eMedinewS29th August 2014, Friday

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

New form of heart failure on the rise

Heart failure is routinely described as the progressive loss of ability of the heart to pump blood. But, there is another form of heart failure where the blood–pumping ability of the heart remains near normal. This second form of heart failure is too often overlooked and is just as lethal.

In this condition the heart muscle becomes thickened. The chamber inside gets smaller and the heart is unable to relax to accommodate the blood it needs to pump out. As there is no room for the heart to relax, the blood backs up into the lungs. This kind of anomaly is not picked up by standard measurements of "ejection fraction" – the percentage of blood in the heart that goes out with every beat.

This form of the disease is called "diastolic heart failure" because the problem occurs during the diastole portion of heart activity, as the heart relaxes after a beat.

Nearly one–third of these patients have an ejection fraction greater than 50 percent, which is very near normal. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure, with more than 20% of all the patients dying within a year. There is a steady increase over 15 years of heart failure with normal or near–normal ejection fraction.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising and fluid retention in the body. Physicians cannot make a diagnosis on the basis of symptoms or routine examinations. One has to have an echocardiogram and see the heart pumping and see if the ejection fraction is normal or reduced. Until now, relatively little attention has been paid to diastolic heart failure. Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.

Pacing for heart failure For patients with advanced heart failure waiting for cardiac transplant, biventricular pacing not only improves the quality of life but also prolongs life. If the ejection fraction is low the combo device also gives an electric shock when the heart stops. It is said that all patients with low ejection fraction should ask their doctors for possible implantation of these devices.

Signals of heart failure

One of the commonest presentations is breathlessness on exertion, which is often confused as a part of aging or being obese. Not being able to climb stairs may be the earliest sign of hypertensive diastolic heart failure. Other signals are:

  1. Feeling extra tired even after a good night’s sleep. People with heart failure may limit activities they like to do or take naps to avoid feeling tired.
  2. Weight gain: Call your doctor if you gain weight for more than 2 days in a row or if you gain 2 or more pounds.
  3. Shortness of breath: Heart failure makes breathing harder, especially during exercise. Lying position may make it worse.
  4. Swollen ankles, legs, belly, and/or lower back, the swelling is often worse at the end of the day.
  5. Going to the bathroom more at night.

Innovations in Cardiology (IIC) Summit 2014

Dr Rajneesh Kapoor

Fat intake and heart risk

A 2014 meta–analysis of prospective observational studies found no association between intake of saturated fat and risk for coronary heart disease (CHD). The meta–analysis, published in Ann Intern Med. 2014 Mar 18;160(6):398–406, also found no relationship between monounsaturated fat intake and CHD, but suggested a reduction in CHD with higher intake of omega–3 polyunsaturated fats; a benefit with omega–6 polyunsaturated fats remains uncertain.

News Around The Globe

  • A new approach to evaluating the neural processes of children with attention–deficit/hyperactivity disorder (ADHD) reveals that, contrary to the traditional belief, the condition represents more of a decision–making impairment than a learning impairment. The study was published online in JAMA Psychiatry.
  • Arthroscopic surgery for middle–aged patients with degenerative meniscal tears and mild or no osteoarthritis may provide no benefit when compared with nonoperative management, suggests a new systematic review and meta–analysis published online August 25 in CMAJ.
  • Ketamine, an injectable anesthetic known to exert a rapid but short–lived antidepressant effect, could possibly reduce suicidal ideation independently of a reduction in depressive symptoms, suggests a new study published online in the Journal of Psychiatric Research.
  • A new study published in the August 28 issue of the New England Journal of Medicine has revealed that for patients with high-risk adenoma polyps removed after colorectal cancer (CRC) screening with colonoscopy, colonoscopic surveillance reduces CRC incidence and mortality; however, there is no reduction in those who have low–risk adenoma polyps removed.
  • The European Commission has approved daclatasvir to treat adults with chronic hepatitis C virus (HCV) infection in combination with other drugs. The drug blocks the action of NS5A, a protein essential for HCV replication and is indicated for adults infected with HCV genotypes 1, 2, 3, and 4.

Rabies News (Dr A K Gupta)

Is there a need to alter the dose or schedule of any concomitant medication during IDRV?

There is no need to alter the dose or schedule of any concomitant medication during IDRV.

Cardiology eMedinewS

  • European societies have published a joint consensus statement on antithrombotic therapy in patients with nonvalvular atrial fibrillation (AF) who present with an acute coronary syndrome (ACS) and may undergo PCI. The statement provides updates since the advent of new oral anticoagulant (NOAC) agents and "new–generation" drug–eluting stents (DES) and also addresses antithrombotic therapy in AF patients undergoing transcatheter aortic–valve implantation (TAVI). The document was published August 25 in the European Heart Journal.
  • A new study suggests that black carbon pollutants from wood smoke may increase cardiovascular disease in women. Researchers found that black carbon pollutant exposure had the highest impact on the women’s blood pressure, which has a major effect on cardiovascular risk. The study is published in Proceedings of the National Academy of Sciences (PNAS).

Pediatrics eMedinewS

  • Exposure to gestational diabetes mellitus (GDM) in the uterus significantly increases the odds of developing early diabetes in adolescence, suggests a new study. Obese children around age 12 with normal initial glucose tolerance whose mothers had GDM were about 6 times more likely to develop impaired glucose tolerance or type 2 diabetes by around age 15. The study was published online August 25 in Diabetologia.
  • A new study, published online in the European Journal of Public Health, has stated that children of women who take prenatal folic acid supplements have fewer autistic traits. However, the link is not explained by maternal folate concentrations, at least not at 13 weeks of gestational age.

Dr K K Spiritual Blog

Ganesha, the Stress Management Guru

If Lord Krishna was the first counselor who taught the principles of counseling, Lord Ganesha taught us the principles of stress management.

We should worship Lord Ganesha and become like him whenever we face any difficulty or are stressed out.

The elephant head of Lord Ganesha symbolizes that when in difficulty, use your wisdom, intelligence and think differently. It can be equated to the Third Eye of Lord Shiva. Elephant is supposed to be the most intelligent animal in the kingdom. Here, wisdom means to think before speaking. Lord Buddha also said that don’t speak unless it is necessary and is truthful and kind.

The big elephant ears of Lord Ganesha signify listening to everybody when in difficulty. Elephant ears are known to hear long distances. Elephant eye see a long distance and in terms of mythology, it represents acquiring the quality of foreseeing when in difficulty. The mouth of Lord Ganesha represents speaking less and hearing and listening more.

The big tummy of Lord Ganesha represents digesting any information gathered by listening to people in difficulty. The trunk denotes using the power of discrimination to decide from the retained information. It also indicates doing both smaller and bigger things by yourself. The elephant trunk can pick up a needle as well as a tree.

The teeth, broken and unbroken, signify to be in a state of balance in loss and gain. This implies that one should not get upset if the task is not accomplished and also not get excited if the task is accomplished. In times of difficulty, Ganesha also teaches us not to lose strength and control one’s attachments, desires and greed.

The four arms of Lord Ganesha represent strength. Ropes in two hands indicate attachment; Laddoo or Sweet in one hand represent desires and mouse represents greed. Riding over the mouse indicates controlling one’s greed.

Lord Ganesha is worshipped either when a new work is initiated or when one finds it difficult to complete a job or work. In these two situations, these principles of Lord Ganesha need to be inculcated in one’s habits.

Wellness Blog

FODMAPS free diet

Symptoms of IBS and inflammatory bowel disease may be at least in part related to impaired absorption of carbohydrates.

Fermentable oligo–, di– and monosaccharides and polyols (FODMAPs) in patients with IBS or IBD may enter the distal small bowel and colon where they are fermented, leading to symptoms and increased intestinal permeability (and possibly inflammation).

Examples of FODMAPs include:

  • Fructans or inulins (wheat, onions, garlic, and artichokes)
  • Galactans (beans, lentils, legumes, cabbage, and Brussels’ sprouts)
  • Lactose (dairy)
  • Fructose (fruits, honey, high fructose corn syrup)
  • Sorbitol
  • Xylitol
  • Mannitol
  • Polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums)

Avoidance of carbohydrates has been a long–popularized non–pharmacologic approach to reducing symptoms in IBS (and possibly modifying disease in IBD).

Inspirational Story

The House with the Golden Windows

The little girl lived in a small, very simple, poor house on a hill. She would play in the small garden and as she grew she was able to see over the garden fence and across the valley to a wonderful house high on the hill – and this house had golden windows, so golden and shining that the little girl would dream of how magic it would be to grow up and live in a house with golden windows instead of an ordinary house like hers.

And although she loved her parents and her family, she yearned to live in such a golden house and dreamed all day about how wonderful and exciting it must feel to live there.

When she got to an age where she gained enough skill and sensibility to go outside her garden fence, she asked her mother is she could go for a bike ride outside the gate and down the lane. After pleading with her, her mother finally allowed her to go, insisting that she kept close to the house and didn’t wander too far. The day was beautiful and the little girl knew exactly where she was heading! Down the lane and across the valley, she rode her bike until she got to the gate of the golden house across on the other hill.

As she dismounted her bike and leaned it against the gate post, she focused on the path that led to the house and then on the house itself…and was so disappointed as she realized all the windows were plain and rather dirty, reflecting nothing other than the sad neglect of the house that stood derelict.

So sad she didn’t go any further and turned, heartbroken as she remounted her bike… As she glanced up she saw a sight to amaze her…there across the way on her side of the valley was a little house and its windows glistened golden …as the sun shone on her little home.

She realized that she had been living in her golden house and all the love and care she found there was what made her home the ‘golden house’. Everything she dreamed was right there in front of her nose!

ePress Release

Do not ignore transient brain dysfunction

TIA or transient ischemic attack or mini paralysis is "a brief episode of neurologic dysfunction caused by lack of blood supply to a specific area of the brain or eye, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction or brain attack", 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.

It is a neurological emergency; its early recognition can identify patients who may benefit from preventive therapy or from surgery of large vessels such as the carotid artery.

The initial evaluation of suspected TIA and minor non disabling ischemic paralysis includes brain imaging, neurovascular imaging, and a cardiac evaluation. Laboratory testing is helpful in ruling out metabolic and hematologic causes of neurologic symptoms.

TIA or minor non disabling ischemic paralysis is associated with a high early risk of recurrent paralysis. The risk of paralysis in the first two days after TIA is approximately 4 to 10 percent. Immediate evaluation and intervention after a TIA or minor ischemic reduces the risk of recurrent stroke.

Risk factor management is appropriate for all patients. Currently viable strategies include blood pressure reduction, statins, antiplatelet therapy and lifestyle modification, including smoking cessation.

For patients with TIA or ischemic stroke of atherothrombotic, lacunar (small vessel occlusive), or cryptogenic type, antiplatelet agents should be given. For patients with atrial fibrillation and a recent ischemic stroke or TIA, the treatment is blood thinners. For patients with carotid blockages surgery is needed.

eMedi Quiz

Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4. X–ray diffraction.

Correct answers received from: Dr P C Das, Dr K Raju, Daivadheenam Jella, Dr K V Sarma, Dr Jainendra Upadhyay, Dr Bitaan Sen & Dr Jayashree Sen.

Answer for 27th August Mind Teaser: 3. Gelfiltration chromatography.

Correct answers received from: Dr Bitaan Sen & Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

Self-Assessment-Quiz

 

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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

press release

FDA panel recommends first drug for HIV prevention

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IJCP Book of Medical Records

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Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

eMedinewS Humor

Jealousy

The guy approached a beautiful looking woman in a mall and asked, "You know, I’ve lost my wife here in the mall. Can you talk to me for a couple of minutes?"

"Why?" she asks.

"Because every time I talk to a beautiful woman, my wife appears out of nowhere."

Quote of the Day

The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened. Johann Wolfgang von Goethe

Twitter of the Day

Dr KK Aggarwal: Diabetes is a progressive disease http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: You were created to be completely loved and completely lovable, for your whole life http://bit.ly/DC_Ananda

medicolegal update

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medicolegal update

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medicolegal update
  1. Dear Sir, Hats off to your efforts. Dr KJ Pal

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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