Sunday, July 31, 2011

Ask Dr KK:How safe is angiography radiation?


One should not opt for imaging studies unless it is a must; they are not safe and can cause cancers in long run.
A UK analysis published in the Journal Lancet in 2004 had shown that fluoroscopic X Ray radiation exposure during catheter-based coronary angiography can cause up to 280 cases of cancer per million examinations performed.
About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  


Ask Dr KK : Which exercise protocol is better: aerobic, weight training or mix

Dr KK Answers: A combination of weight training and aerobic exercise is the best prescription for overweight patients with at risk for diabetes and heart disease.
Only aerobic exercise is also as good as it reduces weight and inches off the waistlines. Jut weight lifting alone has very little benefit.
According to a study published in the July 7th issue of American Journal of Cardiology, people in the weight-training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists.
Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch.  This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score.
Both the aerobic-only group and the combined-exercise group also lowered their levels of bad triglycerides.

Yatha Pinde Tatha Brahmandeuniverse

Yatha Pinde Tatha Brahmande or as is the atom so is the universe, is a traditional Vedic saying, which has a deep social meaning in today’s context.As per the Vedic philosophy there are three different philosophies of human evolution. Firstly, the concept of “dualism” where people believe that.... more http://www.itimes.com/users/iti475269/blogs

Avoid cardiac catheter based imaging procedures if not a must

One should not opt for imaging studies unless it is a must; they are not safe and can cause cancers in long run.
A UK analysis published in the Journal Lancet in 2004 had shown that fluoroscopic X Ray radiation exposure during catheter-based coronary angiography can cause up to 280 cases of cancer per million examinations performed.
The mean duration of fluoroscopy in electro physiologic cardiac interventional procedures ranges from 15 to 67 minutes. The radiation dose from one hour of fluoroscopy during electro physiologic ablation procedures can result in 0.7 to 1.4 excess fatal malignancies per 1000 women and 1.0 to 2.6 per 1000 men as per two studies published in American Journal of Cardiology (1998) and Circulation (2004)
 At doses used in diagnostic and interventional procedures, ionizing radiation releases free radicals that may cause DNA damage. This radiation-induced cancers may develop decades after exposure, and include myeloma, blood cancers, lung cancer, thyroid cancer, breast cancer, bone cancer, and skin cancer.
Effective dose of radiation is measured in sieverts (Sv) or millisieverts (mSv). A whole body radiation dose of 1 Sv is associated with a 4 to 5 percent increased relative risk of fatal cancer. (1 Sv = 1000 mSv).
Mild exposure is called when the exposure is < 3 mSv, Moderate >3 to 20 mSv, High 20 to 50 mSv and very high exposure means >50 mSv.
The effective dose related to any radiologic procedure can be considered in the context of the annual effective dose to individuals from natural background radiation sources, including radon, cosmic rays, terrestrial, and internal sources. This background effective dose, approximately 3 mSv, does not pose a significant risk of future cancer to individuals.
A typical X ray procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy.  The mean cardiac fluoroscopy time in managing paroxysmal atrial fibrillation is 57 minutes, atrial flutter is 20 minutes, ablation is 22 minutes and Pulmonary Vein isolation is 39 minutes.
Multiple medical tests involving radiation exposure lead to high cumulative doses of radiation. In one study in 20 year period a heart patient may end up with 15 procedures involving radiation exposure. Of these four may be high dose procedures (≥3 mSv). The cumulative estimated effective dose from all medical sources exceeds 100 mSv in 31.4 percent of patients.
Use of CT may account for 1.5 to 2 percent of all future cancers in the United States.
The 2006 Biological Effects of Ionizing Radiation VII lifetime attributable cancer risk model predicts that 1 in 1000 persons exposed to 10 mSv (single diagnostic CT scan of the neck, chest, abdomen, or pelvis) will develop cancer due to that single exposure.
The lifetime attributable cancer mortality risk attributable to a single radiation exposure in a one year-old child is 1 in 550 following an abdominal CT and 1 in 1500 following a brain CT.
It has been estimated that 29,000 future cancers could be attributed to CT scans performed in the US in 2007 alone.
1 in 500 women and 1 in 660 men will develop cancer from their abdominal CT scan if the procedure is performed at the age of 20.
A 45 year-old adult undergoing one single full-body CT procedure would accrue an additional lifetime attributable cancer mortality risk of 0.08 percent from a single scan.
The lifetime attributable cancer mortality risk is 1.9 percent lifetime for thirty years of annual scans.
All patients should be given a general idea about the magnitude of the proposed radiation dose. The exposure should be compared with an estimated effective dose to a single chest x-ray (0.02 mSv), a transcontinental airplane flight (0.02 mSv), or annual individual radiation dose from the natural background (3.0 mSv).
The dose from a single abdominal CT scan is comparable to the collective dose of 400 chest x-rays or natural background radiation for three years.  

Ask Dr KK: Why does the groom rides on a mare in the marriage?

Dr KK Answers:  In marriage riding on mare means controlling one’s senses. Horse represents senses and mare the uncontrolled senses. The first thing a groom has to learn  is to tighten his senses and that what reining the mare means . 

Saturday, July 30, 2011

Ask Dr KK: What is the importance of gaining weight after the age of 18?


Even very modest gain of more than 5 kg after the age of 18 years in women and 20 years in men increases the risk of coronary heart diseases and type-2 diabetes at all levels of initial BMI

 (NEJM 1999:341.427).

Ask Dr KK: What is the maximum dose of paracetamol (acetaminophen) which can be combined in another drug?


In January, the US FDA mandated drug makers to include not more than 325 mg of Paracetamol in each tablet or capsule of combination medicines. 

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: At what dose Paracetamol (acetaminophen) and cause acute liver failure?


Practically all patients who take paracetamol (acetaminophen) in excess of 350 mg/kg develop severe liver toxicity unless appropriately treated. Clinically they present with SGOT or SGPT levels (AST or ALT) > 1000 IU/L.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is the toxic dose of Paracetamol (acetaminophen)?


Toxicity is unlikely to result from a single dose of less than 150mg/kg in children or 7.5-10 gm in adults. Toxicity is likely to occur with a single ingestion greater than 250 mg/kg or those greater than 12 gm over a 24 hours period.   

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is the therapeutic dose of Paracetamol (acetaminophen)?


The therapeutic dose is 10-25 mg/kg per dose in children and 325-1000 ml per dose in adults given every 4-6 hours with maximum recommended daily dose of 80mg/kg for children and 3 gm in adults.
3g is the recent change from an early recommendation of 4gm in adults.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How common is paracetamol (acetaminophen) poisoning?

Acetaminophen (Paracetamol) is widely available and lay people commonly underestimate its toxicity. Acetaminophen accounts for more over doses and overdose death each year in the United States than any other drug. Acetaminophen induced acute liver failure is common, 50% of them being intentional or suicidal and other 50% unintentional or cardiac poisoning.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK:What is the difference between Paracetamol and acetaminophen?


They are same. In India it is called Paracetamol and in America it is known as acetaminophen.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

HCFI Update:What not to do in snake poisoning



In the monsoon season, snake bites are common. Most of these bites are by non-poisonous snakes. In a country like India, most people are misled by Bollywood movies showing a typical scene where the hero saves the heroine by giving an incision and then sucks the poison and spits it out. “This is what should not be done”, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Dr. Aggarwal said that methods such as incision, oral sucking, mechanical sucking devices, Cryotherapy, surgery and electric shock therapies have been widely used but are medically not recommended.

A common misconception depicted in the movies is that one should apply tourniquet, suck out the poison and spit it out. Medically, this approach is strongly discouraged as it can damage the nerves, tendons, blood vessels and lead to infections.
Venom removed by suction is minimal and clinically does not prevent snake bite complications. Many studies have shown that mechanical suction device reduces the total body venom burden by only 2%.  

First aid involves removing the patient from the vicinity of the snake. Keep the patient warm, rested and reassured. The wound should be cleaned with soap and water. One should not give drugs and alcohol as it may confound with clinical assessment. Efforts should be made to identify the snake and the patient should be transported to the nearest medical facility as quickly as possible.

Emedinews : Laughter the best medicine


The man told his doctor that he wasn't able to do all the things around the house that he used to do. When the examination was complete, he said, "Now, Doc, I can take it. Tell me in plain English what is wrong with me?" "Well, in plain English," the doctor replied, "you're just lazy." "Okay," said the man. "Now
give me the medical term so I can tell my wife."  

(Contributed by Dr Prabha Sanghi)

Emedinews - Insight on medicolegal issues: The direction of firing is determined from the bullet track


·         The  burning, blackening and tattooing  around a firearm missile entry wound is due to flame/smoke and gunpowder residue is almost suggestive of near shot. However, the accurate assessment of the range of fire requires test firing of the gun with the type of ammunition that was used in shooting.
·     
  
It has been observed that many surgeons have opined the direction of fire arm missile on the position of wound track because a bullet usually travels through the tissues in a straight line. So, the direction of fire may be determined, by a doctor, from the bullet track.
·    
   
In certain conditions, a bullet may be deflected from its course and this occurs most commonly when it strikes a bone in its passage through the tissues. It can also occur due to the inherent instability of a bullet as it penetrates tissues, and it may undergo change in direction within the soft tissues in its track. 
·         
This is illustrated by a case in which a man was struck by a bullet, which went through various tissues in the following order: gallbladder, hepatic flexure of colon, duodenum, pancreas, inferior vena cava, then passing medially through the bony part of the vertebral column, to strike the left kidney, spleen and pass through the diaphragm and pericardium, before coming to rest in the chest cavity. 
·         
The bullet in motion is very notorious. In a case where the wound of entry was on the front of chest, the bullet was recovered from scrotal sac. The only part of the track of bullet which was in a straight line was through the vertebral column.


(Contributed by Dr Sudhir Gupta)

Emedinews: Makesure:A patient with severe OSA developed acute coronary syndrome


Situation: A patient with severe OSA developed acute coronary syndrome.  
Reaction: Oh my God! Why was CAD not ruled out in this case!
Lesson: Make sure that all patients with obstructive sleep apnea (OSA) are investigated for underlying coronary artery disease (CAD).

Emedinews: Dr Good Dr Bad: A patient with high triglycerides developed stroke.


Situation: A patient with high triglycerides developed stroke.
Dr Bad: They are unrelated.
Dr Good: There is an association between the two.
Lesson: Men and women with high triglyceride levels are at an increased risk of ischemic stroke.

Emedinews : Inspiration: A good lesson



A man was lost while driving through the countryside. As he tried to reach for the map, he accidentally drove off the road into a ditch. Though he wasn't injured, his car was stuck deep in the mud. So the man walked to a nearby farm to ask for help. "Warwick can get you out of that ditch," said the farmer, pointing to an old mule standing in a field. The man looked at the decrepit old mule and looked at the farmer who just stood there repeating, "Yep, old Warwick can do the job." The man figured he had nothing to lose. The two men and the mule made their way back to the ditch. The farmer hitched the mule to the car. With a snap of the reins, he shouted, "Pull, Fred! Pull, Jack! Pull, Ted! Pull, Warwick!" And the mule pulled that car right out of the ditch.

The man was amazed. He thanked the farmer, patted the mule, and asked, "Why did you call out all of those names before you called Warwick?"

The farmer grinned and said, "Old Warwick is just about blind. As long as he believes he's part of a team, he doesn't mind pulling."

Keep your words positive, because your words become your actions.
Keep your actions positive, because your actions become your habits.
Keep your habits positive, because your habits become your lifestyle.
Keep your lifestyle positive, because your lifestyle becomes your destiny.

(Contributed by Prof. Dr. Charu)



Emedinews:Children & Adolescent Mobile Users at No Greater Risk of Brain Cancer


There has been a concern about the possibility of developing brain tumors since children have a developing nervous system and their head circumference is smaller, the radiofrequency electromagnetic fields may penetrate regions that are deeper in their brains. However, a new study has shown that children and adolescents who use mobile phones are not at a statistically significant increased risk of brain cancer compared to their peers who do not use mobile phones. The study was published on July 27 in the Journal of The National Cancer Institute.

Emedinews Comments: Is the study applicable to India where there is a lot of active and passive mobile radiation exposure? Is there any study available about the cancer risk taking into account both ionizing and non ionizing radiations? Till their safety is certified, one should use mobile phones only when one is mobile and definitely less than 2 hours a day.

Friday, July 29, 2011

Emedinews : Laughter the best medicine


There were three men in a lifeboat in shark infested water - a lawyer, doctor and a minister. All of a sudden the boat began to spring a leak, so as they were bailing out the water one of them looked over the side and printed there were the words: 'maximum capacity 2 persons', so they decided to draw straws and see who would jump overboard and save the other two. The lawyer drew the short straw and said: "Well I will see you on shore and then he jumped out of the boat and began to swim and the sharks instead of attacking him formed a clear lane like an honor guard. "It's a miracle they didn't attack him!", said the minister. "Oh it's no miracle just professional courtesy", said the doctor.

(Contributed by Dr GM Singh)

Emedinews: Insights on Medicolegal issues - Hair and fiber, found on human body or at the scene of crime, are commonly used in investigation in cases of assaults, sexual offences, bestiality



·         Hair comprises mainly two parts: Shaft is the part above the skin; root lies below the skin. The root has a bulb as a base, embedded in hair follicle. The cuticular scales cover the shaft. The shaft has two layers: outer one is called cortex, and the inner one medulla.
·         The hair pigment is present in the cortex. The cuticular scales present around the cortex are non-nucleated cells originating from follicle, and are keratinized. The medulla consists of cylinder-like cells produced by matrix cells. The ratio of medullar diameter to that of the shaft is known as medullar index.
·         The medullary column is present in the centre of the cortex. The pigment granules present in the cortex consist of melanin. It is made up of several units of monomer, consisting of indole and quinone. It contains amino acids like dihydroxy phenylalanine and tyrosine.
·         The medullar cells contain large amount of glycogen.
·         Macroscopic and microscopic examination of hair is done in the Forensic Laboratory, to distinguish it from fiber and to ascertain whether the hair is of a human hair or an animal and to fix the individual identity.

(Contributed by Dr Sudhir Gupta)

Emedinews: Makesure: A patient with human bite developed infection


Situation: A patient with human bite developed infection
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson  : Make sure all patients with human bite are timely put on beta-lactam/beta lactamase inhibitor antibiotics.

Emedinews : Dr Good Dr Bad : A patient with community acquired pneumonia due to S. pneumoniae


Situation: A patient with community acquired pneumonia due to S. pneumoniae came with resistance to penicillin and erythromycin.
Dr Bad: This may happen.
Dr Good: It is multidrug-resistant S. pneumoniae.
Lesson: Multidrug-resistant S. pneumoniae (MDRSP) is defined as resistance to more than one antimicrobial class (e.g, penicillin-resistant and macrolide-resistant).

Emedinews : Inspiration:The LITTLE Things


 As you might know, the head of a major company survived the tragedy of “9/11” in New York because his son started kindergarten. Another fellow was alive because it was his turn to bring donuts.


One woman was late because her alarm clock didn't go off in time. One was late because of being stuck on the NJ Turnpike because of an auto accident. One of them missed his bus. One spilled food on her clothes and had to take time to change. One's car wouldn't start. One went back to answer the telephone. One had a child that dawdled and didn't get ready as soon as he should have. One couldn't get a taxi. The one that struck me was the man who put on a new pair of shoes that morning, took the various means to get to work but before he got there, he developed a blister on his foot. He stopped at a drugstore to buy a Band-Aid. That is why he is alive today. Now when I am stuck in traffic...miss an elevator... turn back to answer a ringing telephone... all the little things that annoy me... I think to myself... this is exactly where God wants me to be at this very moment.

The next time your morning seems to be going wrong, the children are slow getting dressed, you can't seem to find the car keys, you hit every traffic light... don't get mad or frustrated; God is at work watching over you.

May God continue to bless you with all those annoying little things - and may you remember and appreciate their possible purpose.

(Contributed by Dr GM Singh) 

Ask Dr KK: When in pregnancy women gain weight?

Dr KK Answers: Women have more fat as a percent of body weight than men from puberty onward, and tend to gain more fat during adult life than men. In addition, women experience modest but adverse increases in body weight and fat distribution after a first pregnancy that appear to be persistent.

Ask Dr KK: Can paracetamol increase blood pressure?

Some studies have shown an increase in blood pressure with paracetamol. acetaminophen.

In one two-week randomized crossover trial, paracetamol 1 g three times daily increased systolic and diastolic blood pressure from 122 to 125 mmHg systolic and from 73 to 75 mmHg diastolic. [Circulation 2010; 122:1789]. But most other studies have not confirmed the same.

In therapeutic doses its safe for hypertensive patients to take paracetamol.

Ask Dr KK: What is the significance of gasping respiration in CPR or CCCR?


Agonal/gasping respiration is ineffective respiration and should be an indication for cardiac resuscitation. In fact, gasping is the sign that your resuscitation is likely to be successful.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How effective should be breathing in CPR?


One should not push more than 50% of the tidal volume in each breath. Don’t push air into the stomach as it will impair hemodynamics. If the respiratory rate is more, it will also impair hemodynamics.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: In CPR what should be the compression to breathing ratio?



When giving cardiopulmonary resuscitation involving breathing–chest compression cycles, the ratio should be 30 compressions: 2 breaths. This ratio should not be more than five cycles in two minutes.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: Who should lead the chest compression cardiac resuscitation?


When multiple rescuers are available, the person highest trained should become the leader, direct and take the first two minutes of the resuscitation cycle.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

HCFI Update: The 5 Cs of five-a-day in selecting fruits and vegetables



The current recommendation is to eat 5 or more servings of fruits and vegetables daily to prevent cancer and heart disease.  Fruits and vegetables contain vitamins, minerals, phytochemicals, and antioxidants and are low in calories. Those with the most color – dark green, red, yellow, and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs" which can be incorporated in the five-a-day diet. As per Ayurveda, one should mix all seven colours and six tastes when choosing fruits and vegetables.

As per the USDA Food Guide Pyramid, one should take 5 to 9 servings of fruits and vegetables every day. Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease.  Fiber-containing grain products, fruits and vegetables also reduce the risk of some cancers, said Padma Shri and Dr B C Roy national Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

A serving size is: one medium-size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw  leafy vegetables, 1/4 cup dried fruit.

•5 servings mean 2 fruits and 3 vegetables
•7 servings means 3 fruits and 4 vegetables
•9 servings means 4 fruits and 5 vegetables


Tips for safe eating

1.Snack with raw vegetables instead of potato chips.
2.Add fruits in breakfast.
3.Eat salads when you go out for lunch.
4.Prefer juice instead of the usual coffee, tea or soda.
5.Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
6.Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
7.Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
8.Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been kept at an improper temperature
9.Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
10.Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.

Emedinews : Insights on Medicolegal issues: DNA tests are run at least twice, both independent of each other


No two people, except identical twins, have the same DNA structure

·   DNA testing is done by taking DNA extracts from biological sample putting them into a gel matrix and then using probes to help extract certain markers. Human being has a unique signature that lives within every cell of our body. This signature is commonly known as DNA.
·   Testing can be done on DNA to help determine parentage, ancestry, presence of genetically based diseases and to help identify someone who may have been present at a crime scene
·   Most DNA tests are run at least twice, both independent of each other. This not only builds upon the credibility of the test but also helps ensure that no wrong data or incorrect marker analysis was performed on the first test. If any discrepancies are detected between the two tests then a new sample is used and the entire test is performed again to understand where the discrepancy may lay.
·      We get our DNA from our biological mother and biological father. Each of them contributes 50% of our chromosomes that will make up our DNA – this same DNA will stay with us for our entire lives without change. This is the very reason that makes DNA such a great choice for uniquely identifying a person.
·    Questions may arise as to how accurate DNA tests are. After all, in the past blood tests can not been as accurate as we might have hoped. They often left a bit of uncertainty or could not be conclusive in many areas. But thanks to the uniqueness of DNA almost all of these doubts can be taken away.
·     Modern testing procedures and rules for DNA analysis mean that with rare exception DNA testing results can be guaranteed to be more than ninety percent accurate for most paternity, forensic and genetically based disease analysis. However human error can come into play. A lab may mistakenly switch samples or key in data incorrectly. All of these factors are possible, but also are very rare in occurrence. If there is ever any doubt as to the authenticity or correctness of a test it can simply be performed again to confirm accuracy in another or same lab.

(Contributed by Dr Sudhir Gupta)


Emedinews: Makesure:An hypertensive with obstructive sleep apnea was not responding to CPAP.


Situation: An hypertensive with obstructive sleep apnea was not responding to CPAP.
Reaction: Oh my God! Why was anti hypertensive drug not started?
Lesson: Make sure that all hypertensives with OSA are given anti HT drugs in addition to CPAP. In a randomized crossover trial of 23 patients with OSA and systemic hypertension, an antihypertensive medication (valsartan 160 mg per day) lowered the mean 24-hour blood pressure significantly more than CPAP therapy alone
(Am J Respir Crit Care Med 2010;182(7):954-60).

Emedinews: Dr Good Dr Bad:A 1-year-old child is brought with a complaint of ‘not putting on weight’


 Situation: A 1-year-old child is brought with a complaint of ‘not putting on weight’, vague symptoms and with positive Mantoux test.
Dr Bad: Take a multivitamin syrup.
Dr Good: Start anti-TB drugs.
Lesson: Any child below 2 years of age with positive Mantoux test has active TB unless proved otherwise and is at high risk for developing TB meningitis and military TB.

Emedinews Inspiration: Dad’s Blessings



A young man was getting ready to graduate from college. For many months he had admired a beautiful sports car in a dealer's showroom, and knowing his father could well afford it, he told him that was all he wanted.

As Graduation Day approached, the young man awaited signs that his father had purchased the car.  Finally, on the morning of his graduation, his father called him into his private study. His father told him how proud he was to have such a fine son, and told him how much he loved him. He handed his son a beautifully wrapped gift box.  Curious, but somewhat disappointed, the young man opened the box and found a lovely, leather-bound Bible, with the young man's name embossed in gold. Angry, he raised his voice to his father and said "With all your money, you give me a Bible?" and stormed out of the house, leaving the Bible.

Many years passed and the young man was very successful in business. He had a beautiful home and wonderful family, but realized his father was very old, and thought perhaps he should go to him.  He had not seen him since that graduation day.  Before he could make arrangements, he received a telegram telling him his father had passed away, and willed all of his possessions to his son. He needed to come home immediately and take care of things.

When he arrived at his father's house, sudden sadness and regret filled his heart.  He began to search through his father's important papers and saw the still new Bible, just as he had left it years ago.  With tears, he opened the Bible and began to turn the pages.  And as he did, a car key dropped from the back of the Bible.  It had a tag with the dealer's name, the same dealer who had the sports car he had desired. On the tag was the date of his graduation, and the words PAID IN FULL.

How many times do we miss Spirit's blessings and answers to our prayers because they do not arrive exactly as we have expected?
(Contributed by Dr GM Singh)


Ask Dr KK: How long to wait before starting chest compression cardiac resuscitation?

Do not waste more than 10 seconds to check pulse or breathing before starting chest compression cardiac resuscitation [CCCR]. Even second’s delay matters. Therefore, CCCR should be started without delay.




About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: In sudden cardiac arrest how to defibrillate?



While giving defibrillation, one should use the maximum Jules available in the machine. After defibrillation, one should not wait to watch for the rhythm but continue chest compression cardiac resuscitation [CCCR] uninterrupted for the next two minutes.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: Is chest compression cardiac resuscitation effective in children?



Only chest compression cardiac resuscitation [CCCR] is more effective in adults. In other conditions like children, unwitnessed cardiac arrest and non cardiac arrests, one may have to do complete cardiac pulmonary resuscitation involving breathing and chest compression cycles.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is chest compression cardiac resuscitation [CCCR]


It involves compressing the chest with a speed of 100 per minute. The Mantra is to push as hard and as fast as possible. Each compression should lower the sternum by 1.5 to 2 inches, should be continuous and allow full recoil of the sternum.


One person can effectively carry out chest compression for only 1–2 minutes. After that fatigue will invariably set in. Therefore, it is important to switch resuscitations between available bystanders.



About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat cardiac arrest presenting after 10 minutes of the arrest?



The patient after ten minutes of arrest is in metabolic phase.  Only hypothermia system can work here.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat a cardiac arrest presenting between 5-10 minutes of the arrest?


The 5-10 minutes of cardiac arrest is the Hemodynamic phase.  Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective two minutes of chest compression cardiac resuscitation [CCCR] before defibrillation is attempted followed by two minutes of CCCR again.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat cardiac arrest in the first 5 minutes?


The first 5 minutes after cardiac arrest is the clinical phase. In this phase ventricular fibrillation is the main electrical activity. The treatment of choice is defibrillation followed by chest compression cardiac resuscitation (CCCR).


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What are three clinical phases after a sudden cardiac arrest?


1. Clinical phase: which lasts 0–5 minutes where ventricular fibrillation is the main electrical activity and the treatment of choice is defibrillation followed by chest compression cardiac resuscitation [CCCR].
2. Hemodynamic phase: which lasts 5–10 minutes. Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective two minutes of chest compression cardiac resuscitation [CCCR] before defibrillation is attempted followed by two minutes of CCCR again.
3. Metabolic phase: phase beyond 10 minutes. Only hypothermia system can work here.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How common is sudden cardiac death?


About 4-500,000 people in US, 700,000 in Europe and 2 million in India die every year directly due to Sudden Cardiac Death. In India, majority of them die before reaching the hospital and 75% of them can be revived if chest compression cardiac resuscitation (CCCR) is taught to all.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How is sudden cardiac death different from sudden cardiac arrest?


Sudden cardiac arrest is cessation of cardiac activity which can get revived after resuscitation. On the other hand, Sudden Cardiac Death is unsuccessful sudden cardiac arrest.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Thursday, July 28, 2011

Ask Dr K K : What is the maximum dose of paracetamol (acetoaminophen)?

Maximum daily dose now is six pills a day (3,000 mg) to reduce the risk of paracetamol overdose.




 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

Ask Dr KK : How many types of strokes are there?

Six types
1. Subarachnoid hemorrhage
2. Intracerebral hemorrhage
3. Ischemic stroke
4. Transient ischemic attack
5. Cerebral venous thrombosis
6. Unspecified stroke.


 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

Ask Dr KK: Why treat Atrial Fibrillation?

AF is the most commonly encountered cardiac arrhythmia in clinical practice today, accounting for most arrhythmia-related hospital admissions.

AF is associated with a 50% to 90% increase in mortality risk and a 5-fold increase in the risk for stroke.
AF-related ischemic stroke is nearly twice as likely to be fatal as non-AF ischemic stroke, more likely to recur, and associated with severe neurologic deficits.

 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

Ask Dr KK : How to combine clopidogrel with omeprazole?

There is a strong negative clopidogrel/esomeprazole interaction, compensated by increasing the dose of clopidogrel to 150mg or replacing esomeprazole with ranitidine. That is a simple solution to the PPI-induced clopidogrel resistance. [Moceri P, Doyen D, Cerboni P, Ferrari E; Thrombosis Research (Jul 2011)]




 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

 

Ask Dr KK: How to treat pruritus in renal failure?

Patients with end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus. [Berger TG, Steinhoff M; Seminars in Cutaneous Medicine and Surgery 30 (2), 99-100 (Jun 2011)]


 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

Ask Dr KK: Should people in their eighties build muscles?

Older people, even after the age of eighty, should exercise to build their muscles as it will help them with everyday tasks.

Climbing the stairs, housework, walking and even washing can be made easier if elderly people work out two or three times a week as per a study by Chiung-ju Liu of the Department of Occupational Therapy at Indiana University.

People lose muscle as they age, which can make daily chores more difficult. Working out by using small weights or elastic bands can help to rebuild these muscles.


 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

HCFI Update: Asthma linked to smoking



Active smoking increases the risk of developing asthma, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela.

Dr. Aggarwal said that adolescents who smoke more than 300 cigarettes a year are at 4 times the risk of developing asthma compared to their non-smoking peers. Active smoking is strongly associated with high incidence of asthma between ages 17 to 33.

It is also seen that those children who develop asthma by age 7, usually go in remission but relapse by age 33 if they smoke.

Secondhand smoking is also associated with developing asthma in early life, especially, if the mother is a smoker. Many studies have shown that children of smoking mothers are two times are more likely to develop asthma than children of non-smoking mothers.