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Editorial (Dr K K Aggarwal)                                                                                       (Dr RN Tandon)
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14th October, 2017
AHA survey finds only 25% survivors feel confident in preventing another stroke
Dr KK Aggarwal
Results from a new survey conducted by the American Heart Association/American Stroke Association (AHA/ASA) show that stroke survivors have low confidence in their ability to prevent another stroke.
The survey, which included 1,129 adult participants (survivors, caregivers and healthcare professionals) nationwide, was conducted as part of the American Stroke Association's Together to End Stroke
® second stroke awareness campaign. The specific goals of the campaign include:
  • Reducing stroke reoccurrence
  • Reducing 30-day hospital readmission
  • Increasing stroke patient knowledge of risk factors
  • Educating about healthy lifestyle changes and medication adherence
  • Educating about rehabilitation options and benefits
Exercising regularly was reported as the biggest challenge by Survivors (23%). The most common changes that survivors made to their lifestyle since their stroke are taking recommended medication (83%) and taking aspirin daily (63%). Only half of Survivors and Caregivers (49%) were aware of FAST. Both Survivors and Caregivers view high blood pressure as the most important factor putting someone at risk for a second stroke (58% and 59%, respectively).
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Top News
WHO to establish high-level commission on noncommunicable diseases
The World Health Organization (WHO) has established a new High-level global Commission on Noncommunicable Diseases (NCDs). The announcement came at the 64th Session of WHO's Regional Committee for the Eastern Mediterranean being held in Islamabad, 9-12 October.

The commission's aim is to identify innovative ways to curb the world's biggest causes of death and extend life expectancy for millions of people. The commission will support ongoing political efforts to accelerate action on cardiovascular disease, cancers, diabetes and respiratory disease, as well as reducing suffering from mental health issues and the impacts of violence and injuries. The High-level global Commission will be chaired by Dr Sania Nishtar, a prominent global advocate for action against NCDs, former Federal Minister of the government of Pakistan and civil society leader. Dr Nishtar has also previously served as co-chair of the WHO Commission on Ending Childhood Obesity... (WHO, October 10, 2017).
Practice Updates
US FDA clears first 7T magnetic resonance imaging device
The US Food and Drug Administration (FDA) has cleared the first seven tesla (7T) magnetic resonance imaging (MRI) device, more than doubling the static magnetic field strength available for use in the United States. The Magnetom Terra is the first 7T MRI system cleared for clinical use in the US. It can be used in patients who weigh more than 66 pounds, and is limited to examinations of the head, arms and legs (extremities).

 Abatacept effective in patients with refractory dermatomyositis or polymyositis
In a small pilot study published October 9, 2017 in the Annals of the Rheumatic Diseases, 42% patients with refractory dermatomyositis or polymyositis responded to treatment with abatacept with lower disease activity. Anti-inflammatory Foxp3+ regulatory T cells were significantly greater in muscle biopsies indicating a positive effect of treatment in muscle tissue.

Romosozumab-to-alendronate treatment reduces fracture risk in postmenopausal women
In postmenopausal women with osteoporosis who were at high risk for fracture, treatment with the monoclonal antibody romosozumab for 12 months followed by alendronate resulted in a significantly lower risk of fracture than alendronate alone. These findings from a study were published October 12, 2017 in the New England Journal of Medicine.

Study shows association between sports concussion and common mental disorders
A history of concussions is associated with symptoms of common mental disorders and of later development of neurodegenerative disease, in particular chronic traumatic encephalopathy (CTE) in former male professional athletes across a range of contact sports, says a new study reported September 13, 2017 in the Physician and Sportsmedicine.

Gene therapy successful in in early-stage adrenoleukodystrophy
Results of the STARBEAM trial published October 4, 2017 in the New England Journal of Medicine and also presented at the 2017 Child Neurology Society Annual Meeting in Kansas City, USA demonstrate the success of hematopoietic stem-cell gene therapy (Lenti-D) in children with early-stage adrenoleukodystrophy, fatal neurologic degenerative condition suggesting it as a safe and effective alternative to allogeneic stem-cell transplantation.
eMedi Humor
Who Would Know?
The man passed out in a dead faint as he came out of his front door onto the porch. Someone called 911.
When the paramedics arrived, they helped him regain consciousness and asked if he knew what caused him to faint.
"It was enough to make anybody faint," he said. "My son asked me for the keys to the garage, and instead of driving the car out, he came out with the lawn mower!"
Medicolegal Corner
Can the patient ask for his/her medical records?
Yes, a patient has the right to get a copy of his/her medical records if he/she asks for it. The MCI Code of Ethics Regulations 2002 states as follows: "If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours. (1.3.2.)"
eMedi Quiz
Beta-oxidation of odd-chain fatty acids produces: 
1. Succinyl CoA.
2. Propionyl CoA.
3. Acetyl CoA.
4. Malonyl CoA.
Lifestyle Updates
eWellness: A mix of exercise protocol is better

A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease. Only aerobic exercise is also as good as it reduces weight and takes inches off the waist. Just weight lifting alone has very little benefit.
According to a study published in the American Journal of Cardiology, people in the weight-training group gained about 1.5 pounds and those in the aerobic exercise group lost an average of 3 pounds and half an inch from their waists.
Those who did both weight and aerobic training dropped about 4 pounds and 1 inch from the waistline. This group also saw a decrease in diastolic 'lower' blood pressure and the metabolic syndrome score.
Both the aerobic-only group and the combined-exercise group also lowered their levels of bad triglycerides.
ESpiritual: Best time to sign a deal is at 4 pm

As per Ayurveda 2-6 pm in the evening and 2-6 am in the morning are the periods of Vata or creativity. Most poets and writers do their creative work during these times of the day, especially 2-6 am in the morning.
Vata period is more creative and you are less likely to make mistakes. Four pm in the evening is considered the best time to make a deal, sign a document or to send a confession note.
Vata age is old age and Vata month is rainy season. This is one reason that we always pay attention to the advice of the elderly.

(Disclaimer: The views expressed in this write up are my own).

Inspirational: Gossip
A peasant with a troubled conscience went to a monk for advice. He said he had circulated a vile story about a friend, only to find that the story was not true.
"If you would make peace with your conscience," said the monk, "you must first fill a bag with goose downs, go to every door in the village, and drop in each one of them a feather." 
The peasant did as he was told. Then he came back to the monk and said he had done penance for his folly.
"Not yet," replied the monk. "Take a bag, go two rounds again, and gather up every down that you have dropped."
"But the wind must have blown them all away," said the peasant.
"Yes, my son" said the monk. "And so it is with your vile words. Words and goose downs are quickly dropped, but try as hard as you will, you can never get them back."?
SLE is more common in women than in men
People living with lupus are prone to depression

New Delhi, 13 October 2017: Statistics place the prevalence of Systemic Lupus Erythematosus (SLE) in India at 30 per million people. Women are affected more frequently than men (10:1). SLE is a frequently overlooked disease, primarily due to lack of awareness, with the average diagnostic delay standing at almost 4 years.

A chronic disease, SLE is an autoimmune disease with phases of active disease when the symptoms worsen and phases of remission when the disease is quiet or has minimal symptoms. It is the most common form of lupus. The disease also involves the heart, lungs, kidneys, and brain and can be life threatening. People living with lupus are prone to depression.
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