eMedinewS8th May 2014,Thursday

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

Hypertension and Kidney disease Update

  1. Failure of renal denervation in resistant hypertension: Although several unblinded studies suggested that renal denervation could substantially lower blood pressure in patients with resistant hypertension, a blinded randomized trial (SYMPLICITY–HTN–3) failed to demonstrate benefit (1). Due to the lack of benefit, a larger ongoing international trial (SYMPLICITY–HTN–4) was stopped early.
  2. Revascularization in high–risk patients with renal artery stenosis: Randomized trials of renal artery revascularization in patients with renal artery stenosis did not include many patients with high–risk factors such as flash pulmonary edema, resistant hypertension, and progressive kidney disease. In a prospective cohort study, 467 patients with renal artery stenosis, treated according to patient and physician preferences with either revascularization or medical therapy alone, were followed for a median of 3.8 years (2). Revascularization was independently associated with a lower risk of death in patients who presented with flash pulmonary edema (58 versus 76 percent) and in patients who presented with both resistant hypertension and progressive kidney function decline (9 versus 65 percent).
  3. JNC–8 guidelines: JNC–8, the major change compared with the older JNC–7 guidelines is a higher blood pressure goal for older adults (60 years and older) and for patients with diabetes mellitus or chronic kidney disease. (3)
  4. The CORAL trial of stenting in renal artery stenosis: In a randomized trial comparing revascularization plus medical therapy with medical therapy alone in 947 patients with atherosclerotic renal artery stenosis and either poorly controlled hypertension or a decreased estimated glomerular filtration rate (eGFR <60mL/min/1.73m2), revascularization had no effect at 3.6 years on the primary outcome (a composite of cardiovascular or renal death, stroke, myocardial infarction, hospitalization for heart failure, a reduction in eGFR by more than 30 percent, or end–stage renal disease) or any individual component of the primary outcome (4).
  5. BP goal and progression of renal disease in patients with proteinuric CKD: One meta–analysis, combined seven goal blood pressure trials including 5308 patients with CKD that were followed for at least 1.6 years (5). Compared with standard blood pressure lowering, more aggressive blood pressure lowering significantly reduced the risk of renal events (defined as end–stage renal disease, a doubling of serum creatinine, or 50 percent reduction in glomerular filtration rate) among those with proteinuric CKD (38.5 versus 40.5 percent). 6. Blood pressure lowering and cardiovascular events in patients with non-proteinuric CKD: A meta–analysis examined the cardiovascular outcomes and mortality of 30,295 patients with an estimated glomerular filtration rate <60 mL/min/1.73m2 from 26 randomized hypertension trials; 93 percent of patients were non–proteinuric (6). Compared with placebo, both ACE inhibitors (3.2 percent absolute decrease) and calcium channel antagonists (2.1 percent absolute decrease) reduced the composite of stroke, myocardial infarction, heart failure, and mortality. In drug versus drug trials, the incidence of these events was similar comparing angiotensin inhibitors with diuretics or beta–blockers (18 versus 19 percent) or with calcium channel antagonists (23 versus 24 percent).

References

  1. Bhatt DL, Kandzari DE, O'Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014;370:1393.
  2. Ritchie J, Green D, Chrysochou C, et al. High–risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 2014;63:186. 3.
  3. James PA, Oparil S, Carter BL, et al. 2014 evidence–based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507.
  4. Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal–artery stenosis. N Engl J Med 2014;370:13.
  5. Lv J, Ehteshami P, Sarnak MJ, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta–analysis. CMAJ 2013;185:949.
  6. Blood Pressure Lowering Treatment Trialists’ Collaboration, Ninomiya T, Perkovic V, et al. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta–analysis of randomised controlled trials. BMJ 2013;347:f5680.

(Source Uptodate)

News Around The Globe

  • Panel says no to Medicare coverage for lung cancer screening: After a day’s deliberation, the Medicare Evidence & Coverage Advisory Committee panel voted against recommending national Medicare coverage for annual screening for lung cancer with low–dose computed tomography (CT) in high–risk individuals.
  • Novel data suggest that recombinant Factor VIIa (rFVIIa) could possibly improve the outcomes of acute variceal bleeding in some patients with advanced cirrhosis and could be used as a temporary measure or as a bridge to a more definite treatment.
  • A Vital Signs report published online May 6 in the Morbidity and Mortality Weekly Report has stated that approximately half of US working–age adults with disabilities (approximately 10.1 million individuals) are physically inactive which puts them at increased risk for chronic diseases, like cancer, diabetes, stroke, or heart disease.
  • An extended–release oxycodone that can be sprinkled on food and has abuse–deterrent properties may have potential implications in the treatment of chronic pain, especially in patients with dysphagia, reports a new research. The findings have been presented at the American Pain Society (APS) 33rd Annual Scientific Meeting.
  • Results from the Michigan Mother’s Study presented at the American Congress of Obstetricians and Gynecologists 2014 Annual Clinical Meeting have revealed that mothers who lose a child prenatally have exceedingly high rates of depression and anxiety that often go untreated.
  • A report released on May 6 by the World Health Organization (WHO) and other United Nations agencies has shown that since 1990, maternal deaths during childbirth have dropped 45%. The report also stated that the US is lagging behind in achieving the Millennium Development Goal target of a 75% reduction in maternal mortality from the 1990 rate by 2015.

Rabies News (Dr A K Gupta)

Should modern rabies vaccines meant for use in man be given to animals?

It is advisable to use human vaccines for human use and use the veterinary vaccines for animals.

Cardiology eMedinewS

  • Analysis of a Multi–Ethnic Study of Atherosclerosis (MESA) cohort has revealed that the predicted benefit from daily aspirin therapy for primary prevention surpasses risk when coronary artery calcium (CAC) imaging scores reach or exceed 100, whereas the risks exceed the benefits at a CAC score of 0; in both cases irrespective of risk by Framingham criteria.
  • A case report of a 56–year–old patient with severe hypertension has suggested that the combination of an irreversible monoamine oxidase (MAO) inhibitor and excessive caffeine consumption can cause severe spikes in blood pressure (BP). The case report was published in the May 6 issue of Annals of Internal Medicine.

Pediatrics eMedinewS

  • A novel study published online May 4 in the New England Journal of Medicine has pointed that antibiotic therapy could reduce the recurrence rate for urinary tract infection by 50% among children with vesicoureteral reflux; however, but it does not prevent renal scarring.
  • A new research presented at the Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting has stated that two–month–old infants who are bottle–fed exclusively with big bottles consume, on average, an extra 4 ounces of formula per day. This suggests an excess caloric burden of 5% to 20%.

Dr K K Spiritual Blog

Science behind regrets

In a US–based study, dying people were asked about their regrets, if any. The top five regrets were:

  1. I wish I had the courage to live a life I wanted to live and not what others expected me to live.
  2. I wish I had worked harder.
  3. I wish I had the courage to express my feelings.
  4. I wish I had stayed in touch with my friends.
  5. I wish I had let myself to be happier.

Regrets are always based on suppression of emotions or non–fulfillment of desires and needs. These need-based desires can be at the level of physical body, mind, intellect, ego or the soul. Therefore, regrets can be at any of these levels.

I did a survey of 15 of my patients and asked them a simple question that if they come to know that they are going to die in next 24 hours, what would be their biggest regret.

Only one of them, a doctor said that she would have no regrets.

Only one person expressed a physical regret and that was from a Yoga expert who said that her regret was not getting married till that day.

Mental regrets were two.

  1. A state trading businessman said, "I wish I could have taken care of my parents."
  2. A homeopathic doctor said, "I wish I could have given more time to my family."

Intellectual regrets were three.

  1. A lawyer said, "I wish I could have become something in life."
  2. A businessman said, "I wish I could have helped more people."
  3. A retired revenue inspector said, "I wish I had married off my younger child."

Egoistic regrets were two.

  1. One fashion designer said, "I wish I could have become a singer."
  2. A housewife said, "I wish I could have become a dietician."

Spiritual regrets were six.

  1. A Consultant Government Liaison officer said, "I wish I could have made my family members happy."
  2. A businessman said, "I wish I could have meditated more."
  3. A Homeopathic doctor said, "I wish I could have spent more time with my family."
  4. A reception executive said, "I wish I could have spent more time with my parents."
  5. An entertainment CEO said, "I wish I could have taken my parents for a pilgrimage."
  6. A fashion designer said, "I wish I could have worked more for the animals."

In a very popular and successful movie, Kal Ho Na Ho, the hero was to die in the next 40 days. When asked to remember the days of his life, he could not remember 20 ecstatic instances in life.

This is what happens with each one of us where we waste all our days and cannot remember more than 50 or even 20 of such instances. If we are given 40 days to live and if we live every day ecstatically, we can get inner happiness. Therefore, we should learn to live in the present instead of having a habit of postponing everything we do.

We should learn to prioritize our work and do difficult work first or else we would be in a state of constant worry till that work is over.

I teach my patients that they should practice confession exercise and one confession is to talk about your regrets and take them as challenge and finish before the next Tuesday. When working, there are three things which are to be remembered – passion, profession and fashion. Profession is at the level of mind, ego and spirit.

We should convert our profession in such a manner that it is fashionable and passionate. Passion means working from the heart and profession means working from mind and intellect and fashion means working the same at the level of ego which is based on show–off.

Wellness Blog

Don’t start if you do not drink; if you cannot stop, limit your intake

  • The definition of a standard drink differs in countries: US = 14–15 gm alcohol equivalent to 12 oz beer, 5 oz wine and 1.5 oz 80 proof liquor; UK 8 gm alcohol, Japan 19.75 gm alcohol and India 10 gm alcohol
  • A standard drink usually means a US drink.
  • Alcohol contents: Beer 5%; Malt liquor 7%; Table wine 12%; Fortified wine (sherry, port) 17%; Cordial liquor (aperitif) 24%; Brandy (single jigger) 40% and 80 proof gin, Vodka, whisky 40%
  • 10 ml of alcohol (hard liquor) = 0.8 gm of alcohol
  • 1oz = 30 ml
  • 12 oz of beer = 360 ml of beer (360×5% = 18 ml of alcohol = 14.4 gm of alcohol)
  • 18oz of beer = 8 to 9 oz of malt liquor = 5 oz of table wine = 3–4 oz of 45 wine = 2–3 oz of cordial liquor=1.5 oz of brandy=1.5 oz hard liquor
  • Binge drinking means 4 or more drinks at one time (women) or 5 or more at one time (men)
  • Heavy drinking means more than 7 drinks per week or 3 drinks per occasion (women) or more than 14 drinks per week or 4 drinks per occasion (men).
  • Moderate drinking means less than 2 drinks per day (women) and less than 3 drinks per day (men) and for people aged more than 65, less than two drinks per day
  • Safe limits: No level of alcohol compensation can be 100% safe for some people.
  • Contraindications: Pregnancy, present or strong family history of alcoholism, previous paralysis because of brain hemorrhage, liver disease, pancreas disease, running potentially dangerous equipment or machinery
  • Limit alcohol in acute gastritis, esophagitis, strong family history of breast cancer and pre cancerous GI lesions.
  • Ideal dose of alcohol = 6 gm per day
  • 10–15gm of ethanol is found in one glass of wine, one can or bottle of beer or one mixed drink.
  • One should not take more than two drinks (men), one drink daily (women).
  • Men under the age of 45 may experience more harm than benefit from alcohol consumption.
  • Alcohol benefits for the heart are only in 45+ people.

Inspirational Story

Cure for Sorrow

There is an old Chinese tale about a woman whose only son died. In her grief, she went to the holy man and said, "What prayers, what magical incantations do you have to bring my son back to life?"

Instead of sending her away or reasoning with her, he said to her, "Fetch me a mustard seed from a home that has never known sorrow. We will use it to drive the sorrow out of your life." The woman went off at once in search of that magical mustard seed. She came first to a splendid mansion, knocked at the door, and said, "I am looking for a home that has never known sorrow. Is this a place? It is very important to me."

They told her, "You’ve certainly come to the wrong place," and began to describe all the tragic things that recently had befallen them.

The woman said to herself, "Who is better able to help these poor, unfortunate people that I, who have had misfortune of my own?" She stayed to comfort them, and then went in search of a home that had never known sorrow. But wherever she turned, in hovels and in other places, she found one tale after another of sadness and misfortune. She became so involved in ministering to other people’s grief that ultimately she forgot about her quest for the magical mustard seed, never realizing that it had, in fact, driven the sorrow out of her life.

Zee News – Health Wealth Shows

Alcohol
Cancer Prevention
Depression
Paralysis
Pneumonia
Potbelly Obesity
Sudden Cardiac Death
Safe Drugs
Safe Holi
Vitamin D
Vitiligo
Fluid Intake

 

Total CPR since 1st November 2012 – 88972 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

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VIP’s on CPR 10 Mantra Video

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

emedipicstoday emedipics

World Earth Day Celebration at DAV Public School, RK Puram, New Delhi.

press release

Weight loss may improve sexual health of obese diabetes

video of day video of day

 

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 :

 

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 Following Person

A teacher was sitting at her desk grading papers when her first–grade class came back from lunch. Alice informed the teacher, "Paul has to go to the principal’s office."

"I wonder why," the teacher mused.

"Because he’s a following person," Alice replied.

"A what?" the teacher asked.

"It came over the loudspeaker: ‘The following persons are to go to the office.’"

Quote of the Day

Without a rich heart, wealth is an ugly beggar. Ralph Waldo Emerson

 

Twitter of the Day

Dr KK Aggarwal: Stress may increase smoking habits http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: What keeps life fascinating is the constant creativity of the soul.

 

ePress Release

The type of food you eat also matters

Everyone needs a mix of proteins, carbohydrates, and fats, plus enough vitamins and minerals for optimal health. But some of the food choices within these categories are better than others, 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.

  1. Added sugar: Whether it’s white granulated sugar, brown sugar, high– fructose corn syrup, corn sugar, or honey, sugar contains almost no nutrients and is pure carbohydrate and full of empty calories, causing blood sugar to rise and fall like a roller coaster. Soft drinks and other sugar–sweetened beverages are the primary source of added sugar in the diet and a major contributor to weight gain. One extra 12–ounce can of a typical sweetened beverage a day can add on 15 pounds in a year. Those liquid calories aren’t as satisfying as solid food.
  2. Dairy fat. Ice cream, whole milk, and cheese are full of saturated fat and some naturally occurring trans fat both bad for the heart. The healthiest milk and milk products are low–fat versions, such as skim milk, milk with 1% fat and reduced–fat cheeses.
  3. Baked sweets. Cookies, snack cakes, doughnuts, pastries etc are packed with processed carbohydrates, added sugar, unhealthy fats, and often salt.
  4. White carbohydrates. Bread, pasta, potatoes, rice, cookies, cake, or pancakes are bad. One should opt for whole–grain versions. One can choose homemade cookies or bars using grains such as oatmeal, and less sugar and unhealthy fats.
  5. Processed and high–fat meats. Meats like bacon, ham, pepperoni, hot dogs, and many lunch meats are less healthy than protein from fish, skinless chicken, nuts, beans, soy, and whole grains. Fresh red meat should be eaten sparingly and the leanest cuts selected.
  6. Salt. Current dietary guidelines recommend reducing sodium to 1,500 mg per day and not exceeding 2,300 mg per day. But most of us get 1 ½ teaspoons (or 8,500 mg) of salt daily. That translates to about 3,400 mg of daily sodium.

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 88972 people since 1stNovember 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 10x10 i.e. 100 per minute."

eMedi Quiz

Which of the following factors increase your risk of having a stroke?

A. Hypertension and aging.
B. Being female and Caucasian.
C. Being female and African–American.
D. Menopause.
E. B and C.

Yesterday’s Mind Teaser: Do women have more headaches than men?

A. No, they get equal numbers.
B. Yes, but not that many more.
C. Yes, and the headaches are more severe.
D. Yes, but men tend to get more painful kinds that last longer.
E. None of the above.

Answer for yesterday’s Mind Teaser: C. Yes, and the headaches are more severe.

Correct answers received from: Tukaram Pagad, Deepali Chatterjee, Dr. P. C. Das, Dr Arpan Gandhi, Dr Poonam Chablani, Dr Pankaj Agarwal, Dr.K.V.Sarma, Dr Chandresh Jardosh, Dr Avtar Krishan, Daivadheenam Jella, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr. Pushpa Otiv.

Answer for 5th May Mind Teaser: C. About 30 percent of your daily calories.

Correct answers received from: Dr Prakash Khalap.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Very informative newspaper. Regards: Dr Kunal
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