August 16  2015, Sunday
eMedinewS
editorial
Eating high fiber diet
Dr KK Aggarwal
  • There are two types of fibers: Soluble and insoluble.
  • Soluble fiber includes those that are made up of carbohydrates and absorb water. Examples are oats, barley and legumes.
  • Insoluble fiber comes from plant cells and does not dissolve in water. Examples are wheat, ragi and other grains.
  • Traditionally, fiber is insoluble fiber.
  • Dietary fiber is a combination of soluble and insoluble fiber.
  • The recommended amount of dietary fiber is 20–35 gm in a day.
  • Eating a high–fiber diet both can prevent constipation, reduce cholesterol and help in reversing obesity and heart diseases in children and adults.
  • A high–fiber diet should be a balanced diet with food from all food groups.
  • The common sources of fiber are whole grain produce and cereals, legumes, fruits and vegetables.
  • One should eat fruits with significance, such as prunes and peas, which are natural laxatives.
  • Raw vegetables such as carrot, garlic or cherry tomatoes are rich in fiber.
  • Salads with dark green lettuce provide high fiber content.
  • Eating whole wheat bread or with added fiber is a rich source of fiber.
  • Prefer brown rice over white rice.
  • You can eat whole wheat carbohydrates, bran muffins, bran cereals or oat meals.
  • Avoid eating refined white flour, cereals and other starches.
  • If juices are to be taken, one should take 4–6 ozs.
  • Fruits are better than juices
  • Try to develop a taste for bran by starting with 2–4 tablespoons every day.
  • Mix a high fiber cereal with a regular cereal.
  • Isabgol is a fiber supplement.
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eMedipics
Dr Veena Aggarwal & Dr K K Aggarwal
At Rashtrapati Bhavan Dr KK Aggarwal and Dr Veena Aggarwal
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News
  • Diabetes. Another action of metformin has been reported in a study published online August 5 in Diabetes Care. Metformin has also been found to lower LDL-cholesterol levels. It does so by activating AMP-activated protein kinase (AMPK) and consequently suppressing fatty-acid desaturase (FADS) genes, which leads to reduced levels of lipid metabolites and LDL cholesterol.
  • Nephrology/Neurology. Results from a population-based Rotterdam study suggest that poor kidney function negatively affects cerebral blood flow and may be linked to both stroke and dementia independent of known cardiovascular disease risk factors. The study, by Sanaz Sedaghat, MSc, from the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues, was published online August 6 in the Journal of the American Society of Nephrology.
  • Gynecology. Live birth rates for in vitro fertilization (IVF) cycles using frozen oocytes appear to be slightly lower than for those using fresh ones, according to a research letter published in the August 11 issue of JAMA.
  • Endocrinology/Surgery. An American Thyroid Association (ATA) statement describing how to assess patients with goiter and providing recommendations for ways to manage goiter surgery to minimize complications is now published online for open access. Originally published in Thyroid in 2014, these are the first comprehensive recommendations for goiter surgery.
  • Endocrinology. Dr Genevieve Healy (University of Queensland, Brisbane, Australia) and colleagues report that cardiovascular health benefits—particularly for glucose and lipid metabolism—can be achieved if an individual replaces sitting with standing. Excessive sitting is associated with various cardiometabolic risk factors, including larger waist circumferences, higher triglycerides, and lower HDL-cholesterol levels.
Forthcoming DST school camps
  • Sulabh Public School, Mahavir Enclave on 17th August
  • Mt Abu School, Rohini Sector 5, on 19th August
  • St Mathew School, Paschim Vihar, D Block on 20th August
Cardiology eMedinewS
  • A study from Turkey reported Aug 11 in the journal Coronary Artery Disease concluded that serum fibrinogen level is associated independently with a higher risk of contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
  • According to a study reported Aug 11 in the journal Blood Pressure Monitoring, patients do not have a great deal of confidence in office BP measurements, but have a higher degree of confidence in home BP and ambulatory BP assessment methods may be helpful in guiding strategies to diagnose hypertension and improve antihypertensive medication adherence.
Pediatrics eMedinewS
  • Major depression and bipolar disorder put teenagers at greater risk for heart disease and should be considered as independent risk factors for the condition. This is according to a scientific statement from the American Heart Association, published in the journal Circulation.
  • Intermittent episodes of hypoxemia lasting more than 1 minute during the first 2-3 months after extremely preterm birth are associated with severe disability at age 18 months, according to a report published online Aug. 11 in JAMA.
Dr KK Spiritual Blog
Spirituality is the Key to Health

To stay healthy, one needs to eat right, get plenty of exercise and rest, and avoid bad habits such as smoking. But, now it is said that "what you believe in" can have a big impact on health and longevity. There have been a lot of studies that show how patients with strong spirituality can improve their health from a variety of chronic conditions, like hypertension, heart disease, recover from surgery and more. Research indicates there are real health benefits from spirituality:
  1. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone released by the body in response to stress.
  2. Positive thinking produces nearly a 30 percent drop in perception of pain.
  3. Spirituality and the practice of religion have recently been associated with a slower progression of Alzheimer’s disease.
  4. Those who regularly attend organized religious activities may live longer than those who don't. Regular participation lowers mortality rate by about 12 percent a year.
  5. People undergoing cardiac rehabilitation are more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  6. Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  7. Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body's stress response.
  8. Spirituality can affect immune–system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  9. Prayer heals the heart.
  10. Positive talking and thinking in the ICU produces better results.
Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind-body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.
Inspirational Story
All or Nothing

After the miscarriage of her second child, my sister was so excited to learn that she was pregnant once again. She had a five–year–old son and was anxious to give him a little brother or sister. This pregnancy would soon become a nightmare as well.

At 23 weeks, Kathy started getting very sick and having contractions. Fearing another miscarriage she immediately went to her doctor. He checked her, told her she was fine that it was "all in her head" and to go home and continue doing housework and go about her normal routine. It was December 31st, and several days after that doctor’s appointment, Kathy had barely made it past the 24–week mark of her pregnancy. It was this fateful New Year’s Eve when the ambulance was called. Kathy was in full–blown labor. Riding in the back of that ambulance hearing the sirens roar all that she could think was "When am I going to wake up from this nightmare?"

Kathy was taken to Baptist Hospital in Winston–Salem, the closest hospital equipped with the kind of staff and medical technology to handle this kind of emergency. She was told that she had a terrible infection. If they did a c–section on her, the baby would have more of a chance of survival but there was the possibility that the infection could spread throughout her body and she would be in life threatening danger. She could have natural childbirth but as tiny as the baby was, it would surely never make it through the ordeal. Kathy opted for the c–section, risking her own life to save the life of her baby.

The first thing Kathy was told was, you have a baby daughter, and she is very tiny. She weighs only 1 pound, 8 ounces, and is only 13 inches long. (That is the same height as a Barbie doll) Her lungs are not fully developed so she cannot breathe on her own.

Her chances of living are slim to none. She probably won’t even make it through the night. If she does make it through the night she will have less than a 10% chance of living after that. If she does live, the medical bills are going to be astronomical, the emotional strain will be hardly bearable; furthermore, she will very possibly be severely retarded and will be challenged with so much more than most children in life. Now the question presented to my sister was this, "Do you want us to do all we can, or nothing?" In other words, we can turn her life support off and let her lay there and die, but we have to have your permission. It was the kind of thing where you think, I know what they just ask me, but did they really ask me THAT?? Needless to say Kathy told them to do anything and everything possible to save her baby, even after all the discouraging words told to her. After all she had been through, how could she just give up on this tiny little miracle now?

I guess that first night was the longest. Every church within a sixty–mile radius was praying. We all got through it one minute at a time. Then came the morning and little Elizabeth Nicole Hale was still hanging on, fighting hard for her life. Doctors were still very pessimistic telling Kathy not to get her hopes up. Beth still only had a 10% chance of survival.

Facing reality, Kathy had to go back home an hour and a half away, to take care of her husband and five–year–old son, leaving her tiny baby in the neonatal nursery. She visited as much as possible, which was only 2 or 3 times a week. She called every day however, 7 or 8 times a day. Her first phone bill she could literally stretch across the entire length of her house. That was ok; the money was the least of her worries.

The next major hurdle for Beth was at two weeks old when they discovered a heart murmur that would not close up on its own. Beth had lost down to 1 pound and 4 ounces, she was too small to be under anesthesia so they would have to paralyze her tiny body and do heart surgery. Once again we hung on minute by minute until we found out that Beth was out of surgery and doing ok.

It was touch and go for the next 4 months. It was the week before Mother's Day and I will never forget it, when my sister, her husband and her son were on their way to bring little Beth home from the hospital. She weighed in at a whopping 4 pounds. The doctors constantly warned Kathy that Beth would be challenged and a slow achiever.

On June 8, 2002, the little 1 pound, 8 ounce miracle who was given less than a 10% chance of survival will graduate 15th in her class with high honors. She has already been accepted into the college of her choice. If she is a slow achiever, as the doctors said, I would love to see her at full speed!! She is tall with blonde hair and blue eyes that glow with the beauty that is her future. All or Nothing? Beth is going for it ALL!!
Make Sure
Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.
Dr Good Dr Bad
Situation: A patient with severe migraine wanted to know if xylocaine drops would help.
Dr. Bad: They have no role.
Dr. Good: You can try them.
Lesson: As an intranasal spray, 2% xylocaine drops can help migraine patients.

(Copyright IJCP)
eIMA Quiz
True about Ulcerative Colitis with malignancy

a) It has a better prognosis
b) Is related to disease activity
c) Is related to duration of ulcerative coliti
d) Malignancy is more in anorectal ulcerative colitis

Yesterday’s Mind Teaser: Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of:

a. Diuretics
b. Antihypertensive
c. Steroids
d. Anticonvulsants

Answer for Yesterday’s Mind Teaser: c. Steroids
Answers received from: Dr Avtar Krishan, Dr Shangarpawar, Dr.K.Raju, Dr Poonam Chablani, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr V R Tindwani, Dr Ridu Kumar Sharma Dr Pandit Hantodkar,
Answer for 14th August Mind Teaser: A. 110/70.
Correct Answers received from: Dr Ridu Kumar Sharma Dr Pandit Hantodkar,
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Rabies News (Dr A K Gupta)
Can rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
• Within days of writing about the modern benefits of egg freezing, a new study was published in JAMA based upon old data. They looked at national data from 2013 and concluded that pregnancy rates from egg donors were lower if the eggs had been frozen than if they were fresh. That was probably true -- back then. Medpage Today

• Only about one in four patients with end-stage renal disease in Georgia were referred for kidney transplant evaluation by their dialysis facility from 2005 to 2011, according to a study published in the Journal of the American Medical Association. Medpage today

• Patients with type 2 diabetes and stable ischemic heart disease faced a higher risk of death from cardiovascular causes if they had abnormal levels of cardiac troponin T concentration, found a new study. BARI2D Trial

• The presence of autoantibodies in healthy relatives of patients with rheumatoid arthritis (RA) predicts a higher risk of developing the disease, Mexican researchers have found. [ ARTHRITIS AND RHEUMATOLOGY]

• Metformin, also lower LDL-cholesterol levels, possibly by a complex mechanism, according to new research published online August 5 in Diabetes Care.The study found that patients who were taking metformin had lower levels of three metabolites and LDL cholesterol. Metformin intake activates AMP-activated protein kinase (AMPK) and consequently suppresses fatty-acid desaturase (FADS) genes, which leads to reduced levels of lipid metabolites and LDL cholesterol.
New model of care (Pre-emptive care model)
News
  • Managing incontinence: Watch your weight, Don't smoke, Stay active, Minimize bladder irritants, Don't strain with bowel movements.
  • Carbonated drinks, the artificial sweetener aspartame, spicy foods, and citrus fruits and juices cause urge incontinence in some people
  • In a recent study, restricting dietary fat led to body fat loss at a rate 68 percent higher than cutting the same number of carbohydrate calories when adults with obesity ate strictly controlled diets. Carb restriction lowered production of the fat-regulating hormone insulin and increased fat burning as expected, whereas fat restriction had no observed changes in insulin production or fat burning. The research was conducted at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results were published August 13 in Cell Metabolism .
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
IMA Digital TV – Webcast Done So far
23rd July 2015 – TB Notification

6th August 2015 - Breastfeeding and Neonatal Skin Care

13th August 2015 - All About Vitamin D - IMA USV Initiative
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IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
Media
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Quote of the Day
Life begets life. Energy becomes energy. It is by spending oneself that one becomes rich. Sarah Bernhardt
Events
Event

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IMA in Social Media
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Twitter @IndianMedAssn 1106 followers

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Around 150 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in South Mumbai
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Reader Response
1. Dear KK, Dr Mithilesh Chandra has made a case for waiver of duties on imported microscopes for diagnostic purposes in today's newsletter. This is certainly doable. Let IMA raise the issue with Finance Ministry. It will require data of expected imports during a year and the consequent loss of revenue. Please send a copy of your response to cpranuj@yahoo.com and with best wishes, Yours sincerely, (Er Anuj Sinha)

2. Very good appeal by National IMA .IMA is concerned about clinics and small hospitalssince they are the backbone of health care of rural and poor Dr Alex
Wellness Blog
Children should be screened for the heart before playing any sports

Sudden cardiac death amongst athletes is a rare but a devastating event. Most victims are usually young and, apparently, healthy but many have underlying undiagnosed heart disease.

As per American Heart Association Guidelines, children and adolescents undergoing athletic training need medical clearance. Majority of sudden deaths amongst athletes are due to malignant irregularities in the heart rhythm such as ventricular tachycardia and ventricular fibrillation. The precipitating factors can be prolonged physical training or unaccustomed athletic activities.

In athletes under the age of 35, the most common cause of death is underlying congenital heart disease and for those above the age of 35, it is the presence of blockages of the coronary arteries.

The Heart Care Foundation of India recommends that, in every school/college, the attached doctor should evaluate all students with a 12 step history and examination to rule out high risk cases that need further evaluation.

The Foundation, along the lines of European Society of Cardiology, also recommends an additional standard 12–lead ECG before a medical clearance is given for both competitive as well as recreational athletic activities.

Master athletes who are above the age of 35 will need an additional exercise testing before they can be given a clearance for athletic activity.

Diagnostic echocardiography is indicated when clinical, historical and physical findings suggest possibility of structural heart diseases. Athletes on pacemakers should not engage in sports as bodily collision may damage the pacemaker system.

The 12–element AHA recommendations for pre participation cardiovascular screening of competitive athletes are as follows:
  1. Exertional chest pain/discomfort
  2. Unexplained syncope/near–syncope
  3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
  4. Prior recognition of a heart murmur
  5. Elevated systemic blood pressure
  6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in one relative
  7. Disability from heart disease in a close relative <50 years of age
  8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long–QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
  9. Heart murmur
  10. Femoral pulses examination to exclude aortic coarctation
  11. Physical features of Marfan syndrome
  12. Brachial artery blood pressure (sitting position, both arms)
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eIMA Humor
Those four letter words……

A young couple got married and left on their honeymoon. When they got back, the bride immediately called her mother. Her mother asked, "How was the honeymoon?"

"Oh, mama," she replied, "the honeymoon was wonderful! So romantic…"

Suddenly she burst out crying. "But, mama, as soon as we returned Sam started using the most horrible language…things I’d never heard before! I mean, all these awful 4 letter words! You’ve got to come get me and take me home… Please mama!"

"Sarah, Sarah," her mother said, "calm down! Tell me, what could be so awful? What 4–letter words?"

"Please don’t make me tell you, mama," wept the daughter, "I’m so embarrassed they’re just too awful! Come get me, please!"

"Darling, baby, you must tell me what has you so upset… Tell your mother these horrible 4–letter words!"

Still sobbing, the bride said, "Oh, mama…words like DUST, WASH, IRON, COOK …!"
Press Release
From Law-makers to lifesavers

Heart Care Foundation of India (HCFI) trains 300 people in the Delhi High Court in the life-saving technique of Hands only CPR 10 for revival after sudden cardiac arrest

Sudden cardiac arrest is the number one killer in India taking an estimated 25 lakh lives annually. It can happen to anyone at anytime with no evident warning signs. However what most people remain unaware of is that a sudden cardiac arrest victim can be brought back to life within 10 minutes of their death through the life-saving technique of hands only CPR 10. Keeping this in mind, HCFI took up the task of safe-guarding the lives of our indispensible law makers who with the stress of their daily lives are at high risk of a sudden cardiac arrest. In a one of its kind initiative, over 300 personnel including, lawyers and administration staff of the Delhi High Court were trained in Hands Only CPR 10.

According to the data revealed by the Delhi Economical Survey, 150 to 250 deaths happen in the city every single day. Out of these 25 – 45 deaths occur suddenly. With 60% of the people dying before they reach the hospital and the large number of sudden cardiac arrest victims; it is essential that each one of us must know the essential life-saving technique of hands only CPR – 10. A simple and easy to learn technique, Hands only CPR 10 does not require any mouth-to-mouth resuscitation and can be performed by anyone.

Speaking about the initiative, Padma Shri Awardee, Dr KK Aggarwal, President HCFI& Hony. Sec General IMA said, “With the increasing lifestyle pressures in today’s day and age the incidence of sudden cardiac arrest is on the rise. An increasing number of people living in urban households and the younger generation are becoming victims of sudden cardiac death. While prevention is key and awareness needs to be generated about how lifestyle modifications are a must for healthy heart health, what most people are not aware of is that death is reversible within the first ten mintues of a sudden cardiac arrest. Given this fact, knowing the easy to learn and extremely effective technique of hands only CPR 10 is a must for all. We are extremely thankful to the High Court Bar Association for letting us conduct this training program today.”

“The Heart Care Foundation of India Hands- Only CPR 10 mantra is: Within 10 minutes of death (earlier the better), for a minimum of 10 minutes (adults 25 minutes and children 35 minutes), compress the center of the chest of the deceased person continuously and effectively with a speed of 10×10 = 100 per minute”he added

Heart Care Foundation of India, a non-profit organization working towards raising health awareness in the country has been training people in this life-saving technique for over two years now. It has successfully trained over 1,20,000 people till now in Delhi NCR itself and holds three Limca Book of World Records for the maximum number of people trained at a time, at the same place and in an hour. The NGO is in the process of training 100% of the Delhi Police PCR van staff in association the Indian Medical Association, Delhi Red Cross Society and Delhi Police by the end of this month.

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heartbeats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death.

Continuous compression only CPR compresses the heart between the sternum and the backbone and builds up the pressure that keeps the oxygenated blood flowing to the brain and keeps the person alive until a defibrillator becomes available or expert medical help arrives. It is important to act quickly for every minute lost reduces the chances of revival by 10%. So, if you wait 5 minutes, the chances of surviving are 50% less. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.