eMedinewS30th August 2014, Saturday

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

Heart Disease Myths

Myth No. 1– It is ok to have a high Blood Pressure in elderly.

Blood Pressure tends to rise with age, but it does not mean that this rise is normal. It happens because with age, the arterial walls become stiff and this stiffness cannot be called as a normal stiffness.

Stiff arteries make the heart to pump harder. Blood pounding against the artery walls, damages them over time.

The overworked heart muscles become less effective and pumps even harder to meet the body demand for blood. This further damages the arteries and invites fats into the artery walls. This results in lipid deposition, formation of blockage and future heart attack and paralysis.

So the fact is irrespective of age keep your diastolic blood pressure below 80 and systolic below 120. Start treatment if the blood pressure is more than 140/90.

Myth No. 2 – The risk of heart disease can be lowered with vitamins and supplements.

It’s a myth that vitamin C, E and β carotenes lower heart attack risk. The American Heart Association has stated that there is no scientific evidence that these supplements prevent or treat heart diseases.

The fact is eat a wide variety of nutritious food which includes all 6 tastes and 7 colors and get natural vitamins and supplements.

Myth No. 3 – Women do not suffer from heart disease.

The fact is whether you are a man or a woman, you are at risk, if you do not follow the lifestyle. Heart disease is the leading cause of death in women over age 65. Today more woman get heart disease than combine cancer in them.

Myth No. 4 – Heart patients should not eat fat at all.

It is true that you should eat a diet low in saturated fat and zero in transfats but other fats like unsaturated fats in vegetable oil are beneficial. Infact eating fish high in omega-3 fatty acids twice a week can lower the risk of heart disease.

Innovations in Cardiology (IIC) Summit 2014

Dr Rajneesh Kapoor

Obesity as independent risk for heart disease

In an analysis of pooled data from 97 prospective cohort studies from multiple countries (1.8 million individuals) published in The Lancet. 2014 Mar 15;383(9921):970-83, blood pressure, serum cholesterol, and blood glucose accounted for approximately 50 percent of the excess risk of high body mass index (BMI) for CHD. Blood pressure was the most important mediator, which accounted for approximately one-third of the excess risk. Interventions that reduce high blood pressure, cholesterol, and glucose might address about half of excess risk of coronary heart disease and three-quarters of excess risk of stroke associated with high BMI.

News Around The Globe

  • Results from the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) study have pointed that the absence of additional metabolic risk factors does not protect overweight or obese young men from developing type 2 diabetes. The study is published online in Diabetes Care.
  • The brain’s dorsal medial habenula (dMHb) may be responsible for an individual’s motivation to exercise and participate in other potentially rewarding activities, suggests a study published in the Journal of Neuroscience. This finding could lead to improved depression treatment.
  • A large review of individual–patient data has validated the significance of providing rapid thrombolytic therapy in cases of acute ischemic stroke. Researchers noted that administration of alteplase within 4.5 hours of stroke onset significantly improves the odds of a good outcome and earlier treatment providing greater benefits. The analysis has been published online in The Lancet.
  • According to a new study, repetitive transcranial magnetic stimulation (rTMS) improves memory by activating a network of surface brain regions that interact with the much deeper center of memory, the hippocampus. The findings are published in the August 29 issue of the journal Science.
  • A study published online in The Lancet Oncology revealed that in patients with KRAS exon 2 wild–type metastatic colorectal cancer (MCC) who received first–line FOLFIRI (fluorouracil, folinic acid and irinotecan), adding cetuximab rather than bevacizumab led to longer overall survival.

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 overtreat than undertreat.

Cardiology eMedinewS

  • Adults with hypertension and other cardiovascular disease history or risk factors may be able to reduce their blood pressure levels by monitoring their own readings and adjusting their medications as required, suggests a study published in the August 27 issue of the Journal of the American Medical Association.
  • Hypertension may be more common in pregnant women with high levels of thyroid hormone, including the upper reaches of the ostensibly normal range, reported a study published online in the Journal of Clinical Endocrinology & Metabolism. Researchers noted that the risk for developing hypertension or preeclampsia was three times higher in pregnant women with low levels of thyroid stimulating hormone (TSH) and T4 levels near or above the upper limit of normal.

Pediatrics eMedinewS

  • Children and adolescents with attention–deficit hyperactivity disorder (ADHD) who do not respond well to psychostimulant monotherapy may benefit from adding guanfacine extended–release, suggested a post hoc analysis of a randomized controlled trial, published online in the Journal of the American Academy of Child and Adolescent Psychiatry.
  • Infants whose parents pay attention to their babbling sounds have greater advancement in language development, suggests a new study published in the

Dr K K Spiritual Blog

Science behind Ganesha worship

While mythological studies knit stories of the Almighty’s existence, the fact remains that human being is bestowed with the untainted potential of recognizing heavenly facets in his own self.

Ganesha, the son of Shiva and Parvati is likewise the name given to the harmonious Aacharan or characteristic disposition of man. Remembered and ritually worshiped before starting a new venture, the entity of Ganesha has in store the facets of a complete man.

The magnanimous head of the Ganesha, which is that of an elephant, represents wisdom, intelligence and a healthy mind capable of making sound decisions. Not in vain is it said that ‘think before you speak’, which implies Ganesha’s huge head, that is identified with the need for a thoughtful and retrospective attitude.

The big ears of this elephant–deity instills among the earthly man the patient channel of lending ears to the echo produced by others’ deeds and speech. It is said that half the dispute is resolved when an ear is lend most patiently.

Ganesha or the Ganapati’s extremely small mouth characteristically represents the need for a limited dialogue and the vanity of chattering. Over–expression through words triggers unsought problems many a times which otherwise could be avoided by a tight–lip.

Ganesha also represents the guru of stress affected individuals. Shiva’s most promising son, Ganesha, by virtue of his small eyes, highlights the need of a focused outlook in life. Such an outlook not only redefines and foresees the right goals, but also relieves one from the stress-manifested episodes from the various chapters of life.

The long trunk identifies with the power of discrimination. The sensitivity of the Ganesha long nose has the strength to uproot a tree and the competency of picking up a pin from the ground. Such should be the approach of an individual who should be capable enough to perceive the good and the bad for himself besides the undaunted strength of overcoming all odds.

The tusks and the small teeth of Ganesha should however, be recollected with the loss and gains in the life of a man. Man similarly ought to engrave his mental stature in such a manner that the ups and downs may not deter him from his honest endeavor and the balance of inevitable bliss and sorrow is maintained to add spice in the earthly existences. This stable healthy mental stature is only possible if the physical, social, spiritual and environmental requirements of the body are fulfilled. For the needful, individuals need to be bestowed upon a complete mental and physical health.

Further the big tummy of Ganapati Deva preaches the need for retaining information. Acquiring knowledge, utilizing it and retaining it for years to come, becomes the crux of ‘big–belly commandment’.

The Char–Bhuja Dhari Ganesha, further represents strength by virtue of the four hands in which the Lord entraps his attachments, desires and greed. Two of the arms of Ganesha, which hold rope, symbolize control over the attachments. The laddo or sweet in the other two shows command over the desires and earthly delusion. The mouse sitting near the feet of Ganesha represents greed and gluttony upon which the Almighty rides, propagating a control over the evils.

Ganesha’s physical traits are an assembly of the characteristics most required in an individual of substance. Disposition incarnated with the goodness of such features will result in success in life and will positively procure an ailment–free survival.

Specifically for executives, Ganesha’s characteristic principles may be incorporated in a time–table format which will help in the dawn of a conformable work–atmosphere along with congenial relationship between the management and the union of workers. Deciding the first day of the week to hear all grievance and woes of the workers, the second for thinking and planning strategies to work upon and finally setting targets to be achieved may utilize three days of the week very constructively. Further a day devoted to evaluating losses and gains (Ganesha’s teeth principle) may help additionally in business management. Retaining the information and filing all the pending work can affirmatively call upon the fifth day of the week, which works entirely on the principle of Ganesha’s tummy, which is massive by the virtue of holding tremendous loads of information. Contemplation, discrimination and judging the good and the bad for the entire unit may take another day, leaving the Sunday for self–retrospection through meditation and yoga. One should strive and adopt Ganpati Bappa Maurya’s principles of life management rather than worshiping him with vanity. Life has much in store besides bothering about unnecessary qualms. Giving into a disciplined attitude may assuredly dawn upon a peaceful life. Heaven is where you are, it’s only a matter of perception which makes life as difficult as hell.

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 ulcerative colitis (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 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.

Inspirational Story

Competing wth Others

I was jogging one day and I noticed a person in front of me, about one–fourth of a 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 to what others are doing, where others are going, wearing and driving.

Take what God has given you, the height, weight and personality. Dress well and 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

Older people ‘should exercise to build muscle even into their 80s’

Older people should exercise to build their muscles even into their eighties, according to a review which suggests it will help them with everyday tasks, 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.

Climbing the stairs, housework, walking and even washing was made easier if elderly people worked out two or three times a week, said Chiung–ju Liu of the Department of Occupational Therapy at Indiana University.

People lose muscle as they age, which can make daily chores more difficult. Working out by using small weights or elastic bands can help to rebuild these muscles.

By "walking well", however, you power yourself around all day using muscles in your bottom, midriff and the backs of your thighs. This brings dramatic, sustainable results.

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Total CPR since 1st November 2012 – 96458 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."

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Health Check Up Camp at Sarvodya Kanya Vidyalaya, 8th May 2014

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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

Chance favors those in motion. James Austin

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? http://bit.ly/DC_Ananda

   

eMedi Quiz

An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde–3–phosphate Dehydrogenase.
2.Phosphoglucomutase.
3.Lactate–dehydrogenase.
4.Glucokinase.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Arvind Diwaker, Dr P C Das, Dr K Raju, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr Poonam Chablani.

Answer for 27th August Mind Teaser: 4. X–ray diffraction.

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

Send your answer to ijcp12@gmail.com

medicolegal update

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  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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