eMedinewS29th November 2013, Friday

Dr K K Aggarwal Padma 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
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Take Aspirin at bed time for cardiovascular protection

  • Aspirin at bedtime instead of morning improves its anti–platelet effect but does not lower blood pressure as per Tobias N. Bonten, MD, of Leiden University Medical Center in the Netherlands.
  • Morning platelet reactivity scores averaged 22 aspirin reactivity units (ARU) lower in the bedtime dosing group, though, corresponding to a 5% difference compared with morning dosing (P=0.001).
  • Morning is a time of peak platelet reactivity and peak heart attack risk, so that small impact might be enough to make a difference.
  • Prior studies had suggested a blood pressure benefit of 5 to 7 mm Hg by taking aspirin at bed rather than on awakening.

Folic acid update

  • Folic acid (vitamin B9) is a water–soluble B vitamin.
  • It is lost in traditional Indian cooking.
  • Folic acid is essential for DNA repair, cell division and normal cellular growth.
  • Profound deficiency of folic acid during pregnancy is associated with neural tube defects, such as spina bifida in neonates.
  • Deficiency in adults has been associated with megaloblastic anemia and peripheral neuropathy.
  • In both men and women, low serum levels of folate can increase homocysteine levels, which are correlated with elevated cardiovascular risk.
  • Low folic acid levels during pregnancy in women with epilepsy have been associated with fetal malformation, and older enzyme–inducing anti epileptic drugs are known to reduce serum folate levels.
  • The risk of having a pregnancy complicated by a major congenital malformation (e.g., neural tube defect) is doubled in epileptic women taking anti epileptic drugs compared with those women with a history of epilepsy not taking these agents.
  • Risk is tripled with anti–epileptic drugs polypharmacy, especially when valproic acid is included.
  • Consensus statements recommend 0.4–0.8 mg of folic acid per day in all women planning a pregnancy.
  • Ideally, this should be started at least 1 month prior to pregnancy if possible.
  • The guidelines recommend higher daily folic acid doses (4 mg/day) in women with a history of neural tube defects.
  • In addition, enzyme–inducing anticonvulsants, such as phenytoin, carbamazepine, primidone and phenobarbital, are known to decrease folate levels, and valproic acid may interfere with folate metabolism.
  • Other AEDs, such as oxcarbazepine, lamotrigine and zonisamide, do not appear to alter folate levels.
  • Because many pregnancies are unplanned, most recommend that folic acid supplementation be given routinely to all women of childbearing potential at 0.4 mg/day.

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."


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

All about depression

sprritual blog

1. Depression is a major public health problem as a leading predictor of functional disability and mortality.

2. Optimal depression treatment improves outcome for most patients.

3. Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.

4. A non–psychiatric physician 50% of times misses the diagnosis of the depression.

5. All depressed patients must be enquired specifically about suicidal ideations.

6. Suicidal ideation is a medical emergency

7. Risk factors for suicide are either psychiatric known disorder, medical illness, prior history of suicidal attempts, family history of attempted suicide.

8. The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.

9. World over 1 million people commit suicide every year.

10. 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only 1/3 contacts their mental health service provider.

11. Twice as many suicidal victims had contacted with their primary care provider as against the mental health provider in the last month before suicide.

12. Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.

13. In US suicidal rate is 10.5 per 100,000 people.

14. In America suicide is increasing in middle aged adults.

15. There are 10–40 non–fatal suicide attempts for every one completed suicide. The majority of suicides completed in US are accomplished with fire arm (57%), the second leading method of suicide in US is hanging for men and poisoning in women.

16. Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.

17. 50% of successful victims have made prior attempts.

18. One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.

19. The risk of suicide increases with increase in age, however, younger and adolescents attempt suicide more than the older.

20. Females attempt suicide more frequently than males but males are successful three times more often.

21. The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order.

22. Living alone increases the risk of suicide.

23. Unemployed and unskilled patients are at higher risk of suicide than those who are employed.

24. A recent sense of failure may lead to higher risk.

25. Clinicians are at higher risk of suicide.

26. The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27.

27. Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.

28. The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.

29. Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.

30. Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.

31. High impulsivity or alcohol or other substance abuse increase the risk.

cardiology news

A Touching Story from a Father

My wife called, ‘How long will you be with that newspaper? Will you come here and make your darling daughter eat her food?’

I tossed the paper away and rushed to the scene. My only daughter Sindu looked frightened.

Tears were welling up in her eyes. In front of her was a bowl filled to its brim with Curd Rice. Sindu is a nice child, quite intelligent for her age. She has just turned eight. She particularly detested Curd Rice. My mother and my wife are orthodox, and believe firmly in the ‘cooling effects’ of Curd Rice! I cleared my throat, and picked up the bowl.

'Sindu, darling, why don’t you take a few mouthful of this Curd Rice? Just for Dad’s sake, dear.

Sindu softened a bit, and wiped her tears with the back of her hands.

‘OK, Dad. I will eat – not just a few mouthfuls, but the whole lot of this.

But, you should…’ Sindu hesitated. ‘Dad, if I eat this entire curd Rice, will you give me whatever I ask for?’…

Oh sure, darling’… 'Promise?'……… ‘Promise’.

I covered the pink soft hand extended by my daughter with mine, and clinched the deal.

‘Ask Mom also to give a similar promise’, my daughter insisted.

My wife put her hand on Sindu’s, muttering ‘Promise’. Now I became a bit anxious.

‘Sindu dear, you shouldn’t insist on getting a computer or any such expensive items. Dad does not have that kind of money right now. OK?’

‘No, Dad. I do not want anything expensive’.

Slowly and painfully, she finished eating the whole quantity.

I was silently angry with my wife and my mother for forcing my child to eat something that she detested. After the ordeal was through, Sindu came to me with her eyes wide with expectation. All our attention was on her.

‘Dad, I want to have my head shaved off, this Sunday!’ was her demand.

‘Atrocious!’ shouted my wife, ‘A girl child having her head shaved off? Impossible!’ ‘Never in our family!’ my mother rasped.

‘She has been watching too much of television. Our culture is getting totally spoiled with these TV programs!’

Sindu darling, why don’t you ask for something else? We will be sad seeing you with a clean–shaven head.’

‘No, Dad. I do not want anything else’, Sindu said with finality.

‘Please, Sindu, why don’t you try to understand our feelings?’

I tried to plead with her.

‘Dad, you saw how difficult it was for me to eat that Curd Rice’.

Sindu was in tears. ‘And you promised to grant me whatever I ask for.

Now, you are going back on your words. Was it not you who told me the story of King Harishchandra, and its moral that we should honor our promises no matter what?’

It was time for me to call the shots.

‘Our promise must be kept.’

‘Are you out your mind?’ chorused my mother and wife.

‘No. If we go back on our promises, she will never learn to honor her own.

Sindu, your wish will be fulfilled.’

With her head clean–shaven, Sindu had a round-face, and her eyes looked big and beautiful.

On Monday morning, I dropped her at her school. It was a sight to watch my hairless Sindu walking towards her classroom. She turned around and waved. I waved back with a smile. Just then, a boy alighted from a car, and shouted, ‘Sinduja, please wait for me!’

What struck me was the hairless head of that boy.

‘May be, that is the in–stuff’, I thought. ‘Sir, your daughter Sinduja is great indeed!’ Without introducing herself, a lady got out of the car, and continued,’ That boy who is walking along with your daughter is my son Harish. He is suffering from… … leukemia.’ She paused to muffle her sobs.

Harish could not attend the school for the whole of the last month. He lost all his hair due to the side effects of the chemotherapy. He refused to come back to school fearing the unintentional but cruel teasing of the schoolmates.

'Sinduja visited him last week, and promised him that she will take care of the teasing issue.

But, I never imagined she would sacrifice her lovely hair for the sake of my son! Sir, you and your wife are blessed to have such a noble soul as your daughter.’

I stood transfixed. And then, I wept. ‘My little Angel, you are teaching me how self–less real love is!’

The happiest people on this planet are not those who live on their own terms but are those who change their terms for the ones whom they love.

Life is short, the vanities of world are transient but they alone live who live for others; the rest are more dead than alive.

News Around The Globe

News

  • I have retired as Director Health Services Punjab and have had the personal experience of supervising the working of Rural Dispensaries and Primary Health Centers in Punjab during my tenure as Civil Surgeon of some districts. I totally agree with your findings about the present state of affairs of their working. However regarding the solution suggested by you, I happen to hold a bit different opinion. What I observed was that these dispensaries can be categorized into three different types.

    1. Dispensaries with both a qualified doctor and a pharmacist in place.
    2. Dispensaries where a qualified doctor in place but post of pharmacist lying vacant.
    3. Dispensaries where Pharmacist in place but post of doctor lying vacant.

    The patient turnover, their level of satisfaction and the overall satisfaction of the village population of the area regarding the working of the dispensary was best for the dispensary where only Pharmacist was in place and the post of Doctor was lying vacant. This was followed by the dispensary where both posts were filled up and the worst was the one where only Doctor was posted and the post of Pharmacist was lying vacant.

    It was not difficult to visualize the reasons for this difference. Where only pharmacist was in place, he/she usually stayed in the same village and was available to the village population 24 hours in case of emergency. He/She was able to give them pain relief when required and was actually considered by local population as their Doctor. The dispensaries where both posts were filled up, usually suffered from intrigue between the Doctor and the Pharmacist as villagers would address the pharmacist also as their doctor due to the fact that the later usually stayed in the village but the Doctor would reach late in the morning and leave early in the afternoon and was not available to the local people in case of pain at odd times. Because of intrigue the doctor would not allow use of medicines and other facilities in his/her absence thus handicapping the Pharmacist from giving relief to patients in his absence. Dispensaries where only Doctor was posted and the Pharmacist post was lying vacant obviously had the worst reputation because Doctor would visit only some days from the nearby town for a few hours daily and was not available to the local people in times of pain.

    Now the question obviously arises is, how to make Doctors stay in the village. Most of the Medical Graduates come from urban back ground and a few having a rural back ground also get urbanized after staying in urban areas during their college education. They stay in college hostels having usual urbanized living facilities and get used to the urban life style. How can we expect them to go back to rural set up where the dispensary building even may be a small dilapidated room donated by the village Panchayat? The Doctor may even not have the facility of a clean toilet. What about a good house for stay, a good school for their kids, a good company for the doctor’s family and good recreational facilities for the family? Even the medical facilities being provided are also a few analgesics, antispasmodics, iron and folic acid tablets, some antibiotics, some dressing material and a few injections. All these can be effectively used by a Pharmacist. Normal deliveries can be carried out by the trained Dai/ANM or LHV. All other cases have to be referred to nearby town hospital or PHC or Community Health Centre. A qualified Doctor really feels handicapped and suffocated in such situations where even if he wants to do something, is unable to do the same for want of facilities.

    Under such circumstances, to imagine that Govt. will provide all such facilities to attract doctors to go to villages and stay there is a far–fetched possibility amounting to total improbability. Govt priorities are different and the type of politicians we have that are part of the decision making bodies, we all know their priorities. The less said the better. To expect sufficient budget allocations and provision of such facilities at least during our life times is next to impossible.

    So the only solution for the time being is to produce such doctors who will only work and stay in villages like the bare–footed doctors. For such a class we can think of providing 1–2 years refresher course to our qualified pharmacists and ANMs and give them some name like Rural Health officers or Rural Medical Practitioners who should be permitted to practice only in rural areas and our qualified doctors should be posted only in towns having Community Health Centers or Primary Health Centers that should be provided with due working facilities and due life style facilities for them. (Dr. HS Aneja MD (Medicine) Director Health & FW Punjab (Retd). #145, Sector–6, Panchkula.)

  • In a policy reversal, American Board of Obstetrics and Gynecology (ABOG) has announced that obstetrician–gynecologists can continue to treat male patients for sexually transmitted infections after all. In September, ABOG announced that to remain board–certified, obstetrician–gynecologists must not care for male patients except in several narrow circumstances, such as evaluation of fertility, family planning, and emergency care.

  • A retrospective study reported online in the American Journal of Cardiology has shown that among patients with atrial fibrillation who stopped taking warfarin because of a major gastrointestinal bleed, restarting anticoagulation was associated with improved outcomes with lower risks of thromboembolism and death.

  • Obese patients with no signs of metabolic disease are at a greater risk of developing diabetes and cardiovascular disease than unhealthy people of normal weight, according to a new study published online November 20 in the Journal of Clinical Endocrinology and Metabolism.

  • Preoperative vitamin D blood levels were found to be significantly and inversely associated with risk for hospital–acquired infections after gastric bypass surgery in a new study. Among obese patients with 25–hydroxyvitamin D levels lower than 30 ng/mL, there was a three–fold risk for a hospital–acquired infection after surgery versus patients whose vitamin D levels were 30 ng/mL or higher.

  • Individually targeted lifestyle changes may increase the likelihood nulliparous women will have normal pregnancies, according to results from a large, newly published cohort study. The changes identified include normalizing maternal weight, increasing consumption of fruits before pregnancy, reducing blood pressure, and avoiding use of drugs.

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Rabies News (Dr. A K Gupta)

How is RIG injected locally? What is the mode of administration of full dose of RIG?

It is important to infiltrate all wounds with rabies immunoglobulin (RIG). Intramuscular (IM) administration of RIG is of very little value. The previous recommendation to give antirabies serum half into wounds and half IM no longer holds true and may lead to treatment failure. As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around all the wounds. In the event that some volume of RIGs is left over after all wounds have been infiltrated, the same should be administered by deep IM at a site distant from the vaccine injection site.

If the calculated dose of RIG is insufficient to infiltrate all wounds, sterile saline can be used to dilute it 2 or 3 fold to permit thorough infiltration.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Enhanced pacemaker technology sharply reduced progression of nonpermanent atrial fibrillation to permanent AF in patients with bradycardia and sinus node disease in the large international, randomized MINERVA (Minimize Right Ventricular Pacing to Prevent Atrial Fibrillation and Heart Failure) trial. The use of dual–chamber pacemakers containing features for atrial preventive pacing and atrial antitachycardia pacing, called DDDRPs, plus managed ventricular pacing (MVP) resulted in a 61% reduction in the incidence of permanent AF during 2 years of prospective follow–up, compared with conventional dual–chamber pacing.
  • Effervescent or readily soluble formats of common medications, such as painkillers and vitamin supplements, contain high levels of "hidden" sodium, which was linked with an increased risk of cardiovascular events, researchers from UK have reported. In an observational study of UK adults followed for about seven years, being prescribed a readily soluble formulation as opposed to a regular formulation of a drug was associated with a 22% increased risk of stroke and a seven–fold increased risk of hypertension.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Around a quarter of young people with type 2 diabetes also have diabetic peripheral neuropathy, a new pilot study indicates. The prevalence of diabetic peripheral neuropathy found among the youngsters with type 2 diabetes far exceeded that of young people with type 1 diabetes and approached that of adults with type 2.
  • Extending the duration of initial prednisolone treatment from 2 months to 6 months while escalating the dose failed to reduce the incidence of frequently relapsing nephrotic syndrome in children in a randomized, open–label, noninferiority trial.
cardiology news

Use painkillers with caution in the elderly

Painkillers can cause stroke via irregular heart rhythm. Non selective non–steroidal anti–inflammatory drugs (NSAIDs) and new generation selective COX–2 inhibitors commonly used to treat inflammation are now linked to an increased risk of irregular heart rhythm called atrial fibrillation (AF), as per a Danish Research of 32602 patients led by Professor Henrik Toft Sorensen at Aarhus University Hospital in Denmark.

These drugs are already linked to increased risk of heart attacks and strokes. And now through AF, the risk gets intensified for stroke and new risk added of heart failure and death.

In the study, compared with non users, new users (first drug within 60 days of diagnosis) showed 40% increased risk of AF with non–selective NSAIDS and 70% increased risk with COX–2 inhibitors. This means four extra cases of AF per year per 1000 new users of non–selective NSAIDS and seven extra cases of AF per 1000 new users of COX–2 inhibitors.

The risk was highest in the elderly, patients with chronic kidney disease or rheumatoid arthritis especially on COX–2 inhibitors. NSAIDs should be used very cautiously in older patients with a history of hypertension or heart failure.

cardiology news

Total CPR since 1st November 2012 – 75187 trained

Media advocacy through Web Media

6035 people trained in CPR 10 at the India International Trade Fair

Heart Care Foundation of India trained 6035 people in how to revive a person after sudden death in the recently concluded India International Trade Fair (IITF) in a space provided by the Directorate of Health Services for the said purpose.

Giving the details Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President of the Foundation said that so far the Foundation has trained 75187 people with 1:1 training. Their names and addresses including signatures are being maintained by the Foundation.

The number of people trained day–wise was 156 (14th), 321 (15th), 360 (16th), 300 (17th), 360 (18th), 450 (19th), 420 (20th), 450 (21st), 450 (222nd), 450 (23rd), 390 (24th), 682 (25th), 646 (26th) and 600 (27th).

The Foundation also created awareness about Formula of 10 (CPR-10) to revive a person after sudden cardiac death, which is "To revive after sudden cardiac arrest, within 10 minutes of cardiac arrest (earlier the better) for the next ‘at least’ 10 minutes compress the center of the chest, continuously and effectively, with a speed of 10 x 10 (100) per minute."

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 75187 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."

today emedipics

CPR10 Training at IITF

press release

Reflexology for Cancer Symptoms

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Yesterday’s Mind Teaser: Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5’ Capping.
3. 3’ polyadenylation.
4. Glycosylation.

Answer for yesterday’s Mind Teaser: 4. Glycosylation.

Correct answers received from: DR ARPAN GANDHI, Arvind Gajjar, Dr. Dinesh Narain Saksena, Dr. P. C. Das, Dr.K.V.Sarma, Dr Chandresh Jardosh, Sangeetha Raja, Dr Jainendra Upadhyay, DR AVTAR KRISHAN, Dr.K.V.Sarma,

Answer for 26th November Mind Teaser: 2.Replacement of glutamate by valine in B-chain of HbA.

Correct answers received from: Dr Chandresh Jardosh, Sangeetha Raja, Dr Jainendra Upadhyay, DR AVTAR KRISHAN

Send your answer to ijcp12@gmail.com



medicolegal update

Click on the image to enlarge

medicolegal update

Tech support: "Okay Colin, let’s press the control and escape keys at the same time. That brings up a task list in the middle of the screen. Now type the letter "P" to bring up the Program Manager."

Customer: I don’t have a P.

Tech support: On your keyboard, Colin.

Customer: What do you mean?

Tech support: "P" on your keyboard, Colin.

Customer: I’M NOT GOING TO DO THAT!!

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

medicolegal update

Many of us crucify ourselves between two thieves – regret for the past and fear of the future. Fulton Oursler

medicolegal update

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Empirical facts are not descriptions of fundamental reality but descriptions of modes of human observation using a human nervous system

Forthcoming events

5th eMedinews Revisiting 2013

(a day long single hall medical conference on 2013 happenings, followed by doctors of the year 2013 awards)

Sunday 19th January 2014, Maulana Azad Medical College Auditorium

Dilli Gate Delhi, 10 am-6 pm


Dr KK Aggarwal
Padma Shri and Dr B C Roy National Awardee President
Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman
Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

5th eMedinewS Revisiting 2013
The 5th eMedinewS–revisiting 2013 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 19th 2014.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2013. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. Lunch will be provided.

Register at: rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

5th eMedinewS Doctor of the Year Awards
Nominations invited for 5th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2013.

pls send his/her Biodata at: emedinews@gmail.com

medicolegal update
  1. Dear Sir, very informative news. Regards: Dr Suraj

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medicolegal update

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