The simple software interface includes medication schedules and reminders, as well as lifestyle assessments and care coordination notes that wirelessly let family members and professional caregivers exchange information. The tablet mates with a variety of wireless devices available from the firm—a scale, pulse oximeter, glucometer, blood pressure cuff, thermometer, motion sensors, contact sensors (for doors and windows), and pressure sensors (for bed and chair)—with readings viewable in an online portal.
  11. An early warning system for monitoring inpatients: The device eliminates the need for cumbersome devices, replacing them with a tablet-like sensor inserted under the mattress of the patient's bed. This device wirelessly monitors heart rate, respiration, and body movement. Computer monitors placed in prominent locations and handheld devices alert nurses of a change in patient status, enabling early detection of patient deterioration.
  12. A real-life Tricorder: Physicians and nurses of a certain age will remember a hit TV series from the 1960s, Star Trek, in which the Starship Enterprise's resident physician, Dr Leonard McCoy, relied on something called a "tricorder"—a fictional scanning device—to measure the body temperature, heart rate, and just about every other physiologic function in his mostly human patients. Now a Chinese company, as created virtually the real thing.
  13. Patient-generated eyeglass prescriptions: A plastic eyepiece that clips onto a smartphone screen. A patient views the screen through the eyepiece, sees several parallel lines, and presses the phone's arrow keys until the lines overlap. This is repeated with the lines at different angles, at which point software loaded onto the phone generates the prescription data. The process takes 2 minutes.
  14. The sole of a new machine: World's first wireless sensor insole. As thin as a normal insole, it wirelessly transmits data on a patient's plantar distribution of pressure to a smartphone app. This is useful for clinical research and sports science, particularly for training analysis and optimizing rehabilitation after a foot injury.
  15. Reducing pressure ulcer risk in bedridden patients: An app-device combo automates wound assessment; simplifies wound treatment; wirelessly enables care team communication; and identifies bedridden, at-risk patients before pressure ulcers can develop.

National News

Centre launches 'Mission Indradhanush' for children vaccination

New Delhi: The government has launched 'Mission Indradhanush' that aims to cover all un-vaccinated or partially vaccinated children by the year 2020, against seven vaccine preventable diseases, as reported in Business Standard on December 26, 2014. The diseases that come under the mission launched by the Union Health Minister J.P. Nadda on 'Good Governance Day' are diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. As per reports, four special vaccination campaigns will be conducted under the programme, between January and June next year. Around 201 districts will be covered in the first phase and 297 will be targeted for the second phase.

News around the Globe

  • Eczema may increase the risk of sustaining fractures in adult patients, suggests a study published online in the Journal of Allergy and Clinical Immunology. This could be due to chronic inflammation and the use of topical and systemic corticosteroids.
  • Using a smaller bougie during sleeve gastrectomy (SG) procedures may be associated with a longer hospital stay, suggests a new study published online in the American Journal of Surgery. The researchers reported that there was no difference in long-term weight-loss outcomes based on bougie size (32 French versus 36 French).
  • A small retrospective study has reported that patients with severe obsessive-compulsive disorder (OCD) who responded to dorsal anterior cingulotomy were more likely to have less gray matter signaling in the right anterior cingulate cortex than nonresponders. This suggests that a patient’s response to a surgical procedure for refractory OCD may depend on certain neuroanatomic brain variations in structure and connectivity. The study was published online December 23 in JAMA Psychiatry.
  • Latanoprost eye drops appear to preserve visual field in patients with open-angle glaucoma in a relatively short time, and the benefits increase with longer treatment, suggests a study published online in the Lancet.
  • The U.S. Food and Drug Administration today approved Saxenda (liraglutide (rDNA origin) injection) as a treatment option for chronic weight management in addition to a reduced-calorie diet and physical activity.
  • Although metformin, the popular type 2 diabetes medication, is usually not prescribed for people with kidney disease, a new analysis shows the drug may be safer for these patients than once thought. After reviewing published research to evaluate the risks associated with metformin among people with mild to moderate kidney disease, a team of researchers led by Dr. Silvio Inzucchi, a professor of medicine at Yale University, found these patients were at no greater risk for lactic acidosis than people who were not taking the drug.

Dr KK Spiritual Blog

Why do we offer food to God in every Pooja?

We follow a ritual of offering ‘bhog’ to the deity we worship. The ritual also involves sprinkling water all around the place where we sit down to eat food. Many people have advocated that the sprinkling of water prevents ants and insects from approaching the food. But in spiritual language, these rituals have a deeper meaning.

Bhagwad Gita and Yoga Shastras categorize food into three types corresponding to their properties termed as gunas. Depending upon satoguna, rajoguna and tamoguna, the food items are categorized as satwik, rajsik or tamsik.

Satwik food provides calmness, purity and promotes longevity, intelligence, strength, health, happiness and delight. The examples of satwik food items are fruits, vegetables, leaves, grains, cereals, milk, honey, etc. These items can be consumed as they are. One can also live on satwik food for life.

Rajsik food items possess attributes of negativity, passion and restlessness. Hot, spicy and salty food items with pungent, sour and salt taste promote rajas qualities.

Tamsik food has attributes of inducing sleep, ignorance, dullness and inertia. The examples of tamsik food are meat, onions, garlic, left-over food, etc.

Only satwik food is offered to God. Rajsik and tamsik food is never offered as Bhog. The only persons who were offered tamsik and rajsik food in Ramayana are Ahi Ravana and Kumbhkaran. Both of them were of an evil nature. Kumbhkaran signified tamas and Ahi Ravana, rajas or aggression. Tamsik and rajsik food can be converted into satwik by slow heating, sprouting or keeping them in water overnight. The examples are sprouted wheat and chana (chickpeas), etc.

A mixture of honey, milk, ghee, curd and sugar is called panchamrut and is a routine offering to the God. All the five components have satwik properties and their consumption promotes health.

In Ayurveda, there is a saying that any food item, which grows under the ground, is tamsik in nature and those that come from the top of the tree or plant like leaves, flower and fruits are satwik in nature. Satwik food is usually fresh, seasonal and locally grown.

Human beings are made up of body, mind and soul and soul is equated to consciousness or God. Whatever offered to the external God, if offered to the internal God or consciousness, leads to inner happiness. The ritual, therefore, of offering food to God before eating forces us to either eat only satwik food or to include a substantial portion of satwik food in our meals. It helps a person convert his meal into a pure satwik one or at least adding satwik items.

Sprinkling water around the plate is considered an act of purification.

Many people confuse bhog with chadhava or offerings to the deity. While bhog is shared with God, chadhava is the offering of your illness or negative thoughts to the God and you go back with prasada of inner happiness. Many people counter the above argument by saying that alcohol is offered to Bhairon, viewed as a demon God, which means alcohol, is good for health. I personally feel that alcohol is offered to Bhairon not as a bhog but as an offering, which means that people who are addicted to alcohol go to Bhairon and give their share of alcohol to him so they can de-addict themselves.

Uniform Code for Pharmaceuticals Marketing Practices (UCPMP)

Samples

  1. Free samples of drugs shall not be supplied to any person who is not qualified to prescribe such product.
  2. Where samples of products are distributed by a medical representative, the sample must be handed directly to a person qualified to prescribe such product or to a person authorized to receive the sample on their behalf.
  3. The following conditions shall be observed in the provision of samples to a person qualified to prescribe such product:
    1. Such samples are provided on an exceptional basis only (see (ii) to (vii) below) and for the purpose of acquiring experience in dealing with such a product;
    2. Such sample packs shall be limited to prescribed dosages for three patients for required course of treatment;
    3. Any supply of such samples must be in response to a signed and dated request from the recipient;
    4. An adequate system of control and accountability must be maintained in respect of the supply of such samples;
    5. Each sample pack shall not be larger than the smallest pack present in the market;
    6. Each sample shall be marked "free medical sample- not for sale" or bear another legend of analogous meaning;
    7. Each sample shall be accompanied by a copy of the most up-to-date version of the Product Information (As required in Drug and Cosmetic Act,1940) relating to that product.
  4. A pharmaceutical company shall not supply a sample of a drug which is an anti depressant, hypnotic, sedative or tranquillizer.
  5. The companies will maintain details, such as product name, doctor name, Quantity of samples given, Date of supply of free samples distributed to Healthcare practitioners etc.

Gifts

  1. No gifts, pecuniary advantages or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply drugs, by a pharmaceutical company or any of its agents i.e. distributors, wholesalers, retailers etc.
  2. Gifts for the personal benefit of healthcare professionals and family members(both immediate and extended) (such as tickets to entertainment events) also are not be offered or provided.

Relationship with Healthcare Professionals

  1. Travel facilities: Companies or their associations/representatives or any person acting on their behalf shall not extend any travel facility inside the country or outside, including rail, air, ship, cruise tickets, paid vacations, etc., to HealthCare Professionals and their family members for vacation or for attending conference, seminars, workshops, CME programme etc. as a delegate. It is hereby clarified that in any seminar, conference or meeting organized by a pharmaceutical company for promoting a drug or disseminating information, if a medical practitioner participates as a delegate , it will be on his/her own cost.
  2. Hospitality: Companies or their associations/representatives shall not extend any hospitality like hotel accommodation to Healthcare Practitioners and their family members under any pretext.
  3. Cash or monetary grants: Companies or their associations/representatives shall not pay any cash or monetary grants to any healthcare professional for individual purpose in individual capacity under any pretext. Funding for medical research, study etc., can only be extended through approved institutions by modalities laid down by law/rules/guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

Inspirational Story

The Bird Feeder

Last fall I hung outside my window a bird feeder. Now not knowing the first thing about wild birds, I assumed that as soon as I hung this bird feeder outside, a multitude of beautiful birds would be swooping to my new addition. Days, weeks and months went by; NO BIRDS.

I asked so many people what to do? What was I doing wrong? "Nothing" most of them replied. "Just wait." So I waited and waited and waited trying everything possible, to attract these birds. I cleaned off the deck, I changed the feed, I washed the feeders, I even made the cat go out the other door! But nothing seemed to work. So......I waited, "with patience and hope."

Two months later, on a Saturday afternoon, I FROZE! What to my eyes had appeared on the bird feeder but the most beautiful bird I have ever seen in my life! All of a sudden HUNDREDS UPON HUNDREDS OF BIRDS WERE APPEARING FROM EVERYWHERE!

What a beautiful lesson I learned from this little creature. "Patience and hope" and "things" will attract the beautiful things in life. I never realized how much patience I really do have and how much I do rely upon "hope" to sort out the questions in my heart.

So I keep hoping and waiting, waiting and hoping. I will try to use this "little lesson" with so many other things in my life. I guess "patience is a virtue" after all.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at GB S School, Khan Pur, New Delhi, on 27th November 2014

video of day
press release

Proton–pump inhibitors to carry warning about C

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: An elderly male had an A1C of 6.5%
Dr Bad: Its very good control.
Dr Good: Reduce the dose of drugs.
Lesson: A1C goal should also be set somewhat higher for older patients and those with a limited life expectancy. The American Geriatrics Society suggests an A1C target of 8 percent for frail older adults and individuals with life expectancy of less than five years. (Source: Ann Intern Med 2008;149:11.)

Make Sure

Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Reaction: Oh my God! Why was aspirin given?
Lesson: Make sure to remember that aspirin is contraindicated in children.

eMedinewS Humor

This is how our children may end up learning the alphabets

A – Apple – B – Blackberry C – Chatting D – Download E – Email F – Facebook G – Google H – Hotmail I – iTunes J – Java K – Kaspersky L – Laptop M – Microsoft N – Nintendo O – Outlook P – Playstation Q – Quicktime R – RapidShare S – Skype T – Twitter U – USB V – Vista W – Wikipedia X – XP Y – YouTube Z – Zorpia

Twitter of the Day

Dr KK Aggarwal: A mix of exercise protocol is better
Dr Deepak Chopra: Looking for God is like a thirsty fish looking for water. What you seek is all around you, but you don’t realize it

Rabies News (Dr A K Gupta)

How is rabies transmitted?

Rabies is transmitted by infected secretions. Most commonly, transmission to humans takes place through exposure to saliva following a bite by an infected animal. Rabies virus can be excreted in saliva, urine, nasal discharge and respiratory secretions.

Cardiology eMedinewS

  • Patients with mild hypertension (140 to 159 mm Hg/90 to 99 mm Hg) who received antihypertensive therapy lowered their blood pressure by about 3.6/2.4 mm Hg and had a reduced short-term risk of dying from stroke or cardiovascular disease, in a large meta-analysis. The review was published online December 22, 2014 in the Annals of Internal Medicine.
  • A new slant on the "obesity paradox" in patients with heart failure has surfaced in a new analysis from the Atherosclerosis Risk in Communities (ARIC) cohort, in which obesity prior to development of heart failure seemed protective, thus complicating theories about the complex interaction between heart failure and obesity. The study was published online December 22 in the Journal of the American College of Cardiology.

Pediatrics eMedinewS

  • A review has suggested that "one size fits all" is not the correct approach in the management of peanut and tree nut allergies. Rather, treatment plans need to be individualized for children allergic to peanuts and/or tree nuts to meet their nutritional needs and keep children safe from allergic food reactions. The review was published online in Clinical and Experimental Allergy.
  • New research published online in the Archives of Disease in Childhood has reported that young children, particularly infants and preschool children have an increased risk of Salmonella infection from pet reptiles and amphibians.

Quote of the Day

Act with kindness, but do not expect gratitude. Confucius

Wellness Blog

About thyroid gland

  • Low functioning thyroid is a new epidemic of the society affecting more than 3% of people. If thyroid function is low, it causes weight gain, loss of energy, cold intolerance and menstrual irregularities in women.
  • All people who are aged 50 and above should have their thyroid profile (TSH test) done to look for thyroid deficiency.
  • In younger people, or in cases of infertility, menstrual irregularity, pregnancy, weight gain, one should check for thyroid deficiency.
  • Iodized salt should be used to prevent thyroid deficiency.
  • Non–iodized salt is only used in two conditions: firstly in patient with thyroid inflammation and secondly, while doing Jalneti in naturopathy, a yoga–related nasal wash technique.
  • In pregnancy, even mild thyroid deficiency can affect the growth of fetus hence dose requirement of thyroid medicine is much higher in pregnancy than in non–pregnancy.
  • In the elderly, the dose of thyroid medicine to be started is always low as compared to one in the adults.
  • If thyroid deficiency is untreated, osteoporosis (thickening of bone) and/or atrial fibrillation (irregular and fast heart rate) may result. Osteoporosis can cause recurrent fractures and atrial fibrillation may cause brain paralysis.
  • In allopathic medicine, thyroid deficiency is treated by synthetic T4 hormone replacement. In TFSP, thyroid extracts are available, which contain both T4 and T3 potential drugs.
  • In Ayurveda, thyroid stimulant drugs are available but they are effective only if some amount of thyroid gland is available.
  • As per Ayurveda, eating soya and drinking water from copper vessel is good for thyroid.

ePress Release

The five Cs of ‘five a day’ in selecting fruits and vegetables

The current recommendation is to eat 5 or more servings of fruits and vegetables daily to prevent cancer and heart disease. Fruits and vegetables contain vitamins, minerals, phytochemicals and antioxidants and are low in calories. Those with the most color – dark green, red, yellow, and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs", which can be incorporated in the five a day diet. As per Ayurveda, one should mix all seven colors and six tastes when choosing fruits and vegetables.

As recommended by the USDA MyPlate, fruits and vegetables should make up half of a plate.

Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber-containing grain products, fruits and vegetables also reduce the risk of some cancers, said 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.

A serving size is: one medium-size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw leafy vegetables, 1/4 cup dried fruit.

Five servings means 2 fruits and 3 vegetables, 7 servings mean 3 fruits, 4 vegetables and 9 servings means 4 fruits, 5 vegetables.

Tips for safe eating

  1. Snack with raw vegetables instead of potato chips.
  2. Add fruits in breakfast.
  3. Eat salad bar when you go out for lunch.
  4. Prefer juice instead of a usual coffee, tea or soda.
  5. Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
  6. Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  7. Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  8. Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been held at an improper temperature.
  9. Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
  10. Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.

eMedi Quiz

IRIS commonly occurs after ………. of ART initiation?

a. 1-4 weeks
b.2-12 weeks
c.12-24 weeks
d. After 6 months

Yesterday’s Mind Teaser: Olfleck's phenomenon is seen in:

a. Joint psoriasis
b. Mucosal psoriasis
c. Nail psoriasis
d. Pustular psoriasis

Answer for yesterday’s Mind Teaser: c. Nail psoriasis

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan.

Answer for 24th December Mind Teaser: 3. Nucleic Acid

Correct answers received from: Dr J Daivadheenam, Tukaram Pagad, Dr Rakesh Sharma, Raju Kuppusamy, Dr Avtar Krishan.

Send your answer to email

medicolegal update
  1. Thanks for such informative & beautiful mail; with Regards, Dr Bharat Gadhvi.

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