eMedinewS21st 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
www.facebook.com/Dr KKAggarwal

5 Hematology Procedures that should Stop

The American Society of Hematology (ASH) has issued a list of 5 hematologic tests and/or procedures that should not be continued, or that should be used less than they currently are.

The complete list was published online December 4 in the journal Blood. It is part of the Choosing Wisely campaign spearheaded by the American Board of Internal Medicine Foundation that aims to reduce wasteful practices.

  1. Red blood cell transfusion – use smallest effective dose: Don’t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, noncardiac inpatients). Liberal transfusion strategies do not improve outcomes, compared with restrictive strategies. Clinicians are urged to avoid the routine administration of 2 units of RBCs if 1 unit is sufficient, and to use appropriate weight–based dosing of RBCs in children.
  2. Limit use of thrombophilia testing: Thrombophilia testing involves a series of blood tests that are carried out on patients who develop venous thromboembolism (VTE) for no apparent reason to check if the patient has protein deficiencies or genetic abnormalities that are involved in blood clotting. The new recommendation is not to use the test in adults with VTE that occurs in the setting of major transient risk factors such as surgery, trauma, and prolonged immobility. If a VTE occurs in a patient who has just undergone surgery, the clot is very likely to be due to the surgery, and even if this patient had a thrombophilia test, it would not change the way the VTE would be treated. Thrombophilia testing is costly. It can result in harm to patients if the duration of anticoagulation is inappropriately prolonged or if patients are incorrectly labeled as thrombophilic (which could influence subsequent insurability). In addition, thrombophilia testing does not change the management of VTEs occurring in the setting of major transient VTE risk factors. One caveat to the above recommendation is when VTE occurs in the setting of a major risk factor but in patients who also have additional risk factors such as pregnancy, concurrent exposure to hormonal therapy, or when there is a strong positive family history. In these cases, the role of thrombophilia testing is complex and patients and clinicians are advised to seek guidance from an expert in VTE.
  3. Stop routine use of inferior vena cava filters in acute VTE: IVC devices are used in some patients with acute VTE in order to prevent a clot from reaching the lungs and causing a pulmonary embolism, which is fatal in about 1 out of 10 cases. The idea with these devices, which look like a small upside down umbrella, is that they sit in the large blood vessel below the heart and catch clots that break off from the long veins in the legs, before they lodge in the lungs. IVC filters are costly, can cause harm and do not have a strong evidentiary basis.
  4. Limit use of plasma/PCCs to emergencies: This recommendation concerns the use of plasma or prothrombin complex concentrates (PCC) to reverse immediately the anticoagulation effects of vitamin K antagonists such as warfarin. These products should not be used outside of emergency situations, such as patients presenting with major bleeding or intracranial hemorrhage or for whom emergency surgery is anticipated — for example, after a trauma or accident. These plasma and PCCs can cause serious harm to patients, are costly, and are rarely indicated in the reversal of vitamin K antagonists, the society comments.
  5. Limit CT surveillance of lymphoma after curative therapy: The full recommendation is "limit the use of CT scans in asymptomatic patients following curative–intent treatment for aggressive lymphoma." A lymphoma patient who has undergone curative–intent treatment and is now in remission typically goes back to the oncology/hematologist every 3 to 6 months for a check-up. What ASH is suggesting is that, particularly for patients who have been in remission and have been asymptomatic out to 2 years, for most of the time, routine CT scans are not required," she said. In these cases, the potential negative consequences would outweigh any benefit.

Basis of Lymphoma Diagnosis

This final shortlist of 5 practices was whittled down from around 20 that were considered in great detail. One of the practices that nearly made it onto the shortlist, but didn’t, concerns procedures used in the diagnosis of lymphoma. The recommendation was that a diagnosis of lymphoma should be based on excisional biopsies, and clinicians should not initiate treatment of lymphoma based of tissue obtained exclusively from fine-needle aspirations.

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

The Spiritual Meaning of Lord Shiva

sprritual blog

Most of us worship Lord Shiva without understanding the deeper meaning behind him. In Hindu mythology, Shiva is one of the three forms of God (Brahma, Vishnu & Mahesh).

The Parmatama or spirit or GOD can be equated to a mixture of three forces representing Generator (Creator or Brahma), Organizer (Maintainer or Vishnu) and Destroyer (Winding up or Mahesh or Shiva). The same three forces are also present inside our body to perform any work, which can be linked to create or generate an idea, maintain or organize the contents of the idea, and then destroy or wind up so that new work can be undertaken through Ganesha – the Lord of new happenings.

For day to day life, one has to understand and implement the principles of Lord Shiva, which can be known by understanding the meaning of Shiva.

Shiva is worshipped in the sitting meditating pose, sitting on a deer’s skin against the white Himalayas and the background of blue sky. Shiva is also depicted as smeared with the ash of graveyard, snake around his neck, Ganga coming out of his matted hairs, three eyes, blue neck, trishul in one hand and damru in the other hand.

All these symbolic representations have a deep spiritual meaning and tell us about Shiva’s principles of success.

Shiva’s third eye means thinking differently or using the eyes of our mind and the soul. The message is, whenever you are in difficulty, use your intelligence and wisdom or think differently to get different options. Opening of the third eye also represents the vanishing of ignorance (darkness or pralaya).

Shiva sitting in an open–eye meditating pose indicates that in day–to–day life one should be calm as if you are in the meditation pose. Calmness in day–to–day practice helps in achieving better results. In allopathic language, it is equivalent to mindfulness living.

The snake around the neck represents one’s ego. One should keep their ego out and control it and not let it overpower you. The downward posture of the head of the snake represents that ego should be directed towards the consciousness and not outwards.

The blue neck (Neelkanth) signifies that one should neither take the negative emotions out nor suppress them but alter or modify them. The blue color indicates negative thoughts.

The same in the neck indicates that negative slow emotions akin to negative emotions are neither to be drunk nor to be spitted out but to be held temporarily and with continuous efforts (matted hairs) with cool mind (moon) and with positive thoughts (Ganga) should be directed towards the consciousness keeping the ego directed towards it (sheshnag).

Suppressed anger or any other negative emotions will release chemicals in the body causing acidity, asthma, angina and diarrhea. Expressed anger on the other hand will end up into social unhealthiness.

The ash on the skin of the body of Shiva is a reminder that everything in the universe is perishable and nothing is going to remain with the person. The message is that ‘you have come in this world without anything and will go back without anything, then why worry’.

The Trishul in one hand represents control of three factors i.e. mind, intellect and ego. It also represents controlling your three mental gunas i.e. Sattva, Rajas and Tamas. The damru, the hollow structure, represents taking all your ego and desires out of the body.

The blue sky represents vastness and openness and the White Mountain represents purity and truthfulness.

If one adapts to Shiva’s principles in day–to–day life, one will find no obstacles both in his routine life as well as to one’s spiritual journey.

On Shivratri, it is customary to fast. The fast does not just indicate not eating on that day, but its deeper meaning signifies fasting of all bad things in life like – "seeing no evil, hearing no evil and speaking no evil". Fasting also indicates controlling the desires for eating foods (like fermented, sweet, sour and salt) and control the negative thoughts both in the mind, deed as well as actions.

cardiology news

Growing Deep and Strong!

One day, my mother and I were working together in the garden where we were transplanting plants for the third time.

Grown from seed in a small container, the plants had been transferred to a larger container; then transplanted into the garden. Now, because I was moving, we were transplanting them once again.

Inexperienced as a gardener, I turned to my green–thumbed mother. "Isn’t this bad for them?" I asked, as we dug them up and shook the dirt from the roots. "Won’t it hurt these plants, being uprooted and transplanted so many times?"

"Oh" my mother replied. "Transplanting doesn’t hurt them. In fact, it’s good for the ones that survive. That’s how their roots grow strong. Their roots will grow deep, and they will make strong plants".

Often, I’ve felt like those small plants – uprooted and turned upside. Sometimes I’ve endured the change willingly, sometimes reluctantly, but usually my reaction has been a combination. Won’t this be hard on me? I ask. Wouldn’t things be better if things remained the same? That’s when I remember my mother’s words: That’s how the roots grow deep and strong.

News Around The Globe


1– year compulsory rural Service in PHC before PG

The proposal of Medical Council of India to amend the Post Graduate Medical Education Regulations 2000 to make one–year rural posting at a PHC (Primary Health Centre) mandatory for a MBBS student to apply for admission in a PG medical Course has been approved by the health ministry and is proposed to be implemented in year 2015–2016. This was stated in Rajya Sabha by Hon Sh Ghulam Nabi Azad on 17–12–2013.

Under RTI, we obtained information from Ministry of Health and Family Welfare that there are 31867 sanctioned posts of MBBS doctors in Primary Health Centers all over the country. Of these, only 2489 posts are vacant. 45000 MBBS doctors pass out every year so where are they to be employed ? Around 90000 MBBS doctors sat for NEET PG exam in 2013.

This is disastrous and urgent action is needed. I request:

  1. Medical students to start agitation in various forms against this decision
  2. IMA HQs to engage with the GOI & MOHFW on mismatch between number of applicants and number of jobs available for them in PHCs.
  3. Under RTI application made 3 months ago we have still not been provided copy of decision of MCI BOG regarding the compulsory rural service. I request anyone with a copy of the minutes of meeting/order to provide it to prepare for legal Action. Also needed is copy of the decision of MOHFW based on which written reply has been given in Rajya Sabha on 17–12–2013 in the matter.
  4. Please contribute funds to us so that we can take appropriate legal action in the matter with a professional and senior legal team. For Contributions; "Medicos Legal Action Group" Ac No 499601010036479 Union Bank of India Sector 35, Chandigarh, IFSC UBIN0549967

    Dr Neeraj Nagpal

Early peritoneal dialysis not linked with increased mortality at first year

Among 8047 incident Canadian peritoneal dialysis patients initiating dialysis between 2001 and 2009, early dialysis therapy initiation was not linked with increased risk for premature mortality. Early–start patients (starting dialysis with eGFR >10.5 mL/min/1.73m²), mid–start patients (7.5 to 10.5 mL/min/1.73m²), and late–start patients (<7.5 mL/min/1.73m²) had similar mortality rates overall. However, compared with late–start patients, those in the early–start group were 38% more likely to die within the first year of dialysis therapy, but not in subsequent years. The findings are published in the American Journal of Kidney Diseases.

Anti–smoking Tx doesn’t cause CVD harm

The most widely used smoking cessation therapies did not appear to increase the risk for major adverse cardiovascular events, and one therapy –– the antidepressant bupropion actually showed a trend toward protecting against heart attack and stroke, a meta–analysis found in circulation.

Type of pain no help in ID’ing MI in women

Evaluating the characteristics of chest pain didn’t seem to be of much use for the early diagnosis of acute myocardial infarction (MI) in women, said Christian Mueller, MD, of University Hospital Basel in Switzerland, and colleagues.

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Rabies News (Dr. A K Gupta)

What is the potency requirement of IDRV?

Only three countries are practicing IDRV in regular patients attending regular anti–rabies clinics (ARCs) for more than 10 years. These countries are Thailand, Philippines and Sri Lanka. In Thailand and Sri Lanka, the potency requirement is 0.7 IU/ID dose and in Philippines it is 0.5 IU/ID dose.

cardiology news

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

An apple a day

According to a new British research, if individuals ate just one extra apple a day, approximately 8500 deaths from vascular disease could be prevented in the UK. The reduction is on par with the reduction that would be observed if all UK individuals over 50 years of age were prescribed statin therapy, said Dr Adam Briggs at University of Oxford, UK.

cardiology news

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

  • A longitudinal imaging study conducted by investigators at the University of Wisconsin–Madison and the University of North Carolina–Chapel Hill found that by age 4 years, children living in households with income below 200% of the federal poverty line (FPL) had less gray matter — critical for processing information and executive function — than their peers from more affluent homes. The study was published online December 11 in PLoS One.
  • A 59% reduction in the use of emergency department services, at a community–cost of $700 per child, was found after implementation of in–home nurse visits to newborns in mid– and high–risk homes through 6 months of age as part of a community–wide public health program, Kenneth A. Dodge, PhD, of Duke University, and colleagues wrote in the American Journal of Public Health.
cardiology news

Is caffeine good for health?

  • Caffeine is the most consumed stimulant in the world.
  • It is consumed in the form of coffee and tea.
  • At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in daily diet.
  • Short–term benefits include mental alertness and improved athletic performance.
  • Short–term adverse effects include headache, anxiety, tremors and insomnia.
  • Long–term adverse affects include generalized anxiety disorder and substance abuse disorders.
  • Long–term benefits are dose–dependent. Caffeine is associated with a reduced risk of Parkinson’s disease, Alzheimer’s disease, alcoholic cirrhosis and gout. Coffee, both caffeinated and decaffeinated, is also associated with a lower risk of type 2 diabetes.
  • Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long–term risk factor for myocardial disease.
  • Most studies show a modest inverse relationship between coffee consumption and all–cause mortality.
  • Caffeine withdrawal is a well–documented clinical syndrome with headache being the most common symptom. (Source Uptodate)
cardiology news

Total CPR since 1st November 2012 – 80967 trained

Media advocacy through Web Media

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press release

Avoid late nights to prevent diabetes

Young adults who do not get enough deep sleep are at risk of diabetes, according to a study published in the Proceedings of the National Academy of Sciences, said Padma Shri and Dr B C Roy National Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India while addressing as Chief Guest in annual function of Modern School, Noida.

Failing to sleep deeply for just three nights has the same negative effect on the body’s ability to manage insulin as gaining 20 to 30 pounds. Also, three nights of interrupted sleep gives people in their 20s the glucose and insulin metabolisms of people three times their age.

Improving quality of sleep is an important step in preventing the onset of type 2 diabetes.

The study recruited five men and four women between the ages of 20 and 31. The study analysed participants for two nights of uninterrupted sleep, during which they slept for 8.5 hours, to establish their normal sleep patterns.

They then observed them over a three–night study period, during which the researchers deliberately disturbed their sleep when their brain waves indicated the beginning of slow wave sleep.

Young adults spend 80 to 100 minutes per night in slow–wave sleep, while people over age 60 generally have less than 20 minutes.

At the end of each study, the researchers gave intravenous glucose to each subject and took blood samples every few minutes to measure the levels of glucose and insulin. When the researchers analyzed the data they learned that the participants were almost 25 percent less sensitive to insulin after nights of interrupted sleep.

As their insulin sensitivity declined, they needed to make more insulin to process the same amount of glucose.

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 80967 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."

emedipicstoday emedipics

CPR 10 Utsav was organized by Heart Care Foundation of India in association with NDMC on 15th December 2013 at Talkatora Stadium.

press release

A soda a day raises heart disease risk by 20%

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

All the following are related to legal responsibility of an insane person except.

1. Mc Naughten’s rule
2. Durham’s rule
3. Curren’s rule
4. Rule of nine

Yesterday’s Mind Teaser: The syndromic management of urethral discharge includes treatment of:

1. Neisseria gonorrhoeae and Herpes genitalis.
2. Chlamydia trachomatis and Herpes genitalis.
3. Neisseria gonorrhoeae and Chlamydia trachomatis.
4. Syphilis and chancroid.

Answer for yesterday’s Mind Teaser: 3. Neisseria gonorrhoeae and Chlamydia trachomatis.

Correct answers received from: Dr Dinesh Narain Saksena, Dr Raghavendra Jayesh,
Dr A K Gajjar, Dr V P Thakral, Dr P C Das, Dr Deepalichatterjee, Dr K V Sarma,, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Sahadevudu Gelivi,
Dr Avtar Krishan, Dr B K Agarwal.

Answer for 19th December Mind Teaser: 2. 1 lakh IU/ml.

Correct answers received from: Dr A K Gajjar, Dr Tathagata De.

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update

As an airplane is about to crash, a female passenger jumps up frantically and announces, "If I’m going to die, I want to die feeling like a woman."

She removes all her clothing and asks, "Is there someone on this plane who is man enough to make me feel like a woman?"

A man stands up, removes his shirt and says, "Here, iron this!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

medicolegal update

The recipe for perpetual ignorance is: Be satisfied with your opinions and content with your knowledge. Elbert Hubbard

medicolegal update

Dr KK Aggarwal: ECG not reliable marker for predicting heart disease http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Happiness can be woven into every aspect of life once you make new choices #CosmicConsciousness

medicolegal update
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