eMedinewS29th September 2013, Sunday

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
www.facebook.com/Dr KKAggarwal

All will not benefit by reducing salt

A new analysis from the large international PURE trial has reopened the debate over the link between sodium and blood pressure. Presenting PURE SODIUM here at the European Society of Cardiology 2013 Congress, Dr Andrew Mente (McMaster University, Hamilton, ON) and colleagues found that only certain subgroups will actually experience blood–pressure benefits from restricting their sodium consumption.

Ayurveda has been talking about it for some time. People with Kapha personality and pitta personality will benefit and not with vata personality.

5th Dil Ka Darbar

5th DIL KA Darbar event "Hangouts On Air - Google"

Date: Sunday, 29th September 2013, Venue: Constitution club of India, Rafi Marg, Time: 8 AM to 6 PM

Programme: A non stop question answer–session between all top cardiologists of the NCR region and the public.

The focus of the discussions will be prevention of heart diseases in women and young men. Special discussion will be held on Sex and Heart Diseases. Practical training will also be given to people on Hands–only Cardiopulmonary Resuscitation. Another focus of the discussion will be the launch of the Project Dhadkan (Palpitations) and Project Murmur (Congenital and valvular heart diseases in children).

Entry free…

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

Science Behind Regrets

sprritual blog

In a US-based study, dying people were asked about their regrets, if any. The top five regrets were:

• I wish I had the courage to live a life I wanted to live and not what others expected me to live.
• I wish I had worked harder.
• I wish I had the courage to express my feelings.
• I wish I had stayed in touch with my friends.
• I wish I had let myself to be happier.

Regrets are always based on suppression of emotions or non–fulfillment of desires and needs. These need–based desires can be at the level of physical body, mind, intellect, ego or the soul. Therefore, regrets can be at any of these levels.

I did a survey of 15 of my patients and asked them a simple question that if they came to know that they are going to die in the next 24 hours, what would be their biggest regret?

Only one of them, who was a doctor, said that she would have no regrets. The physical regret was only one and that was from a Yoga expert who said that her regret was not getting married till that day.

Mental regrets were two.

• A state trading businessman said, "I wish I could have taken care of my parents."
• A homeopathic doctor said, "I wish I could have given more time to my family." Intellectual Regrets were three.
• A lawyer said, "I wish I could have become something in life."
• A businessman said, "I wish I could have helped more people."
• A retired revenue inspector said, "I wish had married my younger child." Egoistic regrets were two.
• One fashion designer said, "I wish I could have become a singer."
• A housewife said, "I wish I could have become a dietician." Spiritual regrets were six.
• A Consultant Government Liaison officer said, "I wish I could have made my family members happy."
• A businessman said, "I wish I could have meditated more."
• A Homeopathic doctor said, "I wish I could have spent more time with my family."
• A reception executive said, "I wish I could have spent more time with my parents."
• An entertainment CEO said, "I wish I could have taken my parents for a pilgrimage."
• A fashion designer said, "I wish I could have worked more for the animals."

In a very popular and successful movie, Kal Ho Na Ho, the hero of the movie was to die in the next 40 days. When asked to remember the days of his life he could not remember 20 ecstatic instances in life.

This is what happens in life of each one of us where we waste all our days and cannot remember more than 50 or 20 of such instances. If we are given 40 days to live and if we live every day ecstatically, we can get inner happiness. Therefore, we should learn to live in the present instead of having a habit of postponing everything we do.

We should learn to prioritize the work and do difficult work first otherwise we will be worrying all the time till that work is over. I teach my patients that they should practice confession exercise and one of the confessions is to talk about your regrets and take them as challenge and finish before the next Tuesday.

When working, there are three things which are to be remembered – passion, profession and fashion. Profession is at the level of mind, ego and spirit.

We should convert our profession in such a manner that it is fashionable and passionate. Passion means working from the heart and profession means working from mind and intellect and fashion means working the same at the level of ego which is based on show offs.

cardiology news

The Carrot, the Egg, and the Coffee Bean

A young woman went to her mother and told her about her life and how things were so hard for her. She did not know how she was going to make it and wanted to give up. She was tired of fighting and struggling.

It seemed that, as one problem was solved, a new one arose. Her mother took her to the kitchen. She filled three pots with water and placed each on a high fire. Soon the pots came to a boil. In the first, she placed carrots, in the second she placed eggs, and in the last she placed ground coffee beans.

She let them sit and boil, without saying a word. In about twenty minutes, she turned off the burners. She fished the carrots out and placed them in a bowl. She pulled the eggs out and placed them in a bowl. Then she ladled the coffee out and placed it in a bowl. Turning to her daughter, she asked, "Tell me, what do you see?"

"Carrots, eggs, and coffee," the young woman replied. The mother brought her closer and asked her to feel the carrots. She did and noted that they were soft. She then asked her to take an egg and break it. After pulling off the shell, she observed the hard–boiled egg. Finally, she asked her to sip the coffee. The daughter smiled as she tasted its rich aroma. The daughter then asked, "What does it mean, mother?"

Her mother explained that each of these objects had faced the same adversity – boiling water – but each reacted differently. The carrot went in strong, hard and unrelenting. However, after being subjected to the boiling water, it softened and became weak.

The egg had been fragile. Its thin outer shell had protected its liquid interior. But, after sitting through the boiling water, its inside became hardened! The ground coffee beans were unique, however. After they were in the boiling water, they had changed the water.

"Which are you?" the mother asked her daughter. "When adversity knocks on your door, how do you respond? Are you a carrot, an egg, or a coffee bean?" Think of this: Which am I? Am I the carrot that seems strong but, with pain and adversity, do I wilt and become soft and lose my strength? Am I the egg that starts with a malleable heart, but changes with the heat? Did I have a fluid spirit but, after a death, a breakup, or a financial hardship, does my shell look the same, but on the inside am I bitter and tough with a stiff spirit and a hardened heart? Or am I like the coffee bean? The bean actually changes the hot water, the very circumstance that brings the pain. When the water gets hot, it releases the fragrance and flavor.

If you are like the bean, when things are at their worst, you get better and change the situation around you. When the hours are the darkest and trials are their greatest, do you elevate to another level? How do you handle adversity?

Are you a carrot, an egg, or a coffee bean?

News Around The Globe

20th MTNL Perfect Health Mela Programme Brouchure

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News

  • Taking a breakfast rich in protein and lighter meals at night are of help to type 2 diabetes patients trying to maintain glycemic control, as per a study presented at the annual meeting of the European Association for the Study of Diabetes by Daniela Jakubowicz, MD, professor of medicine at Tel Aviv University, Israel. Patients in the study who were randomly assigned a big breakfast strategy achieved in 3 months a reduction in HbA1c of 0.46%, compared with a 0.146% in the small–breakfast group. Average fasting glucose decreased 14.51 mg/dL in the big breakfast group and decreased 4.91 mg/dL in the small breakfast group
  • Cholesterol–lowering drugs that work by binding to bile acids in the gut modestly improve glycemic control and pose little risk of hypoglycemia, according to a meta–analysis. In the review of 12 randomized controlled trials involving colesevelam (Welchol) and another agent approved in Japan, the drugs were associated with a significant 0.52% reduction in HbA1c compared with controls by the end of the studies, Morten Hansen, MD, of Gentofte University Hospital in Copenhagen, and colleagues reported at the European Association for the Study of Diabetes meeting. According to Morten Hansen, the drop in HbA1c is "not that big," but the advantage is the low risk of hypoglycemia.
  • Waiting on more intensive glycemic control in patients newly diagnosed with type 2 diabetes may increase cardiovascular risk in the future. In a large retrospective study reported at the European Association for the Study of Diabetes meeting, among patients who had a consistently elevated HbA1c (7% or higher) early after diagnosis, a delay in treatment intensification of just 6 months was associated with greater risks of myocardial infarction, heart failure and a composite of cardiovascular events through about 5 years of follow-up, according to Sanjoy Paul, PhD, of the Australia. In general, the findings were similar regardless of whether the patients had had a cardiovascular event before receiving their diabetes diagnosis.
  • Differences in life expectancy between patients with type 1 diabetes and the general population have come down over the past few decades, but wide gaps still remain. In an analysis of Scottish data, men and women with type 1 diabetes had shorter life expectancy than the general population –– a gap of about 11 years for men and 14 years for women when measured in their early 20s, according to Helen Colhoun, MD, MBBCh, of the University of Dundee in Scotland, and colleagues. That’s a much smaller gap than the 27–year difference reported in a 1975 analysis, but more work needs to be done to minimize the discrepancy.
  • The FDA has added a boxed warning of the risk for immunosuppression–related reactivation of hepatitis B virus (HBV) for rituximab (Rituxan) and ofatumumab (Arzerra). The two agents are anti–CD20–directed monoclonal antibodies used to treat chronic lymphocytic leukemia. Rituximab also is used for non–Hodgkin’s lymphoma, rheumatoid arthritis, vasculitis, and other conditions. Reactivation of HPV can occur in individuals who have previously had the infection, even if it resolved clinically, if the virus remains latent in hepatic tissue and the person subsequently becomes immunosuppressed. Liver failure and death can follow.

Rabies News (Dr. A K Gupta)

What is your approach to a person who has consumed milk of a rabid animal?

If a person has consumed milk of a rabid animal, counseling should be done. If counseling is not effective, then PEP by IM or ID route or as a last resort, a course of PEP (only vaccine) should be given.

If the milk is boiled or heated then only counseling or at the most a course of PEP should be given only due to compulsions in medical practice in Indian setting.

cardiology news
  • When hypertensive patients with heart failure with preserved ejection fraction (HFpEF) follow a sodium–restricted diet, several key factors that contribute to their heart failure improve. Echocardiographic measurements showed that 3 weeks on a sodium–restricted DASH (Dietary Approaches to Stop Hypertension) diet significantly improved ventricular relaxation, while reducing diastolic chamber stiffness. There also was a trend toward lower energy for filling (P=0.10), which suggested increased diastolic efficiency. The 13 patients in the study showed significantly improved clinical blood pressure (from 155 to 138 mmHg) and 24–hour brachial systolic BP (130 to 123 mmHg) (both P=0.02) at 3 weeks, as well as a nonsignificant drop in central end-systolic BP (116 to 111 mmHg). Scott L. Hummel, MD, from the University of Michigan, Ann Arbor, and colleagues presented their findings at the annual meeting of the Heart Failure Society of America.
  • Individuals who have both diabetes and depression have an increased likelihood of having a myocardial infarction (MI). The odds of having an MI compared with individuals without either condition were greatest among those ages 45 to 64, with the strongest association seen in women (OR 7.1, 95% CI 6.1-8.2), according to Karin Rådholm, of Linköping University in Sweden at the European Association for the Study of Diabetes meeting. The chances of having an MI were also elevated –– but to a lesser extent –– in men and women who had either diabetes or depression, but not both. The corresponding odds ratio for men in that age group was 2.8. The

Valvular Heart Disease News

The commonest source of infection in endocarditis is infected vascular catheter, dental abscess or infected skin lesion.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news
  • More children got a flu vaccination last year than ever before, according to new figures from the CDC. Across the U.S., 56.6% of children ages 6 months through 17 years were immunized, according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases. That’s up by 5 percentage points from 2011-2012 and up 13 percentage points from 2010-2011. However, for adults, only 42% of those 18 and over got immunized –– although that was still 3 percentage points higher than the previous year.
  • New treatment options and rapid progress in understanding of juvenile idiopathic arthritis (JIA) pathophysiology led the American College of Rheumatology (ACR) to update its 2011 recommendations on the treatment of systemic JIA. The update, published online September 24 and in the October issues of Arthritis & Rheumatism and Arthritis Care & Research , includes new guidance on use of anakinra, canakinumab, and tocilizumab in systemic JIA, as well as recommended treatment pathways for both initial and continued disease. Three phenotypes of systemic JIA, including systemic JIA with features of macrophage activation syndrome (MAS), are specifically addressed in the updated recommendations vs 1 phenotype in the prior guidelines. Recommendations for repeat tuberculosis screening in children are also updated.
cardiology news

Why do commercial and foods cooked by ‘halwais’ taste better?

Hydrogenated oils containing trans fats are tastier than foods cooked in plant oils. Most hydrogenated oils involve hydrogenation of palm oils. Hydrogenation increases their shelf life, makes them easier to cook and spoil less easily. French fries, microwave popcorns and food cooked by traditional halwais are cooked in hydrogenated trans fats.

Most commercial catered food prepared from trans fats are tasty and often people overeat by at least 500 calories because of the taste provided by the hydrogenated oils.

Per serving, 5 grams of trans fatty acids is present in French fries, 6 gm in breaded fish burger, 5 gm in breaded chicken nuggets, 2 gm in biscuits, 2.7 gm in margarine, 2 gm in cakes, 1.6 gm in corn chips, 1.2 gm in microwave popcorn and 1.1 gm in pizza.

Four gm of trans fats are present in one parantha, 3.4 gm in one poori, 5.2 gm in one bhatura, 1.7 gm in one dosa, 6.1 gm in one tikki, 3 gm in one samosa, 2 gm in one serving of pakoda, 2.9 gm in one serving of vegetable pulao and 3.6 gm in one serving of halwa.

Just about 2.6 gm a day of trans fats, half as much contained in a packet of French fries can raise the risk of heart disease significantly.

Some trans fats occur naturally in foods, especially those of animal origin. The chemical configuration of trans fatty acids confers harmful effects, including adverse influences on blood LDL– and HDL–cholesterol concentrations. They raise LDL and lower HDL cholesterols. By comparison, consumption of saturated fats also raises the LDL cholesterol concentration, but does not lower HDL. Thus, while saturated fats adversely affect the lipid profile, they may not be as harmful as trans fatty acids.

Trans fatty acids may also interfere with the desaturation and elongation of n–3 (omega–3) fatty acids. These are important for the prevention of heart disease and complications of pregnancy. In an analysis from the Nurses’ Health Study, for each increase of 2 percent of energy from trans fat, the relative risk for incident coronary heart disease was 1.93. There are no known physiologic benefits related to the consumption of trans fatty acids; thus, reduction in their intake makes sense.

The words "partially hydrogenated" on the list of package ingredients are clues to their presence. Since 2006, the US Food and Drug Administration (FDA) has made it a requirement that Nutrition Facts labels portray trans fat content. FDA estimates that the average daily intake of trans fat in the U.S. population is about 5.8 grams or 2.6% of calories per day for individuals 20 years of age and older. On average, Americans consume approximately 4 to 5 times as much saturated fat as trans fat in their diet.

FDA’s label requirement is that if a dietary supplement contains a reportable amount of trans fat, which is 0.5 gram or more, dietary supplement manufacturers must list the amounts on the Supplement Facts panel. The FDA final rule on trans fatty acids requires that the amount of trans fat in a serving be listed on a separate line under saturated fat on the Nutrition Facts panel.

However, trans fats do not have to be listed if the total fat in a food is less than 0.5 gram (or 1/2 gram) per serving.

All restaurants in New York have banned all food items, which contain more than 0.5 gm of trans fats in one serving.

Guidelines

  • Check the Nutrition Facts panel: Choose foods lower in saturated fat, trans fat and cholesterol.
  • Choose alternative fats. Replace saturated and trans fats in your diet with mono – and polyunsaturated fats. These fats do not raise LDL (or "bad") cholesterol levels and have health benefits when eaten in moderation. Sources of monounsaturated fats include olive and canola oils. Sources of polyunsaturated fats include soybean, corn, sunflower oils, and foods like nuts.
  • Choose vegetable oils (except coconut and palm kernel oils) and soft margarines (liquid, tub, or spray) more often because the combined amount of saturated and trans fats is lower than the amount in solid shortenings, hard margarines, and animal fats, including butter.
  • Consider fish. Most fish are lower in saturated fat than meat. Some fish, such as mackerel, sardines and salmon, contain omega–3 fatty acids that are being studied to determine if they offer protection against heart disease.
  • Limit foods high in cholesterol such as liver and other organ meats, egg yolks and full–fat dairy products, like whole milk.
  • Choose foods low in saturated fat such as fat free or 1% dairy products, lean meats, fish, skinless poultry, whole grain foods and fruit and vegetables.
cardiology news

Total CPR since 1st November 2012 – 63400 trained

CPR Classes 63400

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Be cautious in giving painkiller to patients with high cholesterol

Long–term non–steroidal anti–inflammatory painkiller drugs (NSAIDs) such as naproxen should not be prescribed to patients with high cholesterol said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

In a swine model study published in the journal Surgery, Dr Frank Sellke, chief of cardiothoracic surgery and research at Rhode Island Hospital found that a high–cholesterol diet reduced blood flow to the heart muscle in animal models with chronic heart disease when given daily naproxen. They also found reduced levels of prostacyclin, a compound that dilates blood vessels and prevents blood clots.

These findings suggest that there may be a stronger risk of negative effects on the heart in patients who have high cholesterol levels and are taking NSAIDs as a form of pain or inflammation relief.

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 63400 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

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal received Shaheed Bhagat Singh Bravery Award on 27th September 2013

press release

Can vitamin D treat pain?

today video of the dayDr KK Aggarwal Birthday 5th September

Cultural Evening at IMA

Dr KK Aggarwal on Doctors Day SAHARA SAMAY News

eMedi Quiz

Read this…………………

Which factors may increase your risk of having a stroke?

A. Hypertension and aging. B
. Being female and Caucasian.
C. Being female and African–American.
D. Menopause.
E. B and C.

Yesterday’s Mind Teaser: Do women have more headaches than men?

A. No, they get equal numbers.
B. Yes, but not that many more.
C. Yes, and the headaches are more severe.
D. Yes, but men tend to get more painful kinds that last longer.
E. None of the above.

Answer for yesterday’s Mind Teaser: C. Yes, and the headaches are more severe.

Correct answers received from: Prabha Sanghi, DR AYYAVOO ERODE, Dr. V.P. Thakral, Dr Valluri Ramarao, Dr.K.V.Sarma, soni brijesh, Dr.K.Raju, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, DR AVTAR KRISHAN, Kanta Jain, Arvind Gajjar, Dr Prakash Khalap.

Answer for 27th September Mind Teaser: C. About 30 percent of your daily calories.

Correct answers received from: Dr. V.P. Thakral.

Send your answer to ijcp12@gmail.com



medicolegal update

Click on the image to enlarge

medicolegal update

My doctor sure has his share of nut cases.

One said to him, "Doctor, I think I’m a bell."
The doctor gave him some pills and said, "Here, take these — If they don’t work, give me a ring."

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

medicolegal update

If the looser keeps his smile, the winner will lose the thrill of victory.

medicolegal update

Dr KK Aggarwal: Dr K K Aggarwal: Relaxation during work http://bit.ly/15Lvpwx #Health

Dr Deepak Chopra: You are instantly abundant when you show thanks for what you have.

medicolegal update

Dear Sir, emedinews is very useful. Regards: Dr Sapna

Forthcoming Events

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20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations

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