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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma 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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

7th March 2013, Thursday

March 14 is World Kidney Day

Preventing kidney diseases: The 8 Golden Rules

Chronic kidney disease can strike any one. Diabetes and high blood pressure are the two leading causes. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease.

If you have these risk factors, it is important to be screened for kidney disease. That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working. The urine test checks for a protein called albumin, which is not routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of filtering ability of your kidney. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.

Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis.

The 8 Golden Rules to avoid or delay reaching the point of kidney failure:

  1. Keep fit and active, it helps reduce your blood pressure and on the move for kidney health.
  2. Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage.
  3. Monitor your blood pressure: It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered prehypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases.
  4. Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD). Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients.
  5. Maintain a healthy fluid intake: Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease. But do not advocate “aggressive fluid loading”, which can cause side effects.
  6. Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50 percent.
  7. Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.
  8. Get the kidney function checked if you have one or more of the 'high risk' factors

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

ACE inhibitors better ARBs in new meta–analysis in hypertensives

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

Dr Ashish Jain been awarded with the eMedinewS oration award in the 4th eMedinewS revisiting conference

Dr K K Aggarwal
    National News

4-month malaria epidemic warning for North India

Changes in sea surface temperatures in the South Atlantic Ocean could help predict malaria epidemics in north-west India well before actual outbreaks, scientists have found, potentially handing public health officials more time to tackle the parasitic disease that strikes 9 million Indians every year. Lower July temperatures in the tropical South Atlantic are associated with malaria epidemics in Delhi, Rajasthan, Punjab and Haryana 4-months before actual outbreaks that typically occur in October or November, the scientists at the University of Michigan Ann Arbor have found. Their research was published on Sunday in reputed journal Nature Climate Change. “The climate link we have uncovered can be used as an indicator of malaria risk,” said ecologist Mercedes Pascaul, who headed the team. “We hope these findings can be used as part of an early warning system.” The probability of malaria epidemics is currently calculated largely by looking at monsoon-season rainfall totals to predict the likelihood of breeding sites for the Anopheles mosquito that carries the malaria parasite. This typically gives public health officials just a one-month head-start over actual outbreaks – often not enough time. (Source: Hindustan Times, Mar 4, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Types of testimony

A doctor asked to testify in a child abuse case may be classified as either a material or an expert witness.

  1. Material witnesses help to establish the facts of the case. It may not be in the court during testimony of other witnesses, in order to prevent their own testimony from being influenced by that of the other witnesses.
  2. Expert witnesses provide an opinion regarding the probable cause of, and long-term morbidity from, the injury. They are permitted to be present in court to hear the testimony of other witnesses.

For comments and archives

    Valvular Heart Disease Update

When is antithrombotic therapy indicated after heart valve replacement?

Treatment with warfarin (or other vitamin K antagonist) and/or aspirin is recommended in patients with prosthetic heart valves to prevent valve thrombosis and thromboembolic events.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

CDC warns about carbapenem-resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) are an increasing and deadly threat in US healthcare facilities, according to the Centers for Disease Control and Prevention. (Source: Medscape)

FDA again rejects Xarelto for ACS

The FDA delivered a second blow to the makers of rivaroxaban (Xarelto) in their bid to treat patients with acute coronary syndromes (ACS). (Source: Medpage Today)

ICDs in Brugada syndrome carry long-term complication risks

Patients with Brugada syndrome (BrS) are relatively young and can benefit from implanted cardioverter-defibrillator (ICD) therapy, but they can also encounter complications in the long run, a small retrospective study shows. (Source: Medscape)

Newer sleep meds still carry fall risk in elderly

The use of nonbenzodiazepine sleeping medications -- intended to be a safer alternative than older hypnotics -- continues to place patients at risk for falls and hip fracture, a case-crossover study found. (Source: Medpage Today)

From clinical trial to publication takes close to 2 years

Median time from completion of a clinical trial to publication of results in a peer-reviewed journal is 21 months, according to a study published online March 4 in JAMA Internal Medicine. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Doctors should organise free camp of their own Heart Care Foundation of India happened to be a part of health...http://fb.me/GzDjeObC

@Dr Deepak Chopra: Our brain, our biological organism & the universe are a unified activity in #CosmicConsciousness

    Spiritual Update

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

Express gratitude

Gratitude is a thankful appreciation for what you have.

Appreciate a roof over your head, good health, people who care about you.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the risks and complications of HSG?

A hysterosalpingogram or HSG is considered a very safe procedure. Some complications occur in less than 1% of cases.

  • Infection: The most common serious problem with HSG is pelvic infection. This usually occurs in the presence of previous tubal disease. In rare cases, infection can damage the fallopian tubes or necessitate their removal.
  • Fainting: Rarely, the patient may get light–headed during or shortly after the procedure.
  • Radiation exposure: Radiation exposure from a HSG is very low, less than a kidney or bowel study, and there have been no demonstrated ill effects from this radiation, even if conception occurs later the same month.
  • Iodine allergy: Rarely, a patient may have an allergy to the iodine contrast used in an HSG. A patient should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Patients who are allergic to iodine may have a sonohysterogram performed instead of HSG since that procedure uses non–iodine containing fluids.
  • Spotting: Spotting commonly occurs for one to two days after the HSG. A patient should notify her doctor if she experiences heavy bleeding after the HSG.
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

What’s life after liver transplantation?

Children who survive liver transplant will usually achieve a normal lifestyle despite the necessity for continuous monitoring of immunosuppressive drug levels. They attend normal school sports, activities etc.

Most studies from large pediatric liver transplant centers show a patient survival of 90% at 1 year and > 85% at 5–10 years. Usually there are no significant issues related to mortality after this. Patients usually lead a normal life. There are patients who have been operated as children/adolescents and have also produced children. Patients take part in sports, normal activities and there are examples of children who’ve climbed mountain peaks. Post liver transplant children have grown up into smart adults, married and produced children.

However, regular follow up with doctor is a must to monitor the organ functions and side effects of immunosuppression.

For comments and archives

    An Inspirational Story

Keep your dream

I have a friend named Monty Roberts who owns a horse ranch in San Ysidro. He has let me use his house to put on fund-raising events to raise money for youth at risk programs.

The last time I was there he introduced me by saying, “I want to tell you why I let Jack use my horse. It all goes back to a story about a young man who was the son of an itinerant horse trainer who would go from stable to stable, race track to race track, farm to farm and ranch to ranch, training horses. As a result, the boy’s high school career was continually interrupted. When he was a senior, he was asked to write a paper about what he wanted to be and do when he grew up.

“That night he wrote a seven-page paper describing his goal of someday owning a horse ranch. He wrote about his dream in great detail and he even drew a diagram of a 200-acre ranch, showing the location of all the buildings, the stables and the track. Then he drew a detailed floor plan for a 4,000-square-foot house that would sit on a 200-acre dream ranch.

“He put a great deal of his heart into the project and the next day he handed it in to his teacher. Two days later he received his paper back. On the front page was a large red F with a note that read, `See me after class.’ “The boy with the dream went to see the teacher after class and asked, `Why did I receive an F?’

“The teacher said, `This is an unrealistic dream for a young boy like you. You have no money. You come from an itinerant family. You have no resources. Owning a horse ranch requires a lot of money. You have to buy the land. You have to pay for the original breeding stock and later you’ll have to pay large stud fees. There’s no way you could ever do it.’ Then the teacher added, `If you will rewrite this paper with a more realistic goal, I will reconsider your grade.’

“The boy went home and thought about it long and hard. He asked his father what he should do. His father said, `Look, son, you have to make up your own mind on this. However, I think it is a very important decision for you.’ “Finally, after sitting with it for a week, the boy turned in the same paper, making no changes at all. He stated, “You can keep the F and I’ll keep my dream.”

Monty then turned to the assembled group and said, “I tell you this story because you are sitting in my 4,000-square-foot house in the middle of my 200-acre horse ranch. I still have that school paper framed over the fireplace.” He added, “The best part of the story is that two summers ago that same schoolteacher brought 30 kids to camp out on my ranch for a week.” When the teacher was leaving, he said, “Look, Monty, I can tell you this now. When I was your teacher, I was something of a dream stealer. During those years I stole a lot of kids’ dreams. Fortunately you had enough gumption not to give up on yours.”

“Don’t let anyone steal your dreams. Follow your heart, no matter what.”

For comments and archives

    Cardiology eMedinewS

FDA again rejects Xarelto for ACS Read More

Solid midterm outcomes with transapical mitral valve-in-valve implants Read More

    Pediatric eMedinewS

Bone Marrow Tx in kids may lead to eye problems Read More

BPA exposure linked to childhood asthma risk Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What drugs are contraindicated during rabies immunization?

Immunosuppressive drugs, such as steroids, antimalarials, anticancer drugs are generally contraindicated during rabies immunization. However if these drugs cannot be avoided, then day 0 dose of vaccine should be doubled.

    IJCP Special

Dr Good Dr Bad

Situation: A man who was to be married was found to be HIV–positive.
Dr Bad: Keep the report secret.
Dr Good: I will inform the girl to–be married.
Lesson: Sections 269 and 270 of the Indian Penal Code provide as under: "269. Negligent act likely to spread infection of disease dangerous to life – whoever unlawfully or negligently does not act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

Make Sure

Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure, to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

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  Quote of the Day (Dr GM Singh)

Next to trying and winning, the best thing is trying and failing. Lucy Maud Montgomery

    Mind Teaser

Read this…………………

The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination?

a. A low-riding prostate
b. The presence of a boggy mass
c. Absent sphincter tone
d. A positive Hemoccult

Yesterday’s Mind Teaser: A 51-year-old female patient who has metastatic breast cancer is stabilized on oxycodone (OxyContin) for her pain. The patient exhausts her family medical leave act, is forced to leave her job, and, subsequently, loses her health insurance. What is the pain management nurse's best course of action for the patient?

a. Encouraging the patient to cut the pain tablets in half to make them last longer
b. Offering information to the patient about pharmaceutical assistance programs
c. Preparing the patient to be weaned off of oxycodone (OxyContin)
d. Providing the patient with information on the nearest free clinic

Answer for Yesterday’s Mind Teaser: b. Offering information to the patient about pharmaceutical assistance programs.

Correct answers: Dr KV Sarma, Dr PC Das, Dr Thakor Hitendrsinh G, Dr Arpan Gandhi, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 4th March Mind Teaser: Additional time is needed for the patient to process the information.

Correct answers received from: Dr Kanta Jain, Dr PK Sahu, Dr Shashi Saini.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Car breakdown

There are four engineers traveling in a car. One is a mechanical engineer, one a chemical engineer, one an electrical engineer and the other one an engineer from Microsoft.

The car breaks down.

"Sounds to me as if the pistons have seized. We'll have to strip down the engine before we can get the car working again," says the mechanical engineer.

"Well," says the chemical engineer, "it sounded to me as if the fuel might be contaminated. I think we should clear out the fuel system."

"I thought it might be a grounding problem," says the electrical engineer, "or maybe a faulty plug lead."

They all turn to the Microsoft engineer who has said nothing and say.

They ask him, "What do you think?"

"Well, I think we should close all the windows, get out, get back in, and open the windows again."

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well–known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.

  • Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
  • Section 46 IPC states that death denotes the death of a human being unless the contrary appears from the context.
  • Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

International Women’s Day – 8th March: Focus on the heart of your beloved Wednesday 6th March 2013:

All women are at risk of heart disease and on this International Women’s Day, give them a health checkup said Padma Shri and Dr B C Roy national Awardee Dr KK Aggarwal and National Vice President-Elect IMA and President Heart Care Foundation of India and Dr Anita Kant Sr Gynecologist at Faridabad.

Heart Care Foundation of India and IMA New Delhi Branch released the following guidelines:

  1. Ask all women who are older than 65 for a heart check up.
  2. Ask all young women to do minimum of 60-90 minutes of moderate-intensity activity (brisk walking) on most, and preferably all, days of the week.
  3. Make women aware that their hearts are different. Women get less attention when they have a heart attack; also, the attack is more serious. Heart disease is the leading cause of death among women over 65. Urban women are 4 to 6 times more likely to die of heart disease than of breast cancer. Heart diseases kill more women over 65 than all cancers combined.
  4. Make women aware that they develop heart problems later in life than men -- typically 7 or 8 years later. However, by about age 65, a woman's risk is almost the same as a man's. They are less likely to survive heart attacks than men.
  5. Ask women to change their lifestyle that include weight control, increased physical activity, alcohol moderation, sodium restriction and an emphasis on eating fresh fruits, vegetables and low-fat dairy products.
  6. Help women to quit smoking by counseling, nicotine replacement or other forms of smoking cessation therapy, if they smoke.
  7. Reduce their saturated fats intake to less than 7 percent of calories. Their diet should include oily fish at least twice a week as a source for omega 3 fatty acids. Women with heart disease should take a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which to be increased to 2-4 grams if associated high triglycerides.
  8. Make sure that women do not take hormone replacement therapy, selective estrogen receptor modulators, antioxidant supplements (vitamin E, C and beta-carotene) and folic acid for primary or secondary prevention of heart disease.
  9. If they are 65 or older, tell them to ask their GP for routine low dose aspirin regardless of heart disease risk status. The upper dose of aspirin for high-risk women is 325 mg per day rather than 162 mg.
  10. Reduce bad LDL cholesterol to less than 70 mg/dL in very high-risk women with heart disease.

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 30294 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, 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.”

    Readers Responses
  1. Dear Sir, emedinews is very informative. Regards: Dr KP Sharma
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