eMedinewS
30th September 2014, Tuesday

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

SBTI study: Multi–institutional Collaborative Clinical Trial to Examine Health Benefits of Integrative Lifestyle Practices at the Chopra Center for Wellbeing

Self–Directed Biological Transformation Initiative (SBTI) study will use latest mobile health sensors and genomic/cellular/metabolomics biomarkers

Scientists and clinicians from seven research institutions have joined together for a first of a kind clinical trial on a whole systems approach to wellbeing. Such an in–depth clinically focused study is unique because previous research studies have typically examined the beneficial effects of individual wellbeing practices – such as meditation, yoga, or specific herbal preparations – few have taken anything like a whole systems approach which simultaneously includes a number of such practices to promote improved mind-body functioning.

The Chopra Center for Wellbeing has been in the forefront of integrating whole systems approaches such as Ayurveda, meditation, yoga, massage, herbal treatments, and nutrition into programs for improving health and wellbeing.

This new study pulls these strands together in the most comprehensive manner to date. By measuring the total effect of an intensive immersion into a whole systems program, the aim of the SBTI study is to see if the data will demonstrate a person's connection to the healing process. The body's healing system is still little understood as a whole, because of the complex inputs--thoughts, emotions, diet, stress, exercise, immune response, etc.––that affect whether we heal or not. The picture is further clouded when isolated findings overlap or contradict one another.

In the context of Ayurveda and most other traditional medicine, therapies and practices aren’t done in isolation. Instead of focusing on local symptoms, the diagnosis is systemic. Only now is Western medicine beginning to understand that a blanket condition like "stress" or "inflammation" connects many diverse disorders, including heart disease, cancer, and diabetes. A strong link has also been made to lowered immunity and aging.

The SBTI study will objectively examine the benefits of a whole systems approach in a controlled trial design. The resulting data will cover a broad range of biochemical, physiological, and psychosocial measurements. The intent of the study is not to examine the separate effects of the ‘active ingredients’ of the intervention, but rather assess the combined effects of the full suite of wellness practices.

The SBTI study will be being conducted during a weeklong intensive Ayurveda treatment program at the Chopra Center, located at the OMNI La Costa Resort in Carlsbad, CA. Potential study participants are randomized to join either the Ayurveda program or a seven–day stay at the resort without treatment, which serves as the control. Participants are evaluated four times: at home prior to arriving at the Center, immediately upon arrival, immediately following the treatment program, and one month later in a follow–up assessment. As shown in the table below, the contributing institutions are examining many crucial markers through sophisticated testing of RNA expression; telomerase activity (linked to the aging process), a variety of metabolites, peptides, and neurohormones (connected to metabolism, addictions, and mood changes as well as the messaging between brain and body), the microbiome (the enormous population of microorganisms on the skin and in the intestinal tract, and their collective genetic material), circulating protease activity, mobile cardiac functioning, balance of the autonomic nervous system and assessments of mental, emotional, and spiritual wellbeing.

It is anticipated that findings from the SBTI study will demonstrate the considerable cumulative value of taking a whole systems approach to health and wellbeing (an expectation bolstered by important studies cited below. (Source Dr Deepak Chopra)

News Around The Globe

  • In a randomized trial of 1645 patients with acute low back pain (less than six weeks duration) reported in Lancet 2014, Jul 23, there was no difference in recovery time or other measures of pain and function between patients treated with placebo, as-needed paracetamol and regular paracetamol use.
  • Consumption of alcoholic beverages increases the risk of incident (new) and recurrent gout, although earlier data had suggested that beer and hard liquor increased the risk of incident gout, while wine may not. A significant dose–response relationship was found between the amount of alcohol consumed from any of the three categories (beer, liquor, and wine) and the risk of recurrent gout flare during the subsequent 24 hours in a study in J Clin Oncol 2014, Jul 7. Even moderate amounts of alcohol were associated with an increased risk during this period. The combinations of increased alcohol and high purine intake or diuretic use were associated with higher risk.
  • For women at high risk of developing preeclampsia, the US Preventive Services Task Force (USPSTF) now recommends use of low dose aspirin after 12 weeks of gestation to reduce the risk of preeclampsia, preterm birth, and fetal growth restriction (Ann Intern Med 2014, Sept 9.)
  • Previous observational studies reported an association between proton pump inhibitor (PPI) use and community acquired pneumonia (CAP), but a new meta–analysis in Gut. 2014 Apr;63(4):552–8 suggests the observation might have been due to confounding. The meta–analysis included eight cohort studies with over 4 million new users of nonsteroidal antiinflammatory drugs (NSAIDs), of which nearly 100,000 were treated prophylactically with PPIs and about 50,000 were treated with histamine 2 receptor antagonists (H2RAs). On adjusted analysis, neither the use of PPIs nor H2RAs was associated with an increased risk of hospitalization for CAP during the six months following initiation of NSAIDs.
  • Final results from the CLEOPATRA study have revealed that the combination of 2 targeted agents, trastuzumab and pertuzumab, significantly prolong survival in HER2-positive metastatic breast cancer, compared with trastuzumab alone. The targeted agents were added to chemotherapy with docetaxel. The findings were presented recently at the European Society for Medical Oncology (ESMO) Congress 2014.

National News

Awards to doctors

Of late, I was invited as chief guest in two award functions of doctors. In the last function after the awards were distributed I came to know that the organization has emailed to every award recipient that the awards will be given by the health minister of India. I further found out that every Awardee had paid R. 35000/- to the organization in the pretext of expenses occurred in the hotel arrangements.

To me it looked suspicious and a planned commercial activity. As I was never in the loop that the health minister was invited and he never came. Were the awards sold? Were the awardees lured in the name of the heath minister?

It looked that we who gave away the awards (one of us was a former health secretary of India) were taken for a ride.

It's time to come out with self guidelines as to when to accept and when not to accept to be the chief guest for any function. As our presence often becomes an endorsements for the awardees as they think the awards are genuine.

Under the MCI ethics regulations the awardees can also be in trouble as it may amount to soliciting publicity.

World Heart Day: Dr Harsh Vardhan urges disciplined lifestyle

“Reduce cardio-vascular risk on yourself by exercising; quit smoking”

Dr Harsh Vardhan, Union Health Minister, today announced a series of focused government campaigns centred on major communicable and non-communicable diseases. These will involve NGOs, religious organisations, educational institutions, medical professionals of the government and private sectors, clubs and related social forums as means to developing a social movement over health.

“A specific day in a year will be dedicated to awareness building on a particular disease. For instance, November 7 will be observed as National Cancer Awareness Day, apart from February 4 which is already marked as World Cancer Day. We will use such occasions to communicate with citizens on how to deal with that disease at the prevention and curative levels, the importance of timely check-ups and other matters,” the Minister announced.

The government also plans marking special days for diabetes, anaemia, hypertension, blindness, deafness, malnutrition, obesity, mental conditions and issues related to infant and maternal mortality.

Speaking to reporters on the sidelines of an event, “Walk away from heart attack”, to mark “World Heart Day” which falls on Monday, September 29, the Minister said social mobilisation is essential to making public health work. It is based on the axiom “Prevention is better than cure”.

He lauded the initiative and thanked the organisers –Delhi Medical Association, Rotary Club (District 3010), Saket City Hospital, New Delhi Municipal Committee, Resident Welfare Association of East Delhi, United RWA Joint Action and some city schools. Dr Ganesh Mani, reputed cardiothoracic and vascular surgeon who heads DMA’s World Heart Day initiative, Dr Anil Goel, President of DMA, Dr Harish Gupta and Dr K.K. Aggarwal, past Presidents of DMA, Dr P.K. Sharma, Medical Officer in charge of NDMC, Mr O.P. Mishra, Director (Projects) of NDMC, Mr Sanjay Khanna, Governor of Rotary Club (District 3010), Mr Sandeep Kapoor, Convenor of RWA, East Delhi, and Mr Atul Goel, Convenor of URJA were among the organisers present.

He observed, “Every human body is a stakeholder in the country’s health system. If each body can be kept healthy through balanced diet, avoidance of smoking, drinking and substance abuse, and, put through at least half an hour’s exercise and walk each day, then the entire disease burden of the country would drop dramatically and the Health Ministry’s budget will be optimally utilised.”

After participating in the walk, held in the inner circle of Connaught Place, Dr Harsh Vardhan appealed to all doctors, health workers and NGO activists to work harder to conscientise people on the dangers of cardiovascular diseases –the single biggest cause of premature death.

“Heart disease and strokes are becoming more common in our society than before. I see younger and younger people falling victim to this killer. There is widespread ignorance of the simple fact that it is preventable,” he said.

Dr Harsh Vardhan also advised NGOs to dedicate some of their energies to training neighbourhood people with knowledge in how to administer Cardio Pulmonary Resuscitation (CPR).

He pointed out, “Half the number of fatalities from heart attack is caused by delayed transportation to hospital, yet many of these deaths can be avoided by timely CPR. For this I urge DMA, the RWAs and like-minded groups to conduct camps to train people in such techniques.”

Therefore, social mobilisation can be an all-embracing concept. “The government can lay out hospitals but it would never be possible for it to do enough without the help of developing health resources among common people in awareness generation for disease prevention as well as skills in first aid,” he remarked.

World Heart Day was conceptualised to inform people around the world of the danger of heart disease and stroke. The World Heart Federation, in collaboration with World Health Organisation, uses the occasion to spread the message that at least 80 percent of premature deaths from this quarter can be avoided if the main risk factors –tobacco, unhealthy diet and the sedentary lifestyle – are abandoned.

Dr Harsh Vardhan said, “The government has already launched an offensive against smoking by taxing tobacco products. The next target is fast foods in school and office canteens which leave citizens with no option but gulp fatty and unhealthy foods. The ill effects of alcohol consumption would also be highlighted.”

Spiritual pursuits like meditation or group sessions with philosophers also help avoid heart conditions. Dr Harsh Vardhan mentioned in this context the usefulness of Yoga as preventive medicine for cardiovascular conditions. “A mind at peace is like a fort against heart conditions,” he added.

Dr KK Spiritual Blog

On 6th Navratri chant AUM

Mata Katyayani is worshipped on the sixth day of Navratri. SHE has three eyes and four hands and rides on a Lion.

The top right hand is positioned in a gesture of providing courage and the other hand is positioned in a gesture of rendering a boon. The top left hand is holding a sword and the other holding a lotus.

In Yoga Shastra she represents the Ajna Chakra and AUM bija mantra. AUM chanting helps attaining success in religion, wealth, passion and salvation and removing fear and sorrows.

Spiritual mantra on the 6th Navratri

AUM chanting is one of the most powerful chakra and should be done concentrating on the Ajna chakra.

Inspirational Story

Never Give Up

Life is how you want it to be, open your eyes, and you will see… No matter what, you can have fun, and always remember, when it’s done … The memories of what has been, the mistakes, so you won’t make them again… The good times, but the not–so-good times too, because these memories will see you through.

Never forget friends who've come and gone, Sing life’s praises as a beautiful song Loving and being loved are the greatest gifts, Close your heart, and these you’ll miss Life is how you want it to be, Open your eyes, and this you’ll see…

Just one note: NEVER GIVE UP!

Rabies News (Dr A K Gupta)

How adverse reactions to ERIGs are managed?

Anti–sera of equine origin may cause anaphylactic shock and thus sensitivity testing is mandatory before giving ERIG. A negative skin test must never reassure the physician that no anaphylactic reaction will occur.

Cardiology eMedinewS

  • A novel study reported only modest acute changes in cardiac biomarkers and electrocardiograms and no clinically significant cardiac events in patients with high–dose radiation exposure to the heart following thoracic radiation therapy (RT) and short–term follow–up. The results are published in the October issue of the Journal of Thoracic Oncology.
  • According to Bruce Ovbiagele, MD, of the Medical University of South Carolina in Charleston, and colleagues, patients with chronic kidney disease (CKD) treated with intravenous thrombolytic therapy during ischemic stroke had a higher risk for intracranial hemorrhage and serious systemic hemorrhage, but the risk did not appear to be related to their renal disease. The study findings are reported in the journal Circulation.

Pediatrics eMedinewS

  • The best way to promote bone health for children continues to be through diet, suggests the American Academy of Pediatrics (AAP) Committee on Nutrition in its updated clinical guidelines for pediatric bone health. The guidelines are published online September 29 in Pediatrics.
  • Neonates with glucose–6–phosphate dehydrogenase (G6PD) deficiency have higher bilirubin levels and lower hematocrits during the first week of life as compared to other infants, suggests a new observational study published online in Pediatrics.

Quote of the Day

  • Men for the sake of getting a living forget to live. Margaret Fuller
  • Most people have no idea of the giant capacity we can immediately command when we focus all of our resources on mastering a single area of our lives. Anthony Robbins
  • When one bases his life on principle, 99 percent of his decisions are already made.

IMA News

There is a misuse of antibiotics leading to multi–drug resistant strains. Situation has become all the more serious as bugs have become resistant to most of the prevalent antibiotics including carbapenems. IMA has started a multi pronged strategy involving health professionals, pharmaceuticals Govt, private and international agencies to eradicate this menace. To educate our doctors and medical students, in association with Indian Pediatric Association, IMA has constituted an Advisory Committee with experts from WHO, USAID, Public and Pvt Sectors to prepare a module on "Rational Antibiotic Practices". TOT workshops and CMEs will be arranged throughout the country. During the Advisory Committee Meeting, it was also decided to observe September 28 to October 5 as Antibiotic Awareness Week.

MCI NEWS

The Central Bureau of Investigation on Wednesday (Sept 24) carried out searches at the office of the Medical Council of India here and at a medical college in Thiruvananthapuram in connection with alleged corruption in the granting of recognition to the institute in Kerala. CBI sources said that searches were conducted at the residential and official premises of MCI Additional Secretary Prasanna Raj, Deputy Secretary Anshu Sethi Bajaj, ex–consultant Madhu Handa and Principal of Somervell Medical College, Samson Nessaih. It is alleged that the pending application of the college seeking post–graduate seats was processed in an unauthorised manner by MCI, the sources said. They said that the letter of permission to the college was also issued after the due date.

Wellness Blog

Adverse drug reactions are preventable

Over 50% of all adverse drug reactions treated in hospitals and emergency care are preventable. Many preventable drug reactions like drug overdoses and internal bleeding associated with the improper use of blood thinners and painkillers are life–threatening, especially in the elderly. There are many reasons for these reactions and may include poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education, according to Swedish researchers, who conducted a meta–analysis of 22 studies. Human error is inevitable, and therefore systems must be made to reduce the error. The study concluded that:

  • In outpatient setting, the frequency of preventable adverse drug reactions resulting in hospitalization or emergency treatment is 2%; of these, 51% are preventable.
  • In the elderly, 71% of drug reactions are preventable.
  • In admitted patients the frequency of harmful drug reactions is 1.6% and 45% of them are preventable.
  • A third of preventable adverse drug reactions are life–threatening.

ePress Release

Prehypertension triples the risk of heart attack

A person with prehypertension, systolic blood pressure between 120–139 mmHg and diastolic pressure between 80–89 mmHg, is more than three times likely to have a heart attack and 1.7 times more likely to have heart disease than a person whose blood pressure is lower than 120/80 mmHg.

Systolic blood pressure is the pressure against the artery wall when the heart beats and diastolic blood pressure is the pressure when the heart is at rest between the heart beats. Normal blood pressure is lower than 120/80 mmHg and hypertension is a blood pressure more than 140/90 mmHg or higher.

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 said that research has shown that if prehypertension is aggressively treated, 45% of all heart attacks can be prevented. Lifestyle modifications such as weight control, regular physical activity and changes in diet are recommended for people with pre–hypertension. The importance of prehypertension has been listed as one of the top 10 recent advances in cardiology. Dr. Aggarwal said that every effort should be made to lower the blood pressure below 120/80 mmHg.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at A.S.V.J Sr Sec School, New Delhi on 24th September 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

Varenicline go ahead in heart patients

video of day video of day

Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG https://www.youtube.com/
watch?v=Mc3kKDXKWvs

Kishan, SM Heart Care Foundation Fund, Post CHD Repair https://www.youtube.com/
watch?v=OTEG7toVkAQ

Deepak, SM Heart Care Foundation Fund, CHD TOF https://www.youtube.com/
watch?v=rjOel0aaqt0

 

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."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)


 

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 :

 

Dr Good and Dr Bad

Situation: A patient with stable angina was on beta blockers
Dr Bad: It will also increase survival
Dr Good: It will relieve angina but not survival
Lesson: In patients with stable coronary heart disease who have not had a recent acute MI, beta-blockers are indicated to treat angina but not to improve survival (J Am Coll Cardiol 2014;64(3):247-52).

 

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots by Dr k k Aggarwal http://bit.ly/15ArAmM #Health
Dr Deepak Chopra:Wealth is a state of consciousness. Money is its bookkeeping symbol #CosmicConsciousness

eMedinewS Humor

Another time, he gave a patient six months to live. At the end of the six months, the patient hadn’t paid his bill, So, the doctor gave him another six months.

eMedi Quiz

A 30 year old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1.Medial rectus and superior division of oculmotor nerve.
2.Inferior oblique and inferior division of oculomotor nerve.
3.Lateral rectuas and abducent nerve.
4.Superior rectus and trochlear nerve.

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 ionization 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: Dr. Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Avtar Krishan, Dr.K.V.Sarma, Dr Poonam Chablani.

Answer for 27th Sept Mind Teaser: 3.Low oral bioavailability always and necessarily mean poor absorption

Correct answers received from: Tukaram Pagad, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Poonam Chablani, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Is it necessary to do echo before each angiography?

Excerpts from one of the judgment;

"The cardiologist owed a duty to take care of the deceased. He miserably failed to discharge its duty, whether it was in anxiety not to lose a patient and/or out of over confidence or both? It was a wrong decision and advise for the patient to undergo immediate angiography. It was not an emergency, the cardiologist had sufficient time to have planned angio. The angiography was conducted without baseline ECHO and other investigations. The cardiologists ought to have studied the condition of the deceased, whether he was fit to undergo angio and could have anticipated the probability of occurrence of the known complications. Hence, it was not a Standard of practice, cardiologist ought to have conducted Allergy test for contrast medium.
The Acute Cardiac Failure, which could be consequence of raised LVDEP, it could have been avoided by the Cardiologist by terminating the angiography procedure. It further led to Multi Organ Failure, including Acute Nephropathy, which was further potentiated by the Contrast Medium. The cardiologist also failed to manage the Post–angiography complications as per standards of medical practice. The hospital is a corporate hospital, but lacks infrastructure of Cardiac Alert System or Rapid Response Team. The ICU staff was careless and negligently monitored the patient, who suffered prolonged severe hypoglycemia and unfortunate death on the same day.

The treating team is also guilty of overwriting and making corrections in the medical records. The hospital is directed to pay compensation of Rs.25,00,000/– with interest @ 9% pa from the time of death of the patient and Rs.2,00,000/– as costs of litigation, within 90 days, to the complainant, otherwise it will carry interest @ 9% p.a., till its realisation.

Reference

National Consumer Disputes Redressal Commission
New Delhi: Original Petition No. 228 of 2001: Mrs. Manjeet Chawla & Others vs. ESCORTS Heart Institute & Research Centre
Before: Hon’ble Mr. Justice J.M. Malik, Presiding Member and Hon’ble Dr. S.M. Kantikar, Member
Pronounced on 17th July, 2014

medicolegal update
  1. Dear Sir, Thanks for the information. Regards: Dr Sneha

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