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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


27th May, 2010, Thursday

Tips to Prevent Dementia

Dear Colleague

Recently, I came across a list of 20 points given by Dr. Paul Nussbaum, a neuropsychologist at the University of Pittsburgh School of Medicine to prevent dementia and I thought of sharing them with all readers.

Most of us start worrying about dementia after retirement – and that may be too little, too late. According to experts, one needs to start taking care of their brain while in the 30s and 40s to really want to ward off dementia, or even earlier. Increasing evidence points towards lifestyle as very important to your brain’s health. To live a long and healthy life, most of us need to start as early as we can. So what can you do to keep dementia at bay?

Here are 20 tips from Dr Nussbaum.

  1. Join clubs or organizations that need volunteers. If you start volunteering now, you won’t feel lost and unneeded after you retire.
     
  2. Develop a hobby or two. Hobbies help you develop a healthy brain because you're trying something new and complex.

  3. Practise writing with your non–dominant hand several minutes everyday. This will exercise the opposite side of your brain and fire up those neurons.
     
  4. Take dance lessons. In a study of about 500 people, the only regular physical activity associated with a marked decline in the incidence of dementia, including Alzheimer’s disease was dancing. The people who danced three or four times a week showed 76% less incidence of dementia compared to those people who danced only once a week or not at all.
     
  5. Need a hobby? Start gardening. A study from New Zealand found that, of the 1,000 people, those who gardened regularly were less likely to suffer from dementia! Gardening reduces stress; at the same time, gardeners use their brains to plan gardens; they use visual and spatial reasoning to lay out a garden.
     
  6. Buy a pedometer and walk 10,000 steps a day. Walking daily can reduce the risk of dementia because cardiovascular health is important to maintain blood flow to the brain.
     
  7. Read and write daily. Reading stimulates a wide variety of brain areas that process and store information. Likewise, writing (not copying) stimulates many areas of the brain as well.

  8. Start knitting. Using both hands works both sides of your brain. It also reduces stress.
     
  9. Learn a new language. Whether it’s a foreign language or sign language, you are working your brain by making it go back and forth between one language and the other. Being bilingual may delay symptoms of Alzheimer’s disease for four years as observed by a researcher in England. And some research suggests that the earlier a child learns sign language, the higher his IQ – and people with high IQs are less likely to have dementia. So start them early.
     
  10. Play board games like Scrabble and Monopoly. Not only are you taxing your brain, you’re socializing too. Playing solo games, such as solitaire or online computer brain games can be helpful, but Dr Nussbaum recommends games that also encourage you to socialize.
     
  11. Take classes throughout your lifetime. Learning causes structural and chemical changes in the brain, and education appears to help people live longer. Brain researchers have found that people with advanced degrees live longer – and if they do have Alzheimer's, it often becomes apparent only in the very later stages of the disease.
     
  12. Listen to classical music. A growing volume of research suggests that music may hardwire the brain, building links between the two hemispheres. Any kind of music may work, but some research has shown positive effects for classical music, though researchers don’t understand why.
     
  13. Learn a musical instrument. It may be harder than it was when you were a kid, but you’ll be developing a dormant part of your brain.
     
  14. Travel. When you travel (whether it’s to a distant vacation spot or on a different route across town), you’re forcing your brain to navigate a new and complex environment. In a study of London taxi drivers, experienced drivers had larger brains because they had to store lots of information about locations and how to navigate there.

  15. Pray. Daily prayer appears to help your immune system. And people who attend a formal worship service regularly live longer and report happier, healthier lives.
     
  16. Learn to meditate. It’s important for your brain that you learn to shut out the stresses of everyday life.

  17. Get adequate sleep. Studies have documented an association between dementia and interrupted sleep.
  18. Eat omega–3 fatty acids rich foods: Salmon, sardines, tuna, ocean trout, mackerel or herring, plus walnuts (which are higher in omega 3s than salmon) and flaxseed. Flaxseed oil, cod liver oil and walnut oil are good sources too.
     
  19. Eat more fruits and vegetables. Antioxidants in fruits and vegetables clean up some of the damage caused by free radicals, one of the leading killers of brain cells.
     
  20. Eat at least one meal a day with family and friends. You’ll slow down, socialize, and research shows you’ll eat healthier food than if you ate alone or on the go.

(With input from from Dr Santosh Sahi)

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file)

Cartoons to Convey Health Messages

Cartoons catch immediate attention and are an effective mode of conveying messages in public interest. Heart Care Foundation of India (HCFI) along with its other measures of creating health awareness has also employed this module for an extensive reach in general public. In the photo, Padma Shri Awardee Sudhir Tailing, famous cartoonist can be seen developing a cartoon message. Also seen in the photo Padmashri Awardee Dr. K. K. Aggarwal, President HCFI.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Preoperative skin cleansing with chlorhexidine–alcohol is superior to providone–iodine
In a trial of 849 patients undergoing clean–contaminated surgery, the overall rate of surgical site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5 versus 16 %).
(Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med 2010;362:18)

 

Mnemonic of the Day (Dr Prachi Garg)

Hemorrhagic Ascites – MARA

  • Malignancy
  • Acute pancreatitis 
  • Ruptured ectopic 
  • Abdominal trauma

News and Views

1. Most  papillary thyroid cancer pts survive regardless of treatment

A study published in the May issue of Archives of Otolaryngology–Head & Neck Surgery reports that in patients with papillary thyroid cancer that has not metastasized, the outcomes appear to be favorable despite treatment within the first year after diagnosis. The 20–year survival rate from cancer was estimated to be 97% for those who did not receive treatment and 99% for those who did.

2. Infectious cause of asthma

An animal model developed by American researchers demonstrates how an early childhood lung infection can cause asthma during later life. Chlamydia infection of the respiratory tract has been identified as a risk factor for asthma. But its exact role is not clear. The study showed that chlamydia infections in childhood may cause may abnormal immune responses causing chronic infection eventually and inducing asthma. According to Katir Patel, one of the researchers, early life respiratory colonization with chlamydia elicits pathogen–specific IgE antibody production, which for the first time provides evidence of an infectious asthma phenotype. The study findings were presented at the 110th General Meeting of the American Society for Microbiology in San Diego.

3. BP drops when sugary drinks are reduced

Reducing intake of sugar–sweetened soft drinks causes BP to fall. Dr Liwei Chen, of Louisiana State University Health Science Center in New Orleans reported a significant decline in both systolic and diastolic BP over a period of 18 months in a group of US adults who reduced daily intake of the beverages. Compared with the baseline values, systolic BP reduced by mean of 9.8 mmHg at 6 months and 8.2 at 18 months; the corresponding declines were 5.4 and 5.6 millimeters of mercury, respectively for diastolic BP. The study is reported in June 8 issue of Circulation.

4. Beta–blockers beneficial in COPD

Treating patients with chronic obstructive pulmonary disease (COPD) with beta–blockers caused 30% decrease in mortality and disease exacerbations, according to the results of a large cohort study in the May 24 issue of the Archives of Internal Medicine. Electronic medical records for more than 2000 patients with and without coexisting cardiovascular disease were reviewed in the study. Beta–blockers are usually avoided in these patients. But, this study further adds to evidence suggesting that beta–blockers might also benefit patients with COPD.

Quote of the day (Varesh Nagrath)

Wisdom Quotes (Read only if u have time)

  • A single conversation with a wise man is better than ten years of study.

  • It is not the strongest, who survive, nor the most intelligent, but the most responsive to change.

  • He who asks is a fool for 5 minutes. He who does not ask is a fool forever.

  • To know the road ahead, ask those coming back.

  • When I rest, I rust.

  • Consistency requires you to be as ignorant today as you were a year ago.

  • Luck has a peculiar habit of favoring those who don’t depend on it.

  • Trust men and they will be true to you.

Question of the Day

What are the drugs used in the treatment of Giardiasis?

The most common treatment for giardiasis is metronidazole for 5–10 days. It eradicates the Giardia more than 85% of cases

The other drug is furazolidone given for 7–10 days. It is approximately as effective as metronidazole. Tinidazole is highly effective at treating giardiasis (>90%). It can also be given as a single dose and is well-tolerated. Quinacrine is very effective for treating giardiasis (no longer available in the US) Paromomycin and albendazole are less effective than other treatments.

Evidence–Based Medicine

(Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital)

Association of interruptions with an increased risk and severity of medication administration errors

Abstract

Background Interruptions have been implicated as a cause of clinical errors, yet, to our knowledge, no empirical studies of this relationship exist. We tested the hypothesis that interruptions during medication administration increase errors.
Methods An observational study of nurses preparing and administering medications in 6 wards was carried out at 2 major teaching hospitals in Sydney, Australia. Procedural failures and interruptions were recorded during direct observation. Clinical errors were identified by comparing observational data with patients' medication charts. A volunteer sample of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours from September 2006 through March 2008. Associations between procedural failures (10 indicators; eg, aseptic technique) and clinical errors (12 indicators; eg, wrong dose) and interruptions, and between interruptions and potential severity of failures and errors, were the main outcome measures.
Results Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. The association between interruptions and clinical errors was independent of hospital and nurse characteristics. Interruptions occurred in 53.1% of administrations (95% confidence interval [CI], 51.6%-54.6%). Of total drug administrations, 74.4% (n = 3177) had at least 1 procedural failure (95% CI, 73.1%-75.7%). Administrations with no interruptions (n = 2005) had a procedural failure rate of 69.6% (n = 1395; 95% CI, 67.6%-71.6%), which increased to 84.6% (n = 148; 95% CI, 79.2%-89.9%) with 3 interruptions. Overall, 25.0% (n = 1067; 95% CI, 23.7%-26.3%) of administrations had at least 1 clinical error. Those with no interruptions had a rate of 25.3% (n = 507; 95% CI, 23.4%-27.2%), whereas those with 3 interruptions had a rate of 38.9% (n = 68; 95% CI, 31.6%-46.1%). Nurse experience provided no protection against making a clinical error and was associated with higher procedural failure rates. Error severity increased with interruption frequency. Without interruption, the estimated risk of a major error was 2.3%; with 4 interruptions this risk doubled to 4.7% (95% CI, 2.9%-7.4%; P < .001).
Conclusion Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

Comment: In this study, nurses who were interrupted during medication administration were more likely to make errors. Although multitasking is a necessity for many occupations, it might have adverse effects on the delivery of healthcare, and the study's findings likely are applicable to many aspects of medicine.

Reference
Westbrook JI, Woods A, Rob MI, et al Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010;170(8):683-690.

Liver Fact

A two–fold rise in Gama GT and SGOT/SGPT ratio of more than two is alcoholic liver disease unless proved otherwise.

World No Tobacco Day 31st May

Judaism: The Jewish tradition proposes action not through prohibition but through educational approaches that invite individuals to use their commonsense.

eMedinewS Try this it Works

Understanding high blood pressure

As you measure a person’s blood pressure, inflate the cuff to just above the systolic pressure. Explain to your patient that this is the pressure on the heart and in the blood vessels supplying the brain. This gives a hands–on example of what blood pressure means and may help patients understand why it is important to take their medication regularly.

Dr Good Dr Bad

Situation: A CAD patient on low–dose aspirin was to be prescribed a NSAID.
Dr Bad: You can take it anytime.
Dr Good: Take aspirin 2 hours before the NSAID.
Lesson: In patients using NSAIDs on an occasional short–term basis, aspirin should be taken at least two hours before the NSAID.

Make Sure

Situation: A child with completely repaired tetralogy of Fallot (TOF) with prosthetic material developed infective endocarditis (IE).
Reaction:
Oh my God! Why was IE prophylaxis not given.
Lasson: Make sure that all patients with congenital heart disease repaired with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure are given IE prophylaxis.

IMANDB Joke of the Day

One liner: ek budia javani mei mer gaye.

Formulae in clinical practice

Plasma Oxygen Concentration

Formula: = Po2 × 0.0031

Milestones in Dermatology

1816 Psoriasis: The name is derived from the Greek word psora which means to itch. Psoriasis is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. It was not until 1841 that the condition was finally given the name psoriasis by the Viennese dermatologist Ferdinand von Hebra.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Iron deficiency anemia

In men and postmenopausal women, anemia is usually caused by gastrointestinal blood loss from: Certain types of cancer (esophagus, stomach, colon); long–term use of aspirin or nonsteroidal anti–inflammatory medications (NSAIDS); Peptic ulcer disease.
Tests to diagnose Iron deficiency anemia are serum iron (this test measures the amount of iron in your blood);serum ferritin (it is a protein that helps store iron in your body); transferrin level, or total iron–binding capacity; reticulocyte count and serum transferring receptor.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Calamine 8% + Liquid Paraffin10% lotion

As antipruritic and smoothening agent

26.02.09

 

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eMedinewS–Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Public Forum (Press Release for use by the newspapers)

Minor changes in lifestyle are all that is required for good health

Middle–aged women who move around more in their daily life have lower levels of intra–abdominal fat, a risk factor for heart disease, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Minor modifications in daily routine such as reducing the time watching TV or increasing the walk time to work, can make a difference in the long-term health.

Visceral fat is a hot topic because of metabolic syndrome which predisposes people to disease.

Intra–abdominal fat, or the fat that wraps around the organs in the abdomen and chest, tends to accumulate at midlife and can contribute to developing diabetes, hypertension and heart disease. The fat around the organs is known to be more related to heart disease and diabetes.

A woman does not need to appear outwardly heavy to have a potentially troublesome extra "tire" around her organs.

Exercise for long have been known to reduce the amount of intra–abdominal fat.

 

Readers Responses

  1. Dear Dr KK Agarwal, Thank you for this excellent excercise. We the Alumni of Trivandrum Medical College are arranging an Intensive MRCP training and are inviting First Part passed trainees to join the Medical Training Intiative programme of the National Health Servie of UK and Royal College arranging a 2-Year Paid training programme in UK. I am the International Advisor to Royal College and we are inviting applications from graduates who have 3 years after passing MBBS for selection for these posts. I shall be obliged if you could provide coverage for this excellent programme. Warm regards: Prof S Krishankumar

  2. Respected sir, I have become a fan of ur daily web news. Sir, if I have something in my mind… that I want to share with our colleagues thru ur paper… how can I?? Sandeep Jain                   A: Just email it. KK

  3. Laughter is the best medicine:According to a research presented to American College Of Cardiology, laughter appears to increase the blood flow in the body, protecting the Heart and reducing the incidence of heart attack. Laughing increases the blood flow in the body by 20%, which is equivalent to affect of aerobic exercise, whereas stress decreases the blood flow in the body by about 35%.

    1. This effect is produced by movements of the diaphragm muscle which separates the chest from abdomen and moves vigorously during the act of laughing

    2. Laughing increases the release of endorphins, which gives sense of wellbeing and in turn increases the amount of chemicals in the blood which help in dilating the blood vessels and increasing the blood flow.

    3. Laughter reduces the production of cortisol (stress hormone). Cortisol is produced in excess during stress, which may be endogenous or exogenous. This contracts the blood vessels and increases heart beat, reducing oxygen supply to the cells. Researchers also suggested that a chemical called nitric oxide helps the blood vessels to dilate. Mental stress leads to break down of nitric oxide reducing its circulating quantity resulting in narrowing of blood vessels.
    Mental stress impairs the function of the endothelial layer of blood vessels which can lead to a series of inflammatory reactions culminating in deposition of lipids and cholesterol. People with heart disease laugh less even under positive situations, they also display more anger and hostility. (Dr Santosh Sahi)
  4. Dear Sir, Request to all DMA members, kindly inform DMA Office by email delhimedicalassociation@yahoo.com, or  telephonically 01123271726, 01123285727 alongwith their complete addresses and branch number, in case they are not getting DMA news bulleting published fortnightly. Thx n regards, Dr. Ashwini Dalmiya, Hony. State Secretary, Delhi Medical Association, M. 9811542055