eMedinewS6th August 2014, Wednesday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

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

Managing wounds at home

  1. A wound is a disruption of the normal structure and function of the skin.
  2. Antibiotic therapy is not indicated in all the wounds and is reserved only for infected wounds.
  3. It is important to keep blood sugar under control while managing a wound.
  4. All wounds which are contaminated or with foreign bodies need debridement.
  5. Irrigation or the wound is the best for reducing bacterial load and removing loose material.
  6. Irrigation can be done with worm saline.
  7. Principles of wound management are – scrub, clean and dressing.
  8. Scrubbing means that dressing should be done with clean hands, which requires proper scrubbing of the hands.
  9. Would cleaning means that the wound should first be cleaned and finally after cleaning it requires a proper dressing.
  10. Some wounds may require suturing, especially if the wound is of less than six hours duration.
  11. In an accident if a finger is cut or a tooth is removed, one should preserve the finger or the tooth and take it to the nearest hospital along with the patient for reimplantation.
  12. The best way to carry the amputated finger or uprooted tooth is to put them in a plastic bag and that bag to be put in a box containing ice.
  13. Skin burns should be treated firstly by putting the area under the running water till the burning disappears.
  14. In a patient with burns, the blister that forms should not be punctured.
  15. Presence of pain is also good sign and indicates that the burns are superficial.

News Around The Globe

  • Patients with shoulder pain receiving corticosteroid injections (CSI) versus manual physical therapy (MPT) had the same amount of symptom improvement. However, the corticosteroid group had more physician visits and more additional injections, according to a study published in Annals of Internal Medicine.
  • Alterations in a gene linked to stress reactions may eventually help clinicians identify patients at increased risk for suicidal behavior, including attempts, potentially by way of a simple blood test. A genetic and epigenetic link between suicide and the single– nucleotide polymorphism (SNP) rs7208505 "within the 3’ untranslated region of the SKA2 gene" has been found by investigators at the Johns Hopkins University School of Medicine, Baltimore, Maryland. The study was published in the American Journal of Psychiatry.
  • A new study in the journal Neurology states that making an accurate clinical diagnosis of Parkinson’s disease (PD) remains a challenge, particularly early in the course of disease. The clinical signs of PD (tremor, rigidity, slowness, gait disorder, and so on) are not unique to the disease but also can be found in many other disorders including other neurodegenerative disorders.
  • The US FDA has approved aflibercept (Eylea, Regeneron Pharmaceuticals) injection solution to treat visual impairment caused by diabetic macular edema (DME). Aflibercept is already approved for neovascular (wet) age–related macular degeneration and for macular edema after central retinal vein occlusion.
  • Compared to total knee replacement, unicompartmental knee replacement has a higher rate of reoperation but less risk of mortality and of complications, according to two UK studies published online in The Lancet.

Rabies News (Dr A K Gupta)

Is washing of animal bite wound (s) essential?

The risk of rabies reduces by about 50% by just washing of wounds and application of antiseptics.

The maximum benefit of the wound washing is obtained when the fresh wound is cleaned immediately. It is important to remove saliva containing rabies virus at the site of bite by physical or chemical means. This can be done by prompt and gentle thorough washing with ordinary soap or detergent and flushing the wound with running tap water for at least 15 minutes.

Washing of the wound must be done as long as the wound is raw irrespective of the time elapsed since the exposure. Care must be taken not to disturb the scab, if formed.

After washing with water and soap, disinfectants like Povidone Iodine or Surgical Spirit must be applied.

In extraneous circumstances, other alcoholic (>40%) preparations like Rum, Whisky or aftershave lotion may be applied on the wound. If soap or antiviral agent is not available, the wound should be thoroughly washed with water.

Cardiology eMedinewS

  • Hypertension in middle age could hasten cognitive decline over the next 20 years. In an observational study reported in JAMA Neurology, high blood pressure at baseline in a population ages 48 to 67 was associated with 0.056 z score–points (95% confidence interval minus 0.100–minus 0.012) more decline in global cognition over 2 decades of follow-up than seen with normal blood pressure at baseline.
  • Among patients with ischemic left ventricular dysfunction, CABG was more likely to benefit those with advanced ischemic cardiomyopathy, according to new data from the STICH trial. CABG was found to benefit patients with at least two of the three prognostic factors: three–vessel CAD, ejection fraction below the median of 26.7% and end–systolic volume index above the median of 78.6 mL/m2.

Pediatrics eMedinewS

  • As many as 1 in 3 children seeking treatment in the emergency department for influenza–like illnesses at the peak of influenza season are at high risk of suffering severe complications, such as pneumonia, according to a prospective cohort study reported in Pediatrics. The risks are even higher for children with neurologic or neuromuscular conditions.
  • A new study in JAMA Pediatrics has concluded that an abnormal renal ultrasonographic finding alone or in tandem with a fever of at least 39°C and an etiologic organism other than Escherichia coli are warning signs that children with a urinary tract infection (UTI) are at twice the risk of developing renal scarring.

Dr K K Spiritual Blog

Do we get a human birth each time we die?

As per Vedic sciences, Hindu philosophy believes in rebirth unless your Sanchit and Prarabdha Karmas are totally exhausted.

It also believes in liberation in which once your past karmas debt is over, you do not take a rebirth.

On the other hand, Garuda Purana says that you can take rebirth in animal species, which means you can be born like a donkey or a dog. Vedic science on the other hand says that once you get a human body, you will either be liberated or only get another human body.

The message of Garuda Purana can be read and interpreted in a different perspective. In mythology humans are linked to animal tendencies. For example, bull is linked to sexual and non–sexual desires, peacock to vanity etc. Probably, people who wrote Garuda Purana meant that if you do not live according to the Shastras, you will end up in getting another human body but with animal tendencies and behavior.

Wellness Blog

Caffeine–Alcohol combination in paralysis

A drug caffeinol containing caffeine and alcohol may help stroke patients recover.

In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.

Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.

The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.

Will these findings be applicable to heart attack? Only time will tell as heart attack treatment is also done with tPA.

Inspirational Story

The Smell of Rain

A cold March wind danced around the dead of night in Dallas as the Doctor walked into the small hospital room of Diana Blessing. Still groggy from surgery, her husband David held her hand as they braced themselves for the latest news. That afternoon of March 10,1991, complications had forced Diana, only 24 weeks pregnant, to Danae Lu Blessing.

At 12 inches long and weighing only one pound and nine ounces, they already knew she was perilously premature. Still, the doctor’s soft words dropped like bombs. I don’t think she’s going to make it, he said, as kindly as he could. "There’s only a 10 percent chance she will live through the night, and even then, if by some slim chance she does make it, her future could be a very cruel one." Numb with disbelief, David and Diana listened as the doctor described the devastating problems Danae would likely face if she survived. She would never walk, she would never talk, she would probably be blind, and she would certainly be prone to other catastrophic conditions from cerebral palsy to complete mental retardation, and on and on. "No! No!" was all Diana could say. She and David, with their 5–year–old son Dustin, had long dreamed of the day they would have a daughter to become a family of four. Now, within a matter of hours, that dream was slipping away.

Through the dark hours of morning as Danae held onto life by the thinnest thread, Diana slipped in and out of sleep, growing more and more determined that their tiny daughter would live, and live to be a healthy, happy young girl. But David, fully awake and listening to additional dire details of their daughter’s chances of ever leaving the hospital alive, much less healthy, knew he must confront his wife with the inevitable. David walked in and said that we needed to talk about making funeral arrangements. Diana remembers, ‘I felt so bad for him because he was doing everything, trying to include me in what was going on, but I just wouldn’t listen, I couldn’t listen. I said, "No, that is not going to happen, no way! I don’t care what the doctors say; Danae is not going to die! One day she will be just fine, and she will be coming home with us!"

As if willed to live by Diana’s determination, Danae clung to life hour after hour, with the help of every medical machine and marvel her miniature body could endure. But as those first days passed, a new agony set in for David and Diana. Because Danae’s under–developed nervous system was essentially raw, the lightest kiss or caress only intensified her discomfort, so they couldn’t even cradle their tiny baby girl against their chests to offer the strength of their love. All they could do, as Danae struggled alone beneath the ultraviolet light in the tangle of tubes and wires, was to pray that God would stay close to their precious little girl. There was never a moment when Danae suddenly grew stronger.

But as the weeks went by, she did slowly gain an ounce of weight here and an ounce of strength there. At last, when Danae turned two months old, her parents were able to hold her in their arms for the very first time. And two months later–though doctors continued to gently but grimly warn that her chances of surviving, much less living any kind of normal life, were next to zero. Danae went home from the hospital, just as her mother had predicted.

Today, five years later, Danae is a petite but feisty young girl with glittering gray eyes and an unquenchable zest for life. She shows no signs, what so ever, of any mental or physical impairment. Simply, she is everything a little girl can be and more–but that happy ending is far from the end of her story.

One blistering afternoon in the summer of 1996 near her home in Irving, Texas, Danae was sitting in her mother’s lap in the bleachers of a local ballpark where her brother Dustin’s baseball team was practicing. As always, Danae was chattering non–stop with her mother and several other adults sitting nearby when she suddenly fell silent. Hugging her arms across her chest, Danae asked, "Do you smell that?" Smelling the air and detecting the approach of a thunderstorm, Diana replied, "Yes, it smells like rain." Danae closed her eyes and again asked, "Do you smell that?" Once again, her mother replied, "Yes, I think we’re about to get wet, it smells like rain. Still caught in the moment, Danae shook her head, patted her thin shoulders with her small hands and loudly announced, "No, it smells like Him. It smells like God when you lay your head on His chest." Tears blurred Diana’s eyes as Danae then happily hopped down to play with the other children.

Before the rains came, her daughter’s words confirmed what Diana and all the members of the extended Blessing family had known, at least in their hearts, all along. During those long days and nights of her first two months of her life, when her nerves were too sensitive for them to touch her, God was holding Danae on His chest and it is His loving scent that she remembers so well.

This is a real story http://academictips.org/blogs/the–smell–of–rain/

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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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Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

eMedinewS Humor

A friend recently explained why he refuses to get to married. He says the wedding rings look like miniature handcuffs.

Quote of the Day

Failures are finger posts on the road to achievement. Charles F. Kettering

Twitter of the Day

Dr KK Aggarwal: Eating refined sugar can cause diabetes http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: : Why do you stay in prison When the door is so wide open–Rumi

ePress Release

Resistant hypertension

Blood pressure that remains above the target level in patients with resistant hypertension, despite taking three medications to lower it is called resistant hypertension. High blood pressure that is under control but requires four or more medications to treat it is also considered resistant to treatment.

As many as 25 to 30% people with high blood pressure may have resistant hypertension in India 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.

Older age and obesity are two major risk factors for the condition. People with resistant hypertension have a high cardiovascular risk.

Successful treatment of resistant hypertension requires consideration of lifestyle factors, diagnosing and treating secondary causes and using multiple drug treatments effectively.

Lifestyle factors include weight, salt intake and alcohol consumption.

  • Losing weight can lower blood pressure and reduce the number of medications needed to control blood pressure.
  • Reducing salt intake can lower blood pressure.
  • Reducing alcohol consumption can help lower blood pressure.

Health conditions that can contribute to resistant hypertension include: obstructive sleep apnea, renal parenchymal disease, primary aldosteronism and renal artery stenosis. Treating these conditions may improve blood pressure control.

Drugs that increase blood pressure, such as non–steroidal anti–inflammatory drugs (NSAIDs), should be reduced or stopped, if possible, in patients with resistant hypertension.

Diuretics are often underused in people with resistant hypertension. Patients may benefit from adding mineralocorticoid receptor antagonists (MRAs) to their treatment regimens. MRAs treat primary aldosteronism, which is found in about 20 percent of people with resistant hypertension.

eMedi Quiz

An increased incidence of cholangiocarcinoma is seen in all of the following except:

1. Hydatid cyst of liver
2. Polycystic disease of liver.
3. Sclerosing cholangitis.
4. Liver flukes.

Yesterday’s Mind Teaser: Central nervous system manifestations in chronic renal failure are a result of all of the following, except:

1. Hyperosmolarity.
2. Hypocalcemia.
3. Acidosis.
4. Hyponatremia

Answer for yesterday’s Mind Teaser: 1. Hyperosmolarity

Correct answers received from: Dr Susham Chawla, Raju Kuppusamy, Dr poonam chablani, Madan Kaushik, Daivadheenam Jella, Dr Avtar Krishan, Shashank Jalak,

Answer for 4th August Mind Teaser: 2. Tricuspid valve.

Correct answers received from: Dr Ajay Gandhi.

Send your answer to ijcp12@gmail.com

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  1. Dear Sir, Thanks for the information: Regards–Dr Kanishk

Forthcoming Events

HSICON 2014

Dear Colleague,

Hypertension Society of India is organizing its "23rd Annual Conference HSICON–2014" to be held on 9th & 10th August, 2014 at Kempinski Ambience Hotel, Near Yamuna Sports Complex, New Delhi

Dr. N. P. Singh                          Dr. Neeru P. Aggarwal

Organizing Chairperson               Organizing Secretary

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