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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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

12th May 2013, Sunday

Binge Eating: New Epidemic of the Society

Binge eating disorder is a newly recognized condition. People with binge eating disorder frequently eat large amounts of food while feeling a loss of control over their eating.

This disorder is different from binge-purge syndrome (bulimia nervosa) because people with binge eating disorder usually do not purge afterward by vomiting or using laxatives. But most people with serious binge eating problems have:

  • Frequent episodes of eating what others would consider an abnormally large amount of food.
  • Frequent feelings of being unable to control what or how much is being eaten.
  • Several of these behaviors or feelings:
    • Eating much more rapidly than usual.
    • Eating until uncomfortably full.
    • Eating large amounts of food, even when not physically hungry.
    • Eating alone out of embarrassment at the quantity of food being eaten.
    • Feelings of disgust, depression, or guilt after overeating.
    • The binges occur at least twice a week for 6 months.

The major complications of binge eating disorder are the diseases that accompany obesity. These include diabetes, high blood pressure, high cholesterol levels, gall bladder disease, heart disease and certain types of cancer.

Out-of-control binge eating is the biggest eating disorder of today more common than anorexia and bulimia combined and contributing to a rise in obesity. Binge eating afflicts 3.5 percent of women and 2 percent of men at some point in their lives.

Binge eating disorder is a little more common in women than in men; three women for every two men have it.

Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.

Large amounts of food high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse. Proteins supplement may reduce the craving.

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

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tPA safe in pediatric stroke

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Dr KK Aggarwal live on News Nation

 
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    National News

The Transplantation of Human Organs Act (THOA) 2011 Amendments

Draft Rules

  1. Tissues have been included under the definition of organ transplant
  2. SWAP organ transplant has been included
  3. Mandatory requirement of transplant coordinator in the centre
  4. Mandatory information to a dead in ICU telling about options for organ donation
  5. Penalty has been increased to 20 lakhs.
  6. Diagnosis of train death made easy by including anesthetist and intensivist in the category of neurologist.
  7. No organ donation from mentally challenged person
  8. Minors cannot donate
  9. Indian cannot donate to foreigners unless near relatives.
  10. Eye enucleation can be done by trained technicians

Source: National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS): TRG 1 meeting on 07.05.2013 at Nirman Bhawan

For comments and archives

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

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, 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)

(http://behumanstopchildabuse.emedinews.in/)

Isolated examination or laboratory findings combined with a disclosure of sexual abuse, specific behavioral changes usually confirm sexual abuse.

    Valvular Heart Disease Update

What is transcatheter aortic valve replacement?

Transcatheter aortic valve replacement is a potential option for patients with severe symptomatic aortic stenosis who are considered inoperable for surgical aortic valve replacement.

(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)

Does a pepper a day keep Parkinson's away?

Peppers, a nicotine-containing vegetable in the same family as tobacco, are associated with a lower relative risk of Parkinson's disease, researchers reported. (Source: Medpage Today)

For comments and archives

Bacterial infections diagnosed in hours with new DNA test

A nanoparticle DNA hybridization device described in separate articles published online May 5 in Nature Nanotechnology and in the April issue of Nature Communications identifies bacterial pathogens in less than 2.5 hours. (Source: Medscape)

For comments and archives

Transfusion cuts bleeds in blood cancers

Prophylactic platelet transfusion in patients with hematologic cancers was associated with fewer days of bleeding and a longer time before a first bleed compared with no prophylactic treatment, researchers found. (Source: Medpage Today)

For comments and archives

Low-dose anticoagulation appears safe, effective with new-generation heart valve

A newer-generation bileaflet mechanical aortic valve used for valve replacement shows success in allowing patients to be safely and effectively managed with low doses of anticoagulant therapy, potentially sparing patients the need for aggressive warfarin anticoagulation that can increase the risk of bleeding. Those are interim results from the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) study of high-risk aortic-valve-replacement (AVR) patients at 36 centers around the country, presented here at American Association for Thoracic Surgery 2013 Annual Meeting . (Source: Medscape)

For comments and archives

Genes influence H. pylori infection

Genetic susceptibility appears to play a role in Helicobacter pylori infection, a genome-wide association in two large studies showed. (Source: Medpage Today)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Why in hypothermia the body can be revived even after hours of death? http://blog.kkaggarwal.com/2013/05/why-in-hypothermia-the-body-can-be-revived-even-after-hours-of-death/ …

@DeepakChopra: The Conscious Lifestyle: Awareness Skills - Holding focus http://www.linkedin.com/today/post/article/20130511004156-75054000-the-conscious-lifestyle-awareness-skills-holding-focus …

 
    Spiritual Update

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

The Seven Dhatus in Ayurveda

As per Ayurveda physiology, food is Brahman and contains the same consciousness as in us and this consciousness is the essence of any food.

Any food digested is converted into three portions, the gross undigested food is converted into waist (feces); the middle one is converted in one of the Dhatus and the subtlest form gets converted into ojas or the immunity.

For comments and archives

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

How can ovulatory problems be detected?

  • Transvaginal ultrasound: Follicular growth can be measured with ultrasound. This is a painless procedure usually done with a probe inserted into the vagina, but may be done with an external probe placed on the abdomen. Prior to ovulation, the follicle is thin-walled and filled with fluid. As the egg inside the follicle develops, the follicle increases in size. Ovulation generally occurs when the follicle measures about 1.8 to 2.5 cm.
  • Endometrial biopsy: Progesterone, a natural ovarian hormone, helps prepare the endometrium to receive an embryo. An endometrial biopsy is occasionally used to determine if a woman has ovulated, and if the endometrium has been adequately stimulated with progesterone. During this office procedure, a small amount of endometrial tissue from inside the uterine cavity is removed and examined under a microscope. This test is performed just before menstruation is expected to begin. In order to interpret the endometrial biopsy, the physician will need to know the day that menstruation begins after the biopsy.
  • Tests to measure hormone levels: Elevated progesterone levels in the blood usually are associated with ovulation. A blood test to measure progesterone can be performed about one week before the anticipated onset of the next menstrual period. The LH surge occurs just before ovulation. Estrogen is secreted by the growing follicle and rises rapidly prior to ovulation. If ovulation is being induced with fertility drugs, frequent estrogen level measurements may be needed to determine follicular growth.
  • Basal body temperature chart: The BBT chart helps to monitor the duration of the different phases of the menstrual cycle, and can help determine if and when ovulation has occurred. During the follicular phase, the woman’s body temperature is relatively low. When progesterone production begins at ovulation, it produces a temperature rise with a minimum increase of 0.5oF. An increased body temperature for several days indicates ovulation has occurred.
 
    An Inspirational Story

A small candle and the man

I’m really interested in story about a small candle carried by a man who was climbing the stairs of a lighthouse.

In their way up to the top, the candle asked the man, "Where are we going?" "We’re going to the top of this lighthouse and give signals to the big ships on the ocean," the man answered.

"What? How could it be possible for me with my small light to give signals to those big ships?" "They will never be able to see my light", replied the candle weakly. "That’s your part. If your light is small, let it be. All you have to do is keep burning and leave the rest to me", said the man.

A little later, they arrived at the top of the lighthouse where there was a big lamp with a loop behind it. Then the man lit the lamp with the light of the candle and instantly, the place shone so brightly that the ships on the ocean could see its light.

With our being and our limitations, we’re hardly able to do any meaningful things. Yet, one thing you should bear in mind is that your life is like a small candle in God’s powerful hand. All your abilities and expertise will remain as a small light if you don’t put your life in God’s hand. On the contrary, even if your light is so small or dim, if you entrust all your life to God, he is able to make your small light into a big one that brings blessings to many people.

Even it wasn’t impossible for Joshua, who was Moses’ servant, to feel slightly fear when God ordered him to lead the Israelis invading the Canaan. God comforted and strengthened Joshua that He would never leave him. God even promised him victory over victory. All God asked from him was, "Be strong and very courageous. Be careful to obey all the law my servant Moses gave you; do not turn from it to the right or to the left, that you may be successful wherever you go." (Joshua 1:7)

Do not look at your inability, limitations, and weaknesses. God entrust you with something, whether it is a work or a ministry. Have faith that you are in His mighty hand that He will use you according to His will. When we put all our trust in Him, we will see how He uses our lives, including our limitations, to be blessings to others.

For comments and archives

 
    Cardiology eMedinewS

More clinic time leads to better glycemic control Read More

 
    Pediatric eMedinewS

Govt launches drive to create awareness on immunization 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)

Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it.
Dr. Good: Continue it.
Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.

Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

 
    Quote of the Day (Dr GM Singh)

If you have zest and enthusiasm you attract zest and enthusiasm. Life does give back in kind. Norman Vincent Peale

 
   Mind Teaser

Read this…………………

A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

a. Phosphate binders
b. Insulin
c. Antibiotics
d. Cardiac glycosides

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s  Mind Teaser: b. A new cast is needed every 1 to 2 weeks

Correct answers received from: DR P K SAHU, Raju Kuppusamy, Dr Arpan Gandhi, DR Santhakumari, Dr shashi saini, Dr.Jayashree Sen & Dr.Bitaan Sen, Dr. B.B. Gupta, Dr.K.V.Sarma, Dr. Thakor Hitendrsinh G, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr.Chandresh Jardosh, Dr Vineeta Pande, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr B K Agarwal, Dr.Jayashree Sen & Dr.Bitaan Sen

Answer for 10th May Mind Teaser: a. Clarify the patient's report by reviewing the patient's nonverbal behavior.

Correct answers received from: Dr.Jayashree Sen & Dr.Bitaan Sen, Dr. B.B. Gupta, Dr.K.V.Sarma, Dr. Thakor Hitendrsinh G, Dr Pankaj Agarwal, Dr Jainendra Upadhyay

Send your answer to ijcp12@gmail.com

 
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   Laugh a While (Dr GM Singh)

All the desirable things in life are either illegal, expensive or fattening or married to someone else.

 
    Medicolegal Update

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

Immunization death and legal autopsy

  • It is recommended that an autopsy in a death suspected to be due to an adverse event following immunization (AEFI) be performed as soon as possible (within 72 hours) to avoid tissue damage, development of post mortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
  • The detailed patient’s history is included in the autopsy form that it is submitted to the team (autopsy surgeon/pathologist/forensic specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased, which may be cause of death or contributed in the cause of death.
  • Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference labs through investigating police agencies. The samples should be collected and transported to forensic labs as early as possible to avoid loss of biological samples due to decomposition.
  • All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
  • Samples for histopathology to be sent to a pathologist to detect underlying disease/pathologies in the deceased that may have caused or contributed to death. The samples should be representative of the suspicious area of disease/pathology; however, in general liver (80–100gm), brain (100 gm) with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen and whole heart should be sent.
  • All the visceral specimens should be collected in separate containers or a wide–mouthed bottle as prescribed; 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen 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 pathological examination.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Women should quit smoking to lower their risk of heart disease

12th May is Mother’s Day

Smoking is still the leading preventable cause of death. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases. As per WHO, an estimated 3 million people in industrialized countries will have died as a result of tobacco use by 2030, and an additional 7 million people in developing countries face the same fate.

The harms of smoking are reversible and can decline to the level of nonsmokers, as per a report in Journal of the American Medical Association, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

Women who quit smoking have a 21 percent lower risk of dying from coronary heart disease within five years of quitting their last cigarette. The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease. For chronic obstructive pulmonary disease, it may take up to 20 years. It's never too early to stop, and it's never too late to stop.

Women who are current smokers have almost triple their risk of overall death compared with non smoker women. Current smokers also have a 63 percent increased risk for colon cancer compared with never-smokers, while former smokers have a 23 percent increased risk. There was no significant association between smoking and ovarian cancer.

Women who started smoking earlier in life are at a higher risk for overall mortality, of dying from respiratory disease and from any smoking-related disease. However, a smoker's overall risk of dying returns to the level of a never-smoker 20 years after quitting. The overall risk declines by 13 percent within the first five years of abstaining. Most of the excess risk of dying from coronary heart disease vanishes within five years of quitting.

For chronic obstructive pulmonary disease, the return to normal takes 20 years, although there is an 18 percent reduction in the risk of death seen within five to 10 years after quitting.

And the risk for lung cancer does not return to normal for 30 years after quitting, although there is a 21 percent reduction in risk within the first five years.

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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