eMedinewS8th September 2014, Monday

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

First Cigarette of the Day Most Harmful

Heart patients should avoid smoking and taking coffee early in the morning.

Both smoking and caffeine can acutely raise the blood pressure by as much as 10 mmHg. The rise in blood pressure can be greater in susceptible individuals. The effect is most prominent with the first cigarette of the day in habitual smokers.

In patients with mild high blood pressure, habit of smoking and drinking coffee, elevation of daytime upper or systolic blood pressure can be up to 6 mmHg during winters.

Heart patients, therefore, should avoid taking cigarette, coffee, tea, with or without a cigarette early in the morning.

It was proved that smoking a cigarette in the first 30 minutes after waking up in the morning increases the risk of getting lung cancer by 79%. According to a recent US study, the morning cigarette increases of risk of getting lung cancer substantially.

The cause of this phenomenon has not been precisely determined, but it seems that if we smoke as soon as we wake up in the morning, the smoke and all its harmful components penetrate the lungs. Still, we must remind the fact that those that feel the need to smoke right after they wake up in the morning are hardcore smokers and they smoke more during the day.

The results of this new study are what the doctors advice their patients who cannot manage to quit smoking, to delay the first cigarette of the day for as much as possible.

News Around The Globe

  • The US Food and Drug Administration (FDA) has approved ferric citrate for the control of serum phosphorus levels in patients with chronic kidney disease (CKD) who are receiving dialysis. The approval is based on phase 3 trial data showing that ferric citrate is effective at reducing hyperphosphatemia and improving iron levels in patients receiving dialysis.
  • Obese women who breastfeed their children for at least four months have lesser odds of retaining their pregnancy weight, suggests a new study published online September 2 in the journal Pediatrics.
  • Density-based separation of red blood cells offers a simple, quick and low-cost method to identify sickle cell disease (SCD), suggested a study published online September 2 in the Proceedings of the National Academy of Sciences. The new test could improve access to diagnostic testing in resource poor settings.
  • A study published online in the Journal of Gastrointestinal Surgery has revealed that patients awaiting colon cancer surgery who rated their quality of life (QoL) low were 2 and a half times more likely to have early, serious surgical complications as compared to those who reported a higher quality of life.
  • The US Food and Drug Administration (FDA) has approved the first laboratory test, called NephroCheck, to assess the risk of hospitalized, critically ill patients developing moderate to severe acute kidney injury (AKI). The new test spots significant proteins associated with AKI.

Rabies News (Dr A K Gupta)

Can the vaccine be injected in gluteal region?

Rabies vaccine must not be administered in gluteal region as the gluteal fat may retard vaccine absorption resulting in delayed and lower seroconversion.

Cardiology eMedinewS

  • A new analysis from the FAST–MI registry revealed that continuing beta-blocker therapy over long–term in post–AMI patients with preserved ejection fraction may not be justified. The report was presented at the European Society of Cardiology (ESC) 2014 Congress.
  • Darapladib, a selective inhibitor of lipoprotein–associated phospholipase A2 (Lp–PLA2), given to patients with acute coronary syndrome (ACS), in addition to optimal medical therapy appeared to be no better than optimal medical therapy alone in these patients, suggested the SOLID–TIMI 52 study. The study is published in the Journal of the American Medical Association.

Pediatrics eMedinewS

  • A new study conducted by researchers at the Northwestern University has stated that two years of music lessons improved the precision with which the children's brains distinguished similar speech sounds, a neural process that is linked to language and reading skills. Researchers stated that community music programs can remodel children’s brains and improve sound processing, which could lead to better learning and language skills.
  • A study presented at the British Psychological Society’s Developmental Psychology Section annual conference has pointed that watching fast–paced television programmes does not adversely affect young children’s ability to concentrate.

Dr K K Spiritual Blog

Forgetfulness and Age

By the time we cross 40, most of us suffer from minimal cognitive impairment and have a memory loss of very recent events or objects. This is age–related and should not be confused with dementia.

This can also happen in patients who are vegetarians and deficient in vitamin B12. People often have difficulty in naming objects and name of the people.

Just as a computer hangs up when multitasking is done, so can the human mind. When you are handling multiple projects at the same time, you may experience thought blocks, which is natural and not a sign of a disease. When we introduce ourselves to a new person, we often tell our name first. It is possible by the time you finish your conversation, the person may have already forgotten your name. Therefore, either one should introduce themselves after the conversation is over or both at the start and at the end of the conversation.

Some people introduce themselves before the conversation and hand over their visiting card at the end of a conversation. This is also taught in how to market yourselves.

As doctors, we quite often face these difficulties. People send SMSs without their names or call without telling their names. For example, I once got a call "Malhotra Bol Raha Hoon Pehchana Kya?"

As doctors, we could be treating many Malhotras and it is not expected from us, especially, after the age of 40 to recall a person just by his surname. Unless full information is given to us by patient on phone, mistakes may occur, especially, if it is a phone consultation. Phone consultation should anyway be avoided. Even the Supreme Court in one of its judgments said that giving phone consultation may amount to professional misconduct on the part of the doctor.

Wellness Blog

Diet and Aging: Gaining a Nutritional Edge

Choose fruits and vegetables wisely

  • Get at least five servings of fruits and vegetables a day.
  • When filling your plate with fruits and vegetables, choose from a full color palette.
  • For even more health benefits, aim for nine servings a day. To get there, choose vegetable soups and vegetable or fruit salads. Sprinkle fruit on breakfast cereal, and select it for snacks or as a sweet end note after meals.

Choose fats wisely

  • Whenever possible, use monounsaturated and polyunsaturated oils. Avoid trans fats entirely. Limit saturated fats to less than 7% of daily calories and total fat to 20% to 30% of daily calories.
  • If you don’t have coronary artery disease, the American Heart Association recommends eating foods rich in omega–3 fatty acids, such as salmon, trout, or mackerel, twice weekly. If you have documented coronary artery disease, consume roughly 1 gram a day of EPA or DHA from oily fish and supplements if your doctor advises this.

Choose carbohydrates wisely

  • Choose whole–grain foods over those made with refined grains, such as white bread. Look beyond popular choices like whole oats and brown rice to lesser–known whole grains like barley, bulgur, kasha, and quinoa. Limit your intake of white potatoes.

Choosing protein wisely

  • Emphasize plant sources of protein, such as beans, nuts, and grains, to help you bypass unhealthy fats predominant in animal sources. Enjoying a wide variety of vegetables and eating beans and grains helps you get a full complement of amino acids over the course of a week. Shy away from protein sources high in saturated fat. Favor fish and well–trimmed poultry. If you do eat beef, pick lean cuts.
  • Don’t char or overcook meat, poultry, or fish — it causes a buildup of carcinogens. Cutting off fat, which causes flames to flare on the grill, can help avoid charring; try gently sautéing, steaming, or braising these foods in liquid instead. Grilling vegetables is safe, however.

Inspirational Story

Depend on Miracles

One Sunday morning I heard my minister say if you want result from prayer, pray for thirty days without ceasing. I didn't know why it was thirty days, but I was willing to give it a try. The following became my daily prayer:

I am available, Lord, to be used by You each day. Guide me, precious Lord, and lead me in what I say and do. May my words and actions be a witness that You are living in me. To the one that is lonely, may I be a friend. To those with heavy burdens, help me to meet their needs. Lord, I do not want fame or fortune. My prayer is that You will use me to glorify your name. I know I don't have much to offer, but I will give You my all. Guide me to be what You want me to be. Amen

On the twenty–first day of this prayer, CPR took on a new meaning for me. I was working an extremely busy twelve–hour night shift in Labor and Delivery. I had just sat down for my first break when a phone call came from my friend working in the Emergency Room. I barely recognized her urgent voice. An eighteen–year–old boy had been brought to the ER for alcohol and drug overdose. The young man was very close to death and they had done all they could do to help him. The father of this boy was requesting a priest or minister and they were having difficulty locating one that could come to the ER quickly. My friend stated, "We know you’re a Christian and we need you to come and try to comfort this father. Please help."

Reluctantly, I said I would come down. As I waited for the elevator my thoughts became very judgmental and frustration welled up inside me. Then I remembered the prayer I'd been praying. I walked into the ER and approached the father. Taking his hand, I silently led him to the chapel. Before I could even say, "I am not a minister," this six–foot, two–hundred–twenty–pound man sank into the chair and became a broken hearted child.

Through his non–stop sobbing he spoke, "Christian, pray for Raymond. I remember the first time I held my boy. I felt so proud and I just kept saying, ‘I have a son.’ As the years passed those tiny feet became bigger and walked away from his family’s love and entered a strange, hardened, and destructive world. Tonight, too much alcohol and an overdose of drugs are taking his life.

It’s as though he wants to rebel against everything his family stood for. He knew what he was doing was wrong. Sometimes he seemed so afraid, but he wouldn’t stop. Now it is too late. Christian, you have to pray for Raymond." Those large hands trembled in mine and as I looked into his eyes, I mourned with him. Silence fell between us, as I searched for the words that would comfort this crumbling tower of a man. I felt so inadequate. I wanted to scream, "Lord it has only been twenty–one days since I began that prayer! I am not ready for this!"

Time was running out and I knew I couldn’t stall any longer. I clutched his hands, now wet with tears, and began to pray. The words came easy, much to my surprise. I finished praying with him and went to Raymond’s bedside. I took his cold, lifeless hand and once again began to pray. "Lord I am asking for a miracle and I know you can do it."

I stayed with them both until Raymond was taken to Intensive Care. I visited Raymond on a daily basis and continued to pray for him. Eight days passed with little improvement. On the ninth day I entered the ICU and a miracle had taken place. Raymond was awake and talking with his father. CPR had taken on a new meaning for me: "Christian Pray for Raymond". As I left the ICU with tears falling down my face, I realized, today is the 30th day of my prayer.

Now I not only believe in miracles, I depend on them.

ePress Release

Diabetes is a progressive disease

Diabetes is a progressive disease, 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.

Dr Aggarwal said that an analysis from the United Kingdom Prospective Diabetes Study (UKPDS) found that 50 percent of patients originally controlled with a single drug required the addition of a second drug after three years; by nine years 75 percent of patients need multiple therapies to achieve the target hemoglobin A1C (HbA1c) value which is the average blood sugar of the last three months. After a successful initial response to oral therapy, patients fail to maintain target A1c levels (<7 percent) at a rate of 5 to 10 percent per year.

That means that all diabetic patients will, start with one drug and will invariably end up with three with or without the addition of insulin within 10 years.

A1c should be done every three months until <7 percent and then at least every 6 months and should be preferred over the fasting sugar levels. It represents the average blood sugar of the last three months and the value should be kept lower than 7%.

Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes for blood glucose concentrations is to rise gradually with time.

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients and insulin may be indicated for initial treatment for some.

In the absence of contraindications, metformin is usually the initial therapy for most patients with type 2 diabetes.

eMedi Quiz

Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5’ Capping.
3. 3’ polyadenylation.
4. Glycosylation.

Yesterday’s Mind Teaser: Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Answer for yesterday’s Mind Teaser: 2. Corticosteroid.

Correct answers received from: Dr Chandresh Jardosh, Dr BP Batra, Dr GP Mishra, Dr Kartik, Dr Jyshree Sen

Answer for 7th September Mind Teaser: 2. pKa

Correct answers received from: Dr Jyshree Sen, Dr Shrvan

Send your answer to ijcp12@gmail.com





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Total CPR since 1st November 2012 – 98440 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."

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Health Check Up and CPR 10 Camp at N P CO–ED Sr Sec School, Laxmi Bai Nagar on 28th August 2014

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Do not give citalopram more than 40mg

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Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue

eMedinewS Humor

No man can ever be satisfied with 4 things in life.

• Mobile
• Automobile
• TV
• Wife

Because there is always a better model in neighborhood…

Quote of the Day

Whatever you do in life, surround yourself with smart people who’ll argue with you. John Wooden

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: #God dwells in us as existence , awareness, being.#CosmicConsciousness

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