The Year 2010

Wish All My Friends.

From.

Dr.Prahallad Panda.

Surgeon, Paradip Port Trust, Paradip,

Odisha,India

Symptoms of Heart Attack and First-Aid

Distribution of Pain In Heart Attack.

Heart continuously pumps blood along with nutrients and oxygen to all the parts of body. It is a muscular organ; needs oxygen and nutrition for its survival. Those blood vessels which supply the heart are called coronary arteries. There are two main trunks which branch off to supply oxygen and nutrition to all the parts of heart. If any of these feeding channels is blocked there occurs starvation death of the part of the heart. It ranges from milder attack to massive one depending on the size of artery blocked. The most common cause is atherosclerosis. Atherosclerosis is a plaque of bad fat, calcium and some components of blood; deposited in the inner layer of the coronary artery. These plaques rupture and block; or as such narrow the lumen and block the blood supply beyond the site. That causes death of the tissue.
The main and classical symptom of heart attack is pain in the left side of chest, called angina. It may be localized to the site or may radiate to left arm, neck, back, upper abdomen and to the right side. It is felt as a squeezing pain in the chest, as if something is restricting movement of the chest wall; or it may be a mild discomfort at the other end of the scenario. Effort exaggerates the pain and rest in a head end elevated laying down position may relieve it to some extent. The patient may have sweating, difficulty in breathing to absence of respitation, dizziness to unconsciousness or absence of peripheral pulses. He or she may have vomiting or involuntary passage of stool or urine. The body temperature may be sub-normal and skin may be cold and calmly with goose bumps. The patient may be suffering from diabetes and/or hypertension.
In these circumstances, the nearby person becomes the life savior for the patient. The heart needs to be restarted, if the person is unconscious and does not have a pulse or respiration. The procedure is called cardiopulmonary resuscitation (CPR). Here, a left sided forceful chest compression and mouth to mouth respiration in the ratio of 4:1 is given. If two persons are available for the purpose, it is better; but can be done by one. If a defibrillator is available should be used. I think, performed in an efficient manner can save some lives. If the person is not unconscious, he can be given mouth dissolving aspirin, if available; that will save the victim from more massive damage to the heart. If tablet of nitroglycerin is available should be put below the tongue. Oxygen, if available should be utilized and patient be transported to the nearest hospital first; be it a primary health center.
The immediately available person can help a victim of heart attack by performing CPR and making use of the commonly available household medicines.

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Vaishnav Jana To Tene Kahiye: Gandhi’s Favorite Prayer Song

Mahatma Gandhi

Recently, there has been a get-together of all the doctors of our hospital; where everybody was asked to sing a song. I am not a singer, so also many of us; when my turn came, I choose to sing the famous prayer song of Gandhi, “Vaishnav jana to tene Kahiye...” It has been sung time and again by various artists, but Lata Mangeshkar the living legend of India’s music world had sung it perhaps from her heart; of course, usual for her.

Lata Mangeshkar via last.fm

I regard it as the best. I recited a few lines form the song, not so melodiously; but, was appreciated as usual in a friendly gathering. The essence of the song is that, it preaches honesty, truthfulness, good behavior towards others especially to ladies, help others; and the cream is; not to feel proud after all sorts of good deeds. It is also very much soothing and heart touching to listen from the tongue of Lata; the melody queen of India. I urge every friend of mine to listen to the song here.

Chinese Green Tea.

Tea and coffee intake has been long studied for antioxidant property; this article says about its protective effect on diabetes, and the possible mode of action.

clipped from www.medpagetoday.com Tea, Coffee Seem to Protect Against Diabetes Drinking lots of coffee and tea every day -- even decaf -- might keep diabetes away, new research shows. The researchers found a significant inverse relationship between coffee consumption and subsequent risk of diabetes. Each additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes (95% CI 0.91 to 0.95, P<0.001). The findings suggest that the protective effects of tea and coffee may not be solely related to the effects of caffeine, but rather involve a broader range of chemical constituents including magnesium, lignans, and chlorogenic acids, the researchers wrote. Tea catechins, for example, may decrease glucose production in the gastrointestinal system, leading to lower levels of glucose and insulin, and green tea in particular may prevent damage to pancreatic beta cells.

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Stem Cells a Promising Target in Breast CA

Image of Stem Cell Division

The Notch pathway is rather a new concept; may be helpful in the long run to control recurrences of breast cancer.

clipped from drppanda.amplify.com Stem Cells a Promising Target in Breast CA The Notch pathway is involved in normal mammary development, in communication between cells, and in determining what happens to a cell when it divides, thus “regulating the self-renewal of cancer stem cells,” Chang said in an interview with MedPage Today. She and her team implanted mice with human breast cancer biopsy material that included breast cancer stem cells, then gave them a Notch inhibitor (MRK-003) or a placebo. MRK-003 significantly reduced formation of clusters of tumor cells called mammospheres compared with placebo. Given the proposed mechanism, Notch inhibitors are likely to be developed for upfront use in combination with agents to “debulk” the daughter cells or for chronic administration in the adjuvant setting to prevent recurrence, she speculated. Her group plans a larger Phase II trial, while others are developing agents targeting other cancer stem cell pathways, such as Hedgehog.

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Tips to Prevent Shoulder Dislocation

An X-Rays Image of Shoulder Dislocation 

The stability of shoulder joint has been compromised for the range and varieties of movements, those are possible there. Most of the dislocations are seen in this joint; about 45%, and about 90% are anterior dislocations; the rest are posterior. As the joint is not well protected by bony structures, muscles and ligaments; the incidence of anterior dislocation is much more. It occurs in an out stretched and outwardly rotated arm; a position in which the joint is least supported. So, shoulder dislocation is mostly seen in the sportsman. Therefore, the position as mentioned above should be avoided especially in the case of recurrent dislocations. I reduce anterior dislocation in an arm traction by weight in a face down sleeping position; under sedation; the Stimson’s method. I find it much convenient method for me and also for the patient; as the set up can be arranged very quickly as a day care procedure; and patient walks away soon after the procedure as no general anesthesia is administered; so also the inherent side effects of general anesthesia are avoided.
A little careful movement of the limb will prevent this dislocation and associated pain from that; which is much severe. Still, there will be some cases of this dislocation attracting an emergency attention.

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A Papilloma Of Stomach

A papilloma of stomach as seen in an endoscopy is presented here. A biopsy( taking small bit of tissue) has been done for histopathological study. A small amount of bleeding is seen which ceases quickly.

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Esophageal Erosion And Duodenal Ulcer In Endoscopy

Mediterranean diet: Importance of individual components

Image via Wikipedia

"The most protective components of the Mediterranean diet are moderate alcohol intake, low intake of meat and meat products, and high intakes of vegetables, fruits, nuts, olive oil and legumes." I quote from CIMS the benefits of Mediterranean diet. Of course, we can not go there for the diet; but can adopt the some of the diet feasible to have in our region. And that is the essence.

clipped from www.mims.com The study included 23,349 men and women. After an average follow-up of 8.5 years, mortality was 652/12,694 among people with a Mediterranean diet score of 0–4 and 423/10,655 among people with a score of 5 or more. After controlling for confounders, the Mediterranean diet was associated with a significant reduction in mortality of 14% per 2-unit increase in score. Moderate consumption of alcohol contributed 23.5% to this reduction; low consumption of meat and meat products, 16.6%; high consumption of vegetables, 16.2%; high consumption of fruit and nuts, 11.2%; high monounsaturated: saturated fat ratio, 10.6%; and high consumption of legumes, 9.7%. High intake of fish and seafood was associated with a non-significant increase in mortality. High consumption of cereals and low con­sumption of dairy products had little effect. Trichopoulou A, et al. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009;339:26–29.

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Stomach Acid Inhibitor Drugs May Mask Cancer Symptoms

Cancer Of Stomach

“New dyspepsia in old” is a warning symptom of underlying more serious disease like cancer stomach.
Free availability of medicines from the organizations, little learning and “It will not happen to me” are some of the dangerous notions. Stomach cancer affects insidiously without much clear cut symptoms; often mimic acid related problems. All the above notions add fuel to fire, in delaying consultation with the appropriate health care personnel.
A doctor friend of a bureaucrat, accidentally discovers proton pump inhibitor drugs used to suppress stomach acid, in the drawer of his friend; and inquires the cause of the use. He is a habitual chewer of tobacco in betel. He defends: since long he is using the drug for acid problem and feeling good, but recently there is a little aggravation in spite of its use. The doctor friend of his advises for an upper gastrointestinal endoscopy; and eventually a much advanced cancer of stomach was detected. Needless, to to say that, only a food bypass surgery was possible; the patient passed away some six months later. So, this is the worst result of self medication and self diagnosis. Another patient was virtually dragged and subjected to endoscopy by his wife, but still it was late; a resection of stomach was done and perhaps he survived for some three to four years.
Frequently, symptoms pertaining to stomach cancer like pain abdomen, vomiting, vomiting of blood and obstruction to passage of food come later; than more ambiguous symptoms like dyspepsia, acidity and heart burn etc., which are suppressed by acid inhibitors. “New dyspepsia in old” should be viewed suspiciously and a very affordable and accessible investigation like endoscopy is to be advised. If accompanied by anemia, weight loss, black stool, lymph nodes (above the left collar bone in the neck and near umbilicus) are present; cancer of stomach is a presumptive diagnosis, unless proved otherwise.
H. Pylori infection present in areas with no access to safe drinking water, has been seen to be associated with it. That causes atrophic gastritis, a form of damage to the stomach inside lining called mucosa; and gradual transformation to cancer. Nitrosamines in contaminated food, cigarette smoking, some genetic predisposition and ingestion of hot spicy food are advanced as possible causes; in absence  of knowledge of exact cause for it. More cases are seen in Japan where people are accustomed to taking smoked fish.
A very skeptical doctor and a cautious patient may contribute to the early diagnosis of many cancer stomach patients.

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HDL Fat and Niacin + Ezitimibe

Chemical Structure of Niacin

Niacin, a “B” group vitamin, widely distributed in both vegetarian and non-vegetarian diet; is responsible for many vital metabolisms in the body. It is available as an insoluble compound in maize. Those primarily depending on maize as staple diet may suffer from its deficiency. In its deficiency people suffer from Pellagra; characterized by diarrhea, dermatitis and dementia. There may occur reddish to blackish dis-colorization of the exposed parts of the skin of the extremities, called dermatitis. Dementia is marked by forgetfulness. If not treated adequately, death may ensue.

Stages of Atherosclerosis

It has property of raising high density lipoproteins(HDL) the good fat in the body; which protects heart from atherosclerosis. This a good fat is responsible for mobilizing bad fat, the low density lipo-proteins(LDL). This requires administration of niacin in higher doses. To minimize the adverse reaction to highly dosed rapidly absorbed niacin, sustained released types are available. Combining niacin with ezitimibe, a lipid lowering drug has been seen to have synergistic action; say researchers.

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