eMedinewS28th February 2014, Friday

Dr K K AggarwalPadma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; 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

Low cholesterol linked to anxiety, depression, suicide, hemorrhagic stroke and cancers

People with very low cholesterol levels are at increased risk of developing stomach cancer, according to a study published in the International Journal of Cancer.

The study involved 2,600 residents of Hisayama, Japan, who were followed for 14 years. Gastric cancers developed in 97 subjects. After accounting for age and gender, stomach cancer rates rose significantly with descending cholesterol level. For example, among subjects with the highest cholesterol levels, the gastric cancer rate was the equivalent of 2.1 cases per 1000 persons per year; among those with the lowest cholesterol, the rate was 3.9 per 1000 persons per year.

Patients with low serum cholesterol should consider periodic gastrointestinal examination for the prevention of stomach cancer.

Low cholesterol has been earlier linked to depression, anxiety and suicide in both men and women. Another earlier report has also shown that people with cholesterol level below 180 had twice the risk of brain hemorrhage as compared to those with cholesterol levels of 230.

Congrates Dr KK Aggarwal DST National Science Communication Award (the highest award a doctor can receive in the field of science communication)

  1. Dear Dr.Aggarwal,Many many congratulations for the award which you so rightly deserve. Wish you many more.I am a regular reader of emedinews and found it to be very informative. Dr.Rohini Dhillon.
  2. Heartiest congrats Sir. Great news. warm regards: Atul Kumar, MD, FAMS, Professor of Ophthalmology, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences.
  3. Dear Dr. K.K. Agarwal, Heartiest Congratulations! God Bless you.
  4. Many more recognitions await you.Regards,Prof. (Dr.) Madan Mohan
  5. Dear K K, Congratulations. .! I am delighted..! Kishor Taori
  6. Congrats Dr AGARWAL JI! You deserve it.: Dr Saroj Sahu
  7. Congratulations on being a recipient of DST award ! That shall enable you to be more buoyant . Prof M E Yeolekar, Mumbai.
Dr K K Aggarwal on Zee TV

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 mantra
VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Science behind Shiva the Neelkanth

sprritual blog

The blue neck Shiva called Neelkanth symbolizes that one should neither take out the vices or negative emotions nor suppress them. Instead one should alter or modify them.

The blue colour in mythology symbolizes slow poison that includes attachments, anger, greed, desires and ego. Blue neck means to hold on the negative emotions temporarily so that it can be neutralized at appropriate time.

Suppressed anger releases chemicals which can lead to acidity, asthma, angina, future heart attacks and diarrhea etc. Similarly expressed anger can cause social unhealthiness and acute heart disease.

The only way to mange anger is to take the right and not the convenient action. One should neutralize anger by willful cultivation of opposite, positive of different thoughts.

Anger is a known risk factor for heart blockages. Anger can evoke physiological responses that are potentially life threatening in the setting of underlying heart blockages. It has a dominant influence on the severity, frequency, and treatment of angina.

This Vedic message of Shiva is being validated by many western scientists.

Anger has many phases

1. Anger Expression Inventory
2. Assesses anger frequency (trait anger)
3. Anger intensity
4. Anger expression (anger–out)
5. Anger suppression (anger–in)
6. Anger recall.

Both anger–in and anger–out are associated with heart blockades.

a. Dr. C. Noel Bairey Merz, from Women’s Health at Cedars–Sinai Medical Center has shown women who outwardly express anger (anger–out) are at increased risk especially if they also have other risk factors like age, diabetes and high cholesterol levels. The findings are a part of Women’s Ischemia Syndrome Evaluation Study, a multi–center, long–term investigation sponsored by the National Heart, Lung and Blood Institute.

b. Anger–in is also related to severity of blockages. Dr. TM Dembroski in 1985 has shown that potential for Hostility and Anger–In are significantly and positively associated with the heart blockages disease severity, including angina symptoms and number of heart attacks. Suppressed anger is also associated with increased carotid arterial stiffness in older adults, a condition making them prone to future heart attacks and paralysis.

c. In univariate correlational analysis by Anderson DE from National Institute on Aging, Baltimore, Maryland in 2006 has shown a significant positive association of anger–in with artery stiffness.

d. Suppressed anger has also been shown to increase blood pressure by Thomas and group from University of Tennessee.

e. Recall of suppressed anger has been shown by Dr D Jain in 2001 from Yale University to be associated with angina, heart LV dysfunction and rise in upper blood pressure.

f. G Ironson and colleagues from Department of Psychology, University of Miami in 1992 has shown that anger recall produces more stress than the actual stress in a treadmill. Intensity of anger was associated with severity of angina. In the study vasoconstriction only occurred with high levels of anger. There also showed that there was no narrowing of non–narrowed arteries indicating that anger recall produce coronary vasoconstriction in previously narrowed coronary arteries.

cardiology news

God will never take away something without giving you something better in its place.

The cheerful little girl with bouncy golden curls was almost five. Waiting with her mother at the checkout stand, she saw them, a circle of glistening white pearls in a pink foil box.

"Oh mommy please, Mommy. Can I have them? Please, Mommy, please?"

Quickly the mother checked the back of the little foil box and then looked back into the pleading blue eyes of her little girl’s upturned face.

"A dollar ninety–five. That’s almost $2.00. If you really want them, I’ll think of some extra chores for you and in no time you can save enough money to buy them for yourself. Your birthday’s only a week away and you might get another crisp dollar bill from Grandma."

As soon as Jenny got home, she emptied her penny bank and counted out 17 pennies. After dinner, she did more than her share of chores and she went to the neighbor and asked Mrs. McJames if she could pick dandelions for ten cents. On her birthday, Grandma did give her another new dollar bill and at last she had enough money to buy the necklace.

Jenny loved her pearls. They made her feel dressed up and grown up. She wore them everywhere, Sunday school, kindergarten, even to bed. The only time she took them off was when she went swimming or had a bubble bath. Mother said if they got wet, they might turn her neck green.

Jenny had a very loving daddy and every night when she was ready for bed, he would stop whatever he was doing and come upstairs to read her a story. One night as he finished the story, he asked Jenny,
"Do you love me?"
"Oh yes, daddy. You know that I love you."
"Then give me your pearls."
"Oh, daddy, not my pearls. But you can have Princess, the white horse from my collection, the one with the pink tail. Remember, daddy? The one you gave me. She’s my very favorite."
"That’s okay, Honey, daddy loves you. Good night." And he brushed her cheek with a kiss.
About a week later, after the story time, Jenny’s daddy asked again, "Do you love me?"
"Daddy, you know I love you."
"Then give me your pearls."

"Oh Daddy, not my pearls. But you can have my baby doll. The brand new one I got for my birthday. She is beautiful and you can have the yellow blanket that matches her sleeper."
"That’s okay. Sleep well. God bless you, little one. Daddy loves you."
And as always, he brushed her cheek with a gentle kiss.
A few nights later when her daddy came in, Jenny was sitting on her bed with her legs crossed Indian style.

As he came close, he noticed her chin was trembling and one silent tear rolled down her cheek. "What is it, Jenny? What’s the matter?"
Jenny didn’t say anything but lifted her little hand up to her daddy. And when she opened it, there was her little pearl necklace. With a little quiver, she finally said, "Here, daddy; this is for you."
With tears gathering in his own eyes, Jenny's daddy reached out with one hand to take the dime store necklace, and with the other hand he reached into his pocket and pulled out a blue velvet case with a strand of genuine pearls and gave them to Jenny.
He had them all the time… He was just waiting for her to give up the dime–store stuff so he could give her the genuine treasure.

So it is, with God. He is waiting for us to give up the cheap things in our lives so that he can give us beautiful treasures.
Are you holding onto things that God wants you to let go of?
Are you holding on to harmful or unnecessary partners, relationships, habits and activities that you have come so attached to that it seems impossible to let go? Sometimes it is so hard to see what is in the other hand but do believe this one thing.

News Around The Globe

INDIA LIVE 2014
"Revolutionise Interventional Cardiology in the Region",
Taj Palace Hotel, 28th February to 2nd March 2014

TAVI in patients with previous mitral valve prosthesis – How safe?

Dr Rajneesh Kapoor, Medanta Medicity, Gurgaon

There is increasing evidence and data regarding TAVI (transcatheter aortic valve implantation) as treatment option for patients of severe aortic stenosis, especially with comorbidities like previous CABG and valve surgeries, chest deformities etc.

When a patient with previous mitral valve prosthetic valve, presents with severe aortic stenosis, it not only throws a challenge for repeat surgery for aortic valve but also make TAVI procedure extremely challenging.

Patients with a history of mitral valve surgery are often excluded from TAVI studies because concerns exist about possible interference between the mitral prosthetic housing or bioprosthetic struts and transcatheter valve that might interfere with optimal valve deployment, increasing the risk of prosthesis shift and misplacement. Because of these concerns, the ongoing PARTNER II and CoreValve US pivotal trial studies have both excluded patients who have previously undergone mitral valve surgery.

Since patients of prior mitral valve surgery have often been considered a contraindication for TAVI, evidence concerning TAVI outcomes in this group of patients remains sparse and limited to a few case reports.

In a single–centre study, Bruschi et al reviewed the outcomes of nine patients with a prior history of mitral valve surgery who had undergone TAVI at their centre between 2008 and 2012 (of 172 TAVI patients overall). Of these patients, four had received Sorin Allcarbon monodisc mitral valve prosthesis, two had received Sorin Biocarbon bileaflet mitral valve prosthesis, one received a 25mm On–X bileaflet valve (On–X Life Technologie), one received a Perimount bioprosthesis valve (Edwards Lifesciences), and one patient had received a 26mm Carpentier–Edwards physio ring (Edwards Lifesciences). Additionally, the mean interval between the mitral valve surgery and the TAVI procedure was 12.5 years and four of the patients had undergone two previous operations on the mitral valve. The third–generation of the CoreValve was used in all patients, with seven patients receiving the valve transfemorally and two receiving the valve via a direct aortic access approach.

We have treated total of 10 patients, who previously underwent mitral valve surgery, with CoreValve with successful results with no interference with the mitral prosthesis.

The key point is not only patient selection, including multislice CT evaluation of the distance between the aortic annulus and the mitral prosthesis, but accuracy and control of valve deployment is also crucial. For this reason, we believe that in case of a short distance, an alternative access—such as the direct aortic approach—may be of use.

The lesions un–crossable with stent

Dr. Sanjeeb Roy, Additional Director, Interventional Cardiology, Fortis Escorts Hospital, Jaipur

There are times when the lesions have been crossed and prepared (dilated), but the stent cannot be navigated to the destined site. Such situations arise, especially when the proximal course of the artery is tortuous and/or calcified, or the take–off is steep or extremely angulated.

Some of the strategies discussed here may solve most the problems. The first step is to get adequate guide support. Co–axially aligned guide with back–up support is of extreme importance. Sometimes, the use of 7 or 8 French guide catheter can be of added support. However, in cases such as anomalous origin of arteries, further co–axial alignment can be achieved after wiring the artery or sometimes over the balloon catheter.

Use of additional guide wires (buddy wire technique) does help in some cases, as also anchoring balloon technique. In anchoring balloon technique, either a side branch is wired and appropriately sized balloon is inflated or over a buddy wire, another balloon inflated just distal to the lesion.

Deep engagement of guide catheter does help in some of the cases. This is like in RCA – "amplatzation" of convention JR catheter in RCA. However, such maneuver needs additional skills. The proximal segment should be relatively free of disease, and should be attempted with use of 5-6 Fr guide catheter unless the vessel of very large caliber. Importantly it should be attempted over the shaft of the balloon catheter and not on the naked guide wire. Sometimes, if anatomy permits the guide can be deeply intubated to quite a significant length in distal RCA. Maneuvering in LAD and LCx may not that easy.

With availability of "guideliner" such deep extension and support to navigate stent distally has become easier. Again tracking over balloon shaft and/or balloon anchoring is preferred. Care must be taken to avoid contrast injection while deep intubation with guide catheter or "guideliner".

"Mother and child technique" is another alternative and useful technique. This involves use of smaller caliber longer guide catheter through a larger conventional guide catheter, for deep intubation. Extremely good back–up is provided by such technique.

Even after trying all such techniques, at times there may be exceptional cases when stent cannot be traversed. Sometimes on–table innovations do help to bail out of such unusual circumstances.

Tap Technique – Best strategy for provisional stenting for bifurcation lesions

Dr Harminder Singh, Interventional Cardiologist, Mumbai

There are various strategies for stenting in bifurcation lesions. They are broadly divided into two stent techniques and provisional stenting techniques where the main branch is stented but the side branch is stented only if necessary. TAP Technique (T–stent with Protrusion)1, also called Carina Modification Technique is a technique where the side branch stent is deployed in such a way that the stent in side branch protrudes inside the main branch stent (one example is shown in the pictures). It has following advantages:

• Operator is committed to only one stent strategy at the onset of the procedure. If result after main branch stent and kissing balloon is considered good, the procedure can be stopped without SB stent. Second stent in side branch is only needed in case of dissection in SB, TIMI 2 flow or less and/or angina/ECG changes due to SB compromise.

• It ensures coverage of the side branch ostium.

• Nearly 100% success in re-crossing/stent delivery to the side branch.

• No need for any dedicated bifurcation stents thus simplifying the procedure and reducing cost.

• Avoids large are of 2 or 3 layers of stent struts as in crush techniques.

It has become preferred technique in most cath labs.

Reference

1. Burzotta F, et al. Catheter Cardiovasc Interv 2007;70(1):75–82

Primary Angioplasty in the Indian Scenario

Dr Sharad Chandra, Associate Professor, Dept. of Cardiology, K G Medical University, Lucknow

Data from the CREATE registry showed the rate of primary angioplasty after STEMI to be 8% as against 40% and 58% in the European Heart Surveys 1 & 2, respectively. Considering that the participatory centers and cities in CREATE, the general population figures are bound to be significantly lower. While the reasons for this are multifactorial, ranging from lack of insurance to lack of adequately equipped centres, one must focus on the most easily remediable aspects. In this context, both public awareness and primary physician sensitisation need special mention. While greater patient awareness cuts short the symptom to first medical contact time, sensitisation at the level of primary physician is essential to ensure precious time is not lost in misdirected treatment. With the mean presentation time after STEMI being approximately 5 hours, the need for coordinated ambulance services equipped with telemetry facilities cannot be overemphasized. Telemetry coordinated transport to a PAMI–equipped centre or authorisation for in–ambulance thrombolysis is today one of the most cost–effective and ironically most ignored, aspects of emergency cardiovascular care in India.

Percutaneous Transluminal Coronary Angioplasty

Dr. J.S.Dugal MD MNAMS DM (Cardiology) DIRECTOR OF CARDIAC CATH LAB, JEHANGIR HOSPITAL PUNE

Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calci?ed or ?brotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation.

Creating ill defined vascular interventionists vs refined super specialists

Dr. Raman Chawla, Director of Chawla Heart Care centre, Jalandhar, Punjab (India). M.B.B.S

I remember the time when during our career of DM, we were doing only coronary interventions. As decades progressed, we realized that there is nothing technologically new coming up in coronary interventions except to say chronic total occlusion intervention. Does it mean that technically we are saturated in interventions? But it does not under estimate the point that every patient is a new experience.

The changing trend is that as more and more new interventionists are coming up in the field who are working independently at new centers, where either they are forced to perform every type of intervention or growing competition is making them to enter every vascular intervention.

The spectrum include below knee interventions along with creating plantar arc to another delicate extreme of carotid intervention and not only this, a new era of venous interventions is coming up like deep venous thrombosis interventions venous angioplasty and stenting. Greed to interventionist does not stop him only to deep vens but it makes them to enter into superficial veins that is to say varicose venous interventions too and a complete advance field of uterim artery and bronchial artery embolisation.

The point I want to highlight "WHETHER IS THIS TREND GOOD OR BAD…???" Are we trying to create incomplete specialist of every vascular specialty.

I don’t disagree to the fact that these interventions are much more reqarding and satisfactory to patients and as well as the interventionists himself. But are we pushing against the wall and ultimately landing into era of ill defined vascular specialists.

"Should we stop them or motivate them so that they become super super specialists"

Do we form a national body to decide, who can do what or the rat race should continue…??

I personally feel that doing little bit of everything is not good for the patients. But I leave this to be decided by stalwarts of cardiology or entire cardiology form.

TAVI in patients with previous mitral valve prosthesis, How safe ?

Dr. Rajneesh Kapoor, Senior Director, Division of Interventional Cardiology, Medanta Heart Institute, Gurgaon

There is increasing evidence and data regarding TAVI (transcatheter aortic valve implantation) as treatment option for patients of severe aortic stenosis especially with comorbidities like previous CABG & valve surgeries, chest deformities etc.

While patient with previous mitral valve prosthetic valve, now presenting with severe aortic stenosis, it not only throws a challenge for repeat surgery for aortic valve but also make TAVI procedure extremely challenging.

Patients with a history of mitral valve surgery are often excluded from TAVI studies because concerns exist about possible interference between the mitral prosthetic housing or bio prosthetic struts and transcatheter valve, that might interfere with optimal valve deployment, increasing the risk of prosthesis shift and misplacement. Because of these concerns, the ongoing PARTNER II and CoreValve US pivotal trial studies have both excluded patients who have previously undergone mitral valve surgery.

Since patients of prior mitral valve surgery often considered a contraindication for TAVI, evidence concerning TAVI outcomes in this group of patients remains sparse and limited to a few case reports.

In a single–centre study, Bruschi et al reviewed the outcomes of nine patients with a prior history of mitral valve surgery who had undergone TAVI at their centre between 2008 and 2012 (of 172 TAVI patients overall). Of these patients, four had received a Sorin Allcarbon monodisc mitral valve prosthesis, two had received a Sorin Biocarbon bileaflet mitral valve prosthesis, one received a 25mm On–X bileaflet valve (On–X Life Technologie), one received a Perimount bioprosthesis valve (Edwards Lifesciences), and one patient had received a 26mm Carpentier–Edwards physio ring (Edwards Lifesciences). Additionally, the mean interval between the mitral valve surgery and the TAVI procedure was 12.5 years and four of the patients had undergone two previous operations on the mitral valve. The third-generation of the CoreValve was used in all patients, with seven patients receiving the valve transfemorally and two receiving the valve via a direct aortic access approach.

Total of 10 patients, who previously underwent mitral valve surgery, we're treated with CoreValve with successful results with no interference with the mitral prosthesis.

The key point is not only patient’s selection, including multislice CT evaluation of the distance between the aortic annulus and the mitral prosthesis, but accuracy and control of valve deployment is also crucial. For this reason, we believe that in case of a short distance, an alternative access—such as the direct aortic approach—may be of use.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

What are the most common modes of exposures of rabies virus?

Human exposures to rabies can generally be categorized as bite, open wound, mucous membrane, or other types of exposure:

  • Bite exposure: Any penetration of the skin of a person by the teeth of a rabid or potentially rabid animal.
  • Open wound exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal into an open wound (e.g., broken skin that bled within the past 24 hours).
  • Mucous membrane exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal onto any mucous membrane (eyes, nose, mouth).
  • Other exposure: Any interaction with a rabid or potentially rabid animal where a bite, open wound, or mucous membrane exposure cannot be definitively ruled out.
cardiology news

Diclofenac associated with increased risk of cardiovascular events

Diclofenac, used for the treatment of pain and inflammation caused by arthritis, is associated with a significantly increased risk of cardiovascular complications and should be removed from essential–medicines lists.

It is listed on the EML of 74 countries, increased the risk of cardiovascular events between 38% and 63% in different studies. The increased risk with diclofenac was similar to the COX-2 inhibitor rofecoxib, a drug withdrawn from worldwide markets because of cardiovascular toxicity.

Dr David Henry at Institute for Clinical Evaluative Sciences, Toronto who conducted the review along with Dr Patricia McGettigan at London School of Medicine and Dentistry said that its use is much more common in other non–Western countries.

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

Dr. K K Aggarwal to receive National Award for Science Communication

Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior Vice President, Indian Medical Association will be receiving National Award for Science Communication on Friday, 28th February, 2014 at 4 pm.

This is the highest award presented to an individual or an institution for outstanding work in science communication by the Department of Science & Technology National Science Communication. The award consists of Rs. 2 lakhs, a memento and a citation.

After receiving this award, Dr. Aggarwal will become the first doctor to have received Padma Shri, Dr. B C Roy National Award in the field of health and National Science Communication Award in the field of science. The award will be presented by Shri S. Jaipal Reddy, Hon’ble Union Minister for Science & Technology and Earth Sciences at Raman Auditorium, Technology Bhawan, New Mehrauli Road, New Delhi.

Dr. Aggarwal is known for his low cost science and health communication modules including Perfect Health Mela.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 86664 people since 1st November 2012.

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."

emedipicstoday emedipics

Mega heart checkup camp by Heart Care Foundation of India at Sagar, Madhya Pradesh 20th–23rd February 2014

press release

Should I be registered with MCI?

vedio of day

today video of the dayPadma Shri & Dr B C Roy National Awardee,Dr KK Aggarwal on Tackling tension headaches

Hands only CPR 10 Utsav, 15th December 2013

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

eMedi Quiz

Which one of the following is a recognized X–Ray feature of rheumatoid arthritis?

1. Juxta–articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri–articular calcification.

Yesterday’s Mind Teaser: High resolution computed tomography of the chest is the ideal modality for evaluating:

1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Answer for yesterday’s Mind Teaser: 2. Interstitial lung disease.

Correct answers received from: Dr.K.V.Sarma, Dr shashi saini, Dr.(Maj. Gen.) Anil Bairaria, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Avtar Krishan, Dr.Bitaan Sen & Dr,Jayashree Sen

Answer for 26th February Mind Teaser: 4.Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non–ionised in plasma.

Correct answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay

Send your answer to ijcp12@gmail.com

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lic
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medicolegal update

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medical querymedical query

medicolegal update
medicolegal update

The next day, TV news reported that 100 million was taken from the bank. The robbers counted and counted and counted, but they could only count 20 million. The robbers were very angry and complained "We risked our lives and only took 20 million, the bank manager took 80 million with a snap of his fingers. It looks like it is better to be educated to be a thief!"

This is called "Knowledge is worth as much as gold!"

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

medicolegal update

Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader.

medicolegal update

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Learn the seven stages of consciousness & how they lead to enlightenment. Which stage have you reached? http://bit.ly/WAHF_Am #WAYHF

Forthcoming events

Date: Saturday 2PM-Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

medicolegal update
  1. Dear Dr KK Aggarwal, Heartiest congratulations. Many more laurels to follow. Best wishes: From: DR Chandresh Jardosh

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

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