June 14  2015, Sunday
eMedinewS
editorial
Why do commercial and foods cooked by ‘halwais’ taste better?
Dr KK Aggarwal Hydrogenated oils containing trans fats are tastier than foods cooked in plant oils. Most hydrogenated oils involve hydrogenation of palm oils. Hydrogenation increases their shelf life, makes them easier to cook and spoil less easily. French fries, microwave popcorns and food cooked by traditional halwais are cooked in hydrogenated trans fats.

Most commercially catered food prepared from trans fats are tasty and often people overeat by at least 500 calories because of the taste provided by the hydrogenated oils.

Per serving, 5 grams of trans fatty acids is present in French fries, 6 gm in breaded fish burger, 5 gm in breaded chicken nuggets, 2 gm in biscuits, 2.7 gm in margarine, 2 gm in cakes, 1.6 gm in corn chips, 1.2 gm in microwave popcorn and 1.1 gm in pizza.

Four gm of trans fats are present in one parantha, 3.4 gm in one poori, 5.2 gm in one bhatura, 1.7 gm in one dosa, 6.1 gm in one tikki, 3 gm in one samosa, 2 gm in one serving of pakoda, 2.9 gm in one serving of vegetable pulao and 3.6 gm in one serving of halwa.

Just about 2.6 gm a day of trans fats, half as much contained in a packet of French fries can raise the risk of heart disease significantly.

Some trans fats occur naturally in foods, especially those of animal origin. The chemical configuration of trans fatty acids confers harmful effects, including adverse influences on blood LDL– and HDL–cholesterol concentrations. They raise LDL and lower HDL cholesterols. By comparison, consumption of saturated fats also raises the LDL cholesterol concentration, but does not lower HDL. Thus, while saturated fats adversely affect the lipid profile, they may not be as harmful as trans fatty acids.

Trans fatty acids may also interfere with the desaturation and elongation of n–3 (omega–3) fatty acids. These are important for the prevention of heart disease and complications of pregnancy. In an analysis from the Nurses’ Health Study, for each increase of 2 percent of energy from trans fat, the relative risk for incident coronary heart disease was 1.93. There are no known physiologic benefits related to the consumption of trans fatty acids; thus, reduction in their intake makes sense.

The words "partially hydrogenated" on the list of package ingredients are clues to their presence. Since 2006, the US Food and Drug Administration (FDA) has made it a requirement that Nutrition Facts labels portray trans fat content. FDA estimates that the average daily intake of trans fat in the U.S. population is about 5.8 grams or 2.6% of calories per day for individuals 20 years of age and older. On average, Americans consume approximately 4 to 5 times as much saturated fat as trans fat in their diet.

FDA’s label requirement is that if a dietary supplement contains a reportable amount of trans fat, which is 0.5 gram or more, dietary supplement manufacturers must list the amounts on the Supplement Facts panel. The FDA final rule on trans fatty acids requires that the amount of trans fat in a serving be listed on a separate line under saturated fat on the Nutrition Facts panel.

However, trans fats do not have to be listed if the total fat in a food is less than 0.5 gram (or 1/2 gram) per serving.

All restaurants in New York have banned all food items, which contain more than 0.5 gm of trans fats in one serving.

Guidelines
  • Check the Nutrition Facts panel: Choose foods lower in saturated fats, trans fats and cholesterol.
  • Choose alternative fats. Replace saturated and trans fats in your diet with mono- and polyunsaturated fats. These fats do not raise LDL (or "bad") cholesterol levels and have health benefits when eaten in moderation. Sources of monounsaturated fats include olive and canola oils. Sources of polyunsaturated fats include soybean, corn, sunflower oils, and foods like nuts.
  • Choose vegetable oils (except coconut and palm kernel oils) and soft margarines (liquid, tub, or spray) more often because the combined amount of saturated and trans fats is lower than the amount in solid shortenings, hard margarines, and animal fats, including butter.
  • Consider fish. Most fish are lower in saturated fat than meat. Some fish, such as mackerel, sardines and salmon, contain omega–3 fatty acids that are being studied to determine if they offer protection against heart disease.
  • Limit foods high in cholesterol such as liver and other organ meats, egg yolks and full–fat dairy products, like whole milk.
  • Choose foods low in saturated fat such as fat free or 1% dairy products, lean meats, fish, skinless poultry, whole grain foods and fruit and vegetables.
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News
  • Researchers propose that azithromycin can be efficacious against antibiotic-resistant superbugs. The findings are published in EBioMedicine.
  • Individuals who received injections of the glucagonlike peptide-1 (GLP-1) receptor agonist exenatide had dampened responses in the brain's reward system at the sight of chocolate milk and enhanced responses after drinking the chocolate milk, in a small functional MRI (fMRI) study, presented at the American Diabetes Association (ADA) 2015 Scientific Sessions.
  • Cognitive-behavioral therapy (CBT) can improve sleep in patients with chronic insomnia without recourse to drugs or experiencing adverse outcomes, suggests a meta-analysis published online June 9 in the Annals of Internal Medicine.
  • Short sleep duration during pregnancy is associated with increased risk for gestational diabetes mellitus (GDM), independent of maternal age and body mass index (BMI), reported a new study presented at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.
  • In patients with IgA nephropathy, the optimization of supportive care minimizes renal function loss and can do away with the need for immunosuppressive therapy in the great majority of patients, suggested new research presented at the European Renal Association–European Dialysis and Transplant Association 52nd Congress.
Dr KK Spiritual Blog
Always Respect Other’s Viewpoint

It is an old saying that one is proud of his or her own intelligence and somebody else’s partner and wealth. Most disputes occur when there is an ego clash and this occurs when you want your point of view to be noticed by everybody. But remember that for every situation, invariably, there will be multiple opinions.

In one of my meetings, I asked my lifestyle students–cum–colleagues to imagine Rahul Gandhi as the Prime Minister of the country. Following were the views of various people:
  • He is too young.
  • He is immature.
  • He is childish.
  • It will be failure of democracy
  • He has no political will
  • He has no strength for taking decisions
  • He has no experience.
  • He is open–minded.
  • He will bring youth to politics.
  • He has an experienced team behind him.
  • He will bring a new approach to politics etc. etc.
The message is very clear that everybody has their own perception and we should learn to respect that.
Cardiology eMedinewS
  • Researchers have suggested that consumption of nuts and peanuts can help abate the risk of death associated with various diseases including cancer, heart disease and diabetes. They recommend a daily consumption of 15 grams of nuts to bring down the risk.
  • Coronary computed tomography angiography (CTA) and radionuclide myocardial perfusion imaging (MPI) may not be all that different regarding outcomes in patients with chest pain, suggests new research published online in the Annals of Internal Medicine. Researchers noted that 15% of those assigned to CTA after reporting acute chest pain on admission and 16% of those assigned to MPI had a cardiac catheterization within the following year.
Pediatrics eMedinewS
  • Researchers have observed link between reduced bone mineral density in teenager boys and time spend using screen based media. The findings are published in the journal BMJ Open.
  • Children of teen mothers, older parents and parents with an age gap of 10 years or more have a higher risk of autism spectrum disorder than other children, suggested a new study published in Molecular Psychiatry.
Make Sure
Situation: A patient developed high altitude cerebral edema while traveling to Leh.

Reaction: Oh my God, why was acetazolamide not started before the journey?

Lesson: Make sure all high risk patients are given acetazolamide before they travel to mountains.
Dr Good Dr Bad
Situation: A pregnant lady died.
 
Dr Bad: Declare her dead.
 
Dr Good: Deliver the infant within 5 minutes. 

Lesson: Five minute rule - the best outcome with regards to neonatal neurological outcome is most likely when delivery of the infant occurs within five minutes of maternal cardiac arrest.

(Copyright IJCP)
eMedinewS Humor
Health Professionals in Heaven

Three nurses died and went to Heaven. They were met at the Pearly Gates by St. Peter, who questioned them.

"What did you used to do back on Earth?" he asked the first nurse. "Why do you think you should be allowed into Heaven?"

She told him, "I was a nurse at an inner city hospital. I worked to bring healing and peace to many sufferers, especially poor children."

"Very noble. You may enter." And he ushered her through the gates. He asked the same questions to the next nurse.

"I was a missionary nurse in the Amazon. For many years I worked with a small group of doctors and nurses to help people in numerous tribes, healing them and telling them of God's love." The second nurse replied.

"Excellent!" said St. Peter. And he ushered her through the gates as well. Finally he posed his questions to the third nurse. She hesitated, and then explained, "I was just a nurse at an HMO."

St. Peter considered her answer for a moment, then told her, "Well, you can enter too."

"Wow!" the nurse exclaimed in relief. "I almost thought you weren’t going to let me in."

"Oh, you can certainly come in," St. Peter told her, "but you can only stay for three days.".
eMedi Quiz
The cells belonging to which of the following type of epithelium are provided with extra reserve of cell membrane?

1. Transitional
2. Stratified squamous
3. Stratified cuboidal.
4. Stratified columnar.

Yesterday’s Mind Teaser: A 30-year-old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1. Medial rectus and superior division of oculomotor nerve.
2. Inferior oblique and inferior division of oculomotor nerve.
3. Lateral rectus and abducent nerve.
4. Superior rectus and trochlear nerve.

Answer for yesterday’s Mind Teaser:3. Lateral rectus and abducent nerve.

Correct Answers received from: Dr G Madhusudhan, Dr K Raju, Dr Poonam Chablani, Dr Pandit Hantodkar, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 12th June Mind Teaser: 3. Pain sensation on the contralateral side.

Correct Answers received: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan.
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Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF
eIMA News
  • Pulling in nearby CPR-trained lay people via mobile-phone dispatch while paramedics are on their way to an out-of-hospital cardiac arrest appears feasible, a Swedish study showed. The rate of bystander CPR jumped to 62% with use of a mobile-phone positioning system in Stockholm that could instantly locate and dispatch one of about 6,000 mobile-phone users within 500 m (less than a third of a mile) who were trained in CPR and volunteered to be available. (Medpage Today)
  • Regular consumption of sugared beverages is associated with a greater prevalence of fatty liver disease, even after adjusting for body mass index, according to a large observational study in J of Hepatology (Medscape)
  • Spouses or live-in partners of people newly diagnosed with diabetes were twice as likely to develop diabetes themselves — compared with people in the general population — in the year following the initial diagnosis of their loved one, new data from a large Kaiser Permanente study show (American Diabetes Association (ADA) 2015 Scientific Sessions).
  • The Supreme Court will pronounce on June 15 its order on a batch of petitions seeking re-conduct of All India Pre-Medical Entrance Test (AIPMT) following the leak of the question paper and circulation of answer keys through electronic devices at different examination centres across 10 states
  • The Medical Council of India (MCI) has now begun an investigation into the alleged bogus recruitment scam where over 20 doctors of the 50-odd RKDF medical faculty, shown as permanent employees to clear MCI's inspection in February, are already teaching in Gujarat colleges. (TOI)
  • The Delhi Police have turned a blind eye to complaints against 300 doctors with fake degrees, putting the lives of unsuspecting patients at risk. This is despite the fact that the complaints have been made by the Delhi Medical Council, a regulatory body for registered doctors and medical education in the state. While the police acted swiftly against Delhi's former law minister Jitender Singh Tomar for allegedly using fake degrees to enroll as an advocate, these 300 masqueraders treating patients without certified degrees have been virtually let off the hook. The Delhi Medical Council has, between 2012 and 2015, asked the police to register cases against 422 people, who are proven quacks and cannot practice allopathy. In about 300 cases, however, police have not even lodged first information reports (FIR) (India Today))
  • In an effort to boost a uniform, standard and clear prescription for better safety of patients, the Medical Council of India (MCI) has come out with a new prescription format that should be followed by all allopathic doctors across the country. (TOI)
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Monthly meeting was conducted on 17-05-2015 (Sunday) at Sri Murugan Mini Hall; 36 members attended the function. Dr R Srinivasan MD, DNB (Cardio) talked about “Device Therapy in Heart Failure”
Documents reaffirmed by the 200TH Council Session
WMA Declaration of Hong Kong on the Abuse of the Elderly

Adopted by the 41st World Medical Assembly, Hong Kong, September 1989 and editorially revised by the 126th WMA Council Session, Jerusalem, Israel, May 1990 and the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and reaffirmed the 200th WMA Council Session, Oslo, Norway, April 2015

Elderly people may suffer pathological problems such as motor disturbances and psychic and orientation disorders. As a result of such problems, elderly patients may require assistance with their daily activities that can lead to a state of dependence. This may cause their families and the community to consider them to be a burden and to subsequently limit or deny care and services.

Abuse or neglect of the elderly can be manifested in a variety of ways: physical, psychological, financial and/or material, and medical. Variations in the definition of elder abuse present difficulties in comparing findings on the nature and causes of the problem. A number of preliminary hypotheses have been proposed on the etiology of elder abuse including: dependency on others to provide services; lack of close family ties; family violence; lack of financial resources; psychopathology of the abuser; lack of community support, and institutional factors such as low pay and poor working conditions that contribute to pessimistic attitudes of caretakers.

The phenomenon of elder abuse is becoming increasingly recognized by both medical facilities and social agencies. The first step in preventing elder abuse and neglect is to increase levels of awareness and knowledge among physicians and other health professionals. Once high-risk individuals and families have been identified, physicians can participate in the primary prevention of maltreatment by making referrals to appropriate community and social service centres. Physicians may also participate by providing support and information on high-risk situations directly to patients and their families. At the same time, physicians should employ care and sensitivity to preserve patient trust and confidentiality, particularly in the case of competent patients.

The World Medical Association therefore adopts the following general principles relating to abuse of the elderly.

General Principles
  1. The elderly have the same rights to care, welfare and respect as other human beings.
  2. Physicians have a responsibility to help prevent the physical and psychological abuse of elderly patients.
  3. Whether consulted by an aged person directly, a nursing home or the family, physicians should see that the patient receives the best possible care.
  4. If physicians verify or suspect ill treatment, as defined in this statement, they should discuss the situation with those in charge, be it the nursing home or the family. If ill treatment is confirmed, or if death is considered to be suspicious, they should report the findings to the appropriate authorities.
  5. To guarantee protection of the elderly in any environment there should be no restrictions on their right of free choice of a physician. National Medical Associations should strive to make certain that such free choice is preserved within the socio-medical system.
The World Medical Association also makes the following recommendations to physicians involved in treating the elderly, and urges all National Medical Associations to publicize this Declaration to their members and the public.

Recommendations

Physicians involved in treating the elderly should:
  • make increased attempts to establish an atmosphere of trust with elderly patients in order to encourage them to seek medical care when necessary and to feel comfortable confiding in the physician;
  • provide medical evaluation and treatment for injuries resulting from abuse and/or neglect;
  • attempt to establish or maintain a therapeutic alliance with the family (often the physician is the only professional who maintains long-term contact with the patient and the family), while preserving to the greatest extent possible the confidentiality of the patient;
  • report all suspected cases of elder abuse and/or neglect in accordance with local legislation;
  • utilize a multidisciplinary team of caretakers from the medical, social service, mental health, and legal professions, whenever possible; and
  • encourage the development and utilization of supportive community resources that provide in-home services, respite care, and stress reduction with high-risk families.
Inspirational Story
The Three Races

In old times, a fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.

One day, the boy was preparing himself for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.

The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power… he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy, however, felt proud and important.

A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.

"Another race, another race" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?" quizzed the little boy. "This is no race." he exclaimed.

"Race!" said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy.

"What has happened? Why don’t the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "this time, finish together, all three of you, finish together." continued the wise man.

The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.

"Old man, I don’t understand! Who is the crowd cheering for? Which one of us three?" asked the little boy.

The wise old man looked into the little boy’s eyes, placing his hands on the boy’s shoulders, and replied softly, "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"
Wellness Blog
Normal Aging Changes
 
  • Heart rate shows less variability.
  • There is altered circadian pattern (24–hour cycle of the body).
  • There is a delayed response of bone marrow to loss of blood or hypoxia (reduced oxygen).
  • The function of the white blood cells is impaired.
  • Advancing age is a procoagulant stage. This means that the blood gets clotted easily.
  • Reflux of the stomach acid in the food pipe is common.
  • Tendency to constipation is common.
  • Painkillers can quite easily cause ulcers in the stomach.
  • Renal functions decline with age.
  • Older kidney is more prone to be damaged with painkillers.
  • Calcification of heart valves may occur.
  • The maximum heart rate may not reach the level as that in the young age in response to exercise.
  • About one–third of the lung volume may be lost.
  • Aging slows the rate of fracture repair.
  • Skin may become atrophic (thin) and elasticity is reduced.
  • A person may not be able to read small print.
  • There may be impaired speech recognition in noisy environment.
  • There may be loss of taste.
  • There may be loss of smell.
  • There may be high frequency hearing loss.
  • Immunity may be reduced.
  • With age, one is more prone to get urinary tract infection.
  • With age, ejaculation may get impaired.
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Productive achievement is a consequence and an expression of health, self–esteem, not its cause. Nathaniel Branden
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Dear Sir Thanks for the useful information. Regards: Dr Kiran
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Press Release
Today is World Blood Donor Day

Heart patients on aspirin should not donate platelets


Most medications taken by blood donors pose no known risks to recipients. In most cases, only small quantities of drugs are present in a unit of blood and the drugs will undergo significant dilution in the recipient's plasma volume. However, every donor must disclose what drugs he or she is taking as some of them may not be friendly with the recipients, said Padma Shri Awardees Dr A Marthanda Pillai, National President Indian Medical Association (IMA) and Dr K K Aggarwal Honorary Secretary General IMA on the occasion of World Blood Donor Day.

In December 2007, the US FDA made recommendations that apheresis platelet collections should not occur from donors who have taken aspirin, aspirin-containing drugs, or piroxicam in the previous 48 hours, or from donors who have taken clopidogrel or ticlopidine in the previous 14 days. This restriction is specific to plateletpheresis donors and does not apply to whole blood donors unless platelets made from that unit of whole blood will be the sole source of platelets for a given patient. This is especially for platelet transfusions designated for neonatal and young pediatric recipients.

Donors who are taking warfarin, heparin, or another anticoagulant are temporarily deferred (up to seven days).

Five drugs pose a teratogenic risk: etretinate and acitretin used for severe psoriasis, isotretinoin used for severe acne and finasteride and dutasteride used for prostate enlargement.

For isotretinoin and finasteride, the deferral period is one month and for dutasteride, it is 3 years. Deferral period is permanent for etretinate. Donors are permanently deferred if they have taken bovine or human growth hormone derived from pituitary glands due to the risk of Creutzfeldt-Jakob disease.

The deferral period for donors who have received hepatitis B immunoglobulin or an unlicensed vaccine is one year.
Rabies News (Dr A K Gupta)
What are monoclonal antibodies?

Monoclonal antibodies are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.
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