eMedinewS31st August 2014, Sunday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Why do commercial and foods cooked by ‘halwais’ taste better?

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.

Innovations in Cardiology (IIC) Summit 2014

Dr Rajneesh Kapoor

Warfarin continuation better than discontinuation in AF patients

Results from the role of coumadin in preventing thromboembolism in 1584 patients with atrial fibrillation (AF) undergoing catheter ablation (COMPARE) randomized trial published in Circulation 2014 Jun 24;129(25):2638–44 show that warfarin discontinuation was the strong predictor of periprocedural thromboembolism. Performing catheter ablation of AF without discontinuing warfarin reduces the occurrence of periprocedural stroke and minor bleeding complications compared with bridging with low–molecular–weight heparin.

News Around The Globe

  • The "International Conference of Indian Doctors" is being held on 30th & 31st August 2014 at Scientia Building, Leighton Hall, University of New South Wales, Kensington, Sydney, Australia. The conference has been organised by Australian Indian Medical Graduates Association (AIMGA) in collaboration with Global Association of Physicians of Indian Origin (GAPIO).
  • Divided–attention brain training programs have the potential to improve multitasking skills and reduce cognitive decline in older patients, suggests a new study published online in PLoS One.
  • A report published in the September issue of Obesity has shown that obese women who participated in a weight management program during pregnancy gained significantly less gestational weight and had a lower proportion of large–for–gestational age (LGA) babies than obese women who received only one–time dietary advice.
  • The SNOT–22 questionnaire can possibly assist in the identification of cystic fibrosis (CF) patients with subclinical nasal polyps, suggests a new study published online in JAMA Otolaryngology – Head & Neck Surgery.
  • Women with a history of severe acne in their teenage years are at significantly increased risk of endometriosis, suggests a study published online in Human Reproduction.
  • Researchers in Europe and the United States have devised a model that could successfully predict major complications in type 1 diabetes, suggest results published online on August 28 in Diabetologia.

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.

Cardiology eMedinewS

  • Patients with gout, especially women, have increased risk for vascular disease, suggests a study published online August 27 in the Annals of Rheumatic Diseases. Women with gout had a 25% increased risk for any vascular event as compared to women without gout. Their risk for any CHD and peripheral vascular disease was also higher.
  • Authors of an extremely critical analysis published in the BMJ have asked the European Society of Cardiology (ESC) to revise its recent guidance pertaining to the use of beta–blockers in patients undergoing noncardiac surgery, to mend its guideline process to be more transparent, and to act much more swiftly to revise recommendations when patient lives are at risk. Authors advocated that the ESC should reduce their recommendation to class III (‘not recommended’) to reflect the significant increase in mortality in randomized trials.

Pediatrics eMedinewS

  • Decreases in cerebral oxygenation when sleeping face–down may increase the risk of sudden infant death syndrome (SIDS) in preemies, suggests a report published online August 25 in Pediatrics.
  • Fetal alcohol spectrum disorders (FASD) are associated with an increased risk of overweight and obesity in children and adolescents, suggests a study published online August 26 in Alcoholism: Clinical and Experimental Research.

Dr K K Spiritual Blog

Always Respect Others Viewpoints

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.

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.

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!"

ePress Release

20 minutes of sunlight and a glass of milk can keep osteoporosis at day

Osteoporosis and vitamin D deficiencies are the two new epidemics of the society said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Drinking less milk, avoiding sunlight exposure and omitting the traditional aerobic indoor games are few reasons for these new epidemics. Most young professionals now remain confined to their offices or workplace, with practically no exposure to sunlight. This is especially true for the medical residents.

Here are a few tips for preventing osteoporosis and strengthening the bones.

  1. One should stop smoking as it increases bone loss.
  2. Eat a calcium–rich diet: The aim should be to get 1,500 milligrams of calcium a day in postmenopausal woman or a man over age 65. Good dietary sources of calcium include dairy products, tofu and other soy products, orange juice fortified with calcium, canned salmon with the bones, and cooked spinach. The alternative is to take calcium supplements.
  3. Get enough vitamin D: Vitamin D levels are influenced by how much sunlight one gets. Levels tend to decrease in older adults, especially in winter and in people who are unable to leave their home. One should consider taking a supplement to make sure one gets the recommended daily amount.
  4. Get exposure to sunlight of at least 20 minutes per day. The exposure should be for duration of 20 minutes every day for a month in a year.
  5. Get enough protein in diet: An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds. However, too much protein with too little calcium can be harmful.
  6. Weight–bearing exercise: These are activities such as walking, jogging and climbing stairs that one should do on the feet, with your bones supporting your weight. They work directly on the bones of the legs, hips and lower spine to slow mineral loss.
  7. Weightlifting exercises: These exercises, also called resistance training or strength training. They strengthen muscles and bones in the arms, chest and upper spine. They can work directly on the bones to slow minerals loss.
  8. Get adequate vitamin K: This vitamin may be helpful in enhancing bone strength. Green leafy vegetables are the best sources of vitamin K. If one is taking a blood thinner, he or she should check with the doctor.
  9. Avoid excessive alcohol: Women should limit alcohol consumption to less than one ounce a day and men should limit it to less than two ounces.
  10. Limit cola drinks: People who have high cola intake often have lower bone density.

eMedi Quiz

A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Propriception on the ispilateral side.

Yesterday’s Mind Teaser: An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde–3–phosphate dehydrogenase.
2.Phosphoglucomutase.
3.Lactate dehydrogenase.
4.Glucokinase.

Answer for yesterday’s Mind Teaser: 1.Glyceraldehyde–3–phosphate dehydrogenase.

Correct answers received from: Dr P C Das, Dr K Raju, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr K V Sarma.

Answer for 29th August Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Dr Bitaan Sen & Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

Self-Assessment-Quiz

 

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Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Health Check Up Camp at Sarvodya Kanya Vidyalaya, 8th May 2014

press release

PPIs may be associated with a higher risk for clostridium difficile–associated diarrhea

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IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why did you ignore the blood pressure of 90/80?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

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."

Quote of the Day

Productive achievement is a consequence and an expression of health, self–esteem, not its cause. Nathaniel Branden

Twitter of the Day

Dr KK Aggarwal: Heart disease starts in youth: http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: At our core we are all capable and deserving of love http://bit.ly/DC_Ananda

   
medicolegal update

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  1. Dear Sir, Thanks for the information. Regards: Dr Kanchan

Forthcoming Events

Dear Colleague

Kindly attend ‘Innovations in Cardiology (IIC) Summit 2014’ on 6th September, 11 am – 6 pm at Hotel Oberoi, Gurgaon.

The Organizing Secretary is Dr Rajneesh Kapoor

Highlights of the conference

  • Separate hall for Clinical Cardiology
  • One session on Medicolegal aspects will be taken by me.
  • No registration fee, limited seats

Kindly send your confirmation to rawat.vandana89@gmail.com or sms 9891673085

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