eMedinewS28th August 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Ohio cardiologist indicted for fraud.

A Ohio cardiologist was indicted by the US Dept of Justice for doing unnecessary stents, unneeded catheterizations, unnecessary imaging tests and referrals for bypass surgery that were not medically warranted. The cardiologist was indicted for an insurance fraud worth 7.2 million dollars.

Falsifying cardio care records, making unnecessary referrals, for open heart surgery and performing needless and sometime invasive heart tests and procedures is inconsistent with not only the law but also a doctor’s basic duty to his patients.

The types of frauds included:

  • Performing unnecessary nuclear imaging, aortograms, renal angiograms, intravascular ultrasound, and other tests that were not medically warranted.
  • Recording false nuclear stress test results to justify cardiac catheterizations.
  • Performing cardiac catheterizations and falsely recording occlusions or severity of disease.
  • Falsely recording symptoms to justify tests and procedures.
  • Inserting stents in asymptomatic patients who did not have evidence of 70% stenosis.
  • Referral of patients to bypass when there was no medical necessity for surgery, enabling him to bill for follow-up testing.
  • Starting in 2011, the Society for Cardiovascular Angiography and Interventions has started implementing a series of quality, accreditation, and accountability initiatives that the organization would have to follow to restore public trust in interventional cardiology.

Dr H Persaud has pleaded not guilty on all charges. He was arrested in August 2014, and now finally indicted last week.

Innovations in Cardiology (IIC) Summit 2014

Dr Rajneesh Kapoor

Running and heart risk

Several professional society guidelines recommend at least 30 minutes of moderate–intensity exercise 5 to 7 days per week, but this is not achievable for all patients. A non–randomized study, published in J Am Coll Cardiol 2014 Aug 5;64(5):472–81, concluded that running, even 5–10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease. These findings support the concept that even small amounts of exercise are better than no exercise while at least 30 minutes of moderate–intensity exercise 5 to 7 days per week remains a reasonable goal for most patients.

News Around The Globe

  • Neuropsychiatric symptoms are common in newly diagnosed, untreated patients with Parkinson’s disease (PD); however, they remain relatively stable over a 2–year follow–up, suggests initial longitudinal data from a study published online in Neurology.
  • A new study, published online in Diabetes Care, has shown that daily consumption of pistachios may improve the metabolic risk profiles for people with prediabetes.
  • Regular physical activity may lower the risk for psoriasis and improve the natural course of the disease, suggests a new study. Physical activity may also improve the incidence and severity of metabolic comorbidities associated with psoriasis. The study has been published online in the Journal of the European Academy of Dermatology and Venereology.
  • Schizophrenia is a chronic and severe mental illness, but new research suggests happiness in these patients is an attainable treatment goal. Researchers noted that happiness was not associated with severity of symptoms, duration of illness, physical health, or cognitive functioning. The study was published online in Schizophrenia Research.
  • Endoscopic ultrasound (EUS) results do not correlate with gastric cancer pathologic staging, and should therefore be combined with other modalities to guide therapy, suggests a study published online in the Journal of the American College of Surgeons.

Rabies News (Dr A K Gupta)

What is the incubation period of rabies in humans?

The incubation period of rabies i.e. the time interval between the exposure to virus and the onset of symptoms, is usually from 03 weeks to 03 months (rarely 04 days to 02 years). An incubation period as long as 19 years has been reported. Children are at an increased risk of a shorter incubation period because of their short stature and bites are often closer to CNS. Multiple bites to the head and neck are associated with very short incubation periods less than 1 month.

The incubation period varies with the amount of virus transmitted, virus strain, site of inoculation (bites closer to the head have a shorter incubation period), host immunity and nature of the wound.

During most of the long incubation period of rabies, the virus likely remains close to the site of viral entry. Centripetal spread to the central nervous system and spread within the central nervous system occur by fast axonal transport People who are immunocompromised will most likely be more susceptible to rabies. Rabies is usually undetectable during the incubation period, and infections can also be difficult to diagnose when the clinical signs first appear.

Cardiology eMedinewS

  • A combined analysis of two trials comparing aspirin at 100 mg/day vs placebo in patients with recent deep vein thrombosis (DVT) or pulmonary embolism (PE) has found that daily aspirin can reduce the adjusted recurrence risk by more than a third over three to four years after acute therapy for a first unprovoked venous thromboembolism (VTE). The analysis is published August 25 in Circulation.
  • Data from a large national registry of MI patients has revealed that individuals who participate in clinical trials typically have a lower risk profile and better prognosis compared with the real–world population of MI patients. The analysis is published in the August 27 issue of the Journal of the American Medical Association.

Pediatrics eMedinewS

  • High–dose erythropoietin (EPO) administered within 42 hours of birth to preterm infants was linked with a reduced risk of brain injury, as indicated by magnetic resonance imaging, suggested a study published in the August 27 issue of JAMA.
  • A study published recently in PLOS Medicine on large–scale rural sanitation programs in India has highlighted the challenges in achieving sufficient access to latrines and reduction in open defecation to yield significant health benefits for young children.

Dr K K Spiritual Blog

Think Differently In Mythology

Is the only spiritual mantra taught in mythology? Here are a few examples

  • Lord Ganesha with the elephant’s head depicts that one should use their wisdom before taking any decision.
  • Vishnu’s first incarnation, fish, symbolizes learning to swim in the opposite direction.
  • Brahma’s five heads mean to use all your five senses before taking any decision.
  • Shiva’s third eye means to think differently in difficulties.
  • Ravan’s ten heads mean using your ten senses before taking any decision. But, Ravan used them for negative forces.
  • Maha Mrityunjaya mantra begins as we worship the three–eyed Shiva.
  • Gayatri mantra means that one should ask the heart to direct the intellect to take the right decision. The 3H philosophy is linked to the same. The first H is ask the head for options; second H is to ask the heart to choose one of the options and the third H means to order the hand to do the action

Wellness Blog

Travel more than doubles risk of blood clots

Long distance travelers periodically should move around and stretch their legs instead of just sitting and also drink plenty of water to stay hydrated.

Long–distance travel can lead to potentially fatal blood clots in some people and the risk grows with the length of the trip. Those at increased risk of blood clots include cancer patients, people who have recently had major surgery such as a joint replacement, and women on birth control pills.

In general, travel is associated with a nearly three–fold increase in the risk of venous thromboembolism (blood clots that form in the veins), often in the legs. If such a clot dislodges and travels to the lungs, it can cause a potentially fatal condition called pulmonary embolism.

A combination of factors including dehydration and hours of sitting in cramped conditions explains why some people develop blood clots.

A review published in the Annals of Internal Medicine, analyzed 14 studies involving more than 4,000 cases of venous thromboembolism and found that travelers had a nearly three–fold higher risk of blood clots than non–travelers. The risk climbed along with the duration of the trip, rising 18 percent for every two hours of any type of travel, and by 26 percent for every two hours of air travel.

But there is no reason for panic, because the absolute risk to any one traveler is still low. People who travel long distances should be aware of the risk of blood clots and learn to recognize the symptoms. Symptoms of a blood clot in the leg include pain, warmth, swelling and redness in the limb. If the clot travels to the lungs, it may cause sudden shortness of breath, chest pain or a cough that produces blood.

Inspirational Story

Little Brown Boy

Danielle was only four when she burst through the front door, having just gotten off the school bus, after preschool. Charging through the living room, she spotted me in the dining room and launched into a speech while she headed toward me. While it was comical to see such a little person behave so dramatically, her outrage seemed real enough that she had my full attention.

"They are MEAN to him!" she raged, her little fist hammering the table top for emphasis. "Who is mean to who?" I interrupted.

"Those kids on the bus! They are MEAN to the little brown boy!" She looked up at me, hands on her hips, her eyes wide, incredulous. I knew she expected me to right this injustice immediately. It was the first one she had discovered in her very new Out in the World on Her Own adventures.

"They make fun of him and make fun of him and make fun of him." Her golden head nodded emphatically with each repetition. "They laugh at him. They copy the way he talks. They hurt his feelings!" I watched her while I listened. This was something very different for her, this little girl I knew so well. I had never seen her just this way before. I even saw flashes of anger in her green eyes.

"The way he talks…?" I prompted, as if she needed prompting. I sat down at the table and set her on my lap.

"He doesn’t talk perfect, but that’s just because he’s a little kid!" this four–year–old elderly person informed me loudly, inches from my face. She looked directly into my eyes, needing answers. "WHY are they so MEAN?"

My husband and I had been a little apprehensive about sending her to and from preschool ("Head start") on a bus with many of the kids so much older and bigger and tougher than she was. This was our baby of the family, our sheltered miniature princess, and it was not easy to back off and let her face the world without us for a few hours a day … Alas, even princesses grow up.

"Do you think they might be doing that just because he’s new?" I asked her. She thought for a minute. "No. When I was new, they didn’t make fun of me." I took a deep breath. "Do you think maybe they tease him because his skin is black?"

She thought for a minute, clearly puzzled. Then she wrinkled her nose and said, "You mean brown?" I nodded and she went on: "Because he’s BROWN? You don’t make fun of someone just because of that!"

I told her I hoped she was right. She was learning lessons none of us should need to learn. Man's inhumanity to man … Kid’s inhumanity to kids… Whatever the reason, people can be so cruel.

Since we were looking into that subject, and since Danielle has a Downs’ syndrome sister who rode on the same bus, I asked quietly, "Does anyone on the bus make fun of Shannon, Danielle?"

I'll never forget the look she gave me. My question threw her totally off guard. Her brow furrowed, her nose wrinkled again and she asked, "Why in the world would they make fun of Shannon?" The very idea was ludicrous. Her mother could be so silly sometimes…

Relief was great…

But just in case, just in case there really was a flash of racial prejudice or any other mean–streak residing in the preschool bus in our little rural neighborhood, it was necessary to take a bit of action. First, I telephoned the principal and informed him that my preschooler had come home upset because of the way a little boy was treated on the bus. I told him what she had told me, and he asked me to thank her for him, for alerting us to a possible problem, something that needed his attention. He assured me he would look into it and he appreciated Danielle’s and my concern.

She was happy. We had done something. Then, for good measure, she and I sang a song together: a song we both knew very well.

"Jesus loves the little children…all the children of the world. Red and yellow Black (‘AND BROWN’, I threw in) and white, All are precious in His sight. Jesus loves the little children of the world."

I don’t know how the principal chose to handle the problem: I don’t know what he said to the kids. But rest assured Danielle kept me posted on Life on the School Bus, and there was not even one more negative incident involving the little brown boy.

A princess had seen to that.

ePress Release

Tips for a healthy heart: Walk more and drink less soda

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 gave a few tips and ways to keep a healthy heart.

  • Take a 10–minute walk as part of a larger plan to exercise.
  • Find your comfortable walking shoes or buy a pair.
  • Choose days and times to walk, and then pencil them on the calendar.
  • Plan a route.
  • Think about possible obstacles and solutions. For example, if it’s raining hard, do 10 minutes of mixed marching, stair climbing, and jumping rope before dinner.

Drink more water, less soda

  • Find a water bottle (or buy one).
  • Wash out the bottle, fill it up, and put it in the refrigerator at night.
  • Put a sticky note on the front door, or on your bag as a reminder to carry the water bottle along with you.
  • At work, take a break in the morning and one in the afternoon to freshen up your water bottle. This is a good time to notice how much (or little) you are drinking.
  • When you get home from work, scrub out the water bottle for the following day and repeat.
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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."

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Health Check Up Camp at Sarvodya Kanya Vidyalaya, 8th May 2014

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Strenuous exercise may increase risk of cardiac disorder

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Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

eMedinewS Humor

Where’s the toast I asked for?

An elderly husband and wife visit their doctor when they begin forgetting little things. Their doctor tells them that many people find it useful to write themselves little notes.

When they get home, the wife says, "Dear, will you please go to the kitchen and get me a dish of ice cream? And maybe write that down so you won’t forget?"

"Nonsense," says the husband, "I can remember a dish of ice cream."

"Well," says the wife, "I’d also like some strawberries and whipped cream on it."

"My memory’s not all that bad," says the husband. "No problem – a dish of ice cream with strawberries and whipped cream. I don’t need to write it down."

He goes into the kitchen; his wife hears pots and pans banging around. The husband finally emerges from the kitchen and presents his wife with a plate of bacon and eggs.

She looks at the plate and asks, "Hey, where’s the toast I asked for?"

Quote of the Day

Striving for excellence motivates you; striving for perfection is demoralizing. Harriet Braiker

Twitter of the Day

Dr KK Aggarwal: Natural food and not supplements to prevent heart disease http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Our immune system might respond vigorously to our environment. Here is An Ayurvedic Approach to Seasonal Allergies http://bit.ly/DC_Ananda

eMedi Quiz

The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X–ray diffraction.

Yesterday’s Mind Teaser: The following separation technique depends on the molecular size of the protein:

1. Chromatography on a carboxymethyl (CM) cellulose column.
2. Iso–electric focusing.
3. Gelfiltration chromatography.
4. Chromatography on a diethylaminoethly (DEAE) cellulose column.

Answer for yesterday’s Mind Teaser: 3. Gelfiltration chromatography.

Correct answers received from: Dr PC Das, Daivadheenam Jella, Raju Kuppusamy, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Hitendrasinh Thakor, Dr Chandresh Jardosh, Dr Avtar Krishan.

Answer for 27th August Mind Teaser: 1.Glyceraldehyde–3–phosphate dehydrogenase

Correct answers received from: Dr Jainendra Upadhyay, Pradip Das, Dr Chandresh Jardosh, Daivadheenam Jella, Dr Avtar Krishan, Dr Bitaan Sen, Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Thanks for the information: Regards, Dr Kanishk

Forthcoming Events

Dear Colleague

Kindly attend ‘Innovations in Cardiology (IIC) Summit 2014’ on 6th September, 11 am – 6 pm at Hotel Oberoi, Gurgaon.

The Organizing Secretary is Dr Rajneesh Kapoor

Highlights of the conference

  • Separate hall for Clinical Cardiology
  • One session on Medicolegal aspects will be taken by me.
  • No registration fee, limited seats

Kindly send your confirmation to rawat.vandana89@gmail.com or sms 9891673085

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