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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri 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; Chairman Ethical Committee 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


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  Editorial …

5th April 2012, Thursday

Forgetfulness — 7 types of normal memory problems

It’s normal to forget things from time to time, and it’s normal to become somewhat more forgetful as you age. But how much forgetfulness is too much? How can you tell whether your memory lapses are within the scope of normal aging or are a symptom of something more serious? Healthy people can experience memory loss or memory distortion at any age. Some of these memory flaws become more pronounced with age, but — unless they are extreme and persistent — they are not considered indicators of Alzheimer’s or other memory–impairing illnesses.

Seven normal memory problems

  1. Transience: This is the tendency to forget facts or events over time. You are most likely to forget information soon after you learn it. However, memory has a use–it–or–lose–it quality: memories that are called up and used frequently are least likely to be forgotten. Although transience might seem like a sign of memory weakness, brain scientists regard it as beneficial because it clears the brain of unused memories, making way for newer, more useful ones.
  2. Absentmindedness: This type of forgetting occurs when you don’t pay close enough attention. You forget where you just put your pen because you didn’t focus on where you put it in the first place. You were thinking of something else (or, perhaps, nothing in particular), so your brain didn’t encode the information securely. Absentmindedness also involves forgetting to do something at a prescribed time, like taking your medicine or keeping an appointment.
  3. Blocking: Someone asks you a question and the answer is right on the tip of your tongue — you know that you know it, but you just can’t think of it. This is perhaps the most familiar example of blocking, the temporary inability to retrieve a memory. In many cases, the barrier is a memory similar to the one you’re looking for, and you retrieve the wrong one. This competing memory is so intrusive that you can’t think of the memory you want. Scientists think that memory blocks become more common with age and that they account for the trouble older people have remembering other people’s names. Research shows that people are able to retrieve about half of the blocked memories within just a minute.
  4. Misattribution: Misattribution occurs when you remember something accurately in part, but misattribute some detail, like the time, place, or person involved. Another kind of misattribution occurs when you believe a thought you had was totally original when, in fact, it came from something you had previously read or heard but had forgotten about. This sort of misattribution explains cases of unintentional plagiarism, in which a writer passes off some information as original when he or she actually read it somewhere before. As with several other kinds of memory lapses, misattribution becomes more common with age. As you age, you absorb fewer details when acquiring information because you have somewhat more trouble concentrating and processing information rapidly. And as you grow older, your memories grow older as well. And old memories are especially prone to misattribution.
  5. Suggestibility: Suggestibility is the vulnerability of your memory to the power of suggestion — information that you learn about an occurrence after the fact becomes incorporated into your memory of the incident, even though you did not experience these details. Although little is known about exactly how suggestibility works in the brain, the suggestion fools your mind into thinking it’s a real memory.
  6. Bias: Even the sharpest memory isn’t a flawless snapshot of reality. In your memory, your perceptions are filtered by your personal biases — experiences, beliefs, prior knowledge, and even your mood at the moment. Your biases affect your perceptions and experiences when they’re being encoded in your brain. And when you retrieve a memory, your mood and other biases at that moment can influence what information you actually recall. Although everyone’s attitudes and preconceived notions bias their memories, there’s been virtually no research on the brain mechanisms behind memory bias or whether it becomes more common with age.
  7. Persistence: Most people worry about forgetting things. But in some cases people are tormented by memories they wish they could forget, but can’t. The persistence of memories of traumatic events, negative feelings, and ongoing fears is another form of memory problem. Some of these memories accurately reflect horrifying events, while others may be negative distortions of reality. People suffering from depression are particularly prone to having persistent, disturbing memories. So are people with post–traumatic stress disorder (PTSD). PTSD can result from many different forms of traumatic exposure — for example, sexual abuse or wartime experiences. Flashbacks, which are persistent, intrusive memories of the traumatic event, are a core feature of PTSD.

(Source: HealthBeat)

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7types of normal memory problems

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    Photo Feature (from the HCFI Photo Gallery)

Social Intelligence: The New Science of Success

Social Intelligence is the ability to get along well with others and to get them to cooperate with you. Mary Keightley, Speaker, Trainer, and Coach at Mind Associates Ltd, Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Dr K K Aggarwal
    National News

India’s e–waste output jumps 8 times in 7 years

THIRUVANANTHAPURAM: India’s output of e–waste has jumped by eight times in the past seven years and the open yet illegal incineration of massive quantities of such trash may lead to serious public health hazards, a government report says. According to the latest annual report of the Union ministry of environment and forest (MoEF), by the end of 2012, India would have generated a whopping eight lakh tonnes of e–waste – up eight times in the past seven years. Environmentalists point out that an additional 50,000 tonnes is imported from developed countries despite a ban. "The burning of metals can give rise to dioxins and furans during incineration. Arsenic and asbestos may act as a catalyst to increase the formation of dioxins, which is carcinogenic in nature," the report says. E–waste includes household electronic appliances, toys, electrical and electronic tools, medical devices, mobile phones, monitoring and control instruments, automatic dispensers, I–T and telecom equipment and consumer electronic items. (Source: TOI, Apr 4, 2012)

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Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

Sleep apnea tied to depression

Both men and women with obstructive sleep apnea are at elevated risk for major depression, a large nationwide survey revealed. (Source: Medpage Today)

For comments and archives

Diagonal ear lobe crease associated with coronary artery disease

A diagonal ear lobe crease (DELC) is indeed associated with coronary artery disease as evaluated by coronary CT angiography, a new study confirms. DELC is a wrinkle–like line extending diagonally from the tragus across the lobule to the rear edge of the auricle and is unrelated to sleeping position or earrings. (Source: Medscape)

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IL–17 new target in Psoriasis

Targeting the interleukin (IL)–17 signaling pathway may provide an effective and specific treatment approach for patients with moderate–to–severe plaque psoriasis, two multicenter randomized phase II trials suggested. (Source: Medpage Today)

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FDA softens Celexa arrhythmia warning

The FDA has reworded warnings about potentially fatal arrhythmias associated with the antidepressant drug citalopram (Celexa), acknowledging that some patients may need the drug despite the risks. Last August, the agency ordered numerous changes to the drug’s label, including one stating that citalopram is contraindicated in patients with congenital long QT syndrome. Other new revisions to the label included the following: (Source: Medpage Today)

  • Recommending electrolyte and/or electrocardiographic monitoring in patients at risk for arrhythmia if citalopram therapy is considered
  • A maximum daily dosage of 20 mg for all patients older than 60
  • Discontinuing the drug if QTc measurements are consistently greater than 500 ms

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@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Tips for patients with family histo…: http://youtu.be/Tu7_rpEl3jI via @youtube

@DeepakChopra: The most good you can do for yourself spiritually is to live your life with total love, conviction, and purpose

    Spiritual Update

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

You cannot serve Two Masters (God and Wealth)

This is true for both your internal spiritual journey as well as the external social journey in life. Wealth is an indicator of greed which is one of the five known obstacles to the pathway of self–realization. Greed according to the Patanjali is defined as possessing any material wealth more then your need

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    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is embryo cryopreservation?

Embryo cryopreservation is the most common way of preserving your ability to get pregnant in the future. Before freezing the embryos, you undergo a procedure called in vitro fertilization (IVF). In IVF, you will be given hormones to stimulate the growth of your eggs. After that the eggs will be aspirated (removed by gentle suction). Embryos are then produced by joining the sperm and egg together in the laboratory. The embryos are then frozen. If you decide you want to have children after your cancer treatment is completed, one or two embryos can be placed in your uterus (womb) with or without the help of medications. Embryo cryopreservation offers the best chance of pregnancy. The odds of an embryo surviving the freezing and thawing process and implanting in your uterus are much higher than those noted with thawing and fertilizing an unfertilized egg or ovarian tissue.

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    Hepatitis A Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon)

Who should get hepatitis A vaccine? (CDC guidelines)

  • All children between their first and second birthdays (12 through 23 months of age)
  • Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A
  • Children and adolescents 2 through 18 years of age, who live in high disease incidence areas.
  • Male homosexuals
  • People who use street drugs
  • People with chronic liver disease
  • People who are treated with clotting factor concentrates
  • Members of households planning to adopt a child from a country where hepatitis A is common
  • Unvaccinated children or adolescents in communities where outbreaks of hepatitis A are occurring
  • Unvaccinated people who have been exposed to hepatitis A virus

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    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

What is the importance of knowing the blood groups?

For all practical and routine purposes, it is ideal to transfuse to the patient the same group of blood, which he belongs to. It is only under very dire emergency that we take O Group as universal donor and AB Group as universal recipient. Under no circumstances can O group should be given any blood other than Group O. Similarly, patient with blood group A cannot be given B group blood and vice versa.

This is due to the reason that, the blood of A Group people contains anti–B antibodies. In B group people there are anti–A antibodies. If we give A group blood to a B group patient, it is bound to be incompatible and will result in serious consequences.

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    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Introduction of Transfer Pricing provisions to Specified Domestic Transactions

In line with Supreme Court Ruling in case of Glaxo Smithkline Asia(P) Ltd– Special Leave to Appeal (Civil) No(s).18121/2007

  • A new Section has been introduced by which Specified Domestic Transactions have been brought under the purview of Transfer Pricing regulations
  • The computation of value of Specified Domestic Transactions will be as per Arm’s Length provisions under Transfer Pricing regulations
  • The provision would be applicable if the value of Specified Domestic transactions in aggregate exceeds 5 Crore.
  • The Specific Domestic Transactions for the purposes of application of Transfer Pricing provisions would be as follows:
    • Expenses/payment transactions between related persons as covered under the provisions of Section 40 A (2) (b);
    • Transfer of goods/services/business from one unit/undertaking of the Assessee to another unit/undertaking of the assessee, claiming benefit under Section 80 IA, under Chapter VI A or 10 AA where the provisions of 80IA are applicable;
  • The Assessee would be required to maintain/furnish documentation and obtain certification of Specified Domestic Transactions
  • The other Transfer Pricing provisions pertaining to international transactions would also be applicable for Specified Domestic Transactions

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    An Inspirational Story

(Ms Ritu Sinha)

Luck Favors Those Who Help Themselves

A flood was threatening a small town and everyone was leaving for safety except one man who said, "God will save me. I have faith." As the water level rose a jeep came to rescue him, the man refused, saying "God will save me. I have faith." As the water level rose further, he went up to the second storey, and a boat came to help him. Again he refused to go, Belying, "God will save me. I have faith." The water kept rising and the man climbed on to the roof. A helicopter came to rescue him, but he said, "God will save me. I have faith."

Well, finally he drowned. When he reached his Maker he angrily questioned, "I had complete faith in you. Why did you ignore my prayers and let me drown?" The Lord replied, "Who do you think sent you the jeep, the boat, and the helicopter?"

The only way to overcome the fatalistic attitude is to accept responsibility and believe in the law of cause and effect rather than luck.

It takes action, preparation and planning rather than waiting, wondering or wishing to accomplish anything in life.

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    Fitness Update

(Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, www.mymonavie.com/sonraj)

Physical activity increases bone mineral density in children with type 1 diabetes

According to the American Diabetes Association, 1 in 400 American children have diabetes, and most are type 1. Recently, osteoporosis has become a growing health problem among people with type 1 diabetes. This trend prompted a recent study looking at the effects of weight bearing exercise on bone mass in diabetic and non–diabetic children. Participants (diabetic and non–diabetic) were randomly divided into two groups: the first did not engage in any physical activity, while the second engaged in two 90 minute sessions per week of weight bearing activities such as jumping rope, ball games, and gymnastics. After nine months, children, both diabetic and non–diabetic, who had participated in the exercise program (180 minutes/week) showed significant positive changes in bone mineral density compared to the other group. All children, and especially those with type 1 diabetes, should be encouraged to participate in at least 180 minutes of weight bearing exercise per week to promote bone health.

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    Cardiology eMedinewS

Yogurt Drink Good for Diabetes Read More

FDA Panel Wants Cardio Studies for Weight–Loss Drugs Read More

Fractional Flow Reserve Therapy Trial Shows Positive Results. Read More

    Pediatric eMedinewS

Lung Function Deficits In Babies May Lead To Future Asthma Read More

U.S. Program Helps Cut Infant Hbv Infections Read More

Prophylaxis Effective Up To 10 Days For Varicella Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 44–year–old male came with painless blood in the urine.
Dr. Bad: Do not worry. It is benign condition.
Dr. Good: I need to rule out cancer of the urinary bladder.
Lesson: Cancer of the urinary bladder usually presents with painless blood in the urine.

For comments and archives

Make Sure

Situation: A patient with uncomplicated gonorrhea comes to hospital for treatment.
Reaction: Oh my God! Why did I advise ampicillin to this patient?
Lesson: Make sure to remember that uncomplicated gonorrhoea can be cured by administering oral doxycycline.

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  Quote of the Day

(Dr GM Singh)

Too many people spend money they haven’t earned, to buy things they don’t want, to impress people they don’t like. Will Rogers

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Allergy testing

Allergies are hypersensitivities, overreactions of the immune system to substances that do not cause reactions in most people. Immunoassay and Line Blot Tests are used to screen for type I allergen–specific IgE antibodies.

    Mind Teaser

Read this…………………

Elective cesarean section at 38 weeks of pregnancy before the onset of labor or rupture of membrane decreases transmission by:

a. 50–80%
b. 80–90%
c. 10–20%
d. 5–10%

Yesterday’s Mind Teaser: Polyps are generally managed endoscopically. Which of the following is not an indication for resectional surgery?

a) Lymphovascular invasion
b) Poor differentiation
c) Flat or ulcerated lesion
d) Lesion in upper one–third of submucosa

Answer for Yesterday’s Mind Teaser: d) Lesion in upper one–third of submucosa

Correct answers received from: Dr PC Das, YJ Vasavada, Raju Kuppusamy, Dr Chandresh Jardosh,
Dr Thakor Hitendrsinh G, Dr Jainendra Upadhyay.

Answer for 3rd April Mind Teaser
: c) Astrocytomas
Correct answers received from: Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Pathan doesn’t pay

One fine day, a bus driver went to the bus garage, started his bus, and drove off along the route. No problems for the first few stops – a few people got on, a few got off, and things went generally well.

At the next stop, however, a big hulk of a Pathan got on. Six feet four, built like a wrestler, arms hanging down to the ground. He glared at the conductor and said, "Pathan doesn’t pay!" and sat down at the back.

Conductor didn’t argue with Pathan, but he wasn’t happy about it. The next day the same thing happened – Pathan got on again, made a show of refusing to pay, and sat down. And the next day, and the next.

This grated on the bus driver, who started losing sleep over the way Pathan was taking advantage of poor conductor. Finally he could stand it no longer. He signed up for body building courses, karate, judo, and all that good stuff.

By the end of the summer, he had become quite strong; what’s more, he felt really good about himself. So, on the next Monday, when Pathan once again got on the bus and said, "Pathan doesn’t pay!"

The driver stood up, glared back at Pathan, and screamed, "And why not?"

With a surprised look on his face, Pathan replied, "Pathan has a bus pass."

Moral: Be sure there is a problem in the first place before working hard to solve one.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Samples for toxicological/chemical examination

The doctor conducting the autopsy is duty bound to do sampling for toxicological screening to be sent to forensic laboratory for toxicological/chemical examination

  • The site of injection and the underneath tissues up to 2–3 cms (button size) with dermis and epidermis of the sight of injection prick should be excised out. It should be preserved in a glass jar, which should be filled two–third with saturated saline water. The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police or the investigating officer for further toxicological/chemical examination.
  • The following viscera specimen/biological samples should be collected for toxicological/chemical examination: 80 to 100 gms of liver, 80 to 100 gms of brain with meninges, whole of the stomach with gastric contents. If there are no gastric contents, a section of stomach should be sent. The upper part of small intestine about 30cm long with its contents, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen, blood 100 ml ideal/minimum 10 ml and urine 100 ml/minimum 10 ml.
  • All the visceral specimens should be collected in separate containers, a wide–mouthed bottle as prescribed and saturated saline should be added as preservatives. The quantity of the saline should be sufficient to cover all the pieces of viscera in bottle.
  • The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further chemical examination in a forensic lab.

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    Public Forum

(Press Release for use by the newspapers)

Non violence in action, thoughts and actions can prevent heart attacks

Non violence in action, thoughts and actions can prevent heart attacks, said Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal and Vice Chairman World Fellowship of Religions on the occasion of Mahavir Jayanti the birth day of Mahavira, the last Tirthankara (human beings that achieve enlightenment and become spiritual leader). During Mahavir Jayanti celebration, devotees and practitioners go to Jain temple to pay respect, by bathing Mahavira statues, then proceed to offer prayers and meditate. Monks lead special services and teach the virtuous path. Donations and other charitable acts are encouraged on this day.

To practice non violence one should practice the 3C’s of non violence and they are Not Criticizing, Not Condemning and Not Complaining. Being cynical is also a part of the same, which is fault finding for everything. Cynicism has been studied as a potential cause of heart disease. Studies using American and European populations have demonstrated that high levels of anger/ hostility are predictive of coronary heart disease (CHD) mortality.

Anger, hostility and aggression are three risk factors for heart attack with the fulcrum at the level of anger. A thought arises from the thoughtless state of mind called consciousness, which is then analyzed by the intellect and converted into an action, which is either egocentric or ego–fugal. All actions lead to memory and memory leads to desire. If the desire can be fulfilled, it will end up into action again and the cycle of action, memory and desire continues leading to habit or an addiction.

If the desire is not fulfilled, the first reaction is anger. The response to anger can be an acute reaction with aggressive behavior or chronic suppression leading to cynicism and hostility. It can also be sub–acute transient suppression, which, if repetitive, has the same effects as hostility or cynicism.

While aggressive behaviour after an episode of anger can raise blood pressure and pulse rate acutely, chronic suppression of anger with resultant hostility can cause a permanent over–sympathetic state – clinically characterized by a persistently higher pulse rate.

It is a well-known phenomenon that people who have higher resting basal pulse rate die prematurely and also chances of sudden cardiac death are higher amongst them.

Anger phenomenon was well described in our Vedic literature by Lord Shiva who is also named as Neelkanth. In Vedic language, Vish is acute poison and Vishaya is slow poison consisting of attachment, anger, desire, greed and ego. The message from Neelkanth Shiva is – one should neither drink poison (chronic suppression of negative thoughts) nor spit poison (aggressive behavior) but instead one should manage stress by transiently suppressing emotions (keeping the poison in the throat by Lord Shiva). Stress, therefore, should be acted and not reacted upon.

Amongst anger, hostility and aggression, anger is the root cause. A burst of anger can release chemicals like adrenalin and non-adrenalin, which can rupture a soft blockage inside coronary artery supplying blood to the heart. The rupture of the blockage can initiate the process of formation of clot within the coronary artery leading to cessation of blood flow. In acute heart attack, the patient may present with sudden cardiac arrest or acute chest pain. This clot, if not dissolved in time either by clot dissolving therapy or by angioplasty device can end up with high mortality and morbidity.

High risk patients, defined as uncontrolled diabetes, uncontrolled blood pressure, obesity, strong family history etc. should avoid acute anger and chronic anger states.

While evaluating a person’s cardiovascular risk, many new parameters now have been added which include hostility score, basal pulse rate, pulse variability and heart rate response to exercise.

To reduce sympathetic over activity and to reduce resting heart rate, the methodologies available are pranayam, regular exercise, mind-body relaxation techniques, regular massage etc. Other techniques include acting at the level of thoughts and its analyses using cognitive, behaviour or both therapies.

Learning meditation, relaxation, pranayam etc. can therefore bring about changes in the body, which can withstand a burst of anger more positively. New researches for the last few years have shown that patients who have frequent burst of anger or have higher pulse rate because of suppression of repeated episodes of anger benefit when they are given low dose of prophylactic aspirin as a preventive drug.

Aspirin has anti–platelet action and has been advocated in higher risk individuals with uncontrolled diabetes, blood pressure and cholesterol. This is for the first time aspirin is now recommended in patients with frequent bouts of anger episodes. The Ayurveda and naturopathic counterpart of aspirin is one glove of garlic a day, which has aspirin like properties.

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September 23, 2012 at 9:00 AM – 6:00 PM
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A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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