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EDITORIAL
Dr KK AggarwalDr KK AggarwalUpdates in Medicine

• Adult children who felt they were emotionally closer to their mother than their siblings were more likely to show signs of depression, reported a study published in the Journal of Gerontology: Social Sciences.

• Although sleepwalkers have an increased risk for headaches and migraines when awake, while sleepwalking, they are unlikely to feel pain even after suffering an injury, suggests new research published in the journal Sleep.

• Heart failure patients with preserved ejection fraction do not improve their exercise tolerance if treated with isosorbide mononitrate, instead, they do worse, suggested a new study presented at the American Heart Association meeting.

• Treatment with BGB-290, a new, investigational, highly selective inhibitor of PARP1/2, was safe, tolerable, and yielded clinical responses in patients with advanced ovarian cancer, suggested a phase I clinical trial presented at the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

• The WEGENT trial has confirmed that azathioprine and methotrexate are equally effective for maintaining remission in patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) even though relapses, adverse events, and damage remain a concern. The findings are published in Arthritis & Rheumatology.

• A new Northwestern Medicine study has identified thousands of genetic pathways that the internal body clock takes to control how and when our pancreas must produce insulin and control blood sugar, thus paving way for new therapies for children and adults with diabetes.

• Operations to reduce the size of the stomach can significantly increase the patient's risk of developing an allergy, suggested a new study conducted at the Medical University of Vienna.

• A new study published in Frontiers in Neurology Neurotrauma found that individuals with traumatic brain injury and depression exhibit increased brain connectivity between multiple regions and sub-networks of the brain and the amygdala, the part of the brain responsible for emotional processing, compared to people with minimal depressive symptoms.

• New research presented at the International Conference on Polyphenols and Health discussed how cranberries may serve as a nutritional approach to reduce antibiotic use and support whole-body health. Scientists presented new evidence showing how cranberries can help reduce antibiotic resistance and oxidative stress.

• Just 32.1% of pregnant women who delivered in the United States in 2012 and 2013 had a gestational weight gain (GWG) within the range recommended by the Institute of Medicine, according to a report published in the November 5 issue of the Morbidity and Mortality Week Report.
Breaking News
Gender differences exist in Pay, Types of Procedures and Subspecialties: AHA
Significant gender disparities exist between women and men in the field of cardiology when it comes not only to salaries but also job characteristics and specialization, according to new research presented here today at the American Heart Association (AHA) 2015 Scientific Sessions and simultaneously published in the Journal of the American College of Cardiology.

The study of 2679 US cardiologists showed that 53.1% of the 229 women vs 28.2% of the 2450 men specialized in general/noninvasive cardiology and 11.4% vs 39.3%, respectively, had an interventional subspecialty. The mean salary for women was $400,162 (median $394,586) vs $510,996 (median $502,251) for men. Women worked significantly fewer half-days than men (387 vs 406, respectively, P=0.001), and fewer women worked full-time (79.9% vs 90.9%, P<0.001). Still, "based on measured job and productivity characteristics, the women in this sample would have been expected to have a mean salary that was $31,749 higher than that actually observed," note the investigators… (Medscape)

BEAT-HF: Remote Telemonitoring in HF patients fails to reduce hospitalizations

The Better Effectiveness After Transition—Heart Failure (BEAT-HF) study presented at the AHA 2015 Scientific Sessions shows that a follow-up protocol that included remote monitoring of patients with heart failure did not reduce hospital readmissions at 6 months compared with patients discharged from the hospital and treated with usual care. In addition, the intervention, which included predischarge heart-failure education, regularly scheduled telephone coaching, and remote monitoring of weight, blood pressure, heart rate, and symptoms, did not have any significant effect on hospital readmission rates in the first 30 days or mortality rates at 6 months. According to Dr Michael Ong (University of California, Los Angeles), lead investigator, the overall the results do not support widespread use of the intervention… (Medscape)
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Indian Medical Association National Satyagraha for a Healthy India
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eSpiritual
1st Navratri to Diwali a one-month long spiritual Yagna

One day someone asked me why Muslims and Hindus fight with each other when they worship each other’s Gods. Hindu worship ALI in DIWALI and Muslims worship RAMA in RAMAZAN.

Diwali and Ramadan both have one thing in common and that is one month of spiritual Yagna.

In the Hindu spiritual Yagna, the process starts from first day of Navratri on Amavasya and ends on Diwali, again on Amavasya. The first 10 days involve intense spiritual practice and the rest 20 days entails receiving its benefits. The first nine days, called Navratri are devoted to a process of purification and detoxification of mind, body and soul. During this period a person is required to lead a Satwik spiritual life devoting first three days into activities, which reduces negativity in the mind and the body; the next three days he is supposed to indulge in positive behavior and happenings and in the last three days he is supposed to read and learn about spiritual positive things in life.

Respectively, these three phases of purification are symbolized as worshiping the Goddesses, Kali, Laxmi and Saraswati. The spiritual purification process involves eating only Satwik food, one which is offered to God, and following the principles of Satwik lifestyle which are Satwik Ahaar, Satwik Vichar, Satwik Vyavahaar and Satwik Achaar. There is a custom of worshiping wheat and barley grass during this period. They are detoxifying grasses when consumed in the form of juices. The Satwik fast observed during this period helps in cleansing the internal body.

Once the nine-day purification process is complete, on 10th day one gets the first benefits symbolized with Vijaydashmi as one conquers on that days a victory over Tamas (Kumbhakaran), Rajas (Meghnad) and Ego (Ravana). The victory over the Ego entails the ruling of Satwa (Vibhishan) and reunion of Mind (Lakshmana), Body (Sita) and Soul (Rama). As per the Yoga Sutras of Patanjali when one attains an ego free mind one is likely to get benefits over a period of time.

The first benefit is seen on the fourth day after Vijaydashmi, on Sharad Purnima, a day known for health benefits. People on this day gather in the night and eat kheer rich in moon rays. Again after four days on the day of karva chauth one gets benefit of the longevity of the spouse which gives safety to the family. On this day all married women fast and prey for their husbands. Four days later on “hoi ashtami” one prays for the longevity of their children. This ensures old age protection for the family. Four days later again on “dhanteras” one gets the benefit of wealth. On this day, people worship silver items. On this day no dealings are done and people spend only to invest in silver and gold items for the future needs of the family.

By this time the person, who has undergone the process of purification, learns the true purpose of his/her existence. The inner ignorance and darkness goes away and one gets the true meaning of wealth and that is inner happiness. The day it happens it is called Diwali, when on the day of Amavasya (darkness) one gets internal lighting (Diwali).

Diwali, therefore, is a one-month long spiritual Yagna with nine days of purification and 21 days of acquiring spiritual benefits out of it.

Ramadan similarly involves a deep intense purification process of mind, body and soul. In Christians the similar spiritual purification process is celebrated as Easter.
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Legal Quote
Martin F. D’Souza vs Mohd. Ishfaq SCI: 3541 of 2002, dated 17.02.2009

“A doctor should not experiment unless necessary and even then he should ordinarily get a written consent from the patient.”
Medicofinance
Developing an Investment Portfolio

One of the most difficult tasks that doctors, and the financial advisors who advise them, face is choosing investments with characteristics that will help the individual meet his or her near and long-term goals. While many courses are available that teach portfolio design, none can teach instinct and common sense. These two elements are frequently important factors in developing an investment strategy.

(Source: IJCP)
Industry News
Karnataka becomes the first Indian state to have a startup policy: Karnataka has become the first Indian state to have a startup policy with the cabinet clearing it, state Information Technology and Bio-Technology minister S.R.Patil said on Friday. “It will have a timeframe of five years from 2015-2020,” said Patil at the Bangalore ITE.biz 2015 curtain raiser, adding the cabinet approval was accorded on Thursday… (Bgr.in- IANS)

9 common mistakes that lead to failure in startups: When starting a business, there is always a list of certain Dos and Don’ts which every entrepreneur should follow for avoiding risk and leading to the path of success. Common mistakes that startups should avoid to be successful: Sole founder, location mistake, marginal niche, stubbornness, hiring bad programmers, delay in launch, hasty launch, raising too little money, sacrificing users to profit … (Siliconindia.com)

India to overtake China to become biggest source of workers: By 2050, the Asia Pacific region will have nearly 50% of the world’s total workforce, down from 62% today, according to Bloomberg analysis of United Nations data. India may account for 18.8% of the global workforce compared with 17.8% today, toppling China from the top spot. China will account for 13%, down from 20.9%... (Livemint – Sandrine Rastello)

Govt launches many mobile apps as part of Digital India initiative: In line with the government’s Digital India initiative, Human Resource Development (HRD) ministry launched a number of mobile apps and web-based platforms allowing students to access study material online, and parents to keep a track of the performance and attendance of their children. Elaborating about the initiatives, HRD minister Smriti Irani said through mobile apps and website ‘E-pathshala’ students, parents and teachers can access study material online. Another initiative for CBSE schools ‘Saransh’, which was launched at an event at Vigyan Bhawan in New Delhi, will help parents to compare subject-wise learning outcome of their children, with others at district, state and national levels… (Yourstory- PTI)
IMA Satyagraha
IMA Satyagraha, suggested slogans

• Allow doctors to treat patients irrespective of patients’ income - If compensation is not capped, we can't do this.
• Writing prescription drugs by anyone other than with an MBBS degree is injurious to peoples’ health.
• Please allow Doctors to treat poor and rich equally.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Save single clinic and small establishments - Exclude them from Clinical Establishment Act
• PCPNDT Act needs graded punishments

View Video: https://www.youtube.com/watch?v=UV1zCH33BlU
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eMEDIPICS
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
74% patients know they are suffering from asthma

A national survey conducted on 743 chest physicians reveals that patients do not know the "standard" (clinical) name of the respiratory disease they are suffering from. Like only 74% patients knew that they had asthma. The rest knew it by some other name which is not standard for the disease. "We found that diseases such as chronic obstructive pulmonary disease (COPD) were not referred to by the doctors with the same name. They were using other terminologies such as 'asthma' or 'dama', which is a completely different thing. Asthma is different from COPD," Dr Sheetu Singh said, who conducted the NAPCON Respiratory Disease Survey: Current Trend of Management of Pulmonary Disease in India, along with another respiratory diseases expert Dr Nishtha Singh. The survey was conducted at the 17th National Conference on Pulmonary Diseases (NAPCON), which concluded in Jaipur on Saturday. The survey shows that the common pulmonary diseases afflicting Indian patients are tuberculosis, asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)… (ET Healthworld – Syed Intishab Ali)
China issues guidelines to curb rapidly rising medical expenses
China has issued guidelines for curbing rapidly rising medical expenditures in the country's public hospital system, the media reported on Saturday. According to the National Health and Family Planning Commission (NHFPC), the guideline issued on Friday urged local authorities to closely monitor the rise of medical costs at public hospitals in their jurisdiction, particularly the cost of medicine, medical consumables and large-scale medical examinations, and to publicise the surveillance results regularly. The guidance also set a two-phase target that by 2016 the rise of expenses will slow, and by the end of 2017 insured patients will see the share of out-of-pocket spending in their total medical bill decreasing gradually.... (ET Healthworld)
WHO commends Sierra Leone for stopping Ebola virus transmission
On 7th November, the WHO declared that Ebola virus transmission has been stopped in Sierra Leone. Forty-two days, that is two Ebola virus incubation cycles, have now passed since the last person confirmed to have Ebola virus disease had a second negative blood test. "Since Sierra Leone recorded the first Ebola case in May 2014, a total number of 8,704 people were infected and 3,589 have died, 221 of them healthcare workers, all of whom we remember on this day” said Dr Anders Nordström, WHO Representative in Sierra Leone. The country now enters a 90-day period of enhanced surveillance which will run until 5 February 2016 and WHO will continue to support Sierra Leone during this period. This new phase is critical for ensuring early detection of any possible new cases of Ebola virus disease… (WHO)
GP Tip
Closed eyes sign

The examiner observes the patient’s eyes before and during the abdominal examination. Those with specific intra-abdominal disease keep their eyes open, fearful that the examining hand will cause even more pain. Those with less serious, non-specific abdominal pain problems tend to keep their eyes closed. (Source: IJCP)
eWellness
Beware of Diwali Hazards

Diwali can be hazardous to people. Some of these hazards are as below:

Candles: With Diwali approaching, one should be careful of candle pollution. Candles made from beeswax or soy, although more expensive, apparently are safer because they do not release potentially harmful pollutants. However an occasional paraffin candle and its emissions does not harm but lighting many paraffin candles daily or lighting them frequently in an unventilated bathroom around a tub, may cause problems. Pollutants from burning candles can also cause respiratory irritation and allergy. The candles, which are made from petroleum, are a source of known human carcinogens and indoor pollution.

Diwali sweets: White sugar in sweets can lead to uncontrolled diabetes and gain weight in individuals. Adulterated khoya can cause GI upset. Artificial coloring in sweets can cause cancer in long run. Eating chocolates can add to calories in blood sugar. The best items for Diwali are fruits and dry fruits.

Diwali Fire Hazards: Diwali should not lead to fire with resultant burns and loss to life. If burn injury occurs, the affected part should be put in the running water till burning disappears. Blisters should not be punctured, as they work like a natural dressing.

Eye injury: Particle of crackers can cause eye burn. Continuous water should be poured into the affected eye till the burning is over.

Safe dressing: If medicated bandage is not available, iron a clean piece of cloth, it will work like a medicated bandage.

Alcohol hazards: Diwali is often used as a festival of gambling and drinking alcohol. Avoid driving after consuming more than 30 ml of alcohol in one hour. While gambling one should not argue with others as someone under the influence of alcohol may cause harm.

Diwali pollution: Patients with COPD may worsen during; they should cover their mouth and nose with wet cloth, when they are exposed to smoke.

Noise pollution: Excessive noise pollution during Diwali day can cause hearing loss. Wear ear plugs to avoid noise-related ear injury. Noise pollution can also cause high blood pressure and mental irritation.
Bioethical issues in medical practice
Rights and duties of a parent

Smita N Deshpande

Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

A girl suffering from intellectual disability, serious enough so that she could not take care of herself became pregnant at the care home. By the time the pregnancy was discovered she was pregnant for over four months. The girl was admitted to a government hospital and assessed for MTP. The girl insisted- from the point of view of her limited understanding of the matter- that she wanted to keep the child and bring it up herself. Doctors at the hospital where she was admitted after the pregnancy was discovered were of the opinion that she was intellectually unfit to look after herself, what to say of a child. What should the doctors do?

a) Carry out MTP regardless of the girl’s wishes

b) Allow the pregnancy to continue possibly to the future detriment of the unborn baby.

c) Any other recourse such as going to court – but what if the court orders continuance of the pregnancy? Who will look after the baby?

Do write in with views and your solutions!
 
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Inspirational Story
The Thirst and the Rusty Well

There is a legend of a man who was lost in the desert, dying of thirst. He stumbled on until he came to an abandoned house. Outside the dilapidated, windowless, weather–beaten, deserted shack was a pump. He stumbled forward and began pumping furiously, but no water came from the well. Then he noticed a small jug with a cork at the top and a note written on the side: "You have to prime the pump with water, my friend. P.S. And fill the jug again before you leave." He pulled out a cork and saw that the jug was full of water.

Should he pour it down the pump? What if it didn’t work? All of the water would be gone. If he drank the water from the jug, he could be sure he would not die of thirst. But to pour it down the rusty pump on the flimsy instruction written on the outside of the jug?

Something from inside told him to follow the advice and choose the risky decision. He proceeded to pour the whole jug of water down the rusty old pump and furiously pumped up and down. Sure enough, the water gushed out! He had all he needed to drink. He filled the jug again, corked it and added his own words beneath the instructions on the jug: "Believe me, it really works. You have to give it all away before you can get anything back."

That’s why giving is important…
eMedi Quiz
Which of the following is present intracellularly in muscle cells:

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Yesterday’s Mind Teaser:  The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Answer for Yesterday’s Mind Teaser:2. pKa

Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay.

Answer for 8th November Mind Teaser: 4. Vertebral venous plexus.

Answers received from: Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay.
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Humor
Doctor complaining to mechanic

A doctor is taking to a car mechanic, "your fee is several times more per hour then we get paid for medical care."

‘Yeah, but you see, doc, you have always the same model! It hasn’t changed since Adam. But we have to keep up to date with new models coming every month"
Readers column
Dear Sir, emedinews is very useful. Regards: Dr Kavita
Press Release
HCFI’s annual flagship event, the 22nd MTNL Perfect Health Mela comes to a power-packed end

Key events of Day 5 included a discussion on tolerance and non-violence with nine religious gurus, inter-medical college competitions, and an appeal to have a safe and healthy Diwali

Heart Care Foundation of India (HCFI)’s annual flagship event, the 22nd MTNL Perfect Health Mela concluded recently. Speaking at the valedictory, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General Indian Medical Association (IMA) urged everyone to have a healthy Diwali and to take necessary precautions to protect oneself and others from injury and harm.

According to him, "There is a sudden spike in the number of hospital admissions during the Diwali season. The reasons for this include respiratory ailments and allergies triggered due to the high levels of smog caused by the firecracker and vehicular pollution, complications suffered by heart patients due to the increased decibel levels and the consumption of an unhealthy diet; and burn and accidental injuries. Road accidents are also extremely common during the season due to an increased practice of drinking and driving. It is necessary to take precautions to ensure a safe and healthy Diwali. We thank all our sponsors and partners for helping make the 22ndMTNL Perfect Health Mela such a grand success. We will be back again next year, on a bigger and grander scale.”

The 22nd edition of the event was organized at the Talkatora Indoor Stadium, New Delhi from 4 – 8th November in association with the IMA, MTNL, Coke, MCD, NDMC, Ministry of Science & Technology, Earth Sciences, Textile, and AYUSH – Government of India. None other than Shri Satyendar Jain – Hon’ble Minister of Health & Family Welfare, Govt. of NCT of Delhi and Padma Vibhushan Awardee Dr. Sonal Mansingh, inaugurated the event.

The five-day event served as a podium for over 50 on the spot competitions like a fashion show, classical and western dance and rock band performances. The Mela drew over 20,000 visitors daily including 500 doctors, 5000school students and 2500 nurses who participated in a variety of cultural events. The purpose of inculcating all these cultural activities was to use infotainment as a way of creating mass health education.

As we all know that present day, India suffers from a plethora of modern day epidemics like Dengue, Swine Flu, and Diarrhea. A special focus was given during the event to educate the public about essential prevention measures and the need to maintain cleanliness and hygiene. Medanta – the Medicity in association with MTNL also provided live-telemedicine facilities to all visitors.

UNESCO and IMA also organized a first of its kind discussion on the Bioethics charter. The panelists including Dr Susan Vize, Advisor - UNESCO, Prof Kalra - Vice Chancellor, University of Health Sciences and Patron of the UNESCO Charter, Dr KK Aggarwal Honorary Secretary General IMA and eight Vice-Chancellors from medical universities across the country stressed upon the urgency to include ethics as a part of the medical curriculum across the country.

A one of its kind inter-religious meet was also organized on the last day of the Mela. The panel constituted eminent Dharma gurus like M. Ven Sumithananda Thero, Secretary Mahabodhi Society Centre, Delhi, Fr (Dr) M D Thomas, Christian Scholar, Founder Director, Institute of Harmony and Peace Studies, Dr. Hanif Md. Khan Shastri, Muslim and Hindu Scholar, Dr Amrit Kaur Basra, Lecturer at College and Sikh Scholar, Rabbi Ezekiel I Malekar, Jewish Community Secretary, Delhi, Acharya Vivek Muni, Jain Monk, Acharya Sushil Muni Ashram, Dr A K Merchant National Trustee, Lotus Temple and Baha’i Community of India, Mr M Ananda and Dr S Mohinder Singh, Executive Director, Bhai Vir Singh Sahitya Sadan, New Delhi. The discussion ended with a conclusion that "everyone should learn how to tolerate each other in order to maintain peace and harmony and to avoid any disruptions and violence."

Speaking at the valedictory function, Dr Vinay Aggarwal, Dr D R Rai, Dr Narendra Saini, Dr Anil Goel, Dr Pawan Gupta and Dr Ajay Lekhi said, "We all thank everyone who came and attended the 22nd Perfect Health Mela and made it such a success. We encourage everyone to inculcate healthy habits in their everyday lives and live disease-free.”

Heart disease patients belonging to the economically weaker section in need of surgical intervention were also provided financial and technical assistance by the Sameer Malik Heart Care Foundation Fund another project of HCFI. All visitors were also trained in the life-saving technique of Hands-only CPR 10.