Shri Arun Jaitley achieved Nirvana today

Dr KK Aggarwal

Shri Arun Jaitley, Former Finance Minister of India achieved Nirvana today.

A lawyer by profession, he reached the pinnacle of success as a professional and became a stalwart national political leader.

Arun Jaitley was a Senior Advocate of the Supreme Court of India. He had been active in politics since his university days and became a Cabinet minister in the governments headed by Former Prime Minister, Shri Atal Bihari Vajpayee and Shri Narendra Modi. He held important cabinet portfolios like Finance, Defence, Corporate Affairs, Commerce and Industry and Law and Justice.

He always worked for the good of the medical and legal community and the public at large. He was an icon to many.

Individuals like Arun Jaitley never die. They are always remembered for their immense contribution to the betterment of the society.

IJCP Group and Heart Care Foundation of India (HCFI) pay our heartfelt tributes to Shri Arun Jaitley.

He will always stay on in our memory.

May his soul rest in peace…

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Renowned endocrinologist Padma Shri Dr Anoop Misra joins IJCP Group as Advisor

Dr Anoop Misra, Chairman of the Fortis Centre for Diabetes, Obesity and Cholesterol (C-DOC) and Head of the National Diabetes Obesity and Cholesterol Foundation (NDOC) has joined the IJCP Group as Group Advisor. Dr Misra is an acclaimed endocrinologist and a former honorary physician to the Prime Minister of India.

A former Fellow of the World Health Organization (WHO) at the Royal Free Hospital, UK, Dr Anoop Misra is a recipient of the Dr BC Roy Award, the highest Indian award in the medical category. In 2007, the Government of India awarded him the fourth highest civilian honor of the Padma Shri for his contributions to the field of medicine in the country.

We are extremely happy and proud to have Dr Anoop Misra as an advisor in the IJCP Group. He is a multifaceted person with numerous achievements to his credit in clinical service, teaching, research, community health activities and medical education. He is actively working to uplift the health of socially backward communities.

Dr Anoop Misra has also contributed immensely to undergraduate and postgraduate medical education in various respects.

We are sure that under his guidance and support, we will be better able to strive towards the path and goal we have set out to achieve as part of IJCP.

We welcome Dr Anoop Misra to our IJCP family and look forward to a long and fruitful association.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Emedinews: Dr Good Dr Bad: A patient in insulin pump was taking a flight

Situation: A patient in insulin pump was taking a flight

Dr Bad: Its ok to sue the pump

Dr Good: Off the pump at landing an taking off.

 Lesson: According to a study published online Aug. 4 in the journal Diabetes Care, changes in airliner cabin pressurization during take-off and landing may affect how much insulin is delivered by an insulin pump.  Pumps should be disconnected during take-off and landing and during any flight situations in which a loss of cabin pressure results.

Emedinews: Makesure: A child died of a seizure while swimming.

Situation: A child died of a seizure while swimming.

Reaction: Oh my God!!  Why was he allowed to swim?

Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

Emedinews: Dr Good Dr Bad: An alcoholic 66-year-old diabetic male with pneumonia was not responding.

Situation: An alcoholic 66-year-old diabetic male with pneumonia was not responding.

Dr Bad: It is routine pneumonia.

Dr Good: This is a case of drug-resistant S. pneumoniae.

Lesson: Risk factors for drug-resistant S. pneumoniae in adults include: Age >65 years; beta-lactam, macrolide, or fluoroquinolone therapy within the past 3 to 6 months; alcoholism; medical comorbidities; immunosuppressive illness or therapy and exposure to a child in a day care center 

(Source: Chest 2005; 127:1752; Clin Infect Dis 2005; 40:1288; Clin Infect Dis 2006; 43:432 and Clin Infect Dis 1998; 26:1188)

Emedinews : Inspiration:11 Things you didn't learn in school

Rule 1:  Life is not fair - get used to it.

Rule 2:  The world won't care about your self-esteem. The world will expect you to accomplish something BEFORE you feel good about yourself.

Rule 3:  You will NOT make 40 thousand dollars a year right out of high school. You won't be a vice-president with a car phone, until you earn both.

Rule 4:  If you think your teacher is tough, wait until you get a boss. He doesn't have tenure.

Rule 5:  Flipping burgers is not beneath your dignity. Your grandparents had a different word for burger flipping - they called it opportunity.

Rule 6:  If you mess up, it's not your parents' fault, so don't whine about your mistakes, learn from them.

Rule 7:  Before you were born, your parents weren't as boring as they are now. They got that way from paying your bills, cleaning your clothes and listening to you talk about how cool you are. So, before you save the rain forest from the parasites of your parents' generation, try delousing the closet in your own room.

Rule 8:  Your school may have done away with winners and losers but life has not. In some schools they have abolished failing grades and they'll give you as many times as you want to get the right answer. This doesn't bear the slightest resemblance to ANYTHING in real life.

Rule 9:  Life is not divided into semesters. You don't get summers off and very few employers are interested in helping you find yourself. Do that on your own time.

Rule 10:  Television is NOT real life (nor are video games). In real life people actually have to leave the coffee shop and go to jobs.

Rule 11:  Be nice to nerds. Chances are you'll end up working for one.

(Contributed by Dr Maj. Prachi Garg)

(Source: - By Charles Sykes, from his book "Dumbing Down our Kids")

Will the Banned Rosiglitazone Reintroduced for the Neuropathic Pain

Banned drugs are in the news these days. Many drugs have been banned recently by the Drug Controller of India. DCI banned Gatifloxacin for systemic and oral use. Gatifloxacin eye drops were approved after the systemic use was banned.

Now the banned diabetes drug rosiglitazone is being explored as a short term pain medication in the US.

In patients who take rosiglitazone for glucose control, there is abundant evidence that rosiglitazone can increase the risk for heart failure, myocardial infarction, or death compared with its cousin pioglitazone.

In some patients this drug is the best bet. The US FDA recently released a rosiglitazone risk management strategy which limits the drug to patients already successfully treated with it or those for whom it's a last resort to control blood glucose medically.

The European Medicines Agency and the India DCI went further than its US counterpart by putting a complete halt on the sale of medications that contain rosiglitazone.

As per the new findings one can prevent development of nerve damage–induced neuropathic pain by controlling peripheral acute inflammation. The study will be published in the August issue of Anesthesia and Analgesia.

The preliminary exploration is based on a mouse model. Only 3-day administration of rosiglitazone immediately after nerve injury was sufficient to inhibit the development of chronic pain.

For pain management, patients would not need to take their medication daily like those with diabetes and might experience less risk because of it.

Local injection of rosiglitazone also produced similar effects as systemic administration. The side effects on the cardiovascular system can be avoided by local administration and by limiting duration for treatment to the acute phase.

Source: Anesth Analg. 2011;113:398-404.

Ask Dr KK: When should one decide for carotid endarterectomy or removal of blockages with catheter?

It is indicated for selected medically stable patients with asymptomatic carotid stenosis of 60 to 99 % who have a life expectancy of at least five years, provided the perioperative risk of stroke and death is less than 3 percent. However, long-term outcomes for patients with carotid blockages managed by intensive medical therapy may be similar to surgical management. 

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 the medical interventions for carotid blockages?

The interventions are management of hypertension, smoking cessation, use of statin drugs and low-dose aspirin.

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 symptomatic carotid artery blockage?

Patients who have had a stroke or transient ischemic attack (mini paralysis) due to carotid stenosis are considered symptomatic and often benefit from carotid revascularization. Symptoms means transient or permanent focal neurologic symptoms related to the affected artery (same side loss of vision, opposite side weakness or numbness of an extremity or the face, difficulty in speech or loss of speech). Patients with nonspecific neurologic symptoms (dizziness or syncope/near syncope) are not considered in the definition of symptomatic carotid stenosis. 

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: When to screen for carotid blockages?

Carotid duplex ultrasonography is not recommended for routine screening of asymptomatic patients who have no clinical manifestations of or risk factors for atherosclerosis. However one should screen asymptomatic individuals who have:

• Carotid bruit
•  Peripheral arterial disease
• Coronary disease
• Aortic aneurysm
•   Two or more risk factors for atherosclerotic disease.

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 prevalence is screening beneficial?

Only at prevalence rates of over 20 % significant benefits are seen with at best about 100 strokes prevented for every 10,000 screened at 20 percent prevalence. Clinical features cannot identify asymptomatic individuals likely to have carotid stenosis. The annual risk of stroke in patients with asymptomatic carotid artery stenosis is relatively low. 

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 carotid artery blockages in general population?

The prevalence of carotid stenosis in general population is less than 1 %. Screening with resultant surgical procedures causes more strokes than it can prevent. For severe (≥70 %) carotid stenosis, the prevalence increases with age from approximately 0 to 3 %.

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 risky is carotid stenting or surgery?

Both endarterectomy and carotid stenting are associated with an increased 30-day risk of stroke and death. These are in the range of 2.3 to 3.7 percent for endarterectomy.

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 reliable is Doppler Carotid study for detecting blockages?

The reliability is variable and operator-dependent.

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 the screening methods available?

1.    Carotid ultrasound followed by catheter angiography

2.    Carotid ultrasound followed by MRA

3.    Ultrasound alone

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: Should I screen each patient for presence of carotid neck artery blockages?

The guideline says no. The potential harms include risks associated with the screening procedure itself like false positive findings leading to anxiety and the potential for unnecessary surgical procedures. Carotid angiography is associated with risk of neurological complications including stroke, with rates ranging from 0.1 to 1 %.

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 CT radiation comparable to X ray Chest?

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. 

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 counsel about diagnostic radiation to a patient?

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). 

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: Can CT cause cancer?

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.

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.