eMedinewS30th April 2014,Wednesday

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

Treatment of mild hypertension in low–risk patients

There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease. A meta–analysis combined four placebo–controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow–up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low–risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk 6 meters in less than 8 seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

References

  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.

News Around The Globe

  • A once–daily dose of gabapentin enacarbil has potential efficacy in the most severe cases of restless legs syndrome (RLS) and is associated with an adverse effect profile consistent with use in milder disease, report the results of a pooled analysis of randomized trials. The findings were presented at the American Academy of Neurology (AAN) 66th Annual Meeting.
  • A Swedish study has reported that the early benefits of delayed umbilical cord clamping (DCC) on iron stores seem to disappear by the time infants attain the age of one year. DCC might neither be advantageous nor disadvantageous on infants’ hemoglobin levels, iron stores, or neurodevelopment at 12 months of age.
  • According to the results of a late–stage study, it appears that inhaled indacaterol for chronic lung disease has benefits similar to those of fluticasone/salmeterol. The phase IV study reported that indacaterol once–daily and fluticasone/salmeterol were equally effective in reducing shortness of breath in patients with moderate COPD.
  • A novel systematic review and meta–analysis published online April 28 in the Canadian Medical Association Journal states that induction of labor reduces the risk of cesarean delivery by 12% and also diminishes the risk of the fetus dying or of the newborn getting admitted into the neonatal intensive care unit.

Rabies News (Dr A K Gupta)

A previously immunized person is bitten again. What is the re–exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to over treat than under treat.

Cardiology eMedinewS

  • A Cochrane review has found slight evidence that suggests a benefit for stem–cell therapy in patients with ischemic heart disease or congestive heart failure. Bone–marrow–derived stem cell (BMSC) treatment was associated with reductions in mortality and rehospitalization for heart failure at follow–up for more than 1 year.
  • A new study conducted at the University of Ottawa Heart Institute (UOHI), published in Cell Reports, highlights the role of a variant of SPG7 gene that likely influences cardiovascular health. Five years of extensive research have led the researchers to conclude that the gene contributes to the development of heart disease through processes that promote chronic inflammation and cell division.

Pediatrics eMedinewS

  • Children and young adults who are started with higher doses of antidepressants than usually prescribed have a two-fold increased risk of engaging in acts of deliberate self–harm (DSH), reports a new study published online April 28 in JAMA Internal Medicine.
  • A study published online in Clinical Infectious Diseases has stated that the current pertussis vaccine (diphtheria–tetanus–acellular pertussis (DTaP)) decreases the risk of developing the disease across all age groups; however, the immunity wanes in children aged 7 to 10 years. Also, Tdap booster provides less protection, even in recently immunized adolescents.

Dr K K Spiritual Blog

Spiritual prescription: Meditation vs Concentration

Meditation is not concentration. Concentration is holding the mind to something within or outside the body. On the other hand, meditation is an unbroken flow of thoughts towards the object of concentration. It can be called prolonged concentration. Meditation is like pouring of oil from one vessel to another in a steady unbroken stream.

Samadhi or absorption is when the object of concentration and the mind of the perceiver becomes one. When Concentration, Meditation and Samadhi are brought to bear upon one subject it is called Samyam.

According to yoga sutras of Patanjali, (3.1–3.6), meditation needs to be learnt and applied step by step. The practice starts by sitting straight with erect spine, preferably in Padmasana (one can also sit on the chair) and concentrate on the breathing or on a primordial sound given by the teacher.

When the mind can be made to flow uninterruptedly towards the same object for 12 seconds, one is said to have learnt the process of concentration.

When the mind can continue in that concentration for 12 times (12 seconds × 12 i.e. 2 minutes 24 seconds), one is said to be practicing meditation.

When the mind can continue in that concentration for 12 times (12 minutes 24 seconds × 12 i.e. 28 minutes 48 seconds), one is said to be in Samadhi.

And if this lower Samadhi can be maintained for 12 times, i.e., for 5 hours 45 minutes and 36 seconds, one is said to be in Nirvikalpa Samadhi.

The mind becomes one-pointed when similar thought waves arise in succession without any gap between them.

One should remember that during meditation, the object of concentration may change in form, time and rhythm.

The whole process of meditation, therefore, varies from person to person and day to day. During meditation some may only concentrate, some may actually meditate and some may go into Samadhi. Most of us wander from concentration to meditation.

Once in meditation or Samadhi, by fixing the mind on various structures, internal or external, one can achieve siddhi powers. For e.g., by concentrating on the tip of nose one can acquire better smelling powers; by concentrating on the tip of the tongue, one can acquire supranormal tasting powers; by concentrating on the middle part of the tongue, one can acquire supranormal powers of sensation; by concentrating on the root of the tongue, one can acquire supra normal hearing; and by concentrating on palate one can acquire supra natural colour perceptions. With experience, one can concentrate upon any object of any size, from the atom to the infinity.

Just as pure crystal takes colour from the object nearest to it, the mind when cleared of thoughts achieves identity with the object of concentration.

Primordial sound (beej mantra) meditation is based on the principle that the initial one–point concentration on a particular sound (seed) over a period of time becomes seedless or thoughtless (yoga sutras of Patanjali 1.51).

Swami Vivekananda co-related it with Raj Yoga and said that our average span of attention on a particular object is only around three seconds. He said that if one is able to increase this attention span and concentration at an object of our choice for 12 seconds then we are practicing Patanjali’s sixth stage of yoga or ‘dharana’, which translates as contemplation. And if we can further increase our concentration ability to 12 × 12 seconds or for 144 seconds, then we have reached the mental plateau of meditation or ‘dhayana’. Swami Vivekananda further went on to attribute values to the exalted state of samadhi or transcendental conscious mental state which in value is termed as arising from a meditative or concentration span of 12 × 12 × 12 seconds, which is 30 minutes or half an hour.

Vedanta describes it in terms of units. It says that if you can concentrate 12 seconds on a subject uninterruptedly, it becomes one unit of concentration; 12 such units of concentration make one unit of meditation; 12 units of meditation lead to the first stage of samadhi and 12 units of this samadhi lead to the highest samadhi, the supreme realization of Atman. Dharana is concentration; Dhyana is meditation and Samadhi is trance.

Patanjali called them as ‘Matra: If you are able to sit, withdraw the mind and fix it upon a focal point within (it may be gross, subtle or anything), and are able to keep the mind fixed like that for a period of twelve Matras – a Matra is approximately a moment or a second – it is counted as ‘one concentration’. It says "If you can keep the mind steady without moving, without any contrary thoughts coming in, and without moving away from the object of concentration for a period of twelve Matras, it is regarded as ‘one Dharana or one concentration’". He further says that one should go on practicing this Dharana for days and weeks and months so that it becomes longer and longer. By continuous practice, if one is able to keep the mind focused upon one single point without moving here or there, for 144 seconds (a period of twelve Dharanas), then the person is called Dhyani or a Dhyana Yogi.

Yoga sutra of Patanjali (3.6) clearly says that meditation must be learnt in stages. It calls for repeated practice of meditation. The three basic components of meditation are: The subject of meditation, the center of consciousness at which the mind is held, and the method employed to guide the mind to concentration. The subject of meditation may be the non–dual all–pervading Self, any specific aspect of the divine, or any divine incarnation. The center of consciousness may be at the heart, or between the eyebrows, or at the crown of the head. The method employed to invoke concentration may be any of the following: Japa, or repetition of a sacred word; discrimination between the real and the unreal; dispassion, which is knowing the evil effect of sense–enjoyment; pranayama, or control of breath and ceremonial observances.

But regularity is most important. One can start with looking at any object – flame, idol, or picture for 12 seconds with total concentration and without blinking eyelids (concentration). And then one practices 12 concentrations to make one meditation. The proper meditation thus need not last more than 2 minutes 24 seconds.

Wellness Blog

Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.

  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or UC.
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of ulcerative colitis (UC) was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non–significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.

Zee News – Health Wealth Shows

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Total CPR since 1st November 2012 – 88972 trained

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 Success Stories

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CPR 10 Videos

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emedipicstoday emedipics

World Earth Day Celebration at DAV Public School, RK Puram, New Delhi.

press release

Monitoring LFT in a patient on statins

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IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Make Sure

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

eMedinewS Humor

Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

Quote of the Day

Success usually comes to those who are too busy to be looking for it. Henry David Thoreau

 

Twitter of the Day

Dr KK Aggarwal: Diabetes and heart patients beware during Navratri fasts http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Recurrent anxiety can have a devastating toll on all aspects of our life. How to deal with anxiety?#CosmicConsciousness

 

Forth Comming Event

A symposium on "Importance of Alternate Medicine and Healings in this Era" & "Build India Awards 2014" 4th May 2014, 6:30PM Onwards Gulmohar Hall India Habitat Centre, Lodhi Road New Delhi 7:15PM: Lamp Lighting Ceremony by Chief Guests:

  • Sri Ravindra Bhandari, Convener Bharat Nirman,
  • Homoeopathy King DR. S.P.S. Bakshi,
  • Padma Shri Dr. K.K.Aggarwal
  • Organic Lady Dr. Vandana Shiva (Promoter Navdanya)
  • Reiki Healer Dr. N.K. Sharma
  • Sri A.K.Singh (ZM North Zone LIC)

Inspirational Story

Competing wth Others

I was jogging one day and I noticed a person in front of me, about 1/4 of mile. I could tell he was running a little slower than me and I thought, good, I shall try to catch him. I had about a mile to go my path before I needed to turn off. So I started running faster and faster. Every block, I was gaining on him just a little bit. After just a few minutes I was only about 100 yards behind him, so I really picked up the pace and push myself. You would have thought I was running in the last leg of London Olympic competition. I was determined to catch him. Finally, I did it! I caught and passed him by. On the inside I felt so good.

"I beat him" of course, he didn’t even know we were racing. After I passed him, I realized I had been so focused on competing against him that I had missed my turn. I had gone nearly six blocks past it. I had to turn around and go all back. Isn’t that what happens in life when we focus on competing with co–workers, neighbors, friends, family, trying to outdo them or trying to prove that we are more successful or more important? We spend our time and energy running after them and we miss out on our own paths to our God given destinies.

The problem with unhealthy competition is that it’s a never ending cycle. There will always be somebody ahead of you, someone with better job, nicer car, more money in the bank, more education, better behaved children, etc. But realize that "You can be the best that you can be, you are not competing with no one." Some people are insecure because they pay too much attention 2 what others are doing, where others are going, wearing & driving. Take what God has given you, the height, weight & personality. Dress well & wear it proudly! You’ll be blessed by it. Stay focused and live a healthy life. There’s no competition in DESTINY, run your own RACE and wish others WELL!

ePress Release

Can diabetes be ward off ?

Adhering to Mediterranean diet, rich in fruits and vegetables and low in animal products, may protect one against developing type 2 diabetes 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.

The diet emphasizes olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and deemphasizes meat and dairy products. It is a healthy eating plan that seems to help in the prevention of heart disease.

In the study published in the British Medical Journal, researchers tracked the diets of 13,380 Spanish university graduates with no history of diabetes. Participants filled out a 136–item food questionnaire, which measured their entire diet (including their intake of fats), their cooking methods and their use of dietary supplements. During an average of 4.4 years of follow–up, the team found that people who adhered to a Mediterranean diet had a lower risk of developing type 2 diabetes. In fact, those who stuck very closely to the diet reduced their risk by 83 percent.

Moreover, the people who tended to stick closest to the diet were those with factors that put them at the highest risk for developing diabetes, such as being older, having a family history of di

abetes and being an ex–smoker. These people were expected to have a higher rate of diabetes, but when they adhered to the Mediterranean diet this was not the case.

Type 2 diabetes is typically brought on by poor eating habits, too much weight and too little exercise.

One key factor that might be responsible for the protective effect of the Mediterranean diet is its emphasis on olive oil for cooking, frying, putting on bread and mixing in salad dressings.

Preventing diabetes–TIPS

  1. Eat less
  2. Omit refined carbohydrates (white sugar, white rice and white maida)
  3. Use olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and reduce meat and dairy products.

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 88972 people since 1stNovember 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 10x10 i.e. 100 per minute."

eMedi Quiz

Which of the following is not a post transcriptional modification of RNA?

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

Yesterday’s Mind Teaser: Which of the following is present intracellularly in muscle cells:

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

Answer for yesterday’s Mind Teaser: 2. Corticosteroid.

Correct answers received from: Dr P C Das, Dr KV Sarma, Dr Ajay Gandhi, Dr Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella, Bal Kishan Agarwal.

Answer for 28th April Mind Teaser: 2. pKa

Correct answers received from: Prabha Sanghi, Arvind Diwaker.

Send your answer to ijcp12@gmail.com

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