emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri and Dr. B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

4th March 2010, Thursday

7 ways to keep your memory sharp at any age

Here are 7 ways, as reported in Harvard Newsletter, using which you can enhance your memory at any age

  1. Keep learning: A higher level of education is associated with better mental functioning in old age. Experts think that advanced education may help keep memory strong by getting a person into the habit of being mentally active. Challenging your brain with mental exercise is believed to activate processes that help maintain individual brain cells and stimulate communication among them. Many people have jobs that keep them mentally active, but pursuing a hobby or learning a new skill can function the same way. Read; join a book group; play chess or bridge; write your life story; do crossword or jigsaw puzzles; take a class; pursue music or art; design a new garden layout. At work, propose or volunteer for a project that involves a skill you don't usually use. Building and preserving brain connections is an ongoing process, so make lifelong learning a priority.

  2. Use all your senses: The more senses you use in learning something, more of your brain will be involved in retaining memory. In one study, adults were shown a series of emotionally neutral images, each presented along with a smell. They were not asked to remember what they saw. Later, they were shown a set of images, this time without odors, and asked to indicate which they’d seen before. They had excellent recall for all odor–paired pictures, and especially for those associated with pleasant smells. Brain imaging indicated that the piriform cortex, the main odor–processing region of the brain, became active when people saw objects originally paired with odors, even though the smells were no longer present and the subjects hadn’t tried to remember them. So challenge all your senses as you venture into the unfamiliar. For example, try to guess the ingredients as you smell and taste a new restaurant dish. Give sculpting or ceramics a try, noticing the feel and smell of the materials you’re using.

  3. Believe in yourself: Myths about aging can contribute to a failing memory. Middle–aged and older learners do worse on memory tasks when they’re exposed to negative stereotypes about aging and memory, and better when the messages are positive about memory preservation into old age. People who believe that they are not in control of their memory function are less likely to work at maintaining or improving their memory skills and therefore are more likely to experience cognitive decline. If you believe you can improve and you translate that belief into practice, you have a better chance of keeping your mind sharp.

  4. Economize your brain use: If you don’t need to use mental energy remembering where you laid your keys or the time of your granddaughter’s birthday party, you’ll be better able to concentrate on learning and remembering new and important things. Take advantage of calendars and planners, maps, shopping lists, file folders, and address books to keep routine information accessible. Designate a place at home for your glasses, purse, keys, and other items you use often. Remove clutter from your office or home to minimize distractions, so you can focus on new information that you want to remember.

  5. Repeat what you want to know: When you want to remember something you’ve just heard, read, or thought about, repeat it out loud or write it down. That way, you reinforce the memory or connection. For example, if you’ve just been told someone’s name, use it when you speak with him or her: "So, John, where did you meet Camille?" If you place one of your belongings somewhere other than its usual spot, tell yourself out loud what you’ve done. And don’t hesitate to ask for information to be repeated.

  6. Space it out: Repetition is most potent as a learning tool when it’s properly timed. It’s best not to repeat something many times in a short period, as if you were cramming for an exam. Instead, re–study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day. Spacing out periods of study is particularly valuable when you are trying to master complicated information, such as the details of a new work assignment. Research shows that spaced rehearsal improves recall not only in healthy people but also in those with certain physically based cognitive problems, such as those associated with multiple sclerosis.

  7. Make a mnemonic: This is a creative way to remember lists. Mnemonic devices can take the form of acronyms (such as RICE to remember first–aid advice for injured limbs: Rest, Ice, Compression, and Elevation) or sentences (such as the classic "Every good boy does fine" to remember the musical notes E, G, B, D, and F on the lines of the treble clef).
Dr KK Aggarwal
Chief Editor

News and Views

Craniosynostosis

Craniosynostosis is one of many problems where the pediatric population now and then visits a doctor, viz. a pediatrician, a neurosurgeon or a plastic surgeon. Unfortunately the incidence in India is not known when compared to the western literature. A Medline database search reveals less then thirty articles from India, most of them are anecdotal case reports whereas a similar search with the keyword ‘craniosynostosis’ reveals more then 4900 articles from the western world. The reason why we are far behind in numbers in this particular condition is either due to lack of awareness, ignorance or due to less emphasis on cosmetics when there are many more core issues to focus onto. They are also commonly passed off as positional skull abnormality due to head position that would get corrected with time. Even if reported, they present at a much older age when the results are not as good as in infants.

By definition, craniosynostosis is premature closure of skull sutures before the complete development of brain. It is either syndromic or non syndromic, the latter is more commonly encountered. There are hundreds of syndromes associated with craniosynostosis but the commoner ones are Crouzon’s, Apert’s, Pfeiffer and Saethre–Chotzen syndromes and they are autosomal dominant. The non syndromic ones are usually sporadic but one study quoted 6% of genetically–linked scaphocephaly.

Children with abnormally–shaped skulls are prey to great psychological trauma due to taunting from their peers. There are also reports of delayed poor cognitive performances or even raised intracranial pressure in these children. Lots of ocular abnormalities like squint, nystagmus or optic atrophy may occur when anterior sutures are involved. The common genes involved are FGRF 1 and 2 and TWIST genes though a huge list of genes are being associated with this condition.

The diagnosis is simple by clinical observation and skull radiographs. High definition 3D CT scan of skull aids in better planning but comes at the cost of radiation exposure to small babies which can better be avoided. The treatment is surgical by remodelling of skull bones and is done in neurosurgical and plastic surgery centers. Best results are obtained in infants less then 9 month, a relatively simple and safe surgery. So, the time has come to shed off the myth that craniosynostosis is just a cosmetic deformity and let the babies get treated in the right age by the right surgeon for the right results before it casts its ugly shadow with malfunctioning of the maldeveloped brain. (Dr Suchanda B, Neurosurgeon, suchanda@hotmail.com)

Children can now be prescribed the antihypertensive Benicar

In February this year, the FDA gave its nod to Benicar (olmesartan medoxomil) for the treatment of hypertension in children aged 6 to 16 years based on the results of a phase 3 study of Benicar in pediatric patients. It may be used as monotherapy or given in combination with other antihypertensive agents.

Breast cancer drug Tykerb now approved in combination as first–line therapy

The antineoplastic agent Tykerb (lapatinib) has been approved to be given in combination with with Femara (letrozole) as a first–line oral regimen for hormone-positive and human epidermal growth factor receptor 2 (Her–2)–positive advanced breast cancer in postmenopausal women who are candidates for whom hormonal therapy. In a double–blind, placebo–controlled study, women who were treated with this combination had a 5.2–month increase in median progression–free survival vs women treated with only letrozole.

An extended–release formulation of trazadone approved for adult depression

Based on the results of an 8–week, randomized, double–blind, 2–arm, multicenter study of patients with unipolar major depressive disorder (MDD), trazodone hydrochloride (Oleptro) has been FDA approved as an extended–release tablet for the treatment of MDD in adults. The tablet is to be given once–daily.

Conference Calendar

Prevent India 2010 (Dynamic Programme on Preventive Cardiology)
Date: March 13–14, 2010
Venue: Hotel Marriott Convention Centre, Hyderabad, Andhra Pradesh.

Quote of the Day

If we could all hear one another’s prayers, God might be relieved of some of his burdens. (Ashleigh Brilliant)

Diabetes Fact

Meglitinides (nateglinide and repaglinide) increase insulin and pre formed insulin, are short acting and used in post prandial hyperglycemia

Public Forum (Press Release)

Obese people are more prone to heart failure

Obesity or extra body weight is a major risk factor for coronary artery disease and congestive heart failure.

Since obesity places increased burden on heart it is also associated with enlargement of heart, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor, eMedinewS.

Obesity can lead to a large scale morbidity culminating in mortality in some cases.

Extra body weight also places a burden on the lungs by making breathing difficult.

It predisposes a person to a number of other illnesses including stiffness of joints, atherosclerosis (hardening of arteries), hypertension and gallstones especially in fat women.

Most of these conditions can be reversed if the patient sheds extra weight. But the loss in weight should be gradual and without any ups and downs. It must not rebound.

A person is said to be obese when he reaches a level more than 10 percent above his ideal body weight, which is the standard weight of a person depending on his or her height and the body frame.

The pot–belly obesity where the measurement of the waist is more than that of the hip, is more dangerous.

The body gains weight when the intake of calories exceeds what the body needs for physical activity and growth. The basic principle to lose weight is that one must consume fewer calories than one expends. In this context, "Walk more and eat less" has been recommended. Half an hour of cycling and a brisk walk every day can be helpful.

People should miss a meal a week. Obese people should avoid eating too many sweet, sour and salty things. They may eat more of bitter things like neem, karela and bel, and also ginger.

Question of the day

What are the foods and beverages that are better tolerated by IBS and IBD patients?

  1. Water, ginger ale, sprite and gatorade

  2. Soy milk or rice milk

  3. Soy–or rice–based products

  4. Plain pasta, plain noodles, white rice. No sauces or gravies

  5. Potato: boiled or baked. No French fries

  6. Breads: French, Italian, whole white, English muffins and white rolls

  7. Plain fish, plain chicken, plain turkey or plain ham

  8. Eggs: soft–boiled, poached

  9. Cereals: Plain cornflakes, rice krispies, Cheerios; dry or with soymilk or rice milk.

  10. Salads: lettuce, hard–boiled egg slices, oil and vinegar dressing

  11. Cooked peas, carrots (avoid raw vegetables)

  12. Margarine, jams, jellies, peanut butter.

  13. In small amounts: apple sauce, cantaloupe, watermelon, honeydew melon, fruit cocktail, peaches, pears (canned, nondietetic).

     (Suggested reading: MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis 2007;13:91.)

eMedinewS Try this it Works

Put on a happy face

Blow up a latex exam glove and draw a happy face on it. Ask the parent to hold the balloon and move it from side to side to help you with the examination of the child.

Dr Good Dr Bad

A patient with acute heart attack was not fit for reperfusion therapy
Dr Bad: Start 60 mg prasugrel.
Dr Good: Chew 300 mg aspirin and 300 mg clopidogrel.
Lesson: For patients receiving no reperfusion therapy, start clopidogrel 300 mg as opposed to prasugrel.

Make Sure

Situation: A 4–year–old girl with rickets is unresponsive to high doses of vitamin D.
Reaction: Oh my God! Why didn’t you advise alfacalcidol?
Make sure to advise alfacalcidol in patients unresponsive to calcium/vitamin D therapy. Alfacalcidol, in numerous studies, has been found to be effective in refractory cases of rickets.

Medi Finance
(BUDGET 2010–2011)

Direct Taxes Individual

Income tax slabs for resident woman taxpayers to be as follows:

Income upto Rs 1.9 lakh Nil
Income above Rs 1.9 lakh and upto Rs. 5 lakh 10 %
Income above Rs.5 lakh and upto Rs. 8 lakh 20 %
Income above Rs. 8 lakh 30 %
Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

OPD Note: Patient has two teenaged children, but no other abnormalities.

Formulae in Critical Care

Peak expiratory flow rate (PEFR) in males
Formula: [Height (in inches) × 0.0254 × 5.48] + 1.58 – [Age (in years) × 0.041 × 60]

Milestones in Neurology

Alfons Maria Jakob (1884–1931) was a German neurologist with important contributions in neuropathology. Jakob made a lecture tour of the United States and South America where he wrote a paper on the neuropathology of yellow fever.

Mistakes in Clinical Practice

Give specific instructions. ‘Use as directed’ is not appropriate.

11th March World Kidney Day (Dr N P Singh)

Kidney diseases are common: More than 5% of the adult population have some form of kidney damage, and every year millions die prematurely of cardiovascular diseases linked to Chronic Kidney Diseases (CKD).

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

More than 50% of men above 50 years have prostatic enlargement, out of them only 17% will have varying degree of LUTS (lower urinary tract symptoms).

Lab test (Dr Navin Dang)

Only tissue diagnosis is conclusive. Where tissue diagnosis is not possible, clinical correlation along with radiology findings is mandatory

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Glatiramer Acetate Injection (20mg/ ml) & Pre–filled syringe (20mg/ml)

For the reduction of the frequency of relapses in patients with Relapsing-Remitting Multiple Sclerosis.

3.06.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second eMedinewS–revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited.

Stress Management Workshop (April 17–18)

A Stress Management Workshop with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized on April 17–18, 2010.

Organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, in association with IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Center, National Highway 8, Bilaspur Chowk Pataudi Road, Near Manesar.

Timings: On Saturday (2pm onwards) and Sunday (7am 4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. For booking e–mail to emedinews@gmail.com or sms to Dr KK Aggarwal 9811090206/ BK Sapna 9811796962

Stroke Update Workshop for GPs

Indian Stroke Association and International Stroke Conference is organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. ConfluenceMedical Humanities Group, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi organized its second lecture of Confluence on February 25th, 2010. Renowned rationalist Sanal Edamaruku, founder president of Rationalist International addressed an august gathering vividly on the topic ‘Faith under the scalpel’. He shared his personal encounters with Godmen, tantrics and astrologers and stressed that extraordinary claims requires extraordinary proofs. He gave scientific explanations for a wide range of ‘miracles’ and alleged power demonstrations of supernatural forces. Prof. Shridhar Dwivedi, Head, Dept. of Medicine/Preventive Cardiology began audience–interactive session by reciting his poem on ‘Braving Multiple Maladies with Boldness and Peace –Whose Grace Is This?’ The audience comprising of over 200 enthusiastic medical students, faculty members and other health care workers had a productive session with atheist Sanal Edamaruku. The vote of thanks was proposed by Prof. Navjeevan Singh, Co–ordinator MEU (Medical Education Unit), UCMS: Dr Satendra Singh, Assistant Professor of Physiology, UCMS.

  2. Dear Padma Shri Awardee Dr K K Agarwal: Thanks for raising the issue of Rural MBBS cadre, it needs to be opposed by all means as it will create a new group of quacks, and will in future be a monster to handle in health. The moot point is: "Is it fair to discriminate the rural and urban citizens of India?". I am sure the NHRC will not allow this abject humiliation of the rural people. Moreover it will be a blind end for the poor graduates who unwittingly get trapped in this course! Dr Pradeep Sharma MD,FAMS.Professor, RP Centre AIIMS New Delhi, INDIA