July 28  2015, Tuesday
Tackling obesity in children
Dr KK AggarwalMore than 30 people of the society including children have potbelly abdominal obesity. India is witnessing an epidemic of metabolic syndrome, which is characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high sugar.

Abdominal girth of more than 90 cm in men and 80 cm in women indicates that the person is vulnerable to future heart attack.

Normal weight obesity is the new epidemic in the society. A person could be obese even if his body weight was within the normal range. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times.

Normally once the height stops growing, most organs will also stop growing. The weight of the heart, liver or kidney cannot increase after that. Only muscles can build up to some extent. The only thing, after that stage, which can increase the weight of the body, is deposition of fat. Therefore any weight gain after puberty is invariably due to fat. Though the overall weight can be in the acceptable normal range but any weight gain within that range will be abnormal for that person. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. After the age of 50, the weight should reduce and not increase.

Potbelly obesity is linked to eating refined carbohydrates and not animal fats. General obesity is linked to eating animal fats.

Refined carbohydrate includes white rice, white maida and white sugar. Brown sugar is better than white sugar. Refined carbohydrates are called bad carbohydrates and animal fat is called bad fat.

Trans fat or vanaspati is bad for health. Trans fats increase the levels of bad cholesterol and reduce good cholesterol in the body.

Reduction in weight can reduce snoring, pain of arthritis, blood pressure and control uncontrolled diabetes.

Some points
  • Skip carbohydrates once in a week.
  • Combine a sweet food with bitter food (prefer the combination of aloo methi over aloo matar).
  • Walk, walk and walk…
  • Consume green bitter items in foods such as karela, methi, palak, bhindi etc.
  • Do not eat trans fats (vanaspati).
  • Do not consume more than 80 ml of soft drinks in a day.
  • Do not consume sweets with more than 30% sugar.
  • Avoid maida, rice and white sugar.
In cardiac arrest call 102 or 100
Cardiology eMedinewS
  • Researchers at the University of Cambridge, in collaboration with the University of Edinburgh, have shown how sodium fluoride, a radioactive agent, can highlight the build-up of unstable calcium deposits in arteries, a process that can cause heart attack and stroke. The technique, reported in the journal Nature Communications, could help in the diagnosis of these conditions in at-risk patients and in the development of new medicines.
  • A prospective cohort study presented at the recently concluded Society of Cardiovascular Computed Tomography (SCCT) 2015 Annual Scientific Meeting observed that a large proportion of middle-aged men and women who had a similarly aged sibling with recent MI showed no CV symptoms themselves despite significant coronary lesions by coronary CT angiography (CCTA). Moreover, almost all of the siblings had a low Framingham score and HeartScore, and all but one patient had a negative stress echo (transthoracic echocardiogram).
Pediatrics eMedinewS
Children with refractory enthesitis-related arthritis (ERA) may have an effective treatment option in adalimumab, suggested an international phase III study online in Arthritis Care & Research.

Respiratory Medicine
Inhaled corticosteroids cannot adequately protect children with asthma from high levels of air pollution and may actually exacerbate the effects of pollutants, caution investigators in a clinical study published online July 14 in the Journal of Clinical Allergy and Immunology.
Dr KK Spiritual Blog
Vedanta Laws
  • For every action, there is an equal and opposite reaction.
  • Knowledge proceeds from the known to the unknown. This is the basic law of learning.
  • Yesterday’s miracles are today’s science and today’s miracles will be tomorrow’s science.
  • Reality: Objects continue to exist whether or not we think about them.
  • You sow an action and reap a habit. You sow a habit and reap a character. You sow a character and reap your culture. You sow your culture and reap your destiny.
  • As are the experiences, so is the life.
  • You are what you are because of the indwelling personality determined by the nature of your mind and the intellect.
  • Change or perish is the law of nature.
  • The world is cruel only to be kind.
  • Ignorance manifests in three different stages: Lack of information, lack of understanding and lack of experience
  • The law of life proclaims that none can remain, even for a moment, without performing activity. Even the maintenance of your body will be impaired by inaction.
  • Desires are like bacteria.
  • Fear and love are the only two true emotions of nature.
  • Love is the law.
  • Everybody is born with a unique talent. Search for it and respect it.
  • The Universe is the macrocosm, man is the microcosm” (Return of the Rishi, p. 113).
There’s an ancient saying in Ayurveda:

“As is the atom, so is the Universe. As is the microcosm, so is the macrocosm.
As is the human body, so is the cosmic body. As is the human mind, so is the cosmic mind.”
Make Sure
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.
Dr Good Dr Bad
Situation: A patient with FUO (fever of unknown origin) was advised CT chest by a GP. He came for a second opinion.
Dr Bad: There is no need.
Dr Good: Go ahead.
Lesson: CT scan of the chest is invaluable in the identification of small nodules (indicative of fungal, mycobacterial, or nocardial infection or malignancy). The identification of hilar or mediastinal adenopathy may prompt biopsy by mediastinoscopy providing a diagnosis of lymphoma, histoplasmosis, or sarcoidosis.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 110490 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
A new study suggests that chemotherapy does not improve quality of life for cancer patients who are near death, and may even worsen it for those who have good performance status. The findings from the study were published in JAMA Oncology.

Infectious diseases
New research published in the journal Antimicrobial Agents and Chemotherapy has found that the sulfa-based compound ethoxzolamide, found in many drugs prescribed for the treatment of glaucoma, switches off the tuberculosis bacterium's ability to evade the immune system.

People aged 50 and older who are healthy, active, sociable and wealthy tend to be at greater risk of harmful alcohol consumption, reported new research published in BMJ Open.

A new study published in Arthritis Care and Research suggests that an intensive regimen of regular exercise and a healthy diet might reduce the short-term onset of knee pain (often caused by osteoarthritis) for overweight adults with type 2 diabetes mellitus. Neurology New results from a prespecified interim analysis of the PRIME trial revealed that aducanumab has acceptable safety and tolerability in the treatment of patients with prodromal or mild Alzheimer's disease. The data were presented at the Alzheimer's Association International Conference® 2015.
Inspirational Story
Don’t give up!

One day I decided to quit… I quit my job, my relationship, my spirituality. I wanted to quit my life. I went to the woods to have one last talk with God.

"God," I asked," can you give me one good reason not to quit?"

His answer surprised me………"look around," he said," do you see the fern and the bamboo?"

"Yes," I replied.

"When I planted the fern and the bamboo seeds, I took very good care of them. I gave them light. I gave them water. The fern quickly grew from the earth. Its brilliant green covered the floor. The fern grew more vibrant and plentiful. Yet, nothing came from the bamboo seed.

"But I would not quit. Then in the fifth year a tiny sprout emerged from the earth, just six months later the bamboo rose to over 100 feet tall. It had spent the five years growing roots. Those roots made it strong and gave it what it needed to survive. I would not give any of my creations a challenge it could not handle."

He asked me, "Did you know, my child, that all this time you have been struggling, you have actually been growing roots. I would not quit on the bamboo. I will never quit on you."

He added, "Don’t compare yourself to others. The bamboo had a different purpose than the fern. Yet they both make the forest beautiful."

Don’t tell God how big the problem is, tell the problem how great God is!
Quote of the Day
If we wait until our lives are free from sorrow or difficulty, then we wait forever. And miss the entire point. Dirk Benedict.
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Reader Response
Dr KK sir, doing great help; hats off to you sir: Dr Selvarajan IMA state vice president Tamil Nadu 2006-AMS chairman 2010.
Wellness Blog
First Cigarette of the Day Most Harmful

Heart patients should avoid smoking and taking coffee early in the morning.

Both smoking and caffeine can acutely raise the blood pressure by as much as 10 mmHg. The rise in blood pressure can be greater in susceptible individuals. The effect is most prominent with the first cigarette of the day in habitual smokers.

In patients with mild high blood pressure, habit of smoking and drinking coffee, elevation of daytime upper or systolic blood pressure can be up to 6 mmHg during winters.

Heart patients, therefore, should avoid taking cigarette, coffee, tea, with or without a cigarette early in the morning.

It was proved that smoking a cigarette in the first 30 minutes after waking up in the morning increases the risk of getting lung cancer by 79%. According to a recent US study, the morning cigarette increases of risk of getting lung cancer substantially.

The cause of this phenomenon has not been precisely determined, but it seems that if we smoke as soon as we wake up in the morning, the smoke and all its harmful components penetrate the lungs. Still, we must remember the fact that those who feel the need to smoke right after they wake up in the morning are hardcore smokers and they smoke more during the day.

This is what doctors advice their patients who cannot manage to quit smoking, to delay the first cigarette of the day for as much as possible.
eMedi Quiz
Medullary carcinoma of the thyroid is associated with which of the following syndrome:

1. MEN I.
2. MEN II.
3. Fraumeni syndrome.
4. Hashimoto's thyroiditis

Yesterday’s Mind Teaser: Strong correlation with colorectal cancer is seen in:

1. Peutz-Jegher's polyp.
2. Familial polyposis coli.
3. Juvenile polyposis.
4. Hyperplastic polyp.

Answer for yesterday’s Mind Teaser: 2. Familial polyposis coli.
Correct Answers received from: Dr Poonam Chablani, Dr K V Sarma, Dr Shangarpawar, Dr Bitaan Sen & Dr Jayashree Sen, Dr K Raju.
Answer for 26th July Mind Teaser: 4. Howell-Jolly bodies.
Correct Answers received: Asha Yahoo, Dr Poonam Chablani, Daivadheenam Jella, Dr Avtar Krishan.
eMedinewS Humor
Teacher: Billy, stop making ugly faces at other students!
Billy: Why, ma’am!
Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!
Billy: Well, I can see you didn’t listen then!
IMA Videos
Rabies News (Dr A K Gupta)
Can a 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.
News on Maps
Press Release
5,000 Police PCR Van Staff trained in CPR 10

The training is being personally conducted by Padma Shri Awardee, Dr K K Aggarwal, President, Heart Care Foundation of India and Honorary Secretary General, IMA.

“Our aim is to train 100% of the PCR Staff in this lifesaving technique,” said Dr Aggarwal.

Also known as Bystander CPR or First Responder CPR, CPR 10 requires only two steps. If you come across a victim of sudden cardiac arrest, first, call helpline number 102 and second, start compressing the centre of the chest of the victim with a speed of 100 per minute. The chest compressions should be done continuously and without interruptions until medical help arrives or the patient is revived.

No mouth to mouth respiration is required in this technique.

The most important step is compressing the chest by at least 2 inches so as to empty the heart by external pressure and maintain flow of oxygenated blood to the brain.

CPR is effective in cases of electric shock deaths, cardiac arrest due to excitement, heart attack or any other sudden cardiac death.

Today is World Hepatitis Day

To mark the World Hepatitis Day falling today, Dr Aggarwal said that hepatitis can be caused by drugs, toxins, alcohol, some disease conditions like nonalcoholic steatohepatitis (NASH) etc., but, by far the most common cause is viral infection with the hepatitis viruses. There are five different hepatitis viruses, but the most common types are Hepatitis A, Hepatitis B, and Hepatitis C viruses.

Hepatitis A is transmitted by consuming food or water that has been contaminated with the virus, while hepatitis B and hepatitis C are spread via transfusion of blood and/or blood products, unsafe sex, unsafe injections and/or tattooing.

The theme for the World Hepatitis Day this year is ‘Prevention of viral hepatitis’.

Viral hepatitis can be prevented. Increased awareness amongst the public and better access to treatment are key to controlling and preventing viral hepatitis, added Dr KK Aggarwal.

Following tips on prevention were also released on the occasion.
  • Wash hands well with soap and water before and after eating food, after defecation and after touching blood or other body fluids.
  • Boiled water is safest to drink.
  • Avoid eating unwashed raw food including vegetables and peeled and cut fruits sold on roadside. · Practice safe sex.
  • Avoid sharing personal items such as toothbrush, razors, nail cutters etc.
  • Avoid sharing needles or syringes.
  • Get vaccinated against hepatitis B.