eMedinewS2nd March 2014,Sunday

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

INDIA LIVE 2014

Is there a Difference of Opinion?

A difference of opinion is not negligence.

The Supreme Court of India has observed:

  1. In Bolam v. Friern Hospital Management Committee (1957) 2 All ER 118, the law was stated thus: "Where you get a situation which involves the use of some special skill or competence… The test is the standard of ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill; it is well–established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.…… A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.…… Putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion which a takes contrary view."
  2. "A doctor cannot be held negligent either in regard to diagnosis or treatment or in disclosing the risks involved in a particular surgical procedure or treatment, if the doctor has acted with normal care, in accordance with recognised practices accepted as proper by a responsible body of medical men skilled in that particular field, even though there may be a body of opinion that takes a contrary view. Where there are more than one recognised school of established medical practice, it is not negligence for a doctor to follow any one of those practices, in preference to the others."

References

  1. 6 SCC 1, 334/2005/SCI/144–145 of 2004: Jacob Mathew vs State of Punjab and Anr: 5th day of August 2005: R C Lahoti, CJI: Hon’ble Mr. Justice G P Mathur, Hon’ble Mr. Justice P K Balasubramanyan.
  2. Bolam vs Friern Hospital Management Committee (1957) 2 All ER 118 (QBD).
  3. SCI, Civil Appeal No. 1949 of 2004, 16.01.2008, Samira Kohli vs Dr. Prabha Manchanda and Anr, B.N. Agrawal, P.P. Naolekar and R.V. Raveendran, JJ.

Congratulations

  1. Honorable Padma Shri Dr Aggarwal, Greetings from Mapmygenome !! We on behalf of Mapmygenome would like to offer our Congratulations to you on achieving DST National Award for outstanding efforts in Science & Technology -yet another prestigious award for your noble sincere & game changing role in the society as a Medical professional & a Great son of India. We sanguinely believe that you will kindly continue to offer services to your patients in achieving a Quality Health Life. Sanjay Shashank
  2. Dear Dr Aggarwal, Greetings of the day! I take pleasure to congratulate you on behalf of IAE for receiving the prestigious DST National Award for outstanding efforts in Science and Technology Communication. We wish that you keep bringing more laurels to the medical fraternity by your excellent work for various sections of our society. Warm Regards, Dr Hansa Gupta, Gen Sec IAE
  3. Respected sir, hearty congratulations. The award you received is certainly a recognition you deserve. .your commitment for health education and awareness generation is excellent. .a real model to all doctors in medical profession. Best wishes. Dr. Sagar Thankachan, Secretary. IMA Nedumangad branch, Kerala 4. Dear Dr KK Aggarwal ji, Heartiest Congratulations. You have achieved a stature where every award is a minuscule. Awards stand to gain glory and distinction when associated with your name. Dr kiran Kapoor
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
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Why do we not offer Vanaspathi Ghee at the time of cremation or worship?

sprritual blog

Vanaspati Ghee is never offered to God at the time of Aarti in the Diya or to the dead body at the time of cremation. Only pure ghee is offered.

It is considered a bad omen to offer Vanaspati ghee at the time of the last cremation ritual even though the consciousness has left the body.

What is not offered to God should not be offered to our consciousness and that was the reason for this ritual in a temple. Vanaspati ghee increases bad cholesterol and reduces level of good cholesterol in the blood. On the other hand, pure ghee only increases bad cholesterol but does not reduce the level of good cholesterol. The medical recommendation is that one should not take more than 15 ml of oil, ghee, butter or maximum ½ kg in one month.

It is a spiritual crime to offer vanaspati ghee to God.

cardiology news

Be a Believer to be an Achiever

The professor stood before his class of 30 senior molecular biology students, about to pass out the final exam. ‘I have been privileged to be your instructor this semester, and I know how hard you have all worked to prepare for this test. I also know most of you are off to medical school or grad school next fall, ’he said to them.

‘I am well aware of how much pressure you are under to keep your GPAs up, and because I know you are all capable of understanding this material, I am prepared to offer an automatic ‘B’ to anyone who would prefer not to take the final.’

The relief was audible as a number of students jumped up to thank the professor and departed from class. The professor looked at the handful of students who remained, and offered again, ‘Any other takers? This is your last opportunity.’ One more student decided to go.

Seven students remained. The professor closed the door and took attendance. Then he handed out the final exam. There were two sentences typed on the paper:

‘Congratulations, you have just received an ‘A’ in this class. Keep believing in yourself.’ I never had a professor who gave a test like that. It may seem like the easy way out of grading a bunch of exams, but it’s a test that any teacher in any discipline could and should give. Students who don’t have confidence in what they’ve learned are ‘B’ students at best.

The same is true for students of real life. The ‘A’ students are those who believe in what they’re doing because they’ve learned from both successes and failures. They’ve absorbed life’s lessons, whether from formal education or the school of hard knocks, and become better people.

Those are the people who you look for when you’re hiring or promoting, and the ones you keep if you’re downsizing. Your organisation needs their brand of thinking.

Psychologists say that by the age of two, 50 percent of what we ever believe about ourselves has been formed; by age six, 60 percent, and at eight years, 80 percent. Wouldn't you love to have the energy and optimism of a little kid? There is nothing you couldn’t do or learn or be.

But you’re a big kid now, and you realise you have some limits. Don’t let the biggest limit be yourself. Take your cue from Sir Edmund Hillary, the first person to reach the summit of Mount Everest: ‘It’s not the mountain we conquer, but ourselves.’

Believing in yourself comes from knowing what you are really capable of doing. When it’s your turn to step up to the plate, realise that you won’t hit a homerun every time. Baseball superstar Mickey Mantle struck out more than 1,700 times, but it didn't stop him from excelling at baseball. He believed in himself, and he knew his fans believed in him.

Surround yourself with positive people – they know the importance of confidence and will help you keep focused on what you can do instead of what you can’t. Who you surround yourself with is who you become.

Never stop learning! I would work this advice into every column if I could; it’s that important. Don’t limit yourself only to work–related classes, either. Learn everything about every subject that you can. When you know what you’re talking about, it shows. Be very careful not to confuse confidence with a big ego. If you want people to believe in you, you also have to believe in them. Understand well that those around

you also have much to contribute, and they deserve your support. Without faith in yourself and others, success is impossible. At the end of a particularly frustrating practice one–day, a football coach dismissed his players by yelling, ‘Now all you idiots, go take a shower!’ All but one player headed toward the locker room. The coach glared at him and asked why he was still there. ‘You told all the idiots to go, Sir,’ the player replied, ‘and there sure seems to be a lot of them. But I am not an idiot.’ Confident? You bet. And smart enough to coach that team some day. Moral: Believe in yourself, even when no one else does.

News Around The Globe

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

Indian Experience with BVS

Dr Ashok Seth

There were apprehensions even in short term regarding ABSORB that

  • Stiff, poorly tracked device, should be avoided across bifurcation with SB>2mm
  • Side branch salvage not possible through struts
  • Should not be dilated to high pressures
  • Should be avoided in complex anatomy
  • Does not possess the radial strength, so cannot be used in calcified or ostial lesions
  • Always requires D max prior & OCT/IVUS post for optimization

We have had experience of more than 600 reabsorbable implants. There were a multitude of lesions: Bifurcation, calcified, long lesion, small vessel, ostial, CTO, ISR, tortuous, dissection It can be made to perform if one gets over the learning curve, the implantation is meticulous and judiciously used. Can the acute results which turn out to be safe, can they be transferred to long term results/ This is what we need to know from long term trials.

Post SYNTAX & FREEDOM CABG vs PCI: Where & What does evidence support?

Dr Raj Makkar, USA

  • The subgroup analysis in BARI trial: Outcomes worse in PTCA vs CABG in patients with diabetes with 5–year mortality 80.6% vs 65.5%, respectively.
  • The ARTS I (multivessel disease randomized to BMS or CABG) and ARTS II (multivessel disease treated with SES) trials showed that at 5–year follow–up, CABG has comparable safety and superior efficacy compared with BMS and SES in the treatment of diabetic patients with multivessel disease.
  • Survival is similar with CABG or PCI; 5year survival 90.7% vs 89.07% (Bravata et al. Ann Intern Med. 2007)
  • Two trials have changed the way we think and act: SYNTAX & FREEDOM.
  • SYNTAX score: guidance on optimal revascularization strategies for patients with high risk disease
  • Functional SYNTAX score reclassifies 32% of patients from a higher-risk group to a lower–risk group. It is superior to anatomic SYNTAX score at predicting 1 year clinical events.
  • FREEDOM – randomized trial of PCI and CABG for multivessel disease in diabetics: CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction; 5–year event rates 18.7% vs 26.6%. But the incidence of stroke was higher with bypass surgery and also they are more disabling.
  • FAME 1:Routine measurement of FFR in patients with multivessel coronary disease undergoing PCI and stent implantation significantly reduced the rate of death, non-fatal MI and repeat revascularization
  • The totality of evidence suggests that in non diabetics PCI and CABG have similar long term survival rates in patients with multivessel coronary artery disease at 5 years.
  • CABG has better survival rates compared to PCI in diabetics.
  • Stroke rates are higher with CABG; revascularization rates higher with PCI.
  • Substantial ischemia reduction versus complete anatomical revascularization is what produces good outcomes.
  • There is a need to question complete anatomical revascularization which leads to unnecessary stenting, instead by guided by physiologic assessment of lesions and functional revascularization.
  • Left main stenosis is no longer sacred and is a reasonable target for PCI if technically feasible and coexisting coronary anatomy is favorable.

Complex LMCA PCI Case presentation:

Left main – Fortune favors the bold
Dr Atul Abhyankar, Surat, Gujarat

  • Do not give up for fear of failure.
  • Swift action is required.
  • Thrombus aspiration should be done in most cases.
  • Stent directly wherever possible – using optimal size and single high pressure inflation.
  • Limit procedural steps to really what is required
  • Fix only culprit lesion.

Face to Face with Dr Ashok Seth

What has been your experience of bioresorbable stents?

Bioresorbable stent is one of the technologies that I have been closely associated with over the last few years as I was part of the global advisory board for development of this device. I was also the principal investigator of the Indian arm of the ABSORB-EXTEND study which was the study done on 100 Indian patients. From 2010 onwards, this study enrolled 100 patients in

8 Indian centers after approval from the Drug Controller of India. The study did well, the patients did well and the results were presented to the Drug Controller of India in August 2012, which led to the approval of this device.

I have had experience in using close to 600 of these resorbable stents and I must say, yes, these devices can be considered as a fourth revolution in interventional cardiology. Ten years ago I could not even think, or believe that these stents which could not be made of metal, could be made of plastic, and which would dissolve away in 2–3 years time leaving a normal artery behind… this now a reality and a fascinating one. Think of a patient with fracture foot; you plaster his foot, but he would never want that plaster to remain for his life. So if an artery is diseased and if it’s treated by a stent and once it has healed up in 6 months time, why should a metal tube remain behind for the rest of the life.

There were challenges in the development of this stent, to be made of plastic and yet be able to have radial strength and rigidity to support the artery and then disappear over a programmed period of time over 2–3 years. This device has been actually shown to not to be just effective and safe, but also to restore the artery back to its original structure, and physiological function like the way it had been when it was never diseased, like the way God gave us.

Obviously there is a lot more data to come from these stents over a period of time and as we will have 5- and 10-year data of large studies, we would know that the real potential benefits of these could be tremendous especially in this group of younger patients developing heart disease and who will have to have an implant for the treatment of CAD which will last them for the next 40 years in the coronary arteries. Once they disappear, these devices would allow us to stop antiplatelet treatment at will and the psychological impact and benefit is phenomenal. Think of a young person, who knows that he has a stainless steel stent into him who he believes he is carrying for the rest of his life versus a person who has got this dissolvable stent into him. And who knows that after two years, there is nothing in his coronary arteries and then normal, the psychological impact and benefit over the subsequent 40 years is enormous – of not having an implant in coronary arteries. So we are looking at a new revolution in science.

How do you ensure that the stent is absolutely essential? When is a stent not required; when is it required and when is the use of stent undecided?

There was an apprehension that it would not be possible to use these bioresorbable stents in all forms of CAD, as they were made of plastic and of a thicker material. But our experience has grown rapidly in this area and we have now shown that we can treat a variety of blockages with these bioresorbable stents just like a metallic stents. Much of our data has been appreciated across the world and has been now printed in leading scientific journals.

When we say that blockages or stenosis greater than 70% do require stent implantation, these are just visual estimations, which are based on the fact that stenosis greater than 70% causes ischemia and therefore requires treatment. The whole philosophy is based on documentation of ischemia, an essential part of treatment of CAD. So, if one is able to demonstrate ischemia either on symptoms – if the patient has aggressive symptoms or if significant ischemia has been demonstrated on exercising testing, stress echo, nuclear test or on table, these require treatment of CAD whether it is through substantive plantation or surgery.

Aspirin, statins and lifestyle therapy are the cornerstone of treatment for all patients with CAD, some of whom have required angioplasty or bypass surgery as well. In fact 50% of CAD patients are treated on aggressive medical therapy because aggressive medical therapy has a lot to offer to the patients.

If on table we have a doubt of any blockages or stents than we do a technique called FFR or Fractional flow reserve where we measure flow into the coronary artery through the stenosis and are able to therefore decide that if the flow is limited in an artery through any stenosis whether visually it looks 50% or visually it looks 90 % than it requires stent plantation otherwise it can be treated by medication. We do hope for outcomes in patients with severe ischemia so angioplasty.
Who choose a stent: the cardiologist or the patient?
A variety of stents are available based on research and science development. We have stents which now have been researched and manufactured in this country. So the price of various stents matters in a number of ways. There are certain stents that have been tested and tried out over a period of time through large randomized studies, while there are other stents who haven’t got large pivot randomized studies but only have small registries. All these make a difference between the stents choices. Then, there are situations of anatomies of coronary arteries or the way we want to treat the blockages, which may influence stent choices.

I think it is very important that the patient should be given complete information about every aspect of the stents, in fact every aspect of the treatment per se. He should be told what the benefits of medical treatment are; he should be told about the benefits of angioplasty and benefits of bypass surgery. At the same time, he should also be told of the deficiencies of each very well. The patient should also make the decision in association with the cardiologist about the choice of stent itself because that is based on life. The patient then makes a choice of the treatment as an informed choice in association with the cardiologist. So it is a combined decision about what stent to implant.

A stent cost Rs 40, 000 in CGHS. Is it a good quality stent or should the patient buy a more expensive stent if he/she can afford it?

We need to understand that all the stents being used in India are approved by the Drug Controller of India, so we cannot state that a stent is bad or good. But, what is certain that the stents which are FDA approved or many of the European stents or stents, which have been come from abroad, are actually established. They have data from large pivotal multicenter randomized studies, sometimes multiple studies done with long and meticulous follow ups. These are monitored studies and audited.

Some of these stents, which are becoming available at a very less expensive price, have not gone through large randomized studies; they only go through small registries with limited follow ups. While they may be of good quality, there clinical outcomes have not been thoroughly studied.

So the safety gets proven, but their efficacy needs to be proven in a larger number of patients for a longer time period and that’s what missing at the moment.

So one would not say that they are inferior but there prevalence has to be proven in randomized studies compared to the present gold standards.

And that is why I do say that if I were to have an implant, and if I had a choice and if I could afford it, then I would rather go for a stent which has gone through large randomized studies, multiple large randomized studies over a long period of time to tell me that it is safe and effective or has the best results. Because it is an implant and you cannot remove it once it has been implanted.

If there are numerous limitations in terms of finance, availability and others than it is fine because these devices are safe and probably may be effective as well.

Complex LMCA PCI Case presentation

Dr Kirti Punamiya, Mumbai

  • Distal LM with MV CAD with a Syntax score of 38 needs a heart team approach and CABG must be offered before an angioplasty is planned.
  • IVUS will help us in appropriately sizing stent and planning the strategy.
  • Lesion bed preparation is the key in getting better stent CSA for reducing TLR and MACE.

Complex LMCA PCI

Dr Shirish (MS) Hiremath, Pune

  • FFR in LM: Technical differences
    • Occasionally sequential measurements both in LAD and LCx
    • IC adenosine: Higher dose preferred >100 mg, lower bolus dose and then classed for medical management had higher event rates
    • For ostial and shaft LM lesions, FFR is crucial.
    • Osteal lesion or catheter dumping: Catheter removed from ostium and IV adenosine 140-280 mcg/min
    • Threshold 0.8 is more predictable 0.75 and 0.8 use other parameters also.
  • IVUS improves outcome – strongly recommended
  • FFR crucial in decision making for compromised side branch and borderline lesions
  • Unnecessarily kissing balloon is no always good
  • Treat the patient not the numbers
  • Don’t interpret IVUS or FFR alone e.g. Ag, grossly abnormal TMT and yet, IVUS 8 mm2, does not rule out significant LM stenosis
  • Lesion preparation is most important in left main. Direct stenting strongly discouraged. Hemodynamic support (IABP, Impella) is permitted, but not usually required.
  • Single stent (IVUS-guided) better than 2 stents.
  • Distal LM bifurcation provisional stenting recommended.
  • Two stents must have a final KISS.
  • Stent choice: May be required to stretch to >4.5 mm
  • The role of dedicated bifurcation stents in LM: Avoiding stent deformation, preserving side branch access, avoiding free floating struts in ostia of distal branches, covering and supporting the side branch ostium, avoiding multiple metal layers in bifurcation core, avoiding gaps between stented segments and avoiding protrusion of stent material
  • PCI or CABG – which is better? Similar mortality at 3 years.
    • PCI: Lower risk of stroke, higher rate of repeat revascularization
    • CABG: More effective in more extensive disease (syntax score >33)
  • PCI attractive option for large diameter vessel, proximal location
  • PCI Unattractive: Up to 80% of LM disease involves the bifurcation (high risk of restenosis), up to 80% of patients have multivessel CAD: potential survival benefit with CABG

Absorb Clinical program an update

Dr Stephen Windecker, Berne, Switzerland

There has been a tremendous progress in metallic stents. Strut thickness has reduced by two-thirds. But what has been shown from experimental models and large trials that some amount of device resorption dos occur.

Limitations and unmet needs of coronary stents: Neovascularization, acute MI, diabetes, CAD progression and diffuse multivessel CAD

Potentials of fully bioresorbable coronary scaffolds

  • Physiological variation: ABSORB@ 2 years; BIOSOLVE
  • Return of Physiological cyclic strain is important. Assessment of vascular compliance by elastography (pre, post, 6 and 24 months after bioresorbable scaffolding). The translation of mechanical forces into chemical signals by cells is referred to as ‘mechanotransduction’. Normal responses to physiologic pulsatile cyclis strain and shear stress lead to cellular responses that stabilize the vessel.
  • Late lumen enlargement:
  • Neocap formation – plaque sealing

    Device efficacy with BRS
     
  • What has been shown: angiographic potency, promising clinical outcomes, no stent thrombosis
  • What needs to be demonstrated: angiographic efficacy, clinical efficacy and extension of results to more complex subsets of patients and lesions (BRS vs new generation DES in ACS, STEMI, diabetic patients and bifurcation lesions) Perspectives on bioabsorbable scaffolds
  • What has been established:
    • Apparent restoration of normal physiology: Complete biodegradation of the device, vessel remodeling with lumen gain over time, signs of physiological vasomotion
    • Promising clinical outcomes; Low rates of cardiac adverse events in patients with simple lesions during long–term follow up to 5 years
  • What needs to be established
    • Stable CAD: BRS vs newer generation DES (at least equivalent efficacy and safety, extension of results to more complex lesions or patients and BRS vs medical treatment in symptomatic CAD
    • ACS: BRS vs newer generation DES In culprit lesions, BRS vs medical treatment in non culprit lesions
    • Diabetic patients: BRS vs new generation DES
    • Device performance & antiplatelet therapy: Investigate optimal antiplatelet regimens

Incorporating BVS in daily clinical practice

Dr Upendra Kaul, New Delhi

We have come a long way in stents, we have sorted out many problems, but we still have some problems such as neoatherosclerosis, late stent fracture and diffuse disease. BVS is not a new concept, it gives the patient and the physician that there is no metallic stent in the body after 2–3 years. But it cannot be used in calcified lesion, fibrotic lesions. Technical problems with present generation BVS: strut thickness, side branch lesion, tortuous lesions. We do not know if they are going to be equal to present generation DES in the long term. We need to find out equivalence in short and long-term where 1:1 randomization is done. We need to find out the optimum duration and the long term results in MI and diffuse disease. But we have a device, which is very promising, with advantages of dilatation, tissue remodeling, endothelial function restoration and increased exercise capacity. But there are many questions yet unanswered, which will be provided by trials. But, if things are equal in all aspects, BVS is a device that should be considered in all patients.

BVS in daily clinical practice
Dr BB Chanana, New Delhi
• In-stent restenosis (ISR) occurs in 3–20% in DES era depending upon patient and clinical characteristics. The reasons: biological, mechanical and technical.

• Predominantly focal and the presentation can be CSA/ACS.

• There are no definite recommendations for ISR
• Most of the published data are from small studies.
• There is no single strategy that works best. DES for DES ISR is the most popular treatment. It is advisable to choose

different drug DES for diffuse ISR.

• It has acute results like metallic stent, radial support like metallic stent. The long term benefits are probably like of DES.

• It is technically feasible to use absorb in ISR cases.

• Radial strength seems good.

• Long term follow up is required.
Drug–coated balloon therapy in coronary and peripheral artery disease

Dr. Jayesh Prajapati

Non stent–based local drug delivery during percutaneous intervention offers potential for sustained antirestenotic efficacy without the limitations of permanent vascular implants. Preclinical studies have shown that effective local tissue concentrations of drugs can be achieved using drug-coated balloon (DCB) catheters. Matrix coatings consisting of a mixture of lipophilic paclitaxel and hydrophilic spacer (excipient) are most effective.

Clinical applications most suited to DCB therapy are those for which stent implantation is not desirable or less effective, such as in–stent restenosis, bifurcation lesions, or peripheral artery stenoses. Randomized trials have shown superiority of DCBs over plain–balloon angioplasty for both bare–metal and drug–eluting coronary in–stent restenosis, and similar efficacy as repeat stenting with a drug–eluting stent (DES). By contrast, randomized trials of DCBs in de novo coronary stenosis have, to date, not shown similar efficacy to standard–of–care DES therapy. In peripheral artery disease, DCB therapy has proven superior to plain–balloon angioplasty for treatment of de novo femoropoliteal and below–the–knee disease, and shown promising results for in–stent restenosis.

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)

Is it essential to perform an antibody test on the patient following antirabies vaccination?

Antibody tests – rapid fluorescent focus inhibition test (RFFIT), mouse neutralization test (MNT) – are done only at select few reference centers in India. Antibody tests are not required on a routine basis following antirabies vaccination if vaccination is correct and reliable.

cardiology news

All about tea

When we speak of tea, it is commonly assumed to be black tea with milk and sugar. However, the word ‘Tea’ means any herb. This means even hot Tulsi water is Tulsi tea or hot mint water is Mint tea. Herbs which can be converted into tea are jasmine tea, lemon tea, lemon grass tea, masala tea, sounf tea etc.

When the decoction of the leaves and the water is reduced to 50% on boiling, it is called Kadha. Black tea without milk and sugar is much healthier than black tea with milk and sugar. Classical tea without sugar and milk has an astringent taste. But according to Ayurved, this is good for health as it reduces Kapha imbalance. When sugar and milk is added, both of which have sweet taste, they neutralize the weight reducing and kapha–relieving properties of the black tea. Therefore, milk or sugar should not be added to tea. For the purpose of taste, one can add Gur or jaggery or artificial plant sweetener Stevia.

Black tea is also a mild diuretic and increases urination as it contains caffeine, which is also a stimulant and that is the reason why tea is used to remain awake. In this regard, coffee is stronger than tea. When taken in moderation, black tea is good for the heart and the health. If one has to choose tea then jasmine, lemon and lemongrass teas are better than others.

In Ayurveda, there are different teas for different personalities. Therefore, you can get Vata–pacifying tea, pitta-pacifying tea and kapha–pacifying tea

cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

web mediawebmediawebmedia
press release

Scorpion bites can even be fatal

Scorpion bites are common in India. Usually, these bites are harmless but sometime have serious clinical sequelae, including death. Tarachand Saini and Colleagues at Dept. of Medicine Jawaharlal Nehru Medical College, Ajmer have reported a case of scorpion bite that presented with acute severe myocarditis in the January Issue of Asian Journal of Critical Care.

There are about 1,500 species of scorpions worldwide, out of these 50 are dangerous to human. Among 86 species in India, Mesobuthus tamulus and Palamnaeus swammerdami are of medical importance. Almost all lethal scorpions except Hemiscorpius species, belong to the scorpion family called Buthidae.

Scorpions live in warm dry regions throughout India. They commonly inhabit the crevices of dwellings, underground burrows, under logs or debris, paddy husk, sugarcane fields, coconut and banana plantations. Their distribution is more in regions with abundant red soil.

They hunt during night and hide in crevices and burrow during the day to avoid light. Scorpion stings increase dramatically in summer months and lower in winter.

Scorpion stings causes a wide range of manifestation, from local skin reaction to neurological, respiratory and cardiovascular collapse. Cardiovascular effect are particularly prominent after stings by Indian red scorpion (M. tamulus).

Scorpion bites usually have a good prognosis. However, occasionally potentially fatal complications involving heart can occur leading to heart failure 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

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

Padma Shri Awardee Dr. K K Aggarwal receives the DST National Award for Outstanding Efforts in Science & Technology Communication

press release

PPIs may be associated with a higher risk for clostridium difficile –associated diarrhea

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

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 Chandresh Jardosh, Arvind Gajjar, Dr,Bitaan Sen & Dr.Jayashree Sen, Dr Prakash Khalap, Dr.B.R.Bhatnagar

Answer for 28th February Mind Teaser: 3. Bone erosions.

Correct answers received from: : Dr,Bitaan Sen & Dr.Jayashree Sen, Dr Prakash Khalap, Dr.B.R.Bhatnagar

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

Flashing Traffic Camera

A man was driving when he saw the flash of a traffic camera.

He figured that his picture had been taken for exceeding the limit, even though he knew that he was not speeding.

Just to be sure, he went around the block and passed the same spot, driving even more slowly, but again the camera flashed.

Now he began to think that this was quite funny, so he drove even slower as he passed the area again, but the traffic camera again flashed.

He tried a FOURTH TIME with the same result.

He did this a FIFTH TIME and now was laughing when the camera flashed as he rolled past, this time at a snail’s pace.

Two weeks later, he got FIVE tickets in the mail.……for driving WITHOUT A SEAT BELT.

medicolegal update

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medicolegal update

Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: : Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make Sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

medicolegal update

The harder you fight to hold on to specific assumptions, the more likely there's gold in letting go of them. John Seely Brown .

medicolegal update

Dr KK Aggarwal: Some Alcohol Terms Dr K K Aggarwal 1. Do not start if you do not drink Limit if you take and can not stop 3. (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: A Mind-Body Approach to Depression 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 Sir, very informative news: Regards: Dr Ketan

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