eMedinewS
6th December 2014, Saturday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

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

Today is Patient Solidarity Day

We have all been patients at some point of time in our lives, or cared for one.

Let’s recommit ourselves to provide safe, high quality, equitable and affordable healthcare to all. Let’s make “High quality and Minimal Stay" for our patients our motto.

Every person, every patient is equal and all have the right to access the healthcare they need, when they need it. We need to unite to ensure that all people, across the world, have fair and impartial access to quality healthcare.

Patient Solidarity Day is a day to come together, unite and speak with one voice. It recognizes that regardless of disease, religion or nationality, we all share common problems. Let's all share what our patients have taught us in our practice. Here are mine:

“During our career, we have learnt a lot of spiritual prescriptions from our patients. Not only did they help us heal our patients, they also changed our perception about health and sickness.

I recall Swami Bodhanand, a disciple of Swami Chinmayananda, was once hospitalized under our care. When I asked him to give me a spiritual message, he just said two words “Detached Attachment”. He said, “As a doctor you should behave like a lotus leaf. The lotus leaf is wet as long as a there is a drop of water on it, but once the drop is out, the leaf is as dry as if the water was never there.” The message was that “we should be attached to our patients as long as they are with us. The day they die, we should be completely detached from them or else we will not be able to treat other patients.”

I met another spiritual guru through our Chief Anesthetist. The fee he paid to me was a spiritual message “Suno, Samjho, Jano, Karo” i.e. Hear, Understand, Wisdom and Do.” He said that hearing is different from listening, listening is different from wisdom and wisdom is different from doing. Unless you hear, understand what you have heard and implement, learning has no value.

One of my Buddhist patients gave me a spiritual learning, which has helped me a lot in my routine clinical practice. He taught me the basic Buddhist message that there is suffering all over; there is a reason for every suffering and it is possible to maintain sufferings. This message fits into the main message of Hinduism and also the main teaching from Garud Purana.

In Hinduism, we know that the very fact that we are born in this life means that in our last life, we could not get liberation because Hinduism believes that after liberation you are not reborn. Not getting liberated in the last birth means that there are some sufferings still left in our life. The basic purpose of this birth, therefore, is to face sufferings. When the basic purpose of our birth is to face sufferings, then why suffer from these sufferings. Every time we suffer, we should thank God that he has reduced one more. The period in between two sufferings is called a Happy period (Sukh). In fact, this period is nothing but a period of rest given to us by God to prepare our body for the next suffering. This as a concept of counseling helps my patients to manage most of their mental disturbances.

Sometimes not telling a patient that he is suffering from terminal cancer works. The father of one of my patient was found to have extensive cancer of the prostate. He was 83 years old. Medically, we all gave him three months to live. My patient did not have the courage to tell his father or the family members that he (the father) had extensive cancer. He took me into confidence and played a game with the family. We gathered all the family members and told them that this cancer had been cured with the surgery. A party was organized in the evening to celebrate the cure. The magic happened; he lived almost a symptom-free life for the next 9 years. I have tried this on many of my patients thereafter and it works. The probable explanation was loss of fear of death, confidence in his doctor and faith in his own self.

The way to live to 100 years is to go on working in life. My great grandfather-in-law was 75 years old when I got married. That year, he gathered all family members across the world and said that his purpose of life was over; he would like a collective family photograph and like to quit the world. Nothing happened for a year. On 20th July next year, he again acted in a similar manner. The whole family from across the world gathered but he remained alive for another year. This went on for three years. Suddenly, we decided to play a spiritual trick on him and told everyone to convince him that he is going to live for 100 years as he still had to carry out lot of work for the family. Every year, we gave him law students from within the family to be taught (he was a lawyer himself), or entrusted him with the responsibility of finding a boy for some eligible girl in the family. We made him teach and search for a prospective bride or groom for eligible family members for years together and he actually died at the age of 100 years.

This is the beauty of a positive attitude in life

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66th Annual Conference of Cardiological Society of India (CSI) -2014 conference newsletter day 2

66th Annual Conference of Cardiological Society of India (CSI) -2014

Dr Tiny Nair

An Interview with: Dr Tiny Nair, Kerala

In your opinion does IV iron have the potential to improve the prognosis and outcome in CHF patients with ID ?
Iron deficiency is a major comorbidity in heart failure. It affects the prognosis CHF by many mechanisms including interference with oxygen delivery to the tissues in heart failure, which is a critical determinant of symptoms. Correcting iron deficiency has the potential to improve CHF.
FAIR HF was the first study on ferric carboxymaltose (available as Ferinject) in CHF patients with iron deficiency. Could you please share the key outcomes of FAIR HF study.
In FAIR HF trial, ferric carboxymaltose was administered to patients with CHF with anemia and low ferritin levels; 949 patients of NYHA class 2 and 3 CHF were randomized to receive either ferric carboxymaltose 200 mg per week or matching placebo. The primary outcomes were patient global assessment (PGA) score and NYHA class at 24 weeks. The secondary endpoint included combination of the primary endpoints as also 6 min walk test, KCCQ score and EQ5D score. Safety endpoints were also noted. The results clearly showed improvement of both symptomatic status (PGA) and NYHA class across all patients. All the symptomatic endpoints including 6 min walk test and KCCQ scores showed improvement. There were no statistically significant safety signals. This trial conclusively shows the benefit and safety of ferric carboxymaltose in treating anemia in CHF
Another landmark Study “CONFIRM HF” has been presented at the ESC 2014 annual conference at Barcelona. What are the key take home points of the study?
In CONFIRM HF trial, CHF patients of NYHA class 2 or 3 with EF < 45% with elevated BNP with serum ferritin < 100 ng/ml were randomized to either ferric carboxymaltose or placebo. A Hb level of less than 15 was the entry criteria, meaning the study tried to dissociate anemia from iron deficiency. 300 patients were included. The results showed improvement of 6 min walk test, PGA, NYHA class and KCCQ score.
Based on the recent CONFIRM HF trial, what would be the median dose of ferric carboxymaltose required to correct and maintain the iron status in CHF patients in India?
The median dose of ferric carboxymaltose in CONFIRMHF was 1500 mg. With no data available from India, we can assume that the mean dose of ferric carboxymaltose would be at least 1500 mg or more, since iron deficiency is more profound in India.
What is your recommendation on ferric carboxymaltose in CHF patients with ID with or without anemia?
With publication of FAIR HF and the new CONFIRM HF trial, the role of ferric carboxymaltose in correcting anemia in CHF has been proven. In addition CONFIRM HF has indicated that the benefit of ferric carboxymaltose may be much beyond correcting anemia, but correcting iron deficiency, indicating that ferritin rather than hemoglobin may be the target for correction. As far as the physician is concerned, one must look for anemia as well as iron deficiency (serum ferritin) in patients of heart failure. Correcting iron deficiency is important in improving quality of life and functional class. Larger studies would indicate the benefits of correcting iron deficiency on hard endpoints in CHF.

News Around The Globe

  • Greater adherence to the Mediterranean diet may be associated with greater telomere length, a biomarker of aging, suggests a new study published December 2 in the British Medical Journal.
  • Selective laser trabeculoplasty (SLT) is effective in the short term for treating primary angle-closure glaucoma (PACG), although complete success is more common with prostaglandin analog, suggests a new clinical trial published online in JAMA Ophthalmology.
  • A new study suggests that smoking induces loss of chromosome Y (LOY) in blood cells and is thus a preventable risk factor for this common human mutation. The study is published online December 4 in Science.
  • A large, pooled multipopulation analysis has found little evidence that cumulative exposure to pioglitazone causes bladder cancer in men or women. The analysis was published online December 3 in Diabetologia.
  • People who add a little walking to their routines after weight loss surgery decrease their risk of diabetes and improve their heart health more than those who stay sedentary, suggests a new study published online December 1 in the Journal of Clinical Investigation.

Dr KK Spiritual Blog

Thinking differently

There are three ways to manage stress. One is to think opposite, second is to think different and the third is to think positive.

Thinking opposite was advocated by Patanjali, thinking differently by Adi Shankracharya and thinking positive by Gautam Buddha. Out of three approaches, the Indian Vedic philosophy focuses on thinking differently. Thinking positive and thinking opposite may not be feasible at the time of any adversity.

Thinking differently has been emphasized in mythology at multiple places. Ten heads of Ravana, five heads of Brahma, elephant head of Lord Ganesha, Fish incarnation of Lord Vishnu and third eye of Lord Shiva remind us of the principle of thinking differently.

We can see or analyze a person or a situation with the eyes of our physical body (physical eye) or eyes of the mind (thinking and analyzing) and eyes of the soul (conscious based decision).

Lord Buddha once said that a good action should be based on truth, should be necessary and bring happiness both for the person doing it and the society. The 3H principle advocated in the West is also based on the same which means before any action think from your Head and from multiple options available, choose from the Heart and then order the Hands to do the job.

The first incarnation of Lord Vishnu Fish indicates the capacity of swimming against the stream. The third eye of Lord Shiva means thinking from the mind and choosing the right answer from the heart. The ten heads of Ravana and five heads of Brahma also indicate thinking to get multiple options.

The example of thinking differently comes from the dialogue between Urvashi and Arjuna. Once Urvashi in a mind full of Kama went to Arjuna and said “If you are not going give me a son like you today, I am going to give you a curse”. Arjuna was in a dilemma but he thought differently and said – “Why do you want to wait for 25 years to get a son like me from today I am your son: Mother.”

Inspirational Story

Bumps and Bruises

"Life is full of bumps and bruises. It's what you learn from it and what you do with it that makes you who you are."

I was reading this article in Glamour magazine and it was about these five women who overcame deadly situations and got on with their lives. These women went through a double lung transplant, an open heart surgery and then gave birth to twins, a cancer survivor, a deadly bacterial infection, and one of the women, who was still a teenager, survived knife wounds that most people wouldn't survive.

This article got me thinking about how people go about their lives. Life is not a smooth ride. Some people, when they hit a bump, give up and turn around while others find ways to go over the bump or around the bump. I believe that everyone should do the latter and be like these five women and find ways to get around these bumps.

So when you reach a bump on the road called life, don't give up because you're not the only person to ever reach that particular bump and you're not the last. Be an example for your followers!!!!

Rabies News (Dr A K Gupta)

Does strain of virus used in rabies vaccine play a role in eliciting the required response?

Response to rabies vaccination is a unique mix of specificities to rabies virus antigens. Antibodies develop out of intrinsic host responses and in response to extrinsic factors such as the amount of antigen given, type of antigen, and route of exposure or vaccination. There may be substantial variation in the neutralizing activity and quantity of rabies virus neutralizing antibodies (RVNA) produced. Therefore, the strain of virus used in antirabies vaccine plays a role in eliciting the required response.

Cardiology eMedinewS

  • An analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial suggests that intensively lowering glucose concentrations in diabetic patients might reduce the risk of ischemic heart disease. The analysis was published in the Lancet.
  • Non-ergot derived dopamine agonists used to treat Parkinson's disease may be safe for the heart, suggests preliminary research presented at EuroEcho-Imaging 2014.

Pediatrics eMedinewS

  • A new study published in The Lancet Respiratory Medicine suggests that preterm children are at greater risk of flu-related complications.
  • A new urine test could help ensure that asthmatic children receive the level of medication they need and prevent future asthma attacks, suggests new research presented at The British Thoracic Society Winter Meeting.

Quote of the Day

  • Many people love in themselves what they hate in others. E. F. Schumacher

Wellness Blog

Cycling can cause erectile dysfunction?

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hrs a week can cause erectile dysfunction in males. For those who drive cycles for more than 3 hours a week should do so in reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate.Surgery or priapism may cause erectile dysfunction.

Bicycling —Less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling.

Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling induced impotence, is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than three hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting ten minutes.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at Sarvodaya Kanya Sec. School, Pushp Vihar on 7th November 2014

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video of day
press release

Treating vitamin D deficiency in the country

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

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 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 diabetes wanted to know if he could do aerobic exercise.
Dr. Bad: You cannot do it
Dr. Good: You can do it.
Lesson: People with type 2 diabetes should get 150 minutes of aerobics exercise every week.

Make Sure

Situation: A patient on binasal oxygen developed nasal mucosal damage.
Reaction: Oh my God! Why was the oxygen given at 4 liter per minute?
Lesson: Make sure that oxygen via nasal catheter, is not given at a rate of more than 3 liter per minute.

eMedinewS Humor

Signing Checks

Mr. Schwartz was the oldest of 7 children, so he had to quit school and work to help support his younger brothers and sisters. He never learned to read, so when he married and started a checking account, he signed his checks simply "XX". Eventually he started his own business, which immediately prospered. He soon was a very rich man. One day, he got a call from his bank. "Mr. Schwartz," said the banker, "I need to ask you about this check. We weren’t sure you had really signed it. All these years you’ve been signing your checks ‘XX’, but we just got one that was signed with three XXX’s…"

Mr. Schwartz answered, "No problem, my friend. It’s just that since I’ve become so wealthy, my wife thought I ought to have a middle name."

Twitter of the Day

Dr KK Aggarwal: Eating Disorders are contagious
Dr Deepak Chopra: "When you surrender to uncertainty, nothing ever goes wrong."

ePress Release

Heart Patients Beware of Eating Cakes

Food of animal in origin and saturated foods contain cholesterol. 1% rise in cholesterol raises the chances of heart attack by 2% said Padma Shree and National Science Communication and Dr. B.C. Roy National awardee Dr. K K Aggarwal, President Heart Care Foundation of India. Heart Patients should therefore avoid eating cakes during the Christmas and New Year Season. They should distribute fruits & dry fruits instead of cakes.

Beware of the term Low or High Cholesterol on the labels

  1. Cholesterol Free means less than 2 mg cholesterol and 2 grams or less fat.
  2. “Low Cholesterol” means 20 mgs or less cholesterol and 2 grams or less saturated fat.
  3. “Fat Free” means less than ½ gram fat;
  4. “Low Fat” means 3 grams or less fat;
  5. “Reduced Fat” means at least 25% less fat than other brands of same food.

eMedi Quiz

A 20 year old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:

1. Macular edema.
2. Sympathetic ophthalmia.
3. Optic nerve avulsion.
4. Delayed vitreous hemorrhage.

Yesterday’s Mind Teaser: A vitreous aspirate has been collected in an emergency at 9 pm what advice you like to give to the staff on duty regarding the overnight storage of the sample.

1. The sample should be kept at 4°C.
2. The sample should be incubated at 37°C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37°C.

Answer for yesterday’s Mind Teaser: 1. The sample should be kept at 4°C.

Correct answers received from: Dr Rakesh Sharma, Tukaram Pagad.

Answer for 4th December Mind Teaser: 4. Superior vena caval obstruction.

Correct answers received from: Dr KV Sarma, Raju Kuppusamy, Dr Pankaj Agarwal, Manu Shankar, Dr Rakesh Sharma, Tukaram Pagad, Dr Poonam Chablani.

Send your answer to email

medicolegal update
  1. Dear Sir, Very Informative. Regards: Dr Karan

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