eMedinewS Daily Medical News Paper Medical Media Medical Website for Daily Use Health Care News New Delhi INDIA

9th December 2014, Tuesday

Padma 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

20 min of sunlight and a glass of milk can keep osteoporosis at bay

Osteoporosis and vitamin D deficiencies are the two new epidemics of the society.

Drinking less milk, avoiding sunlight exposure and omitting the traditional aerobic indoor games are few reasons for these new epidemics. Most young professionals now remain confined to their offices or workplace, with practically no exposure to sunlight. This is especially true for the medical residents.

Here are a few tips for preventing osteoporosis and strengthening the bones.

Stop smoking as it increases bone loss.
Eat a calcium-rich diet: The aim should be to get 1,500 mg of calcium a day in postmenopausal woman or a man over age 65. Good dietary sources of calcium include dairy products, tofu and other soy products, orange juice fortified with calcium, canned salmon with the bones, and cooked spinach. The alternative is to take calcium supplements.
Get enough vitamin D: Vitamin D levels are influenced by how much sunlight one gets. Levels tend to decrease in older adults, especially in winter and in people who are unable to leave their home. Consider taking a supplement to ensure intake of the recommended daily amount.
Get exposure to sunlight of at least 20 min per day. The exposure should be for duration of 20 min every day for a month in a year.
Get enough protein in diet: An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds. However, too much protein with too little calcium can be harmful.
Weight-bearing exercise: These are activities such as walking, jogging and climbing stairs that one should do on the feet, with your bones supporting your weight. They work directly on the bones of the legs, hips and lower spine to slow mineral loss.
Weightlifting exercises: These exercises, also called resistance training or strength training. They strengthen muscles and bones in the arms, chest and upper spine. They can work directly on the bones to slow minerals loss.
Get adequate vitamin K: This vitamin may be helpful in enhancing bone strength. Green leafy vegetables are the best sources of vitamin K. If one is taking a blood thinner, he or she should check with the doctor.
Avoid excessive alcohol: Women should limit alcohol consumption to less than one ounce a day and men should limit it to less than two ounces.
Limit cola drinks: People who have high cola intake often have lower bone density.

NATIONAL NEWS

Proceedings of 66th Annual Conference of Cardiological Society of India (4-7th December, Hyderabad)

3D echo is gaining importance as a valuable supplement to 2D echo in clinical practice (Dr Navin C Nanda, USA)

3D echo is now considered the gold standard for accurate assessment of mitral valve orifice area in mitral stenosis.
It provides quantitative assessment of valvular regurgitation by accurately viewing en face and providing measurement of the vena contracta area without making any assumptions regarding its shape.
LV volumes and ejection fractions as well as mass are more accurately assessed by 3D echo because no assumption is made regarding its geometric shape and there is less inter-observer and intra-observer variability.
The volumes and internal characteristics of a cardiac mass can be delineated by 3D echo resulting in more accurate estimation of its size and etiology.
3D echo, especially 3D TEE has become essential in percutaneous repair of structural heart disease such as use of mitral clip for reducing the severity of mitral regurgitation.

Secondary hypertension (Dr. Saumitra Ray, Kolkata, India)

Secondary hypertension represents about 5% of all hypertension cases, the percentage being more in younger people.
Secondary hypertension should be suspected in all cases of resistant hypertension.
Renal parenchymal disease, renovascular disease, primary aldosteronism and obstructive sleep apnea are the most common causes of secondary hypertension.
A thorough and stepwise approach in a specialist hypertension clinic offers the best management.
A joint consultation with nephrologist, endocrinologist and interventional cardiologist may be required.

PCI in Anomalous Coronary Arteries (Dr Shivanand Patil, Bangalore)

Incidence of 0.024-0.066%. Ischemia in anomalous coronaries is a consequence of anatomical malformations in the vessels, acute angle take off, narrowed slit like orifice, transmural course and compression in between great arteries and atherosclerosis. Sudden cardiac death may occur, if vessel traverses between aorta and pulmonary artery. Association with acute STEMI is even rarer.
Because of unusual direction and tortuous angle cannulation is usually difficult. Proper choice of guide catheters and other equipments are essential to prevent complications like dissection jeopardizing the entire myocardium. The procedural risk of PTCA is very high.
The main importance of single coronary artery resides in difficulties in diagnosis during CAG and cardiac surgery. So, every coronary angiographer should therefore be familiar with the existence and anatomical types of this congenital anomaly.
There are no guidelines for treatment of this condition. Patients should avoid heavy exercise. Revascularization is recommended only in patients with severe symptoms and documented ischemia.

News Around The Globe

The injectable glucagon-like peptide 1 (GLP-1) agonist liraglutide has received a positive opinion in the European Union for an additional indication: use in adults with type 2 diabetes and moderate renal impairment. If this label extension is endorsed in the European Union, liraglutide will become one of a few glucose-lowering agents sanctioned for use in this difficult-to-treat patient population.
More than a quarter of patients with epilepsy are prescribed opioids, which is significantly more than in the general population, reported a new study presented during the American Epilepsy Society (AES) 68th Annual Meeting.
Most patients with inflammatory bowel disease (IBD) do not receive screening for or vaccination against hepatitis B virus (HBV), suggested a new study published in the World Journal of Gastroenterology.
Contact lens wearers with "dry eye" and discomfort may find relief from liposomal sprays or drops that add lipids back to the eye, suggests a new study published online in Optometry and Vision Science.
More than three quarters of patients with acute lymphocytic leukemia (ALL) who had residual disease after chemotherapy and were subsequently treated with the novel immunotherapy blinatumomab experienced a complete eradication of minimal residual disease (MRD), suggested a new study presented at the American Society of Hematology (ASH) 56th Annual Meeting.

Dr KK Spiritual Blog

Positive Attitudes

All those out there who feel at your wit’s end wondering how things don't ever work out for you can now relax and dwell on all those failures that life has taken you through and turn failure into success. Adopting positive attitudes will help you overcome failure.

Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
Failure doesn’t mean you have been a foolish. It does mean you had a lot of faith.
Failure doesn’t mean you've been discouraged. It does mean you were willing to try.
Failure doesn’t mean you don’t to do. It does mean you have to do it in a different way.
Failure doesn’t mean you are inferior. It does mean you are not perfect.
Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
Failure doesn’t mean you should give up. It does mean you must try harder.
Failure doesn’t mean you'll never make it. It does mean it will take a little longer.
Failure doesn’t mean God has abandoned you. It does mean God has a better idea.

Inspirational Story

Mother’s Day

A man stopped at a flower shop to order some flowers to be wired to his mother who lived two hundred miles away. As he got out of his car he noticed a young girl sitting on the curb sobbing.

He asked her what was wrong and she replied, “I wanted to buy a red rose for my mother and I don’t have enough money.” The man smiled and said, “Come on in with me. I’ll buy you a rose.” He bought the little girl her rose and ordered his own mother’s flowers.

As they were leaving he offered the girl a ride home. She said, “Yes, please! You can take me to my mother.” She directed him to a cemetery, where she placed the rose on a freshly dug grave.

The man returned to the flower shop, canceled the wire order, picked up a bouquet and drove the two hundred miles to his mother’s house.

Rabies News (Dr A K Gupta)

A person started with PVRV wants to change over to HDCV or PCECV or PDEV or vice versa. What should be done?

The currently available TCVs such as HDCV, PCECV, PVRV, and PDEV, are all equally good and approved by WHO. All are interchangeable following non availability of one brand or due to allergy to one of the CCVs or PDEV. All are considered protective against different strains of rabies viruses in different parts of the world.

Cardiology eMedinewS

New research has pointed that differences in gene expression suggest that defective maturation of the endometrium during the secretory phase and early pregnancy precedes the development of preeclampsia. The findings are published online in Hypertension.
Three new studies have reported that a chemical called nitrate, found in green vegetables including spinach, lettuce and celery, may aid heart health and reduce the risk of obesity and diabetes. The studies are published in The FASEB Journal, The Journal of Physiology and Diabetes.

Pediatrics eMedinewS

Recommendations by physician groups to avoid bedsharing among mothers and their babies are intended to reduce sleep-related infant deaths. However, evidence suggests that the advice never to bedshare is unrealistic, and avoiding bedsharing may interfere with breastfeeding, according to an article published in Breastfeeding Medicine.
A new study has found a duplication of a short stretch of the X chromosome in some people with a rare disorder that causes excessive childhood growth. Researchers pointed that a single gene within the region likely has a large influence on how much children grow. The study is published in the New England Journal of Medicine.

Quote of the Day

And in the end, it's not the years in your life that count. It's the life in your years. Abraham Lincoln

Wellness Blog

Vegetarian Diet and Soya Products Help Reduce BP

Ingestion of a vegetarian diet may reduce systolic blood pressure by 5 mmHg. A 5 mm reduction in blood pressure may reduce the risk of heart disease by 21%.

One major feature of a vegetarian diet that may affect blood pressure is the amount of dietary fiber; with an increased amount being associated with decreased systemic pressures. Multiple meta-analyses have shown benefits with dietary fiber intake on blood pressure. Vegetarians, in general, have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. Experts postulate that a typical vegetarian's diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, vitamin C and vitamin A, all of which may have a favorable influence on blood pressure.

More significant reductions were observed in older (greater than 40 years) and hypertensive individuals.

Soya is good for high blood pressure because it is naturally high in potassium and low in sodium. Potassium and sodium are electrolytes, and a high-potassium, low-sodium diet promotes a healthy blood pressure.

Soya can be good for high blood pressure when you eat it as an alternative protein source to unhealthy meats. Soya-based meat substitutes, such as veggie burgers, veggie bacon and meatless cold cuts, can be higher in fiber and lower in sodium than animal-based meat products. They can lower your risk for heart disease because they are lower in saturated fat. However, soya does not contain the long-chain omega-3 fatty acids that are found in fatty fish and shellfish; these may lower blood pressure, according to the Linus Pauling Institute.

Even though soya is low in unhealthy saturated fat, some soya products are high in total fat and calories, and as a result will contribute to weight gain if you eat too much. Losing weight if you are overweight, or maintaining your current weight if you are already at a healthy weight, improves your chances of lowering your high blood pressure.

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

No Blood Tests for TB

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

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 Mediclaim needed chemotherapy.
Dr. Bad: Get admitted for 24 hours.
Dr. Good: Take it as day care.
Lesson: Admission limit of 24 hours is not applicable for chemotherapy, radiotherapy etc.

Make Sure

Situation: A patient died after receiving 30 ml IV potassium chloride (KCl) bolus.
Reaction: Oh my God! Why was KCL given as bolus?
Lesson: Make sure that IV KCL is not given more than 10 mEq per hour.

eMedinewS Humor

There was this man driving along in his car when he suddenly got a flat tire. When he pulled over he was at the fence of a mental hospital. When he got out of the car one of the patients came to the fence and asked "Can I help you?" And the man said "No, I need to figure out how to make it home with only 2 lugs on this wheel." The patient asked again "Are you sure you do not need any help?" And the man said "No." The man tried to figure it out when all of a sudden the patient said "If I were you I would take one lug off the other 3 wheels and put them on that wheel and you should be able to get home." The man asked "How did you think of that?" The patient replied "I am in here because I'm crazy not because I'm stupid."

Twitter of the Day

Dr KK Aggarwal: Anger recall is as bad as Anger itself
Dr Deepak Chopra: The same thing that roots life in suffering also leads to the way out of suffering: self-awareness

ePress Release

Cycling can cause erectile dysfunction

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

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 10 minutes.

eMedi Quiz

An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde-3-phosphate dehydrogenase.
2.Phosphoglucomutase.
3.Lactate dehydrogenase.
4.Glucokinase.

Yesterday’s Mind Teaser: All of the following conditions may predispose to pulmonary embolism except:

1. Protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Answer for yesterday’s Mind Teaser: 4. Progesterone therapy.

Correct answers received from: Dr Jainendra Upadhyay, Tukaram Pagad, Dr K V Sarma.

Answer for 7th December Mind Teaser: 1. Propamidine.

Correct answers received from: Dr Poonam Chablani, Dr Thakor Hitendrsinh G, Dr Avtar Krishan.

Send your answer to

Dear Sir, Very Informative. Regards: Dr Karan

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)