15th August 2012, Wednesday

eMedinewS wishes all fellow citizens a happy and glorious
66th Independence Day

Six simple ways to smarter, healthier eating

1. Ditch whole milk: Not only does this reduce saturated fat in your diet, it shaves off calories.
   
   How: Switch to 1% or nonfat milk, and nonfat versions of other dairy products like yogurt and ice cream. Step down more slowly to 2% milk, then 1% en route to nonfat, if possible.
2. Harness the power of nuts (and seeds): Almonds, cashews, filberts, hazelnuts, peanuts, pecans, and pistachios pack plenty of beneficial nutrients, including vitamin E, folic acid, potassium, and fiber. Although many nuts are high in fat, the fat is mainly unsaturated – a healthy choice.
   
   How: First, put nuts on the grocery list. Nuts are high in calories, so it’s best to enjoy them in place of other snacks, not in addition, and to keep serving sizes small.
3. Taste food before you salt it: Break the autopilot habit of reaching for the salt shaker.
   
   How: For two days, don’t put any salt on your food at all. A short break can help reset your taste buds. Then, leave the salt shaker in the cabinet, so it becomes a bit of an effort to reach for it. Make a ritual out of truly tasting your food before you decide if it needs tweaking.
4. Pack lunch once a week: This makes healthy food choices readily available to you at work or on an outing. And since you are controlling portion sizes, you can make sure that you’re not supersizing your meal. Plus, it saves you money.
   
   How: Once a week before you shop for groceries, write out a meal plan that leaves enough leftovers for one or two lunches.
5. Eat five (or more) vegetables and fruits a day: It’s a nutrient-packed way to fill your plate that is generally low in calories.
   
   How: First, for one week, keep track of how often you eat fruits and vegetables. One serving equals one-half cup of chopped fruit or most vegetables; for raw leafy vegetables like lettuce and spinach, a serving is one cup. Once you have your baseline, try adding one fruit or vegetable serving a day.
6. Plan meals that are delightful, delicious and healthy: In an ideal world, food delights all our senses: it looks beautiful, smells heavenly, and tastes delicious, and its textures feel and even sound satisfying. Start thinking about food as something to really savor and enjoy.
   
   How: Pencil in time to prepare and savor one or two special meals a week. Once you’ve assembled great ingredients, set a gorgeous table. Take a moment to truly take in scents, companions, and surroundings, and if you like, give thanks. (Source HealthBeat)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

India witnesses 56 per cent drop in HIV cases

New Delhi, Aug 13 (PTI): The country has witnessed a 56 per cent drop in HIV related cases in the last one decade, the government today said. "HIV infections have declined by 56 per cent during the last decade from 2.7 lakh in 2000 to 1.2 lakh in 2009 in our country," Health and Family Welfare Minister Ghulam Nabi Azad said.

Health ministry objects to Plan Com draft paper for the sector

The Health Ministry has raised serious objections to the Planning Commission's 12th Plan draft approach paper for the sector, which proposes enhanced role of the private sector in health care delivery. Insisting that public spending on health be pegged at least at 2.5 per cent of the GDP, the ministry has said the same should further be enhanced to 2.85 per cent of the GDP by the end of the plan. The plan panel has suggested merely 1.58 per cent of the GDP spending on health during the 12th Plan. "We have told the Planning Commission that our endeavour should be to reach 2.5 per cent of the GDP target for public spending on health which should be gradually increased to 2.85 per cent by the end of the plan period," a senior Health Ministry official told PTI. Voicing concerns over the Plan panel's draft paper on health for the 12th plan, the ministry has sought strengthening of the public health system, red flagging the panel's stress on private sector involvement for health care delivery. "We should not abdicate our responsibility to the private sector without strengthening the public health system. Health care delivery should depend more on public health infrastructure, with the private sector only supplementing it," the Health Ministry has said in its note to the Planning Commission. The note further points out, "the public health system is suffering due to under investment resulting in poor infrastructure and health capacity across the country. The focus in the 12th Plan should be to strengthen the public health system". (Source: Business Standard, August 12, 2012)

My Profession My Concern

Professor Suchitra N. Pandit, Kokilaben Dhirubhai Ambani Hospital & Research Centre, Mumbai, Vice President, FOGSI (2008 -2009) on the profession

For comments and archives

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

(Contributed by Dr Monica and Brahm Vasudev)

Thyroid disease during pregnancy: guidelines updated

The Endocrine Society's clinical practice guideline for the management of thyroid disease during pregnancy and after birth has been updated from its 2007 version. The clinical practice guideline, published in the August issue of the Journal of Clinical Endocrinology and Metabolism, recommends approaches to diagnosing and treating patients with thyroid-related medical issues before, during, and immediately after pregnancy. Revisions and additions to the clinical practice guideline include the following: (Source: Medscape)

• Trimester-specific reference ranges for pregnant women, using a free T4 assay, should be established. "The nonpregnant total T4 range (5–12 µg/dL or 50–150 nmol/liter) can be adapted in the second and third trimesters by multiplying this range by one and a half-fold. Alternatively, the free T4 index...appears to be a reliable assay during pregnancy," the authors write.
• Propylthiouracil (PTU) should be the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy. Methimazole (MMI) may also be prescribed if PTU is not available or not tolerated. Clinicians should change treatment of patients from PTU to MMI after completion of the first trimester because of the potential for liver toxicity.
• Breast-feeding women should maintain a daily intake of 250 µg iodine to ensure breast-milk provides 100 µg iodine per day to the infant.
• Once-daily prenatal vitamins should contain from 150 to 200 µg iodine in the form of potassium iodide or iodate, "the content of which is verified to ensure that all pregnant women taking prenatal vitamins are protected from iodine deficiency," the authors write.
• Thyroid receptor antibodies should be measured before 22 weeks' gestational age in mothers with "1) current Graves' disease; or 2) a history of Graves' disease and treatment with 131I or thyroidectomy before pregnancy; or 3) a previous neonate with Graves' disease; or 4) previously elevated [thyroid-stimulating hormone receptor antibodies (TRAb))," according to the authors
• In women with TRAb at least 2- to 3-fold the normal level, and women treated with antithyroid drugs, "fetal thyroid dysfunction should be screened for during the fetal anatomy ultrasound done in the 18th–22nd week and repeated every four to six weeks or as clinically indicated. Evidence of fetal thyroid dysfunction could include thyroid enlargement, growth restriction, hydrops, presence of goiter, advanced bone age, tachycardia, or cardiac failure," the authors write.
• Women with nodules from 5 mm to 1 cm in size should be considered for fine-needle aspiration (FNA) if they have a high risk history or suspicious findings on ultrasound, and women with complex nodules from 1.5 to 2 cm in size should also receive an FNA. "During the last weeks of pregnancy, FNA can reasonably be delayed until after delivery. Ultrasound-guided FNA is likely to have an advantage for maximizing adequate sampling," the authors conclude.

New technology to detect resistant TB bacteria developed

Scientists have developed a new technique to detect tuberculosis bacteria which survive the treatment, paving the way for effectively treating TB bacilli resistant to antibodies. Researchers from the Antwerp Institute of Tropical Medicine have created a simple technique of Fluorescein diacetate staining, which only stains living tuberculosis bacilli (and not dead ones) which can immediately tell if resistant bacilli survived after treatment. Tuberculosis bacilli have become resistant against major antibiotics. According to World Health Organization (WHO) estimates, only 11 per cent of multiresistant cases were discovered in 2009. Checking smears under the microscope still is the recommended technique for TB screening, but it cannot differentiate between living and dead bacilli. It is therefore not clear whether you are looking at the cadavers of a successful treatment, or at resistant survivors. Only if the numbers after a long wait still don't fall, you know you are dealing with a resistant strain. But all that time the patient has remained contagious, the researchers said in a statement. (Source: The Indian Express, Aug 12 2012)

Tai Chi helps COPD symptoms

A modified tai chi program proved beneficial for improving exercise capacity among patients with chronic obstructive pulmonary disease (COPD), Australian researchers found. (Source: Medpage Today)

@DrKKAggarwal: Azadi from Diseases 15th August marks the day when India became free from British Rule. The day is celebrated...http://fb.me/1YVcNfFCU

@DeepakChopra: Explore every thought in depth. Be above the drama of the situation.

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

Desire, Hatred and Ignorance

According to Buddhism, the three negative emotions that cause disease are ignorance, hatred and desire and accordingly physical sickness are classified into three main types.

Disorders of desire (Ayurvedic equivalent of Vata imbalance): These are due

For comments and archives

• 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
• The 4th Asia Pacific Vascular Interventional Course begins Read More
• Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
• 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
• Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
• 4th Asia pacific vascular intervention course Read More
• 4th Asia pacific vascular intervention course paper clippings Read More

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 have a procedure done 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.

For comments and archives

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

Cryo poor Plasma

Definition: Plasma from which approximately half the fibrinogen and factor VIII has been removed as cryoprecipitate.

Volume: 150-200 ml

Storage: - 30°C or colder

Shelf Life: 5 years

Indications: TTP (thrombotic thrombocytopenic purpura)

Dosage: 10-15 ml/kg

Administration:

• Use ABO compatible product
• No cross-matching is required
• After thawing, infuse as soon as possible through standard blood transfusion set

For comments and archives

Potential new target for treating diabetes and obesity

Researchers at Washington University School of Medicine in St. Louis have identified a potential target for treating diabetes and obesity. Studying mice, they found that when the target protein was disabled, the animals became more sensitive to insulin and were less likely to get fat even when they ate a high-fat diet that caused their littermates to become obese.

The researchers studied how the body manufactures fat from dietary sources such as carbohydrates. That process requires an enzyme called fatty acid synthase (FAS). Mice engineered so that they don't make FAS in their fat cells can eat a high-fat diet without becoming obese. "Mice without FAS were significantly more resistant to obesity than their wild-type littermates," says first author Irfan J. Lodhi, PhD. "And it wasn't because they ate less. The mice ate just as much fatty food, but they metabolized more of the fat and released it as heat." To understand why that happened, Lodhi, a research instructor in medicine, analyzed their fat cells. Mice have two types of fat: white fat and brown fat. White fat stores excess calories and contributes to obesity. Brown fat helps burn calories and protects against obesity.

In mice genetically blocked from making fatty acid synthase in fat cells, Lodhi and his colleagues noticed that the animals' white fat was transformed into tissue that resembled brown fat. "These cells are 'brite' cells, brown fat found where white fat cells should be," Lodhi says. "They had the genetic signature of brown fat cells and acted like brown fat cells. Because the mice were resistant to obesity, it appears that fatty acid synthase may control a switch between white fat and brown fat. When we removed FAS from the equation, white fat transformed into brite cells that burned more energy."

Q. The government of Uttar Pradesh has not granted permission for doing autopsies in government medical colleges while the autopsies are routinely being carried out by MBBS doctors employed in the Provincial Medical Service in UP. What should be done?

Ans.

• This is unusual. There must be some reason. It is for the medical college faculty to find the reason.
• Performing an autopsy for the police is work done for the police. Redressal of a wrong can be asked only when a wrong has been done or a right has been denied. Medical college faculty cannot demand work from the police department.
• The government medical college faculty has a right to demand autopsy work if as per the terms and conditions of service, the job of the faculty involves performing, supervising and teaching how to do autopsies. It is a right of the faculty to demand autopsy work for which it was employed. To secure this right, the faculty should send a proper legally drafted representation to the government, on the basis of which a writ petition may be filed if the government does not act.
• The above representation/writ petition should be so drafted as to include the MCI as a party because it is the MCI which inspects medical colleges and grants them recognition.

Categories of Anemia

Microcytic/hypochromic anemia (decreased MCV, decreased MCHC)

• Iron deficiency (common)
• Thalassemia
• Anemia of chronic disease (uncommonly microcytic)
• Sideroblastic anemia (uncommon; acquired forms more often macrocytic)
• Lead poisoning (uncommon)
• Hemoglobin E trait or disease

Read this…………………

The client presents with severe rectal bleeding, 16 diarrheal stools a day, severe abdominal pain, tenesmus and dehydration. Because of these symptoms the nurse should be alert for other problems associated with what disease?

A. Crohn’s disease
B. Ulcerative colitis
C. Diverticulitis
D. Peritonitis

Yesterday’s Mind Teaser: A Sengstaken-Blakemore tube is inserted in the effort to stop the bleeding esophageal varices in a patient with complicated liver cirrhosis. Upon insertion of the tube, the client complains of difficulty of breathing. The first action of the nurse is to:

A. Deflate the esophageal balloon
B. Monitor VS
C. Encourage him to take deep breaths
D. Notify the MD

Answer for yesterday’s Mind Teaser: A. Deflate the esophageal balloon

Correct answers received from: Dr AK Kela, Dr PC Das, Dr Pankaj Agarwal, Dr K Raju, Dr (Maj. Gen.) Anil Bairaria, YJ Vasavada, Dr Jainendra Upadhyay, Dr LC Dhoka, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr PC Das, Dr Dinesh Yadav.

Answer for 13th August Mind Teaser: C. Meperidine

Correct answers received from: Dr Dinesh Yadav

Send your answer to ijcp12@gmail.com

CLASSIC INSULT

When I See Your Face, There's Not A Thing That I Would Change. . .
Except The Direction I Am Walking In .

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

Common Grounds of MTP as per law

The proposed measure which seeks to liberalize certain existing provisions relating to the termination of pregnancy has been conceived

• As a Health measure – when there is danger to the life or risk to the physical or mental health of the women;
• On humanitarian grounds – such as when pregnancy arises from a sex crime like rape or intercourse with a lunatic women, etc.;
• Eugenic grounds – where there is a substantial risk that the child, if born, would suffer from deformities and diseases.

The Bill was passed by both Houses of the Parliament and the President’s assent was received on 10–8–1971. The Act has recently been amended as the Medical Termination of Pregnancy (Amendment Act), 2002.

For comments and archives

(Press Release for use by the newspapers)

Heart risks detected by age 7 in overweight kids

Children at risk of future obesity should be examined for body mass index rebound, stated Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

BMI rebound is the age at which body mass index (BMI) reaches its lowest point before increasing through later childhood, adolescence and adulthood.

An earlier BMI rebound age is associated with adverse risk factors for heart disease as measured at age 7: higher BMI, higher systolic and diastolic blood pressures, higher serum insulin and leptin levels, higher left ventricular mass and left atrial size.

Early BMI rebound age for children is lower than 4.4 years for boys and 4.2 years for girls. Normal values are 4.4 to 6.6 years for boys and 4.2 to 5.7 years for girls.

All children who start gaining weight between 3-4 years should be classified as a high risk for future diabetes and heart disease.

1. Thanks for education. Lot to learn and accept that will to do with purity and sincerity; it is easier to reach near full achiever. God bless all. Kuldeep Dhatwalia

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta