eMedinewS9th September 2014, Tuesday

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

Tips on family history of high cholesterol

Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL("bad cholesterol") levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.
 

News Around The Globe

  • A new study has pointed towards a potential risk factor for memory loss that is irreversible: our blood type. Researchers noted that people with blood type AB were 82% more likely than other types to develop the thinking and memory problems that can lead to dementia. The study is published in the journal Neurology .
  • A study published in the journal Stroke has found that older women who consume potassium-rich foods may be at a lower risk of stroke and have a greater life expectancy than women consuming less potassium-rich foods.
  • Quadrupling the US Food and Drug Administration's approved dose of doripenem in patients with cystic fibrosis (CF) and acute respiratory infection is safe and could serve as a new therapeutic option for those with advanced disease and evidence of resistant bacteria in their lungs, suggests a new study presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
  • Results of a new pharmacokinetic study have revealed that when first-line tuberculosis (TB) drugs are taken with food, a reduction in maximum plasma concentration and bioavailability of the drug is noted, compared with when taken on an empty stomach. The study was presented at the European Respiratory Society (ERS) International Congress 2014.
  • A study published online in Thorax has stated that a simple LENT score predicts survival in patients with malignant pleural effusion. The LENT score calculation assigns 0 (<1500 IU/L) or 1 (>1500 IU/L) for pleural fluid LDH level; 0 to 3 points for matching ECOG performance scores (3 and 4 are combined); 0 (<9) or 1 (>9) for neutrophil-to-lymphocyte ratio; and 0 (lowest risk), 1 (moderate risk), or 3 (highest risk) for tumor type.

Rabies News (Dr A K Gupta)

Can rabies vaccine be given to HIV or AIDS patient?

Rabies vaccine can be given to HIV or AIDS patient. It is recommended to administer RIGs even in category II exposures in such patients and double the dose of anti–rabies vaccine must be given on day 0 of vaccination.

Cardiology eMedinewS

  • There has been a significant improvement in the one-year mortality rates of elderly individuals admitted to the hospital for acute MI over the past 15 years, and this could be attributed to improved medical therapy and access to PCI, suggests a new analysis presented at the European Society of Cardiology 2014 Congress.
  • The use of an algorithm with a highly sensitive assay for cardiac troponin T (hs-cTnT) allows physicians treating patients with chest pain in the emergency department to safely and effectively rule out acute MI within one hour, suggested the results of the High-Sensitivity Cardiac Troponin T Assay for Rapid Rule Out of Acute Myocardial Infarction (TRAPID-AMI) study. The results were presented recently at the European Society of Cardiology 2014 Congress.

Pediatrics eMedinewS

  • A new study by researchers from Massachusetts General Hospital noted that among cannabis-using adolescents undergoing treatment for substance abuse, 40% displayed withdrawal symptoms, a hallmark of drug addiction. The study was published in the Journal of Addiction Medicine.
  • An epidemiological study, published in the journal Epidemiology, has suggested that exposure to certain phenols during pregnancy, especially parabens and triclosan, may disrupt growth of boys during fetal development and the first years of life. Bisphenol A, however, was not associated with any definite modification in growth.

Dr K K Spiritual Blog

The Science behind Training and Development

Training in any field requires gaining knowledge, skills and positive mental attitude towards the object of learning.

Knowledge is everything about what and why. In Yoga, it correlates with the Gyan (Gnana) Marg. Skill is all about how to do it and correlates with Karma Marg.

The positive mental attitude is linked to willingness to do any work or in other words one’s Astha in that action. In Yoga, it is synonymous with Bhakti Marg.

In Bhagwad Gita, Lord Krishna talks about all the principles of management including how to train and develop an individual.

The development teaches and increases one’s intelligence quotient (IQ), physical quotient (PQ), emotional quotient (EQ) and moral quotient (MQ).

Wellness Blog

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.

Inspirational Story

Look Fear in the Face

Look fear in the face. Be brave and bold. Don't be scared of the unknown. Accept your own wrong doings as an opportunity to search deep within your soul. This way, you can't blame others for your problems.

Be strong my child, admit defeat and always stand tall with dignity and pride. Allow your tribulations to become your guide for new found wisdom. Don't look back with regret; move forward with positive thoughts about the good and bad.

Be slow to speak and listen openly to what others have to say with respect. Remember you have a choice to make. Live negative or positive; the choice is only dependent upon you. You are sent to this world for a reason; a gift to others and remember always you have a special purpose so never give up but move straight ahead with love, peace, forgiveness, and strength!

ePress Release

Donate blood at least once in a year

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 " said that one should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks.

Also, blood donation is one of the best charities that one can do as it can save multiple lives through various components obtained from one blood transfusion.

Advocating autologous transfusion, Dr. Aggarwal said that all those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

Dr. Aggarwal said in the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation. Jehovah’s Witnesses do not accept even transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time.
A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

eMedi Quiz

IRIS commonly occurs after how many weeks of ART initiation

a.1-4 week
b.2-12 weeks
c.12-24 weeks
d.after 6 months

Yesterday’s Mind Teaser: Which of the following is not a post transcriptional modification of RNA?

1.Splicing.
2.5' Capping.
3. 3' polyadenylation.
4. Glycosylation.

Answer for yesterday’s Mind Teaser: 4. Glycosylation.

Correct answers received from: Dr Jainendra Upadhyay, Dr KV Sarma, Dr Rishipal Singh, Daivadheenam Jella, Dr Avtar Krishan, Dr Chandresh Jardosh, Najib Khatee, Arvy Patel

Answer for 7th September Mind Teaser: 2. Corticosteroid.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella

Send your answer to ijcp12@gmail.com

Self-Assessment-Quiz

 

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Total CPR since 1st November 2012 – 98440 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 and CPR 10 Camp at N P CO–ED Sr Sec School, Laxmi Bai Nagar on 28th August 2014

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Weight loss may improve sexual health of obese diabetes

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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 dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue

eMedinewS Humor

No Exit

A person checks into a hotel for the first time in his life, and goes up to his room. Five minutes later he calls the desk and say, "You've given me a room with no exit. How do I leave?"

The desk clerk says, "Sir, that's absurd. Have you looked for the door?"
The person says, “Well, there's one door that leads to the bathroom. There's a second door that goes into the closet. And there's a door I haven't tried, but it has a 'do not disturb' sign on it."
 

Quote of the Day

A good head and a good heart are always a formidable combination. Nelson Mandela

Twitter of the Day

Dr KK Aggarwal: Caloric restriction may prevent disease increase life span http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: : I go into silence midnight tonight with this guy for 7 days. Won't be tweeting. My office may do…

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