eMedinewS3rd November 2013, Sunday

Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at
www.twitter.com/DrKKAggarwal
www.facebook.com/Dr KKAggarwal


eMedinewS wishes its readers a happy and healthy Diwali

Harvard 5 exercises to improve hand mobility and reduce pain

Range–of–motion exercises

Your muscles and tendons move the joints through arcs of motion, as when you bend and straighten your fingers. If your normal range of motion is impaired — if you can’t bend your thumb without pain, for example you may have trouble doing ordinary things like opening a jar. These exercises move your wrist and fingers through their normal ranges of motion and require all the hand’s tendons to perform their specific functions. Hold each position for 5–10 seconds. Do one set of 10 repetitions, three times a day.

Wrist extension and flexion sprritual blog

Wrist supination/pronation

  • Place your forearm on a table on a rolled–up towel for padding with your hand hanging off the edge of the table, palm down.
  • Move the hand upward until you feel a gentle stretch.
  • Return to the starting position.
  • Repeat the same motions with the elbow bent at your side, palm facing up.
  • Stand or sit with your arm at your side with the elbow bent to 90 degrees, palm facing down.
  • Rotate your forearm, so that your palm faces up and then down.

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."


VIP’s on CPR 10 Mantra Video
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Diwali, the Festival of Inner Purnima on Outer Amavasya

sprritual blog

Diwali is celebrated on the day of Amavasya but the festival is symbolized by inner happiness, lighting or Purnima.

Moon in mythology is symbolized by cool positive thoughts. One usually encounters negatives thoughts on the day of Amavasya and positive thoughts on the day of Purnima.

Diwali is the only day in a year where one experiences positive thoughts on the day of Amavasya, hence some people believe that the festival symbolizes inner Purnima and outward Amavasya.

Diwali celebrations also coincide with the terminal phase of Chaturmas, the four months of negative state of mind.

The purification process in Chaturmas starts with 1st Navratra falling on Amavasya. During these nine days, one undergoes mind, body and soul detoxification by not thinking negative, doing positive things and acquiring soul-based knowledge.

The mind, body detoxification during Navratras ends with killing of Tamas (Kumbhakarna), Rajas (Meghnath) and ego (Ravan) and the victory of consciousness (Rama) over the evil.

These benefits do not lead to inner Moksha or happiness until 20 days, the day of Diwali. In order to continue getting benefits of Navratras, one should fast with positive state of mind every fourth day till Diwali.

On Sharad Purnima, the fast involves thinking positive with a cool mind to get health benefits. Four days later, on Karvachauth again, one fasts and worships the Moon with positive thoughts and acquires longevity benefits. Four days later on Ahoi Ashtami again, one worships the moon and the stars with positive thoughts and acquires fertility benefits. On the day of Dhanteras one acquires a win over the fear of death (Yama). On this day, the fast involves deeper meditation (Samudra manthan) to acquire all the benefits of Samadhi.

At the end of the meditation in the state of Samadhi, one gets in touch with the consciousness or the God, the insight gets illuminated and a person experiences bliss, a state of ecstasy of inner happiness and this is what is called experiencing inner Purnima on the day of outer Amavasya and the festival is celebrated as Diwali.

Let us all worship this Diwali as a state of positive mental state. This one month of purification of thoughts helps one in combating the depression phase seen in winter.

Diwali is the only Amavasya where one does not do Shraadh pooja. On Diwali Amavasya (falling in Chaturmas) one is allowed to start any new project. Even deaths on this Amavasya are considered auspicious (unlike on other Amavasya days).

cardiology news

True Story: Real Winners Don’t Give Up!

This is a true story of a young woman who went through the most gruesome fire. When you read her story, you’ll realize that your trials are absolutely nothing compared to what this young girl went through.

It was September 25, 2000. Maricel Apatan was an 11–year old girl in Zamboanga. On that day, this little girl went with her uncle to draw water. Along the way, four men met them. They were carrying long knives. They told her uncle to face down on the ground, and they hacked him on the neck and killed him.

Maricel was in total shock especially that the men were their neighbors. She tried to escape, but the men ran after her. She cried, "Kuya, ‘wag po, ‘wag n’yo akong tagain! Maawa po kayo sa akin!" ("Don’t kill me! Have mercy on me!") But they weren’t listening. With a long knife, a man slashed her on the neck too. Maricel fell to the ground and lost consciousness.

When she woke up, she saw a lot of blood. She also saw the feet of the men around her, but she pretended to be dead. When they walked away, Maricel ran back home. But along the way, she saw that both her hands were falling off. Because the men hacked them too. She cried but she kept running.

Sometimes, she would faint and fall to the ground. But she’d regain consciousness and run again. When she was near her home, Maricel called her mother. Upon seeing her daughter, her mother screamed in terror. She wrapped her bloodied child in a blanket and carried her to the hospital. Here was the problem: From her house to the highway, it was a 12–kilometer walk. It took them 4 hours just to reach the highway.

When they arrived in the hospital, the doctors thought Maricel was going to die. But for 5 hours, they operated on her. It took 25 stitches to stitch together the long knife wound in her neck and back.

Maricel barely survived. And she lost both of her hands. Ironically, the next day was Maricel’s birthday. She was 12 years old. But tragedy didn’t end there. When they went home, they saw their home was gone. It was ransacked and burned down by the goons. Being very poor, Maricel’s family also didn’t have money for their hospital bills.

But God sent many angels along the way to help them. Archbishop Antonio Ledesma, a distant relative, paid for hospital bills and helped them bring the criminals to court. They were sentenced to prison.

Today, she’s staying with the nuns at Regina Rosarii with Sr. Eppie Brasil, O.P. But this is the incredible miracle. Instead of staying down, Maricel kept running.

Instead of cursing God why she had no hands, she now uses her wrists in incredible ways that will boggle your mind. Maricel was cited as the most industrious, best in computer and most courteous in the School for Crippled Children.

In 2008, she graduated from a course in Hotel and Restaurant Management. She even received a Gold medal for Arts and Crafts. In 2011, she finished her education to be a chef. Yes, a Chef without hands. Nothing can stop this young lady from reaching her dreams.

News Around The Globe

News

  • The US FDA has announced approval of changes to labeling for the antiseizure medication ezogabine (Potiga, Valeant Pharmaceuticals International) to underline previously reported risks for retinal abnormalities, potential vision loss, and skin discoloration, all of which may become permanent."The revised label includes a new boxed warning stating that Potiga use be limited to patients who have not responded adequately to several alternative therapies to decrease the frequency of seizures, or epilepsy, and for whom the benefits of treatment outweigh the risks.
  • For the first time, a scientific study presented at the American College of Rheumatology 2013 Annual Meeting has shown that a simple slip–on knee brace reduces bone marrow lesions and pain associated with osteoarthritis. Bone marrow lesion change offers a tremendous opportunity for drug development in osteoarthritis. Unlike cartilage loss, bone marrow lesions are associated with pain. They could be a structural treatment target if we can demonstrate repeatedly that treatments are effective.
  • Early imbalances in angiogenic factors predict poor pregnancy outcomes in women with systemic lupus erythematosus or antiphospholipid syndrome (APL), a new research presented at the American College of Rheumatology (ACR) 2013 Annual Meeting. According to the authors, these findings could lead to a test to predict poor pregnancy outcomes as early as 16 weeks of gestation.
  • No differences were found in health status, well–being, quality of life, and treatment satisfaction between screen–detected type 2 diabetes patients receiving intensive treatment and those receiving routine care. Results of the Euroqol 5 Dimensions (EQ-5D) questionnaire –– which covers five domains of health –– showed that EQ–5D did not change between diagnosis and follow–up, with a median (interquartile range) of 0.85 (0.73–1.00) at baseline and 0.85 (0.73–1.00) at follow–up, which occurred at an average of 5.7 years later. These outcomes published in Oct. 29 issue of Diabetologia suggest that intensive treatment does not adversely affect patient–reported outcomes.
  • Measuring levels of parathyroid hormone (PTH) that haven’t been oxidized may be a more accurate means of assessing mortality risk in patients with end–stage renal disease (ESRD). In a prospective study reported online in the Journal of Clinical Endocrinology and Metabolism, median levels of non–oxidized PTH were significantly higher among ESRD patients who survived over a 5–year period than in those who died (7.2 ng/L versus 5.0 ng/L).

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Rabies News (Dr. A K Gupta)

How should the animal causing the bite be handled?

It is important to establish if the biting animal is healthy or diseased, bearing in mind that a rabid animal excretes the virus in its saliva not just throughout the illness but also several days before the appearance of the first signs. An unknown animal, which has disappeared, must be considered as rabid and a full course of PEP must be given. Cats and dogs, which can be identified, must be kept under observation. The risk of rabies can be considered as slight if the animal shows no sign of disease after 5 days, and non–existent if the animal is still healthy on the 10th day (The European Standards recommend an observation period of 15 days).

All wild animals, and those domestic animals suspected of having rabies must be put down and the rabies diagnosis must be carried out in the laboratory.

If it is proven that the animal is not rabid, only then the anti–rabies treatment may be halted.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • The first results out of the U.S. pivotal trial for Medtronic’s CoreValve prosthesis for transcatheter aortic valve implantation (TAVI) showed a significant benefit for patients with symptomatic severe aortic stenosis who had an extremely high surgical risk. The study presented at the Transcatheter Cardiovascular Therapeutics meeting showed that the 1–year rate of all–cause mortality or major stroke was 22.5% (95% CI 21.6%–29.4%), meeting the trial's primary endpoint by coming in under the goal of 43% (P<0.0001). The rate of major stroke was low at both 30 days (2.4%) and 1 year (4.1%), and paravalvular regurgitation improved over time.
  • Use of the self–expanding Medtronic CoreValve transcatheter aortic valve in the CoreValve Extreme Risk pivotal trial led to some of the lowest stroke and paravalvular leak rates seen in any transcatheter aortic–valve replacement (TAVR) study to date. The trial, presented here at TCT 2013 by Dr Jeff Popma (Beth Israel Deaconess Medical Center, Boston, MA) also met its primary end point of reduction in all–cause death or major stroke; as expected, however, use of the device was associated with pacemaker implantation in more than one in five patients.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • At least one concussion symptom was common in roughly two–thirds of pediatric sports medicine and orthopedic patients who had no history of the disorder. However, vestibular deficits –– common in roughly 81% of a separate sample of pediatric sports medicine clinic patients who did have concussions –– were not seen in this healthy group. The large presence of vestibular deficits was associated with extended recovery time and need for vestibular rehabilitation in those whose symptoms persisted 4 weeks after injury. The AAP released a recommendation at the meeting that concussed students should take time off from the classroom as well as from the field following their injury, and that recovery should incorporate a team–based approach.
  • Uniformity in the bacterial composition of low birth weight infants’ gut, mouth, and skin after birth may leave them open to potentially fatal infections. Across a six–infant sample of low birth weight infants, patients’ bacterial microbiomes were ripe, at times, with bacteria associated with neonatal infections and necrotizing enterocolitis. Analysis of these infants showed "a delayed compositional differentiation of the oral cavity and distal gut microbiota, and, in the case of one infant, an abundant, uncultivated oral Mycoplasma sp., recently detected in human vaginal samples.
cardiology news

Diwali Alcohol And Gambling

Many people indulge in alcohol drinking on Diwali and gamble. It is the duty of the host to see that alcohol is not served to people who are going to drive back home themselves. They should take away their car keys and get them dropped by an arranged driver or by car poling.
After consumption of 30ml of alcohol (whiskey), one should not drive for the next one hour. For every subsequent 30 ml of alcohol, one should add one hour of not driving.

Alcohol takes away the power of judgment and one may end up with accidents.
Drunken driving and using a mobile while driving work like a Sone Pe Suhaga

cardiology news

Total CPR since 1st November 2012 – 69833 trained

Media advocacy through Web Media

Air Quality a Temporary Trigger for MI

Heavy air pollution can trigger acute heart attack in the hours after exposure, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India.

Every 10 μg/m3 increase in small particulate matter and nitrogen dioxide temporarily boosts heart attack risk by 1.2% and 1.1%, respectively, as per a report in the BMJ. The chances of suffering an attack increase by 1.3% in the six hours after coming in contact with high levels of vehicle-related pollutants.

The increased risk is seen up to six hours after exposure to typical traffic–related pollutants. The take home message is that breathing in large amounts of traffic fumes can trigger a heart attack within six hours following exposure.

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 71933 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

today emedipics

20th MTNL Perfect Health Mela 2013

press release

Healthcare worker fatigue and patient safety

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

The primary defect which leads to sickle cell anemia is:

1.An abnormality in porphyrin part of hemoglobin.
2.Replacement of glutamate by valine in B–chain of HbA.
3.A nonsense mutation in the B–chain of HbA.
4.Substitution of valine by glutamate in the a–chain of Hba.

Yesterday’s Mind Teaser: The main enzyme responsible for activation of xenobiotics is:

1.Cytochrome P–450
2.Glutathione S–transferase.
3.NADPH cytochrome P–450–reductase.
4.Glucuronyl transferase.

Answer for yesterday’s Mind Teaser: 3.NADPH cytochrome P–450–reductase.

Correct answers received from: Dr. P. C. Das, Anil Bairaria, Dr Pankaj Agarwal, daivadheenam, DR AVTAR KRISHAN, Dr Kanta Jain, Dr Abbas Vakil, DR P K SAHU, Dr Prakash Khalap

Answer for 1st November Mind Teaser: 1.Buccinator.

Correct answers received from: Muthumperumal Thirumalpillai, DR AVTAR KRISHAN, Dr Kanta Jain, Dr Abbas Vakil.

Send your answer to ijcp12@gmail.com



medicolegal update

1264––A doctor commits medical negligence in a hospital. Who will pay the compensation—the doctor or the hospital?—JOINTLY, SEVERALLY, LIABILITY

1264––QUESTION –– A doctor working in a hospital is found guilty of negligence. There is no apparent negligence on the part of the hospital. Who will be liable to pay the compensation—the doctor or the hospital?

ANSWER—


1––The general practice is that both the doctor and the hospital are made liable jointly as well as severally. However, in an occasional case, the court awards a certain compensation (a small percentage of the total) to be specifically payable by the doctor. This is done when the nature and degree of negligence are such that the court wants to send a terse message to the doctor directly. For example, in Kunal Saha case, where the compensation was about 6 crore, the doctor was asked to pay Rs. 10 lakh.

2—The reason for the above approach is that the patient comes for treatment not to a specific doctor in the hospital but to the hospital itself. The fees are charged by the hospital, not by the doctor. The contract for service is between the patient and the hospital and not between the patient and the doctor. Very often, the patient is managed by several doctors in the hospital and not by a single specific doctor.

3—The above principle is laid down in the following judgments:

A—In Sh. Naresh Mehra v. Dr. A.P. Choudhary, decided on 31–10–2008, Delhi State Consumer Commission held as follows:

"18. We have taken a view that whenever any patient lands in any Hospital or Nursing Home, Medical Centre, his direct relationship of consumer for hiring or availing the medical services is with the said Hospital or Nursing Home or medical Centre and not with the treating Doctors and other personnel, secondly, the entire consideration in the form of expenses including the component of charges or fees of the operating Doctor and other junior Doctors and staff engaged in pre or post operative care or any other kind of care are paid to the Nursing Home or Hospital or Medical Centre directly and thirdly that there is totality or compendium of various services including medical and those of para staff and other conveniences and the privity of contract is not with the operating or treating or attending Doctors, nurses and other staff.

19. Thus if a patient suffers due to the medical negligence or carelessness of Doctors and staff of the Hospital or Nursing Home or Medical Centre whose services he avails against consideration, said Hospital or Nursing Home or Medical Centre alone is liable to compensate the patient as to loss or injury suffered by him and Nursing Home or Hospital or Medical Centre has independent remedy to take any kind of action against such doctors or staff but no doctor or staff has a joint or several liability qua the patient.

20. Similarly Nursing Homes or Medical Centres or Hospitals alone are liable for the acts of omission or commission or medical negligence of visiting or consulting Doctors as the patient has no direct contract with such Doctors and services of such Doctors are availed by the Hospital or Nursing Home or Medical Centre and not the patient."

B–– In Mrs. Nisha Marwah v. Dr. Sangeeta, decided on 07–11–2008, Delhi State Consumer Commission held as follows:

"6. It is made clear that the respondent shall be treated as a hospital and not an employee. We have taken a view that whenever a consumer avails the services of a Nursing Home or Hospital it is the hospital or the nursing home who is the service provider and not the doctor as the consumers have no independent contract with individual treating doctors nor any consideration is paid directly to the doctor. So if at all any order will be passed by the District Forum, it will be against the GTB Hospital and not against Dr. Sangeeta as the hospital will be free to take any action against the concerned doctor if she is found to be guilty of medical negligence."

C–– In Dr. D.S. Gambhir V. Sh. Suraj Bhan, decided on 20–11–2008, Delhi State Consumer Commission held as follows:

"6. Aforesaid reasons persuade us to allow the appeal but with the observations that the appellant who was employee of the G.B. Pant Hospital should not have been held guilty jointly and severally along with the Hospital as the respondent had contacted the hospital first and not the appellant directly as the appellant was the government employee over there and the charge for recovery of awarded amount shall be on the G.B. Pant Hospital whose services respondent had availed. "

medicolegal update

As an airplane is about to crash, a female passenger jumps up frantically and announces, "If I’m going to die, I want to die feeling like a woman."

She removes all her clothing and asks, "Is there someone on this plane who is man enough to make me feel like a woman?"

A man stands up, removes his shirt and says, "Here, iron this!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given at the time when meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

medicolegal update

There are some people, who live in a dream world, and there are some who face reality; and then there are those who turn one into the other. Douglas H. Everett

medicolegal update

Dr KK Aggarwal: Heart risks detected by age 7 in overweight kids http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: What is a Spiritual Solution? #CosmicConsciousness

medicolegal update
  1. Your spiritual blogs are very enlightening, and emedinews also, we want many more in future…………thanks a lot for sharing. Uma Allure.

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