eMedinewS16th 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

Fat intake and coronary risk: Will Desi Ghee be back

It is known that there is a continuous graded relationship between serum cholesterol concentration and coronary heart disease, and that dietary intake of saturated fat raises total serum cholesterol.

But a 2014 meta–analysis of prospective observational studies found

  • No association between intake of saturated fat and risk for CHD.
  • No relationship between monounsaturated fat intake and CHD
  • But suggested a reduction in CHD with higher intake of omega–3 polyunsaturated fats
  • A benefit with omega–6 polyunsaturated fats remains uncertain.

Given these results many cardiologists

  • No longer suggest avoiding saturated fats per se. However, many foods high in saturated fats are less healthy than foods containing lower levels.
  • No longer feel that there is substantial evidence for choosing dairy products based on low fat content (choosing skim milk in preference to higher fat milk).
  • Continue to advise reducing intake of trans fatty acids.


Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta–analysis.
Chowdhury R, Warnakula S, Kunutsor S, et al. Ann Intern Med. 2014;160(6):398.

Background: Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
Purpose: To summarize evidence about associations between fatty acids and coronary disease.
Data sources: MEDLINE, Science Citation Index, and Cochrane Central Register of Controlled Trials through July 2013.
Study selection: Prospective, observational studies and randomized, controlled trials.
Data extraction: Investigators extracted data about study characteristics and assessed study biases.
Data synthesis: There were 32 observational studies (530,525 participants) of fatty acids from dietary intake; 17 observational studies (25,721 participants) of fatty acid biomarkers; and 27randomized, controlled trials (103,052 participants) of fatty acid supplementation. In observational studies, relative risks for coronary disease were 1.02 (95% CI, 0.97 to 1.07) for saturated, 0.99 (CI, 0.89 to 1.09) for monounsaturated, 0.93 (CI, 0.84 to 1.02) for long–chain?–3 polyunsaturated, 1.01 (CI, 0.96 to 1.07) for?–6 polyunsaturated, and 1.16 (CI, 1.06 to 1.27) for trans fatty acids when the top and bottom thirds of baseline dietary fatty acid intake were compared. Corresponding estimates for circulating fatty acids were 1.06 (CI, 0.86 to 1.30), 1.06 (CI, 0.97 to 1.17), 0.84 (CI, 0.63 to 1.11), 0.94 (CI, 0.84 to 1.06), and 1.05 (CI, 0.76 to 1.44), respectively. There was heterogeneity of the associations among individual circulating fatty acids and coronary disease. In randomized, controlled trials, relative risks for coronary disease were 0.97 (CI, 0.69 to 1.36) for α–linolenic, 0.94 (CI, 0.86 to 1.03) for long–chain ?–3 polyunsaturated, and 0.89 (CI, 0.71 to 1.12) for ?–6 polyunsaturated fatty acid supplementations.
Conclusion: Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

News Around The Globe

  • A study presented at the American Society for Bone and Mineral Research (ASBMR) 2014 annual meeting has pointed that the significant reduction in calcium absorption known to occur after gastric–bypass surgery occurs even when healthy vitamin D levels are maintained postoperatively and patients receive recommended calcium supplementation.
  • Another study presented at the American Society for Bone and Mineral Research (ASBMR) 2014 annual meeting reported that women taking a drug holiday from bisphosphonate treatment for a year or longer after 3 or more years of exposure exhibited no greater risk for osteoporosis–related fragility fractures or hip fractures in comparison with those who remained on the drugs without a break.
  • A Food and Drug Administration (FDA) advisory committee has recommended the recombinant human parathyroid hormone (rhPTH(1–84)) (Natpara, NPS Pharmaceuticals) for approval for the long–term treatment of hypoparathyroidism. The committee voted 8 to 5 in favor of recommending rhPTH(1–84) to replace endogenous parathyroid hormone in patients with hypoparathyroidism.
  • The inability to stand on one leg for 10 seconds or to squat down to reach the floor represent robust early predictors of hip fracture and mortality in postmenopausal women, suggested a 15–year follow–up study presented at the American Society for Bone and Mineral Research (ASBMR) 2014 annual meeting.
  • A new study published in the journal Human Reproduction suggests that women who have difficulty accepting that they will not conceive a child after fertility treatment have worse long–term mental health as compared to those who accept the fact that they cannot conceive.

Rabies News (Dr A K Gupta)

How to approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

The first three doses of modern rabies vaccine must be very timely; for the fourth and fifth doses, variation of one or two days is permissible.

Cardiology eMedinewS

  • A large study evaluating two different vascular–closure devices suggests that they are as good as manual compression for reducing vascular–site complications among patients undergoing transfemoral diagnostic angiography. The study was presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2014.
  • Findings from a new analysis of the ADVANCE study point out that those patients who are diagnosed with type 2 diabetes at an early age need good glucose control to avoid the risk for microvascular complications; while older patients are at risk for macrovascular complications, such as MI and stroke. The findings were published online September 11 in Diabetologia.

Pediatrics eMedinewS

  • There is a clear subset of pediatric patients with demyelinating disease who have substantial damage to the nerve layer in the retina yet have no vision loss, suggested a new study. The study was presented at the 2014 Joint Americas and European Committees for Treatment and Research in Multiple Sclerosis (ACTRIMS/ECTRIMS) meeting.
  • Binge drinking during pregnancy can heighten the risk of mental health problems (particularly hyperactivity and inattention) in children aged 11 and can adversely affect their school examination results, suggested a new research published in the journal European Child & Adolescent Psychiatry.

Dr K K Spiritual Blog

Neti–Neti (Not This Not This)
(The Main Principle of Knowing the Truth)

The main figure in the Upanishads is the sage Yajnavalkya known as one of the greatest philosophers. He taught the great doctrine of neti–neti, the view that truth can be found only through the negation of all thoughts about it.

Brhadaranyaka Upanishad is the oldest and the most important of all the Upanishads. Its name actually means the great forestbook.

Sage Yajnavalkya’s dialogues with his wife, Maitreyi are featured in the Muni Kanda or Yajnavalkya Kanda. The doctrine of netineti suggests the indescribability of the Brahman, the Absolute. Yajnavalkaya attempts to define Brahman.

Atman is described "neither this, nor this" neti–neti. The Self cannot be described in any way. Na–iti that is Neti. Through this process of neti–neti you give up everything the cosmos, the body, the mind and everything to realize the Self.
Once the Atman is defined in this manner are you become familiar with it, a transformation takes place as realization dawns that the phenomenal world and all its creatures are made up of the same essence of bliss.

Brahman is infinite, amorphous, colorless, characterless and formless Universal Spirit, which is omnipresent and omnipotent, and like cosmic energy, is pervasive, unseen and indescribable.

  • Neti–neti Meditation: The principle of neti–neti has been used in meditation involving gnana yoga. Whenever a thought or feeling that is not the goal of the meditation, or is not the soul or the inner self, comes to mind, the meditator simply has to say, "Not this, not this," and dismiss the thought, image, concept, sound, or sense distraction. Any thought, any feeling, is patiently discarded — again and again if necessary, until the mind is clear and the soul/or the self is revealed.
  • Neti–neti and the mind: When you get into the habit of neti–neti, you can also discard thoughts of worry, doubt, or fear, and become established in the light of your inner self. You can, then, look back at worries and fears with deep insight and handle them.
  • Neti–neti and the medical profession: One of the basic medical teachings is to diagnose a condition by way of excluding other similar conditions. This is called differential diagnosis and this is the mainstay of allopathy. This also makes one investigative–oriented but is the only scientific way of knowing the truth.
  • Neti–neti and multiple–choice questions: In any modern exam today, the principle of neti–neti is used. A question has about four nearly similar answers and the student has to answer the correct one. He can only answer by the principle of negation.
  • Neti–neti and police investigations: This principle is also used while handling a criminal case. Everyone is a suspect in the crime initially, until a process of elimination clears them.

Wellness Blog

Lifestyle can prevent 50% of common cancers

More than 50% of cancers could be prevented if people simply change lifestyles, according to Graham Colditz, PD, DrPH, from the Washington University School of Medicine in St. Louis, Missouri at the Union for International Cancer Control (UICC) World Cancer Congress 2012.

Among the "biggest buys" from lifestyle intervention is smoking cessation. One third of cancer in high–income countries is caused by smoking.

Being overweight or obese causes approximately 20% of cancers today. If people could maintain a healthy body mass index (BMI), the incidence of cancer could be reduced by approximately 50% in 2 to 20 years.

Poor diet and lack of exercise are each associated with about 5% of all cancers. Improvement in diet could reduce cancer incidence by 50% and increases in physical activity could reduce cancer incidence by as much as 85% in 5 to 20 years.

Eradicating the main viruses associated with cancer worldwide by implementing widespread infant and childhood immunization programs targeting three viruses — human papillomavirus and hepatitis B and C — could lead to a 100% reduction in viral–related cancer incidence in 20 to 40 years.

Tamoxifen reduces the rate of both invasive and noninvasive breast cancer by 50% or more, compared with placebo, at 5 years.

Raloxifene has been shown to reduce the risk for invasive breast cancer by about 50% at 5 years.
Bilateral oophorectomy in women carrying the BRCA1 or BRCA2 gene, although rare, has been associated with a 50% reduction in breast cancer risk among high-risk women.

Aspirin is associated with a 40% reduction in mortality from colon cancer.

Screening for colorectal cancer has a similar magnitude of mortality reduction (30% to 40%).

Inspirational Story

Love in action

One night a man came to our house and told me, "There is a family with eight children. They have not eaten for days," I took some food and I went. When I finally came to the family, I saw the faces of those little children disfigured by hunger. There was no sorrow or sadness in their faces, just the deep pain of hunger. I gave the rice to the mother. She divided it in two, and went out, carrying half the rice with her. When she came back, I asked her, "Where did you go?" She gave me this simple answer, "To my neighbors–they are also hungry."

I was not surprised that she gave–because poor people are generous. But I was surprised that she knew they were hungry. As a rule, when we are suffering, we are so focused on ourselves we have no time for others.

ePress Release

Shedding weight improves the relaxation functions of the heart

Shedding extra weight improves the functions of the heart regardless of whether the weight loss comes from eating less or exercising more, 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

Moderate weight loss, around 10% of the weight, can restore heart’s elasticity –– making it easier for the heart to relax between contractions and refill with blood.

With age, the body tissue accumulates collagen fibers, which cause heart muscle and arteries to become stiffer. So over time, the heart starts to take a bit longer to relax between contractions and fill back with blood. Excess weight and obesity, in particular, add to this misery by causing further worsening of the relaxing functions of the heart.

The weight can be reduced by diet alone, exercise alone or both. The end result is improvement in the heart functions so long as one loses weight.

eMedi Quiz

All of the following statements regarding bioavailability of a drug are true except:

1. It is the proportion (fraction) of unchanged drug that reaches the systemic circulation.
2. Bioavailability of an orally administered drug can be calculated by comparing the Area under Curve after oral and intravenous administration.
3. Low oral bioavailability always and necessarily means poor absorption.
4. Bioavailability can be determined from plasma concentration or urinary excretion data.

Yesterday’s Mind Teaser: Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionization of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Answer for yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Raju Kuppusamy, Dr Jainendra Upadhyay, Dr KV Sarma, Dr Poonam Chablani, Dr Avtar Krishan.

Answer for 13th September Mind Teaser: a. Hemiplegia

Correct answers received from: Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com





Zee News – Health Wealth Shows

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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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Intensive medical treatment prevents second stroke not intracranial stenting

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Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10-14 days reverses the increased risk of atherosclerosis. Seroepidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.

eMedinewS Humor

As an English professor

As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned.

"Mr. McDonald," he said, "I can’t make out this comment you wrote on my paper."

My father took the paper and, after studying it, sheepishly replied, "It says that you should write more legibly."

Quote of the Day

Just for today don’t be angry. Just for today don’t worry. Just for today be grateful and humble. Just for today be honest. Just for today be kind to others.

Twitter of the Day

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont)
http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra:We can affect change every day. Through our thoughts, our words, and our actions. Join me at @DeepakChopra #CosmicConsciousness

medicolegal update

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  1. Congratulations sir Padma Shri Dr K K Aggarwal on being elected unopposed as Secretary General of National IMA for the year 2014–2016: Dr. Bharath Prakash Avula, CWC Member, Past President, IMA Hyderabad city.

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