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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

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    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

11th April 2013, Saturday

Eating junk food: it’s in the brain

When it comes to eating junk food one may blame the brain. Addiction is a disease and the same has been proved by a study.

Two areas of the brain have to work together to give the self-control to reject unhealthy foods. California Institute of Technology researchers used MRI to scan the brains of volunteers as they looked at photos of dozens of types of foods and decided which ones they'd like to eat. They found significant differences in the brain activity between people who had self-control in terms of making food choices and those with no self-control.

An area of the brain called the ventromedial prefrontal cortex is involved in all value-based decisions. When ventromedial prefrontal cortex activity decreases, a person will probably reject an item, whereas increased activity means they'll probably choose it.

The study published in the issue of Science found that in people with no self-control, the ventromedial prefrontal cortex seemed to take into consideration only the taste of a food.

In people with good self-control another area of the brain called dorsolateral prefrontal cortex becomes active and modulates the basic value signals so that the self-controllers also incorporate health considerations into their decisions.

The study showed that ventromedial prefrontal cortex is active during every decision and that the DLPFC is more active when a person is using self-control.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Intensive medical treatment prevents second stroke not intracranial stenting

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

In cardiac arrest, CPR 10 should be started within 10 minutes

Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India trained 2236 students at a CPR 10 camp at Bahadur Garh

Dr K K Aggarwal
    National News

Multi-drug resistant TB prevalence three times high in north India: Study

CHANDIGARH: Prevalence of multi-drug resistant (MDR) TB is three times more in north India than the global average projected by the WHO, as reported in TOI. This has come out in a study published recently in an international journal "BMC Infectious Diseases" by PGIMER doctors Sunil Sethi, microbiology department, and Dheeraj Gupta, pulmonary medicine. According to the study, in a sample of 2,100 patients, who were suspected TB cases from Chandigarh, Himachal Pradesh, Punjab, Jammu and Kashmir and Haryana, the prevalence of MDR TB was found to be 9% in newly diagnosed cases, which is 3-5 % globally. A new case of TB was defined as a patient who has never had treatment for TB or who has taken anti-TB drugs for less than a month. There were 121 newly-diagnosed and 98 previously treated patients, of which MDR TB was found to be associated with 9.9% and 27.6% cases respectively.

A majority of patients were between 21 to 50 years of age. This was an Indian Council of Medical Research-funded study for over three years. The study demonstrated high prevalence of drug resistance among pulmonary TB isolates from north India as compared to the WHO estimates for India in 2010. "This could possibly be attributed to the clustering of more serious or referred cases at our tertiary care centre," said Sunil. The study also reasoned that MDR TB is a consequence of lack of proper interventions and stopping the treatment for TB. "If person is diagnosed with MDRTB he has to be treated with 10 drugs per day for at least 2 years and chances of cure is less and cost of medicine is 1 lakh," said Sunil. There was no case of extreme drug resistance (XDRTB), which has been shown worldwide and prevalence in different parts of the country is 2-8 %. The mortality for XDRTB is 80%. (Source: TOI, May 9, 2013)

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, every Thursday 4:30 PM in DD India

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Child abuse: multiple foreign bodies in gastrointestinal tract

The incidents of foreign body ingestion in infants and children are usually viewed as accidents, but these events may be a form of child abuse. We are reporting a case of child abuse who presented with multiple foreign bodies in the gastrointestinal tract. Physicians are required to report abuse when they have reason to believe or to suspect that it occurred. The purpose of reporting is not punishment of the perpetrator – it is the protection of the child. It is certainly in the best interest of the child, because child abuse is a recurrent and usually escalating problem that exposes the child to substantial risk.

Source: Wadhera R, Kalra V, Gulati SP, Ghai A. Int J Pediatr Otorhinolaryngol. 2013

    Valvular Heart Disease Update

Mitral stenosis in the elderly

Mitral stenosis remains a valvular disease of predominantly young people, and rheumatic fever remains the leading cause of mitral stenosis in all age groups.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Can eating peppers help ward off Parkinson's Disease?

Eating foods that contain even a small amount of nicotine, such as peppers, may reduce the risk for Parkinson's disease (PD), new research hints. (Source: Medscape)

Protein rich diet may boost IVF success

Results from a small study suggest that women whose diets consist of at least 25% protein may have more successful outcomes when undergoing assisted reproduction. (Source: Medpage Today)

Cognitive therapy feasible for patients in the ICU

Patients in the intensive care unit (ICU) can participate in cognitive therapy, according to a pilot study presented here at the American Geriatrics Society's (AGS) 2013 Annual Scientific Meeting. (Source: Medscape)

Stroke spikes after Japan tsunami

Elderly men living in the region most affected by the earthquake and tsunami that devastated Japan in 2011 had a significantly higher risk for stroke in the weeks following the disaster, researchers found. (Source: Medpage Today)

Gestational influenza increases risk for bipolar disorder

If a woman has influenza during pregnancy, her child has a nearly 4-fold increased risk of having bipolar disorder later in life, new research shows. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: AJCC Alternative Therapies Lower BP A group of experts has reviewed all the existing studies and concluded... http://fb.me/2mQaGkWyM

@DeepakChopra: I feel that I follow dreams that are way outside my capabilities. Should I still pursue them? http://tinyurl.com/bvdjvmx #askdeepak

    Spiritual Update

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

Why can the body be revived in hypothermia even after hours of death?

It is well known phenomenon that cardiopulmonary resuscitation (CPR) is not successful if the body temperature is less than 35°C.

In hypothermic deaths, a person can be revived even after hours of cardiac arrest. Only once the body temperature is brought back to normal CPR will be effective.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the risks and complications of sonohysterography?

A sonohysterography (SHG) is a very safe procedure. It may cause mild cramping, spotting, or discharge. Some women may experience cramps for several hours. The most common serious complication with SHG is pelvic infection; however, this occurs less than 1% of the time and usually occurs in the presence of pre-existing tubal disease.

    An Inspirational Story

Things Change

Alex W Miller

For most people, graduation is an exciting day – the culmination of years of hard work. My graduation day… was not.

I remember that weekend two years ago. Family and friends had flown in from across the country to watch our class walk across that stage. But like everyone else in my graduating class, I had watched the economy turn from bad to worse my senior year. We graduates had degrees, but very limited prospects. Numerous applications had not panned out and I knew that the next day, when my lease ended, I would no longer have a place to call home.

The weeks ahead weren’t easy. I gathered up everything I couldn’t carry and put it into storage. Then, because I knew my small university town couldn’t offer me any opportunities, I packed up my car and drove to Southern California to find work. But what I thought would take a week dragged into two, and then four, and 100 job applications later, I found myself in the exact same spot as I was before. And the due date to begin paying back my student loans was creeping ever closer.

You know that feeling when you wake up and you are just consumed with dread? Dread about something you can’t control – that sense of impending failure that lingers over you as you hope that everything that happened to you thus far was just a bad dream? That feeling became a constant in my life. Days felt like weeks, weeks like months, and those many months felt like an unending eternity of destitution. And the most frustrating part was no matter how much I tried, I just couldn't seem to make any progress.

So what did I do to maintain my sanity? I wrote. Something about putting words on a page made everything seem a little clearer – a little brighter. Something about writing gave me hope. And if you want something badly enough… sometimes a little hope is all you need!

I channeled my frustration into a children’s book. ‘Beyond the River’ was the story of an unlikely hero featuring a little fish who simply refused to give up on his dream.

And then one day, without any sort of writing degree or contacts in the writing world – just a lot of hard work and perseverance – I was offered a publishing contract for my first book! After that, things slowly began to fall into place. I was offered a second book deal. Then, a few months later, I got an interview with The Walt Disney Company and was hired shortly after.

The moral of this story is… Don’t give up. Even if things look bleak now, don’t give up. Two years ago I was huddled in my car drinking cold soup right out of the can. Things change.

If you work hard, give it time, and don’t give up, things will always get better. Oftentimes our dreams lie in wait just a little further upstream… all we need is the courage to push beyond the river

For comments and archives

  Cardiology eMedinewS

More clinic time leads to better glycemic control Read More

  Pediatric eMedinewS

Obesity: Pre-ordered lunch key to healthy eating Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

How to approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

First three doses of modern rabies vaccine must be very timely and for the fourth and fifth, one or two days of variation is permissible.

    IJCP Special

Dr Good Dr Bad

Situation: An HIV+ patient was found to have increased upper trunk subcutaneous adipose tissue (SAT).
Dr. Bad: It has no significance
Dr. Good: It makes you prone to diabetes.
Lesson: In the study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) trial, increased upper trunk subcutaneous adipose tissue (SAT) and decreased leg SAT are associated with higher 2-hour glucose in HIV infection. These body fat characteristics may identify HIV-infected patients with normal fasting glucose but even so at increased risk for diabetes (Diabetes Care 2011 Nov;34(11):2448-53).

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10-14 days reverses the increased risk of atherosclerosis. Seroepidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.

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  Quote of the Day (Dr GM Singh)

Just for today don’t be angry. Just for today don’t worry. Just for today be grateful and humble. Just for today be honest. Just for today be kind to others.

    Mind Teaser

Read this…………………

Nurse Rose is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents?

a. The cast will be removed in 6 weeks
b. A new cast is needed every 1 to 2 weeks
c. A short leg cast is applied when the baby is ready to walk
d. The cast will be removed when the baby begins to crawl

Yesterday’s Mind Teaser: Yesterday’s Mind Teaser: The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to:

1. Clarify the patient's report by reviewing the patient's nonverbal behavior.
2. Confronting the patient's denial of pain.
3. Obtaining an order for pain medication.
4. Supporting the patient's stoic behavior.

Answer for Yesterday’s Mind Teaser: a. Clarify the patient's report by reviewing the patient's nonverbal behavior.

Correct answers received from: Dr Bharat Bhushan Aggarwal, Dr Deepali Chatterjee, Dr KV Sarma, Tukaram Pagad, Dr Arpan Gandhi, Dr Santha Kumari, Dr Raghavendra Jayesh, Dr K Raju, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr PC Das & Dr Mrs. S Das, Tukaram Pagad.

Answer for9th May Mind Teaser: d. White blood cell (WBC) count of 20,000/mm3

Correct answers received from: Dr BR Bhatnagar, Dr Sushma Chawla.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Teacher: George, go to the map and find North America.
George: Here it is!
Teacher: Correct. Now, class, who discovered America?
Class: George!

    Medicolegal Update

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

No Narcoanalysis without valid consent, rules Supreme Court of India

The most exhausting/frustrating and laborious parts of a criminal investigation are extracting information from uncooperative accused persons and suspects by investigators in India as well as abroad. Since no individual should be forcibly subjected to any of these techniques of interrogation in question, whether in the context of investigation in any criminal cases or otherwise. The narcoanalysis test began to be used with a presumption that it provides a simply, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation.

  • The Supreme Court of India said that so–called narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent.
  • The apex court further said the confession of guilt during the course of the tests can’t be treated as evidence in court.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Take Care of your Mother

Over 60% of mothers believe their biggest health threat is breast cancer but heart disease kills 6 times as many women as breast cancer, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Some risk factors are different for women than for men. Heart disease symptoms may be milder in women. Heart attacks often strike without warning. If a woman does not realize that heart disease is a health threat, she will not make heart-healthy changes or respond to symptoms once they occur.

The woman is at risk if:

  1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to secondhand smoke every day.
  4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise with 60–90 minutes with moderate–intensity activity on most days. About 70% of American women don't exercise regularly.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL cholesterol (High density lipoprotein or "good" cholesterol) is less than 50mg/dL.

    LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches:
    1. LDL–C<100mg/dL, HDL–C>50mg/dL, triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL.
    2. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d.
    3. For diabetic women, LDL should be <100.
    4. For vascular disease and very high risk women, LDL should be<70.
    5. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3T of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  8. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  9. Either natural or through surgery, early menopause–before the age of 40 – is associated with increased risk for cardiovascular disease.
  10. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  11. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  12. A healthy diet consists of eating fruits, vegetables and whole–grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily);
    1. Eating fish, especially oily fish, at least twice a week
    2. Limiting saturated fat to <10% of energy, and if possible to <7%, cholesterol to <300 mg/dL.
    3. Limiting alcohol intake to no more than 1 drink per day
    4. Limiting sodium intake to <2.3 g/d (approximately 1 tsp salt)
    5. Avoiding all trans–fatty acids (listed as "hydrogenated oil" in the ingredients section)
  13. Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  14. Having at least three of a cluster of symptoms that are listed below put her at risk:
    1. High blood sugar >100 mg/dL after fasting
    2. High triglycerides – at least 150 mg/dL
    3. Low HDL (<50 mg/dL in women)
    4. Blood pressure of 130/85 or higher
    5. Waist circumference >35 inches. (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 50118 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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  1. Dear Sir, we like reading emedinews. Regards:Dr Shravan
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