Friday, September 30, 2011

Be Cautious In Giving Pain Killer To Patients With High Cholesterol

Be Cautious In Giving Pain Killer To Patients With High Cholesterol

Medical Science behind Chanting Aum

Medical Science behind Chanting Aum

Science behind 4th Navratri or Kushmanda Worship (Keep smiling and be happy in all situations)

Science behind 4th Navratri or Kushmanda Worship (Keep smiling and be happy in all situations)

Padma Shri Awardee Dr KK Aggarwal on Be cautious in giving pain killer t...

Padma Shri Awardee Dr KK Aggarwal on Be cautious in giving pain killer t...

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal Do not give citalopram more than 40mg_new_1-2.mp3

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal Do not give citalopram more than 40mg_new_1-2.mp3

Samak Chaval: a healthy replacement for rice in Navratri diet

Samak Chaval: a healthy replacement for rice in Navratri diet

Science behind 2nd Navratri or Mata Brahmacharini (Sati) Worship (let go your impure thoughts)

Science behind 2nd Navratri or Mata Brahmacharini (Sati) Worship (let go your impure thoughts)

Science behind 3rd Navratri or Chandraghanta Worship (Controlling your negative energies)

Science behind 3rd Navratri or Chandraghanta Worship (Controlling your negative energies)

Wednesday, September 28, 2011

Padma Shri Awardee Dr KK Aggarwal on Anger prone people at risk of heart...

Padma Shri Awardee Dr KK Aggarwal on Anger prone people at risk of heart...

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Navratri.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Navratri.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Navratri.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Navratri.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Bhagwad Gita Chapter 3.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Bhagwad Gita Chapter 3.mp3

Stay Tuned with- Padma Shri Awardee Dr KK Aggarwal on 1st Navratri to Diwali a one-month long spiritual Yagna - Amavasya to Amavasya. 29 sept_1-2.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on 1st Navratri to Diwali a one-month long spiritual Yagna - Amavasya to Amavasya. 29 sept_1-2.mp3

Thursday, September 15, 2011

#AskDrKK: Can patient with high blood pressure take Viagra group of drugs?

#DrKKAnswers:
Viagra group of drugs are typically well tolerated with only minor reductions in blood pressure in patients taking conventional antihypertensive drugs (ACE inhibitors, AR blockers, calcium blockers, beta blockers, and diuretics), even when used in combination.
Source:
1. Sildenafil Study Group. Am J Hypertens 2001; 14:70.
2. Am J Hypertens 2004; 17:1135.

Padma Shri Awardee Dr KK Aggarwal on 18th MTNL Perfect Health Mela to Fo...

zSHARE - Padma Sri Awardee Dr KK Aggarwal on Insulin Nasal Spray May Slow Alzheimer_s Disease. 16 september _1-2.mp3

Stay Tune with Padma Sri Awardee Dr KK Aggarwal on Insulin Nasal Spray May Slow Alzheimer_s Disease. 16 september _1-2.mp3

Padma Shri Awardee Dr KK Aggarwal on 18th MTNL Perfect Health Mela to Fo...

#AskDrKK:How to handle patients on nitrates who wants to take Viagra group of drugs?

#DrKKAnswers:
1. Men treated with PDE-5 inhibitors (Viagra group of drugs) and nitrates are at risk for severe hypotension and syncope (loss of consciousness).
2. Co-administration of Viagra group of drugs (sildenafil) with isosorbide mononitrate or sublingual nitroglycerin lowers blood pressure (52/29 mmHg with isosorbide mononitrate and 36/21 mmHg with sublingual nitroglycerin).
3. In men on Viagra group of drugs with chest pain nitrates should not be administered for 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.

#AskDrKK:Can heart patients take Viagra group of drugs Vardenafil and tadalafil?

#DrKKAnswers:
Tadalafil has the advantage of a longer duration of action.
Both drugs and sildenafil potentiate the BP lowering response to nitrates. This interaction lasts 24 hours with vardenafil and up to 48 hours with tadalafil.
Tadalafil, vardenafil and sildenafil are contraindicated with concomitant nitrate use.

#AskDrKK:Can heart patients take Viagra or Sildenafil?

#DrKKAnswers:
Sildenafil improves erectile function in patients with stable heart blockages. It is also effective in patients with hypertension, diabetes, and nonvascular organic or psychogenic causes for erectile dysfunction.
However it can lower blood pressure and interact with nitrates.
It lowers the systolic upper blood pressure by about 8 mmHg.
The BP lowering is not more when given with amlodipine.
Sildenafil also improves endothelial dysfunction and inhibits platelet activation.


#AskDrKK:Can drugs lead to sexual dysfunction?

#DrKKAnswers:
Always look for a reversible causes including drugs (thiazide diuretics, beta blockers, and lipid-lowering drugs)

Emedinews : Insulin nasal spray may slow Alzheimer's disease

Intranasal insulin therapy may have beneficial effects on cognition and function among patients with Alzheimer's disease, a pilot study suggested. Patients who received 20 IU of intranasal insulin daily for four months had improvements on delayed story recall tests (P=0.02, Cohen f effect size=0.36), according to Suzanne Craft, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues.
Study suggests that intranasal administration of insulin over a four-month period to patients with amnestic mild cognitive impairment or mild-to-moderate Alzheimer's disease improved delayed memory and preserved general cognition compared with placebo.

Insulin is critical for normal brain function, and dysregulation of its metabolism has been shown to contribute to the development of Alzheimer's disease. Because patients with Alzheimer's disease also exhibit decreased levels of insulin in the central nervous system, it has been hypothesized that raising these levels to normal might help maintain cognitive ability. (MedPage)

Tuesday, September 13, 2011

#AskDrKK:Can heart patients have sex?

#DrKKAnswers:
1. Low risk patients can safely initiate or resume sexual activity and should receive treatment for sexual dysfunction.
2. Intermediate risk patients should receive further evaluation by stress testing.
3. High risk patients should be stabilized by appropriate therapy before resuming sexual activity or being treated for sexual dysfunction.

Padma Shri Awardee Dr KK Aggarwal on Controlling five lifestyle risk fac...

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Bisphophonate update. 14 september -1-2.mp3

Stay Tuned Padma Shri Awardee Dr KK Aggarwal on Bisphophonate update. 14 september -1-2.mp3

#AskDrKK:Can patient with hypertrophic cardiomyopathy be given Viagra or Sildenafil?

#DrKKAnswers:
The decrease in preload and after load by Viagra can increase the outflow obstruction in patients with hypertrophic cardiomyopathy culminating in an unstable hemodynamic state.

Source: N Engl J Med 1999; 341:700.

#AskDrKK:Is Viagra (sildenafil) in heart patients not on nitrates?

#DrKKAnswers:
1. Viagra is generally well tolerated in men with severe coronary disease not using nitrates. [1].
2. Sildenafil is also safe during exercise in patients with stable coronary disease. [2].

References
1. N Engl J Med 2000; 342:1622.
2. JAMA 2002; 287:719.


#AskDrKK: Can Sildenafil (Viagra) cause acute heart attack?

#DrKKAnswers:
1. Acute heart attack and sudden death have been described after sildenafil therapy [1, 2].
2. Seventy percent of the men who developed MI of SCD had known cardiovascular disease and several were using a nitrate concurrently with sildenafil [3].

References
1. Lancet 1998; 352:957.
2. N Engl J Med 1999; 341:700 .
3. Circulation 2000; 102:2516.

#AskDrKK: Can drugs lead to sexual dysfunction?

#DrKKAnswers:
Always look for a reversible causes including drugs (thiazide diuretics, beta blockers, and lipid-lowering drugs)


Padma Shri Awardee Dr KK Aggarwal on Controlling five lifestyle risk fac...

#AskDrKK:How common is sexual dysfunction after acute heart attack?

#DrKKAnswers
1. Sexual dysfunction is common due to concern about risk; side effects of drugs (diuretics, beta blockers, lipid-lowering drugs) and due to risk factors like high lipis, diabetes, smoking, hypertension and psychologic factors [1].
2. Erectile dysfunction after a heart attack occur in one-half to three-quarters of patients. [2,3].
3. ED is also seen after bypass surgery (though less common)
4. Both men and women have less sexual activity and less satisfaction with sexual act after a heart attack [1].
5. Psychologic causes for sexual dysfunction are due to perceptions of their illness [4].
6. Worries about triggering a heart attack or sudden death and depression and anxiety of the disease especially the occurrence of a heart attack contribute. [5,6].
7. The fear can be in the mind of the patient or the spouse.
8. Most doctors do not discuss this issue of sexual act with post-heart attack patients or their spouses [7,8].
9. Counseling may improve sexual function [9].
10. Exercise stress testing is used to measure exercise tolerance and tolerance for sex..

References
1. Am J Cardiol 2000; 85:1283.
2. Arch Sex Behav 1986; 15:499.
3. Chest 1986; 90:681.
4. BMJ 1996; 312:1191.
5. Am J Cardiol 2000; 86:41F.
6. Am J Cardiol 2000; 86:46F.
7. Am J Cardiol 2000; 86:38F.
8. Arch Intern Med 1980; 140:38.
9. J Behav Med 1984; 7:61.


zSHARE - Padma Shri Awardee Dr KK Aggarwal on Revise Psychiatry.mp3

Stay Tuned- Padma Shri Awardee Dr KK Aggarwal on Revise Psychiatry.mp3

#AskDrKK:Can heart patients have sex?

#DrKKAnswers:
1. Low risk patients can safely initiate or resume sexual activity and should receive treatment for sexual dysfunction.
2. Intermediate risk patients should receive further evaluation by stress testing.
3. High risk patients should be stabilized by appropriate therapy before resuming sexual activity or being treated for sexual dysfunction.

#AskDrKK:Which patients are at intermediate risk for getting heart attack after sex?

#DrKKAnswers:
1. No symptoms and three or more cardiovascular risk factors (excluding gender); a sedentary lifestyle is considered a risk factor
2. Moderate, stable angina
3. A recent heart attack (> 2 weeks but less than 6 weeks); in patients who have not undergone revascularization. The risk can be assessed with stress testing.
4. Asymptomatic left ventricular dysfunction with left ventricular pumping ejection fraction <40 percent or New York Heart Association class II heart failure. 5. Non cardiac manifestations of atherosclerotic disease, such as peripheral vascular disease or prior stroke or transient ischemic attack.


Source: Am J Cardiol 2005; 96:313.

Monday, September 12, 2011

Padma Shri Awardee Dr KK Aggarwal on Harmony Interschool health festiv...

#AskDrKK: Which patients are at low risk for getting heart attack after sex?

#DrKKAnswers
1. Patients with no symptoms and less than three cardiovascular risk factors (excluding gender)
2. Patients with controlled blood pressure
3. Patients with mild, stable angina
4. After bypass surgery
5. After six to eight weeks of acute heart attack (asymptomatic and negative exercise-induced ischemia)
6. After 3-4 weeks of acute heart attack who have undergone successful revascularization
7. Mild valvular disease
8. Pericarditis, mitral valve prolapse, or atrial fibrillation with a controlled ventricular response.
Source: Am J Cardiol 2005; 96:313.

#AskDrKK:Which patients are at high risk for getting heart attack after sex?

#DrKKAnswers:
1. Patients with unstable or refractory angina
2. Uncontrolled hypertension
3. New York Heart Association class III or IV heart failure
4. A heart attack within the past two weeks
5. High-risk irregular heart rhythms
6. Patients with obstructive hypertrophic cardiomyopathy
7. Patients with moderate-to-severe valvular disease, particularly aortic stenosis

Source: Am J Cardiol 2005; 96:313

#AskDrKK: Can the risk of heart attack after sexual act be minimized?

#DrKKAnswers:
a. The triggers to acute heart attack are increase in heart rate, blood pressure, and myocardial oxygen demand, as well as increased platelet agreeability and coagulation in combination with a vulnerable coronary plaque [1].
b. Drugs that reduce heart rate or blood pressure or inhibit platelet aggregation reduces the risk of triggers of heart attack.
c. Beta blockers minimize or eliminate angina heart pain during sexual act.
d. The Determinants of Myocardial Infarction Onset Study showed that beta blockers reduced the risk of MI following anger [2] but not sexual act [3].
e. Aspirin lowers the risk of heart attack following anger [3] and the morning waking hours [4].

References
1. J Am Coll Cardiol 1994; 23:809.
2. Circulation 1995; 92:1720.
3. JAMA 1996; 275:1405.
4. Circulation 1990; 82:897.

#AskDrKK: Does exercise reduces chances of heart attack after sex in heart patients?

#DrKKAnswers:

1. The risk of acute heart attack after sexual act is reduced in patients who exercise regularly (1,2).
2. Regular physical exercise should be done at levels of ≥6 METs to reduce the risk (3).
3. The more regularly a person exercises the lower will be the heart attack risk.
4. Regular exercise also reduces the risk of heart attack and sudden death from heavy physical exertion (4,5)
5. Exercise training increases the aerobic capacity and decreases the peak heart rate in post-heart attack subjects engaging in sexual act (6).

References
1. JAMA 1996; 275:1405.
2. Heart 2001; 86:387.
3. Am J Cardiol 2000; 86:14F.
4. N Engl J Med 1993; 329:1677.
5. N Engl J Med 2000; 343:1355.
6. Circulation 1977; 55:738.

#AskDrKK:What is the absolute risk of acute heart attack after sex?

DrKKAnswers:


Sexual act is a transient trigger that increases risk of heart attack for only a two hour period. The absolute increase in risk is very small.

A 50 year-old man with no cardiac disease with an annual baseline risk of heart attack of 1 percent would increase his annual risk of heart attack to only 1.01 percent from weekly sexual activity.

A person with a high annual risk for a heart attack of 10 percent would increase the annual risk to only 10.1 percent from weekly sexual activity.

Source: Am J Cardiol 2000; 86:10F.


#AskDrKK:What is the risk of acute heart attack after a sexual act?

#DrKKAnswers:
Sexual act contributes to the onset of acute heart attack in only 0.9 percent of patients.

The relative risk of acute heart attack within two hours after sexual activity is 2.5. There is no increased risk of heart attack beyond this time period.

This risk is reduced in patients who undergo regular exercise. The risk is same irrespective of past history of heart disease.

Source:JAMA 1996; 275:1405.

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Intensive medical treatment prevents second stroke not intra cranial stenting.13 september _1-2.mp3

Stay Tuned - Padma Shri Awardee Dr KK Aggarwal on Intensive medical treatment prevents second stroke not intra cranial stenting.13 september _1-2.mp3

Padma Shri Awardee Dr KK Aggarwal on Adulteration in silver foil in swee...

Padma Shri Awardee Dr KK Aggarwal on Harmony Interschool health festiv...

Emedinews:Intensive medical treatment prevents second stroke not intra cranial stenting

Patients at a high risk for a second stroke who received intensive medical treatment had fewer strokes and deaths than patients who received a brain stent in addition to the medical treatment. The investigators published the results in the online first edition of the New England Journal of Medicine.

The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, funded the trial. The medical regimen included daily blood-thinning medications and aggressive control of blood pressure and cholesterol.

New enrolment in the study was stopped in April because early data showed significantly more strokes and deaths occurred among the stented patients at the 30-day mark compared to the group who received the medical management alone.

In addition to the intensive medical program, half of the patients in the study received an intervention of a self-expanding stent that widens a major artery in the brain and facilitates blood flow. One possible explanation for the higher stroke rate in the stented group is that patients who have had recent stroke symptoms sometimes have unstable plaque in their arteries which the stent could have dislodged, the study authors suggest. The study device, the Gateway-Wingspan intracranial angioplasty and stenting system, is the only system currently approved by the U.S. Food and Drug Administration (FDA) for certain high-risk stroke patients. The study participants were in the highest risk category, with blockage or narrowing of arteries of 70 to 99 percent.
Intensive medical management included a daily dosage of 325 milligrams of aspirin; 75 milligrams a day of Clopidogrel, for 90 days after enrollment; and aggressive management of key stroke risk factors—high blood pressure and high levels of low density lipoprotein (LDL), the unhealthy form of cholesterol. All patients also participated in a lifestyle modification program which focused on quitting smoking, increasing exercise, and controlling diabetes and cholesterol.

"The SAMMPRIS study results have immediate implications for clinical practice. Stroke patients with recent symptoms and intracranial arterial blockage of 70 percent or greater should be treated with aggressive medical therapy alone.

(New England Journal of Medicine, published online September 7, 2011).

#AskDrKK:What sexual advice to give to a patient with stable angina?

#DrKKAnswers:
1. Patients with angina often become symptomatic during sexual act (1,2).
2. 65 percent ends up with heart chest pain enough to stop activity (2).
3. Beta blockers and/or prophylactic sublingual nitrates, can prevent heart pain in these patients and permit a normal sex life (2).
4. Post angioplasty and bypass surgery patient do not carry excess risk
5. Asymptomatic chronic heart blockage patients also do not have an increased risk of symptoms during sexual act.

References
1. Arch Intern Med 1970; 125:987.
2. Int Rehabil Med 1981; 3:35.

#AskDrKK: Which position is better for sex in heart patients?

#DrKKAnswers:
There is no difference in heart rate (114 vs 117) or blood pressure (163/81 vs 161/77 mmHg) between man on top or man on bottom [1]. However there is slightly lower minute oxygen consumption for men in the supine position, but this lasts only for a brief period during orgasm [2].

References
1. Am Heart J 1976; 92:274.
2. Arch Intern Med 1984; 144:1745.

#AskDrKK: How to calculate platelet counts from peripheral smear?

#DrKKAnswers:
A: There are two methods: Platelet count per uL =
1. Average number of platelets per oil immersion field multiplied by 20,000.
2. Average number of platelets per oil immersion field multiplied by Hb (g/dL) and then multiplied by 1,000.

Sunday, September 11, 2011

AskDrKK: How a sexual act linked to physical exercise?

#DrKKAnswers:
1. Both are measured in terms of MET (metabolic equivalent of oxygen consumption).
2. 1 MET = 3.5 mL O2 uptake/kg per min (resting oxygen uptake in a sitting position).
3. Sexual act is equated to 2-3m METS during the pre-orgasmic phase and 3 to 4 METS during orgasm.
4. This is equivalent to walking at two to four miles per hour on a level surface [1].
5. Exercise stress testing is used to assess both exercise tolerance and tolerance for sex [2].
6. A sexual act causes a modest increase in myocardial oxygen demand that lasts only a brief time [3].
7. Exercise training attenuates the heart rate response [4] and reduces the small risk of heart attack following sex [5,6].

References:
1. Arch Intern Med 1984; 144:1745.
2. Am J Cardiol 2000; 86:51F.
3. Am J Cardiol 2000; 86:27F.
4. Circulation 1977; 55:738.
5. JAMA 1996; 275:1405.
6. Heart 2001; 86:387.

#AskDrKK:What physiological changes occur during orgasm?

#DrKKAnswers:
In volunteers (1,2)
1. Peak heart rate reaches 140-180 beats per minute
2. The mean increase in blood pressure is 80/50 mmHg
3. Respiratory rates and tidal volumes increases to values seen in moderately severe physical exertion
4. The exertion is enough stable angina patients to develop chest discomfort during or immediately after sexual act.
In real life partners the hemodynamic changes are (3,4)
1. Mean heart rate at the time of orgasm is 117 beats per minute (mean heart rate during normal daily activities is 120 beats per minute).
2. The mean estimated blood pressure is 162/89 mmHg.

References
1. Masters, WH, Johnson, VE. Human sexual response, Little, Brown, and Co, Boston 1966.
2. J Appl Physiol 1956; 9:469.
3. Arch Intern Med 1970; 125:987.
4. Am Heart J 1976; 92:274.

#AskDrKK: What is the physiology of sexual act?

#DrKKAnswers: 
 Sexual act includes arousal, erection, ejaculation, orgasm, refractory period, and resolution and depend on changes in the autonomic nervous system. Arousal and erection in men results from stimulation of parasympathetic nerves in the male penile organ; reduced activity of sympathetic pathways and release of nitric oxide from the endothelium (1). In women early sexual arousal results from activation of sympathetic nervous system (2).

References
1. Am J Cardiol 2000; 86:19F.
2. Am J Cardiol 2000; 86:30F.

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Ventilator-associated tracheobronchitis. 12th Sept.mp3

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Ventilator-associated tracheobronchitis. 12th Sept.mp3

Padma Shri Awardee Dr KK Aggarwal on Medico Masti College and Youth Fest...

Padma Shri Awardee Dr KK Aggarwal on Medico Masti College and Youth Fest...

Saturday, September 10, 2011

Padma Shri Awardee Dr KK Aggarwal on Strenuous exercies may increase ris...

Padma Shri Awardee Dr KK Aggarwal on Strenuous exercies may increase ris...

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Hepatitis B Vaccination updated. 11th Sept..mp3

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Hepatitis B Vaccination updated. 11th Sept..mp3

Emedinews: Dr Good Dr Bad:A patient with diabetic nephropathy was found to have a high homocysteine levels.

Situation: A patient with diabetic nephropathy was found to have a high homocysteine levels.
Dr Bad: Homocysteine has no correlation with nephropathy.
Dr Good: You should control your homocysteine levels.
Lesson: Results of a nested case–control study suggest that hyperhomocysteinemia has an etiologic role in the pathogenesis of diabetic nephropathy. In the study, baseline plasma homocysteine concentrations and mean HbA1c levels during follow–up were significantly higher in patients who developed microalbuminuria than in those who remained normoalbuminuric. Multivariate logistic regression analysis showed that baseline plasma homocysteine level and mean HbA1c were independent predictors of microalbuminuria in type 2 diabetes (Korean Diabetes J 2010 June; 34(3): 200–206).

Emedinews : Hepatitis B Vaccination update

• The regimen for the vaccine is three doses at one and six months apart.
• Longer than recommended intervals between doses do not reduce final antibody concentrations, although protection might not be attained until the recommended number of doses has been administered.(1-5)
• A positive immune response to the vaccine is defined as the development of hepatitis B surface antibody (anti-HBs) at a titer of >10 mIU/mL.
• An interruption in the vaccine schedule does not require restarting the entire series of vaccination or adding extra doses.(6,7)
• If the vaccination schedule is interrupted after the first dose, the second dose should be administered as soon as possible.(8)
• The second and third doses should be separated by an interval of at least two months.
• If only the third dose is delayed, it should be administered when convenient.
• Protective anti-HBs titers may be attained in some after only one or two doses of vaccine, completion of the full course (three doses) is recommended to maximize the anti-HBs titer and duration of protection.
• Anti-HBs titers decrease with time but the duration of protection is long (15 -22 years after the primary vaccination schedule).(9-13) Routine booster injections are not required.(14,15)
• Patients with serologic markers of past HBV infection (anti-HBc and anti-HBs positive) do not need HBV vaccination even if they have low titers of anti-HBs.
• Vaccines should be given intramuscularly since deposition of the vaccine into adipose tissue result in a lower seroconversion rate.(16)
• Deltoid is the preferred site in adults for vaccination.
• Longer needles should be used in overweight individuals.
• Hepatitis B vaccine is effective not only in preventing HBV infection but also in preventing the sequelae of chronic HBV infection.
• It is the first example that cancer can be prevented by vaccination.

References
1. Wiström J, Ahlm C, Lundberg S, et al. Booster vaccination with recombinant hepatitis B vaccine four years after priming with one single dose. Vaccine 1999;17:2162.
2. Zechowy R, Rubin LG. Effect of the time interval between the first and second doses of hepatitis B vaccine on the antibody titer achieved after the third dose. Child Hos Q 1997;9:67.
3. Middleman AB, Kozinetz CA, Robertson LM, et al. The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents. Pediatrics 2001;107:1065.
4. Halsey NA, Moulton LH, O'Donovan JC, et al. Hepatitis B vaccine administered to children and adolescents at yearly intervals. Pediatrics 1999;103:1243.
5. Heron LG, Chant KG, Jalaludin BB. A novel hepatitis B vaccination regimen for adolescents: two doses 12 months apart. Vaccine 2002;20:3472.
6. Saito K. Introductory remark of Dr. Rokuzo Kobayashi's achievements. Keio J Med 2002;51 Suppl 2:2.
7. Hepatitis B vaccine: What you need to know. Available at: www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf (Accessed on October 20, 2009).
8. Hoofnagle JH. Toward universal vaccination against hepatitis B virus. N Engl J Med 1989;321:1333.
9. Liao SS, Li RC, Li H, et al. Long-term efficacy of plasma-derived hepatitis B vaccine: a 15-year follow-up study among Chinese children. Vaccine 1999;17:2661.
10. Lin HH, Wang LY, Hu CT, et al. Decline of hepatitis B carrier rate in vaccinated and unvaccinated subjects: sixteen years after newborn vaccination program in Taiwan. J Med Virol 2003;69:471.
11. Yuen MF, Lim WL, Chan AO, et al. 18-year follow-up study of a prospective randomized trial of hepatitis B vaccinations without booster doses in children. Clin Gastroenterol Hepatol 2004;2:941.
12. McMahon BJ, Bruden DL, Petersen KM, et al. Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up. Ann Intern Med 2005;142:333.
13. Zanetti AR, Mariano A, Romanò L, et al. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005; 366:1379.
14. Lu CY, Chiang BL, Chi WK, et al. Waning immunity to plasma-derived hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination. Hepatology 2004;40:1415.
15. Jan CF, Huang KC, Chien YC, et al. Determination of immune memory to hepatitis B vaccination through early booster response in college students. Hepatology 2010;51:1547.
16. Shaw FE Jr, Guess HA, Roets JM, et al. Effect of anatomic injection site, age and smoking on the immune response to hepatitis B vaccination. Vaccine 1989;7:425.

zSHARE - Padma Shri Awardee Dr KK Aggarwal on Obesity.mp3

Stay Tuned - Padma Shri Awardee Dr KK Aggarwal on Obesity.mp3

Friday, September 9, 2011

The Right Action: The Dharma

Dharma is the path of righteousness and living one's life according to the codes of conduct as described by the Vedas and Upanishads. Its western equivalents might include morality, ethics, virtue, righteousness and purity. The term dharma can best be explained as the “law of being” without which things cannot exist.

The word dharma is derived from dhri, which means “to hold”. It literally means “that which holds” the people of this world and the whole creation. The same is described in the Vedic Text, in Atharva Veda as: Prithivim dharmana dhritam, that is, “this world is upheld by dharma”.

In Hinduism, Dharma is the very foundation of life. Tulsidas, the author of Ramcharitmanas, defined the root of dharma as compassion. Buddha has also described this principle in his book Dhammapada. According to Hindu philosophy, it's the GOD, which holds us through “Truth” and/or “LOVE”. “Dharma prevails” or “truth prevails” is the essence of Hinduism.

In order to achieve good karma, Vedas teach that one should live according to dharma (the right action). This involves doing what is right for the individual, the family, the class or caste and also for the universe.

According to the Bhagavad Purana, righteous living or life on a Dharmic path has four pillars: truthfulness (satya), austerity (tap), purity (shauch) and compassion (daya). It further adds that the adharmic or unrighteous life has three main vices: pride (ahankar), bad company (sangh), and intoxication (madya).

Manusmriti prescribes ten essential rules for the observance of dharma: Patience (dhriti), forgiveness (kshama), piety or self control (dama), honesty (asteya), sanctity (shauch), control of senses (indriya-nigrah), reason (dhi), knowledge or learning (vidya), truthfulness (satya) and absence of anger (krodha). Manu further writes, "Non-violence, truth, non-coveting, purity of body and mind, control of senses are the essence of dharma”.

In Bhagwad Gita Lord Krishna says that in the society dharma is likely to fall from time to time, and to bring dharma back, a GOD representative is born from time to time.

The shloka “(parithraanaaya saadhoonaam vinaasaaya cha dhushkr.thaam| dharma-samsthaapanaarthaaya sambhavaami yuge’ yuge’ (Chapter IV - 8)” says that “For the protection of the virtuous, for the destruction of evil-doers, and for establishing the rule of righteousness (Dharma), I am born from age to age [in every age]”. Another shloka “yada yada hi dharmasya glanir bhavati bharata abhyutthanam adharmasya tadatmanam srjamy aham” means that O descendant of Bharata “Whenever and wherever there is a decline in religious practice, and a predominant rise of irreligion - at that time I descend Myself”.

Deepak Chopra in his book Seven Spiritual Laws of Success talks about the “Law of ‘Dharma’ or Purpose in Life’”. According to him, everybody should discover his or her divinity, find the unique talent and serve humanity with it. With this, one can generate all the wealth that one wants.

According to him, when your creative expressions match the needs of your fellow humans, then wealth will spontaneously flow from the un-manifest into the manifest, from the realm of spirit to the world of form. In spiritual terms this is an attempt to find out whether one’s life is progressing as per the Laws of Dharma (Dharma in Sanskrit means ‘purpose in life’) which, according to the scriptures, is said to be the sole purpose for a human being to manifest in this physical form.

For one to achieve ‘DHARMA’ he suggests the following affirmative exercises:

1. Today I will lovingly nurture the god or goddess in embryo form that lies deep within my soul. I will pay attention to the spirit within me that animates both my body and my mind. I will awaken myself to this deep stillness within my heart. I will carry this consciousness of timeless, eternal being in the midst of time-bound experiences.

2. I will make a list of my unique talents. Then I will list all of the things I love to do while expressing my unique talents. When I express my unique talents and use them in the service of humanity, I lose track of time and create abundance in my life as well as in the lives of others.

3. I will ask myself daily, ‘How can I serve?’ and ‘How can I help?’ The answers to these questions will allow me to help and serve my fellow human beings with love.

Karma, dharma and samsara are three fundamental aspects of Hinduism. Buddhism, Jainism and Hinduism are all built on these aspects. Dharma is one’s appropriate role or attributes. Karma measures of how well one performs one’s dharma, explains why one is born where he or she is, and why there is suffering and seeming injustices. Samsara, is the continuous cycle of birth, death and rebirth, and the context for all experience.

Dharma sutras from Dharma Shãstras are the basic texts which talks about the morality of individuals and the society. Most Indian laws are made from these Shãstras.

In Jainism also, the wheel of Dharma (Chakra) with 24 spokes represents the religion preached by the 24 Tirthankaras consisting of nonviolence (Ahimsa) and other virtues.

The very first word of the Gita is “Dharma”. The Gita concludes with the word “Mama”. The whole of Bhagavad Gita is contained in the two words ‘Mama’ and ‘Dharma’. When you join these two words it becomes mamadharma, meaning ‘your true Dharma’. This is what the Gita teaches. ‘What is your Dharma?’


How to achieve your Dharma:
1. Do unto others what you do unto yourself and satisfy your conscience. That is your Dharma.
2. The word ‘Living Dharma’ signifies the right action in every moment of the life.
3. Do not follow the dictates of body, and do not indiscriminately follow the mind, for the mind is like a mad monkey. Hence, follow the conscience.

Padma Shri Awardee Dr KK Aggarwal on EcoFest School Eco Club's Festiva...

Padma Shri Awardee Dr KK Aggarwal on EcoFest School Eco Club's Festiva...

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Emedinews:Makesure: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn't you observe the IV site carefully?
Lesson: Make sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, as extravasation of calcium can produce severe interstitial necrosis.

Emedinews: Dr Good Dr Bad: A patient with painful diabetic neuropathy came with postural hypotension.

Situation: A patient with painful diabetic neuropathy came with postural hypotension.
Dr Bad: The two are unrelated conditions.
Dr Good: It is due to autonomic dysfunction.
Lesson: Painful diabetic neuropathy is associated with significantly greater autonomic dysfunction than painless diabetic neuropathy. The greater autonomic dysfunction seen in painful diabetic peripheral neuropathy (DPN) may reflect more predominant small fiber involvement and also adds to the growing evidence of its role in the pathophysiology of painful DPN 

(Diabetes Care 2010;33(7):1585-90).

Emedinews : New Delhi metallo-beta-lactamase (NDM-1)

Enterobacteriaceae isolates carrying a novel MBL gene, the New Delhi metallo-beta-lactamase (NDM-1) was first described in December 2009 in India with Klebsiella pneumoniae (1). Later, it was described in patients who had traveled to and undergone procedures in India and Pakistan (2). Cases were also reported in Asia, Europe, and North America (2-4). Isolates have also included E. coli and Enterobacter cloacae (2).
Risk factors

1. Recent treatment with carbapenem
2. Indwelling urinary or venous catheters
3. Severe illness (5)
4. NDM-1 can inactivate all beta-lactams except aztreonam.

Salient points
1. It is an important emerging resistant pathogen (6).
2. NDM1 isolates are susceptible to colistin or tigecycline
3. The susceptibility is short-lived.
4. NDM-1 has been identified in public water supplies in India (7)

References
1. Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046.
2. Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597.
3. Centers for Disease Control and Prevention (CDC). Detection of Enterobacteriaceae isolates carrying metallo-beta-lactamase - United States, 2010. MMWR Morb Mortal Wkly Rep 2010;59:750.
4. Sidjabat H, Nimmo GR, Walsh TR, et al. Carbapenem resistance in Klebsiella pneumoniae due to the New Delhi Metallo-β-lactamase. Clin Infect Dis 2011;52:481.
5. Deshpande P, Shetty A, Kapadia F, et al. New Delhi metallo 1: have carbapenems met their doom? Clin Infect Dis 2010;51:1222.
6. Nordmann P, Poirel L, Toleman MA, Walsh TR. Does broad-spectrum {beta}-lactam resistance due to NDM-1 herald the end of the antibiotic era for treatment of infections caused by Gram-negative bacteria? J Antimicrob Chemother 2011;66:689.
7. Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis 2011;11:355.

Emedinews :Soul does not leave the body immediately after the death


According to Prashna Upanishad, at the time of death, the Prana Vayu (respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body. But this does not happen immediately after clinical death which is defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is cardiac arrest.


As per the modern medicine, in cardiac arrest, the brain does not die for the next ten minutes and during this period, if the heart can be revived, life can be brought back.



The revival of patient during this period can be remembered by the formula of ten which is that within ten minutes of the stoppage of heart (cardiac arrest), if effective chest compression are given for the next ten minutes with a speed of 100 per minutes (10X10), 80% of the cardiac arrest victims can be revived.



This period can be much longer in hypothermia state. If the temperature of the body is low, the soul does not leave the body till the temperature is brought back to normal. Today, this property of soul is also used as therapeutic measure where patients who cannot be revived in the first ten minutes of clinical death are put in a freezing chamber and artificial hypothermia is produced and these patients can then be transported to an advance cardiac centre where even after 24 hours resuscitation measure can be applied after re-warming the body. Many people have been revived even after 24 hours of cardiac arrest with such a technology.



There are instances in literature where a newborn with hypothermia was declared dead and got revived in the cremation ground when the heat of the atmosphere brought his temperature to normal and the pressure of the wood worked like cardiac massage. 



This aspect of “life after death” is a contribution of the modern science to the Vedic science. Though in Vedic literature, it was well known phenomenon as Savitri brought life back into Satyavan even after his clinical death.



Take home message is that one should not declare a patient dead in the first ten minutes if cardiac massage and try reviving him with chest compression cardio pulmonary resuscitation.

Thursday, September 8, 2011

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Padma Shri Awardee Dr KK Aggarwal on Divya Jyoti Nurse's Festival at M...

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Emedinews:Makesure: A patient died after receiving 30 ml IV KCL bolus.

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

Emedinews: Dr Good Dr Bad:A patient of CAD developed dengue.

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low-dose aspirin.
Lesson: In dengue, lose-dose aspirin needs to be stopped.

Emedinews :One can predict acute lung injury

The lung injury prediction score (LIPS) should be used to predict patients who are unlikely to develop ALI/ARDS.

• LIPS >4 predicts ALI with a sensitivity and specificity of 69 and 78 %, respectively.
• LIPS <4 has a negative predictive value of 97%. Score: Sum up the assigned points
1. Shock (2 points)
2. Aspiration (2 points)
3. Sepsis (1 point)
4. Pneumonia (1.5 points)
5. Orthopedic spine surgery (1.5 points)
6. Acute abdominal surgery (2 points)
7. Cardiac surgery (2.5 points)
8. Aortic vascular surgery (3.5 points)
9. Traumatic brain injury (2 points)
10. Smoke inhalation (2 points)
11. Near drowning (2 points)
12. Lung contusion (1.5 points)
13. Multiple fractures (1.5 points)
14. Alcohol abuse (1 point)
15. Obesity (BMI >30, 1 point)
16. Hypoalbuminemia (1 point)
17. Chemotherapy (1 point)
18. Fraction of inspired oxygen >0.35 or >4 L/min (2 points)
19. Tachypnea >30 breaths/min (1.5 points)
20. Oxyhemoglobin saturation <95 percent (1 point)
21. Acidosis (pH <7.35, 1.5 points)
22. Diabetes mellitus (-1 point)

 (Ref : Gajic O, Dabbagh O, Park PK, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med 2011;183:462).

Wednesday, September 7, 2011

Padma Shri Awardee Dr KK Aggarwal on Bomb blast in Delhi in Hindi

Padma Shri Awardee Dr KK Aggarwal on Bomb blast in Delhi in English

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Emedinews:Makesure:A 7-month-old infant presented with grunting respiration, fever, anorexia and irritability. On chest x-ray, pneumatoceles was present.

Situation: A 7-month-old infant presented with grunting respiration, fever, anorexia and irritability. On chest x-ray, pneumatoceles was present.
Reaction: Oh my God! Why did you not start erythromycin immediately?
Lesson: Make sure to remember that erythromycin is an effective drug for Staphylococcal acquired pneumonia.

Emedinews: Dr Good Dr Bad: In how many patient of DVT does embolization occur? (JR to SR)

Situation: In how many patient of DVT does embolization occur? (JR to SR)
Dr Bad: Rare!
Dr Good: Common!
Lesson: Embolization occurs in about 50% of patients having proximal vein DVT.

Emedinews:Another Bomb Blast in Delhi

A powerful bomb exploded outside Delhi High Court gate number 5 on Wednesday morning. The blast took place at around 10.15 am. It left 11 people dead and more than 100 injured. This is the second such incident at the High Court this year.

Half of all early casualties seek medical care over first hour. To know the total number of casualties, double this number after one hour. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.

The most severely injured arrive after the less injured who self–transport to the closest hospitals, so always expect upside down triage.

It is important that we as doctors know how bomb blast cause injuries in order to tackle the repercussions of bomb blasts. Bomb blast injuries can be categorized into four types:

• Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. It involves injuries to the hollow gas–filled organs like the lungs, ear drum or intestines leading to their rupture.
• Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
• Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
• Quaternary blast injuries are due to direct effect of burn or crush injuries.
The most important aspect is not to waste energies and resources on patients with non-serious injuries.
Look for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non–serious injury.
• If the ear drums are intact, the patient can be discharged with first–aid treatment.
• If ear drum is ruptured, immediately do an X–ray chest. Keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation.
Hence, otoscopic ear exam can be used as a screening procedure for triage. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

Bomb blast injuries are always hollow organ injuries; Delhi Blast Update



1.      Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body.

2.       Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

3.       Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

4.       Quaternary blast injuries are due to direct effect of burn or crush injuries.

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.  The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury.

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation.

Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals.

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

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, Chairman Ethics Committee Delhi Medical Council, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association and Past Academic and Research Wing Heads IMA.


Tuesday, September 6, 2011

Thanks Krishan for not started smoking: Dr K K

This is an open letter from Padmashri Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Senior Physician Cardiologist at Moolchand Medcity to Mr. Krishan Kumar who represents his own past in the Medical College as a medical student.

Dear Krishan,

I must congratulate and reward you for not indulging in smoking, drinking or taking drugs while you were at school, college or medical college. I know what hard times you had faced in your life. You were 7th out of 9 brothers and sisters and that to living in one room in the crowded old city of Delhi. Your father was handling accounts of a company and living a tight financial life.

You studied in a Government School (ASVJ) located at Darya Ganj. Later you did your first year from Deshbandu College of Delhi University. There all the times you were compared with convent students who used to humiliate you and pass comments at you.

Subsequently you went to MGIMS Sevagram for doing M.B.B.S. and M.D. Throughout your life you were under constant stress with financial crisis, not good in English, stigma of coming from a traditional Hindu Baniya family and from a Government School.

Heads off to you! Even then you did not indulge in any of the addictions. Now I recall what great favours you have done to me as how difficult it would have been for me to de-addict myself. In the last 28 years of my practice at Moolchand Hospital, I have seen people with addiction living a life full of miseries. I have seen people with tobacco chewing dying with oral cancers and smokers getting pre-mature deaths, severe heart attacks, paralysis at an early age and losing their memories in 40s and 50s. I saw one of my friends at age 40 suddenly dying of heart attack just because he could not stop smoking in time.

I even saw those who wanted to quit, how difficult it was for them to quit. I saw people drink and completely spoiling not only theirs but also their families’ health and financial status. I came across people consuming drugs and indulging into the illegal activities. One of my patients was an opium addict and was ridiculed by his wife and children for years and they even attempted to make him stay in a mental hospital.

One of my industrialist colleagues who is just two years younger to me practically ruined his industry, as he could not de-addict himself. He even went to Europe for a de-addiction course which gave him relief only for a few months.

I came across each and every type of cancer in smokers in the last two decades.

You were smart enough not to listen to your colleagues and did not get under pressure or got influenced by the Stars in the Indian Movies or the Politicians.

I now realize the importance as I see many of my colleagues continue to smoke as they have failed again and again after trying quitting.

We belong to a professional community who work late night and under constant pressure and are vulnerable to end up with addictions. The only answer is to say no to the first addictive instance that to when we are still in our youth and that was what you rightly did in time.

I am not only grateful to you myself but also on behalf of my family as if I would have been smoking there was no way I could have told them not to smoke.

Because of my non-addiction, I am today a successful preventive doctor who has received Dr B C Roy National Award and Padmashri.

You will agree with me that if I would have been smoking there was no way I could have asked my patients not to smoke. It is not that I belong to a family of non-smokers. I have seen my brothers smoking and one of them a chain smoker with all sorts of health problems.

Once again Thanks

Regards

Dr K K Aggarwal


Padma Shri Awardee Dr KK Aggarwal on Anmol School Festival for childre...

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Emedinews :Makesure: A patient who had multiple blunt trauma on his abdomen is admitted for management.

Situation: A patient who had multiple blunt trauma on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt trauma to exclude peritoneal haemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

Emedinews: Dr Good Dr Bad: A diabetic patient was diagnosed with sarcopenia.

Situation: A diabetic patient was diagnosed with sarcopenia.
Dr. Bad: It is related to diabetes.
Dr. Good: It is not related to diabetes
Lesson: In the Korean Sarcopenic Obesity Study (KSOS), type 2 diabetes was associated with increased risk of sarcopenia. These characteristics may contribute to physical disability and metabolic disorders in older adults with diabetes
Source: Diabetes Care 2010 July; 33(7): 1497-9.

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Monday, September 5, 2011

Spiritual: Am I a spiritual seeker?

Every one cannot be a spiritual seeker. Infact majority are not interested in seeking spiritual knowledge and they keep themselves busy in the worldly desires. To become a good seeker one need to acquire many qualities.

In Bhagavad Gita Arjuna in a state of disturbed mind sought guidance from Lord Krishna. In Katha Upanishad Nachiketa as a healthy seeker learned the knowledge of life after death from Yama.

Katha Upanishad described in detail the qualities of a seeker in Nachiketa.

The story goes as under” Vajashrava sage performed a sacrifice in which he was required to give away all his worldly possessions. His son Nachiketa saw that the cows given in the donations were all old. Such charity was not going to give his father any merits. Feeling disturbed by the inappropriateness of his father's observance of the sacrifice, Nachiketa asked to whom was he given. The sage ignored him twice, but on third asking, the irritated sage said in anger, "Unto Yama, I give thee.". Whereupon Nachiketa went to the abode of Yama, and, finding him absent, waits there for three days and nights. Yama on his return offered to grant him three wishes.

Nachiketa wished the following:

1.To be allowed to return to his father alive, and that his father not be angry with him

2. To be instructed about fire sacrifice

3.To be given knowledge about life after death

Yama granted the first wish immediately. In answer to Nachiketa's second question, Yama named performance of a special fire-sacrifice after Nachiketa. Before answering the third question, Yama tested Nachiketa, offering him all sorts of worldly pleasures instead, but Nachiketa insists. And then Yama taught him about life after death.

The properties of true seeker therefore are

1.Righteousness and truthfulness: Nachiketa did not agree with his father as his (fathers’ act) was not based on Dharma.

2.Persistence: He waited for three days to meet Yama

3.Compassion and forgiveness: The first boon he asked was to have his father forgiven

4.Intellectual understanding: The fire of knowledge means intellectual understanding

5.Let go off the desires: He let go all his desires and did not get attracted to the worldly offers given by the Yama.

Only after that he qualified to get the knowledge of soul and become a true seeker.

Padma Shri Awardee Dr KK Aggarwal on Eat juggery and gram Gur Chana once...

Padma Shri Awardee Dr KK Aggarwal on Eat juggery and gram Gur Chana once...

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Emedinews: Strenuous exercise may increase risk of cardiac disorders

Strenuous exercise, whether performed by elite athletes or competitive weekend warriors, comes with a risk of developing cardiac disorders, including atrial fibrillation, according to a study presented at the European Society of Cardiology meeting.

Investigators found that among people who exercise four hours or more during the week, there was about a 39% increased risk of developing atrial fibrillation that required medical treatment.

Among elite cross-country endurance skiers, the risk of developing arrhythmias increased by 37% when compared with athletes in the same race that skied at a more moderate pace.

Source: MedPage Today

Emedinews: Dr Good Dr Bad: An asymptomatic patient with no obvious underlying cardiac disease shows ventricular premature contractions (VPCs).

Situation: An asymptomatic patient with no obvious underlying cardiac disease shows ventricular premature contractions (VPCs).
Dr Bad: Anti-arrhythmics should be given.
Dr Good: No treatment is needed.
Lesson: In the absence of cardiac disease, isolated asymptomatic VPCs regardless of configuration and frequency need no treatment.

Emedinews:Makesure: A patient with fever developed melena.

Situation: A patient with fever developed melena.
Reaction: Oh my God! why was platelet count not done?
Lesson: Make sure in all patients with fever platelet counts are done.

Sunday, September 4, 2011

Dengue special: Transfusion-related acute lung injury (TRALI)

Transfusion of even one unit of a plasma-containing blood product sometimes causes ALI/ARDS (1,2).
What can cause TRALI: Fresh frozen plasma, platelet, and packed red blood cell transfusions? 

Definition: New ALI occurring during or within six hours after a transfusion. 

Pathogenesis: A "two-event" hypothesis holds that recipient granulocytes are primed, either by transfused active substances or by virtue of the patient's underlying clinical condition. Preformed anti-leukocyte antibodies contained in the transfusion product then "activate" these functionally hyperactive granulocytes.

Which donors: Anti-leukocyte antibodies are more likely to be found in blood donated by multiparous women due to sensitization to fetal antigens during pregnancy.

When to suspect: Whenever dyspnea, hypoxemia, and pulmonary infiltrates occur during or within six hours after transfusion of any plasma-containing blood product.

Differential diagnosis
• Transfusion-associated circulatory overload
• Hemolytic transfusion reaction
• Anaphylaxis of IgA-containing products to a IgA deficiency recipient

Management: Is supportive (mechanical ventilation, supplemental oxygen, diuretics when volume overload is present). Clinical improvement will occur spontaneously as lung injury resolves.
Action: Individuals who have developed TRALI should receive no further plasma-containing blood products from the implicated donor.

Prevention
1. Take plasma products only from male donors
2. Screen previously-pregnant and previously-transfused apheresis donors for HLA antibodies
3. Start testing for the detection of white blood cell antibodies

References:
1. Bux J, Sachs UJ. The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol 2007; 136:788.
2. Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007; 131:1308.


#AskDrKK: Starting enteral nutrition in a patient on ventilator


#DrKKAnswers: Starting enteral nutrition with a low infusion rate improves tolerability, compared to initiation at the target rate. A randomized study of 200 mechanically ventilated patients showed that enteral feeding (at the target rate or at 10 mL/hr for six days before being incrementally increased to the target rate) showed no differences in mortality, ventilator-free days, or ICU-free days, but the group that began at the target rate had more episodes of elevated gastric residual volumes and a trend toward more diarrhea.
Source: Crit Care Med 2011; 39:967.

#AskDrKK: Ventilator induced Diaphragmatic atrophy


#DrKKAnswers: Controlled mechanical ventilation can lead to a very rapid type of disuse atrophy involving the diaphragmatic muscle fibers.
An observational study found that diaphragmatic strength decreased progressively during mechanical ventilation and that long-term (>24 hours) mechanical ventilation was associated with diaphragmatic muscle injury, atrophy, and proteolysis compared to short-term mechanical ventilation (2-3 hours)

Source: Am J Respir Crit Care Med 2011; 183:364.

#AskDrKK: How serious is Ventilator-associated tracheobronchitis?


#DrKKAnswers: Ventilator-associated tracheobronchitis VAT has the same clinical implications as ventilator-associated pneumonia (VAP). An observational study of 28 patients with VAT and 83 patients with VAP showed that VAT groups had a similar length of intensive care unit stay, length of hospital stay, duration of mechanical ventilation, survival rate to discharge, need for tracheostomy, and need for antibiotics.

Source: Chest 2011; 139:513.

Saturday, September 3, 2011

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Emedinews: Dr Good Dr Bad: A diabetic HIV patient came with A1c of 6.5.

Situation: A diabetic HIV patient came with A1c of 6.5.
Dr Bad: It’s perfect.
Dr Good: It is not 100% reliable for your situation.
Lesson: A1c may not be accurate for assessing glycemia among HIV-infected patients on NRTI–based therapy, especially those with macrocytosis or those on abacavir. In a prospective study evaluating the accuracy of A1c in HIV–infected patients with diabetes, glucose levels were significantly higher than anticipated by A1c levels when compared with HIV–uninfected control subjects and established reference values. Relative to the control subjects, A1C underestimated glucose by 29 ± 4 in the HIV–infected subjects (Diabetes Care 2009;32(9):1591–3).

Emedinews:Makesure: A 28–year–old male presents with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria.

Situation: A 28–year–old male presents with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. A sterile pyuria is the first clue to diagnosis.

Emedinews:Dr Good Dr Bad: A patient developed tetany after he was given metoclopramide.

Situation: A patient developed tetany after he was given metoclopramide.
Dr Good: Stop metoclopramide. Give inj promethazine.
Dr Bad: Give calcium.
Lesson: Metoclopramide can cause extrapyramidal symptoms

Emedinews:Makesure: A patient with angina and abnormal endothelial functions was put on atenolol.

Situation: A patient with angina and abnormal endothelial functions was put on atenolol.
Reaction: Oh my God! Why you did not consider nebivolol?
Lesson: Make sure that nebivolol is used as the beta blocker of choice in patients with proven endothelial dysfunction (Kardiologiia 2004;44(2):15–18).

Friday, September 2, 2011

MTNL Perfect Health Mela 2011 to Focus on Science behind Rituals




18th MTNL Perfect Health Mela 2011 will be held from 14th to 23rd October 2011 at NDMC Grounds Laxmi Bai Nagar, New Delhi.

The Mela is being organised by Heart Care Foundation of India jointly with Department of Health & Family Welfare, Govt. of Delhi, MTNL, NDMC, MCD, LIC, Deptt. of Science & Technology, Govt. of India, Coca Cola India Ltd., World Fellowship of Religions, etc.

The Mela attended by over 300,000 people creates health awareness about all aspects of health among people from all walks of life and all ages, incorporating all pathies under one roof through the medium of infotainment. The Mela is the right mix of health picnic, exhibition, competition and infotainment.

Addressing a press conference Padma Shri & Dr. B.C. Roy Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela said that the theme this year will be science behind mythology.

Member of Parliament and Former International Cricketer Sh. Kirti Azad and eminent National Kavi Sh. Gajendra Solanki said that mela will provide young budding artists an opportunity to test their talent. They said that the  healthy competitions to be held in the mela will bring the best out of these participating children.

Sh. Deepak Chanduka, GM Marketing (Corporate Office) and B K Badola GM Marketing operations, Dr N Tuli from MCD in a joint statement and said that every person should aim to live up to the age of 100 years and live healthy and active till the last moment of life. They further said that these events will provide the right opportunities to the public to know how to live healthy up to that age of 100. The entry to the event will be free.


zSHARE - PAdma Shri Awardee Dr KK Aggarwal on Science Behind Hanuman Chalisa chopia 31-40.mp3

zStay Tuned with Padma Shri Awardee Dr KK Aggarwal on Science Behind Hanuman Chalisa chopia 31-40.mp3

Padma Shri Awardee Dr KK Aggarwal on Debunking Diatetes Myths in English

Padma Shri Awardee Dr KK Aggarwal on Debunking Diatetes Myths in Hindi

Emedinews:Makesure:A patient of suspected MI died after receiving sublingual nitrate.

Situation: A patient of suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of intake of Viagra drug was not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because the two drugs when co-administered can cause fatal fall in blood pressure.

Emedinews: Dr Good Dr Bad: A patient with migraine was put on the herb, Butterbur.

Situation: A patient with migraine was put on the herb, Butterbur.
Dr. Bad: It is a drug of choice for preventing migraine.
Dr. Good: It benefits still remain unproven
Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproven. Neither treatment is recommended.

Thursday, September 1, 2011

Spiritual:Purusharthas: Dharma, Artha, Karma and Moksha


Purusha means human being and artha means object or objective. Purusharthas means objectives of man. 

According to Vedanta a person should strive to achieve four main objectives (Purusharthas) in his life. They are: 

1.    Dharma (righteousness), 
2.    Artha (material wealth), 
3.    Kama (desire) and 
4.    Moksha (salvation). 

Every person is expected to achieve these four objectives and seek fulfillment in life before death.

The four principles can be summarized as “acquiring material wealth through righteousness to fulfill the desires to acquire inner happiness”

The word dharma means, “To hold together”. It represents “any act” of omission or commission, which holds people together in the society. The purpose of earning money should to be to hold one’s dharma and the money should be earned using the principles of dharma. 

Mokhsha is the very purpose of life and in broader séance means acquiring inner happiness. The same can only be acquired using the principles of duty, discipline and devotion. Only if the desire or intention to acquire one’s happiness is focused one can get it.

Intention and attention are thus the main two tools of acquiring any thing in life. With right intention and focused attention, one can get over all the adversities in life. 

The main principles also tell us the message of the trimurti: Brahma Vishnu and Mahesh, the three God of our existence. While Brahma teaches us about Dharma, Vishnu about righteous earning and Mahesha about fulfilling the desires.

All the four Purusharthas are also related to the ashrams of life. Bramcharya with dharma, Grasthya with Artha, Vanprasthan with kama and sanyasa with the moksha.

On each of the objective Vedic texts are available; dharamshastra, artyhashastra, kamashastra and the Upanishads.  

Summary: “Using dharma to earn money which in turn can be spent on fulfilling the desire to get inner happiness”or “Fulfilling one’s desire of inner happiness using the means earned through righteous earning”

Padma Shri Awardee Dr KK Aggarwal on 18th MTNL Perfect Health Mela to Fo...

Padma Shri Awardee Dr KK Aggarwal on 18th MTNL Perfect Health Mela to Fo...

zSHARE - Padma Shri Awardee Dr KK Aggarwal on DVT risk starts early_ stays long after acute stroke. emedinews 2nd September Audio_1-2.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on DVT risk starts early_ stays long after acute stroke. emedinews 2nd September Audio_1-2.mp3

zSHARE - PAdma Shri Awardee Dr KK Aggarwal on Science Behind Hanuman Chalisa chopia 31-40.mp3

zSHARE - PAdma Shri Awardee Dr KK Aggarwal on Science Behind Hanuman Chalisa chopia 31-40.mp3