eMedinewS7th December 2013, Saturday

Dr K K AggarwalPadma 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
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Measles eliminated from the US: Will India learn?

Fifty years after the introduction of an effective measles vaccine, the disease is no longer endemic in the U.S. Measles was declared "eliminated" from the U.S. in 2000 –– with elimination defined as the lack of any continuous disease transmission for 12 months or more in a defined geographical area –– and a study by Mark Papania, MD, of the CDC’s Division of Viral Diseases in Atlanta, and colleagues that was published online in JAMA Pediatrics confirmed that the disease remained eliminated through 2011. But cases continue to be imported into the country from around the world, where an average of 430 children die from measles each day.

From 2001 to 2011, Papania and colleagues reported, the median number of U.S. cases each year was 61. But 175 –– including 20 resulting in hospitalization –– were reported to the CDC from January through the end of November this year. Another surge was seen in 2011, when 222 cases were recorded. That number is minute compared with the burden before the measles vaccine was introduced in 1963. Up until then, measles was common, causing 450 to 500 deaths, 48,000 hospitalizations, 7,000 seizures, and 1,000 cases of permanent brain damage or deafness each year, according to the CDC (MedPage).

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

What are three great sentences of importance other than Mahavakyas?

sprritual blog

Brahma Satyam Jagan Mithya Jivo Brahmaiva Na Aparah: Brahman only exists truly, the world is false, and the individual soul is Brahman only and no other.
Ekam Evadvitiyam Brahma: Brahman is one, without a second (There is one absolute reality, without any secondary parts)
Sarvam Khalvidam Brahma: All of this is Brahman

cardiology news

The Eagle and The Chicken

Once upon a time there was a large mountain side where there an eagle’s nest rested. The eagle nest contains four large eagle eggs. One day an earthquake rocked the mountain causing one of the eggs to roll down the mountain, to a chicken farm, located in the valley below. The chickens knew that they must protect and care for the eagle’s egg, so an old hen volunteered to nurture and raise the large egg.

One day the egg hatched and a beautiful eagle was born. Sadly, however the eagle was raised to be a chicken. Soon the eagle believed he was nothing more than a chicken. The eagle did what the other chicken did. It scratched in the dirt for seeds. It clucked and crackled. It never flew more than a few feet because that is what the other chickens did. The eagle loved his home and family but his spirit cried out for more. While playing a game on the farm one day he looked to the skies above and noticed an eagle soaring gracefully and majestically in the skies. He asked the chickens: "What is that beautiful bird?’ the chickens replied, "That is an eagle. He is an outstanding bird, but you cannot fly like him because you are just a chicken." So the eagle never gave it a second thought, believing that to be truth. He lived the life of and died as a chicken depriving himself of his heritage because of lack of vision.

What a waste! He was born to win but conditioned to lose.

The same thing is true for most people. The unfortunate part of life is as Oliver Wendall Holmes said, "We don’t achieve excellence because our own lack of vision."

Don’t let negative people drag you down. Remember that a person’s character is not only judged by the company they keep but also by the company they avoid.

News Around The Globe

News

  • According to Philippe Autier, MD, MPH, of the International Prevention Research Institute in Lyon, France, and colleagues, vitamin D deficiency may increase risk for several major health disorders, but supplementation may not reduce risk in deficient patients if the dose isn’t high enough. After reviewing 290 prospective studies and 172 randomized trials, vitamin D sufficiency appeared to provide a protective benefit from multiple diseases and all–cause mortality. But, in 34 of the interventional studies, 2,805 vitamin D deficient participants did not have improved outcomes after taking 50 mcg of vitamin D per day. Supplementation of 20 mcg per day in a group of older patients, mostly women, did, however, slightly reduce all–cause mortality (The Lancet Diabetes & Endocrinology).
  • Acute kidney injury during a hospital stay may be more deadly than hospitalization for myocardial infarction (MI) and is associated with a long–term increased risk for cardiovascular and renal events. The analysis of hospital data on close to 37,000 mostly male patients treated at VA facilities showed that those who developed acute kidney injury were twice as likely to die as patients treated for MI. The findings were reported in CJASN, the journal of the American Society of Nephrology.
  • In a single–center study, less than a quarter of patients diagnosed with localized lung cancer got testing in the guidelines–recommended sequence, resulting in unnecessary costs and complications. Guideline–consistent care was associated with patients getting fewer invasive tests (1.3 versus 2.3 per patient) and fewer complications (0% versus 17%). Most of the complications –– 16 of the 18 that occurred among the 108 patients with care that didn’t follow the guidelines –– were related to getting CT–guided needle biopsy.
  • According to a study presented at the annual meeting of the Radiological Society of North America, simple "gestalt" analysis of calcium deposits on coronary arteries, observed in lung screening CT scans, can alert doctors that patients who are at high risk for cancer also show risk of coronary disease. Coronary artery calcification is a known predictor for cardiovascular events strongly correlated with age and smoking history.
  • Colonic diverticulosis progresses to acute diverticulitis more rarely than previously expected, particularly among older patients. Over an 11–year follow–up, 4.3% of patients with diverticulosis at baseline progressed to diverticulitis as defined by more liberal parameters, and 1% met a "rigorous definition of diverticulitis. Risks for disease progression fell by 24% for every 10 years the patient had been alive at the time of diagnosis (Clinical Gastroenterology and Hepatology)

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Rabies News (Dr. A K Gupta)

Why is rabies an important disease?

Rabies is one of the oldest and most feared zoonotic diseases, and has been a threat to human health for more than 4000 years. Rabies is a neglected and severely under–reported disease killing each year an estimated 55,000people (24,000 to 90,000 deaths) worldwide (WHO 2007). All mammals, but mainly carnivores and bats, are susceptible and can transmit rabies virus. Human exposures are most frequently associated with bites by rabid dogs and transmission of virus from dogs’ saliva. The Association for the Prevention and Control of Rabies in India (APCRI) estimated in 2004 that in India, there were 20,565 reported human deaths every year. About half of the world’s population lives in areas in which rabies is enzootic. Rabies is practically 100% fatal even today but easily preventable.

cardiology news

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

  • Two meta–analyses show that compared with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) improved outcomes in patients with multivessel disease and medical therapy provided similar benefits in patients with stable disease and proof of ischemia. Both studies were published online in JAMA Internal Medicine.
  • Leading cardiologists at The Mount Sinai Hospital have contributed to the development of a new classification system called MOGE(S) for cardiomyopathies, the diseases of the heart muscle which can lead to heart enlargement and heart failure. The new cardiomyopathy classification system was published simultaneously by the Journal of the American College of Cardiology (JACC) and Global Heart, the journal of the World Heart Federation.
cardiology news

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

  • The administration of a one–time iodine dose to new mothers in iodine–poor regions is superior to a direct dose to the infant in terms of providing the child with adequate iodine for at least 6 months, according to new research published online November 22 in Lancet Diabetes & Endocrinology. The World Health Organization (WHO) and International Council for the Control of Iodine Deficiency Disorders (ICCIDD) recommend that new mothers in such regions receive 1 annual iodine capsule of 400 mg and exclusively breast–feed their infant for at least 6 months. If the child is not able to be breast–fed or to receive iodine–fortified complementary food, a lower concentration — a one–time dose of 200 mg as iodized oil or a daily dose of 90 μg as potassium iodide — is recommended to be administered directly to the infant.
  • The use of chest radiography, steroids, and bronchodilators for infants and toddlers with bronchiolitis decreased significantly after the American Academy of Pediatrics (AAP) published evidence–based clinical practice guidelines in 2006, according to a retrospective, observational cohort study published online December 2 in the journal Pediatrics.
cardiology news

Fecal Microbial Transplantation for Ulcerative Colitis

Fecal microbial transplantation (FMT) via enema is shown to be effective, tolerable, and feasible for treating children with ulcerative colitis (UC), according to findings from a phase 1 pilot study published online March 29 and in the June issue of the Journal of Pediatric Gastroenterology and Nutrition.

It involves infusion of human stool from a healthy adult donor into the patient’s intestine and has been proposed as an option for recurrent Clostridium difficile infection and possibly for ulcerative colitis as per Sachin Kunde, MD, MPH, from Spectrum Health Medical Group, Helen DeVos Children’s Hospital in Grand Rapids, Michigan. The procedure may restore ‘abnormal’ bacteria to ‘normal’ in patients with UC.

Ten children, aged 7 to 21 years, who had mild to moderate UC, received freshly prepared fecal enemas daily for 5 days.

The investigators collected data on tolerability, adverse events, and disease activity during FMT and weekly for 4 weeks thereafter. At baseline, pediatric UC activity index ranged from 15 to 65. The investigators considered a reduction in PUCAI by more than 15 to be clinical response, and PUCAI lower than 10 to be clinical remission.

There were no serious adverse events. Self–limiting adverse events were mild cramping, fullness, flatulence, bloating, diarrhea, blood in the stool, and moderate fever. Although 1 child could not retain fecal enemas, average tolerated enema volume in the other 9 children was 165 mL/day.

Clinical response within 1 week occurred in 7 (78%) of the 9 children, including 3 (33%) who had clinical remission and 6 (67%) who maintained clinical response at 1 month. Compared with baseline, median PUCAI significantly improved after FMT. (Medscape)

cardiology news

Total CPR since 1st November 2012 – 75187 trained

Media advocacy through Web Media

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press release

CPR 10 Utsav on 15th December at Talkatora Stadium

Heart Care Foundation of India (HCFI) and New Delhi Municipal Council (NDMC) will be jointly organizing a mega CPR 10 Utsav camp in association with Gas Authority of India Limited (GAIL) on Sunday, 15th December 2013. More than 20,000 members of the public including school children and teachers would be practically trained one to one on human manikins.

Addressing the press conference, Padma Shri & Dr. B. C. Roy National Awardee and President, HCFI, Dr K K Aggarwal and Dr. P. K. Sharma, MOH–NDMC, said that this would be for the first time in the world that such a large number of people would be trained in one day.

CPR 10 is based on the concept that consciousness does not leave the body for 10 minutes after the cardiac arrest. If Hands–only CPR is done on the victim by a bystander during this period, the person can be revived.

The Foundation has created a Savitri CPR 10 mantra which states "within 10 minutes of 10 – earlier the better, for the next 10 minutes – longer the better, press the centre of the chest of the deceased victim with a speed of 10×10 i.e. 100 per minute effectively and continuously. In Hindi, it reads as "Marne ke dus minute ke under dus minute tak aur 10 × 10 yani 100 minute ke speed par apni chhati peetne ke badle marne wale ki chhati peeto."

Over 80,000 people have been trained by the Foundation in the last one year. Co–addressing the press conference Mr CS Majithia, Chief Manager, GAIL India Ltd. and Stuti Kohli, Sr Official from GAIL said that GAIL is committed to spread awareness about revival of a person after sudden cardiac death in the community. GAIL is providing human manikins for use in the one to one training.

The CPR probably started in India with Savitri for the first time saving the life of her husband Satyavan from Yamraj. The Foundation, therefore, has named this the "Savitri Mantra". People in the camp would be provided one to one training. The participants will include nursing students, medical students, general public, NDMC schools and other schools & colleges, etc.

Public can also visit, participate and get the training. There will be no fee for the training.

Following 25 facts of CPR were also released:

  1. Project CPR 10 was launched by Heart Care Foundation of India on 1st November, 2012
  2. It is possible to revive a dead person within 10 minutes of death.
  3. The consciousness does not leave the body for up to 10 minutes after cardiac arrest and the brain remains alive during this period.
  4. If the heart can be revived before the brain dies, it is possible to revive a person.
  5. It is practically impossible to seek medical assistance in these 10 minutes.
  6. In out of hospital cardiac arrests, the only answer is cardiopulmonary resuscitation i.e. CPR 10 done by a bystander.
  7. Everybody above the age of 10 can learn CPR 10 and save a life.
  8. CPR 10 does not require mouth to mouth breathing.
  9. No certification is required under the Good Samaritan Law for doing CPR 10.
  10. CPR 10 can be remembered by understanding the Savitri Mantra and doing practically one to one learning with the manikins.
  11. The name ‘Savitri Mantra’ has been given as the first successful CPR was done by Savitri on her husband Satyavan.
  12. The Savitri Mantra: "Marne ke dus minute ke ander (earlier the better) kam se kam dus minute tak (longer the better), 10 × 10 hundred per minute ki speed se apni chhati peetne ke badle mare hue vyakti ki chhati peeto."
  13. The HCFI trained 11459 people in one day and created a world record on 6th April, 2013 on the eve of World Health Day.
  14. Early recognition of sudden cardiac arrest: unresponsiveness or absent/gasping breathing
  15. Immediate initiation of excellent CPR is important.
  16. Excellent CPR 10: Push hard, push fast – with continuous attention to the quality of chest compressions, and to the frequency of ventilations
  17. Minimize interruptions in CPR.
  18. Compress the chest by 1½ inches.
  19. Push hard and push fast on the center of the chest: Maintain a rate of at least 100 compressions per minute; compress the chest at least 5 cm (2 inches) with each down–stroke; allow the chest to recoil completely between each down–stroke and minimize the frequency and duration of any interruptions
  20. Lay rescuers should not interrupt chest compressions to palpate for pulses and should continue CPR until an automated external defibrillator (AED) is ready to defibrillate, emergency doctor assume care, or the patient wakes up.
  21. CPR 10 is not recommended for children or arrest of non cardiac origin (e.g., near drowning).
  22. Electrical phase comprises first 4 minutes after cardiac arrest and requires immediate defibrillation if available along with CPR 10
  23. Hemodynamic phase spans 4–10 minutes following sudden cardiac arrest and patients in this phase benefit from excellent chest compressions to generate adequate cerebral and coronary perfusion and immediate defibrillation.
  24. Metabolic phase occurs following approximately 10 minutes of pulselessness and few patients who reach this phase survive.
  25. Formula of 10 (CPR–10): To revive after sudden cardiac arrest, within 10 minutes of cardiac arrest (earlier the better) for the next ‘at least’ 10 minutes (longer the better) compress the center of the chest, continuously and effectively, with a speed of 10 × 10 (100) per minute.

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 75187 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."

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A Press Conference was held on 6th December 2013 to announce about CPR 10 Utsav on 15th December at Talkatora Stadium on 15th December 2013

press release

Longer CPR efforts may improve survival chances

vedio of day

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

A 64–year–old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end–tidal carbon–dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1.Fat embolism.
2.Hypovolemia.
3.Bronchospasm.
4.Myocardial infarction.

Yesterday’s Mind Teaser: A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1.Pain sensation on the ipsilateral side.
2.Proprioception on the contralateral side.
3.Pain sensation on the contralateral side.
4.Propriception on the ispilateral side.

Answer for yesterday’s Mind Teaser: 3.Pain sensation on the contralateral side.

Correct answers received from: Dr.Dinesh Narain Saksena, DR.A.K.GAJJAR, Dr Prakash Khalap, Dr Arpan Gandhi, Dr.K.V.Sarma, Dr.K.Raju daivadheenam, Dr ajay Gandhi, DR AVTAR KRISHAN, Dr. Sneharanjan Bhattacharyya, DR. SUSHMA CHAWLA.

Answer for 4th December Mind Teaser: 3.Lateral rectus and abducent nerve.

Correct answers received from: Dr. Sneharanjan Bhattacharyya, Archna Parwani, Narahari Kandakatla, manoj kumar Bhatt.

Send your answer to ijcp12@gmail.com

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medicolegal update

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medical querymedical query

medicolegal update

A woman customer called the Canon help desk with a problem with her printer.
Tech support: Are you running it under windows?
Customer: "No, my desk is next to the door, but that is a good point. The man sitting in the cubicle next to me is under a window, and his printer is working fine."

medicolegal update
medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A hypertensive patient on atenolol developed erectile dysfunction (ED). Atenolol was stopped.
Reaction: Oh my God! Why did you stop the beta–blocker? You should have just switched over to nebivolol.
Lesson: Make Sure that nebivolol is used as the beta–blocker of choice in a hypertensive patient with ED (Source: Asian J Androl 2006;8(2):177–82).

medicolegal update

More beautiful than a rose is the soul that beholds it. Sunny Brooke

medicolegal update

Dr KK Aggarwal: Sudden Cardiac Death By Dr k k Aggarwal http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Why is food that is so delicious so bad for us and yet food that is healthy for us, I just don’t like? #CosmicConsciousness

Forthcoming events

5th eMedinews Revisiting 2013

(a day long single hall medical conference on 2013 happenings, followed by doctors of the year 2013 awards)

Sunday 19th January 2014, Maulana Azad Medical College Auditorium

Dilli Gate Delhi, 10 am-6 pm


Dr KK Aggarwal
Padma Shri and Dr B C Roy National Awardee President
Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman
Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

5th eMedinewS Revisiting 2013
The 5th eMedinewS–revisiting 2013 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 19th 2014.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2013. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. Lunch will be provided.

Register at: rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

5th eMedinewS Doctor of the Year Awards
Nominations invited for 5th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2013.

pls send his/her Biodata at: emedinews@gmail.com

medicolegal update
  1. Dear Sir, emedinews is very informative. Regards: Dr Kanchan

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Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

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