March 10  2015, Tuesday
editorial
Sleep deprivation and sleep apnea both bad for the heart
Dr KK AggarwalBoth sleep deprivation and sleep apnea have been linked to a higher risk of heart disease.

Over time, inadequate or poor quality sleep can increase the risk of heart disease. Short–term sleep deprivation is linked with high cholesterol, high triglycerides and high blood pressure.

Sleep apnea makes people temporarily stop breathing many times during the night. Up to 83% of people with heart disease also have sleep apnea.

In sleep apnea, oxygen levels dip and the brain sends an urgent "Breathe now!" signal. That signal briefly wakes the sleeper and makes him or her gasp for air. That signal also jolts the same stress hormone and nerve pathways that are stimulated when you are angry or frightened. As a result, the heart beats faster and blood pressure rises — along with other things that can threaten heart health such as inflammation and an increase in blood clotting ability. (Source: Harvard)
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CPR 10 Training Camp on 4th to 6th March 2014 at Delhi Science Exhibition, MCD South Delhi, M C Boys School, Okhla
News
  • In patients with relapsed or refractory urothelial carcinoma, the antitumor activity of paclitaxel chemotherapy plus the targeted agent pazopanib is significant, suggest data presented at the Genitourinary Cancers Symposium 2015.
  • The US Food and Drug Administration (FDA) has approved isavuconazonium sulfate, a new antifungal for the treatment of adults with invasive aspergillosis and invasive mucormycosis, rare, but potentially life-threatening infections.
  • Combining a conventional disease-modifying antirheumatic drug (DMARD) with a tumor necrosis factor inhibitor (TNFi) seems more effective than a TNFi alone in patients with ankylosing spondylitis (AS) or undifferentiated spondyloarthritis (uSpA), suggested a nationwide prospective study published online in the Annals of the Rheumatic Diseases. However, experts caution that the beneficial effect might not be large enough to justify changing current treatment guidelines.
  • Menopausal hormone replacement therapy does not appear to affect mortality either positively or negatively, suggests a new systematic review and meta-analysis presented at the Endocrine Society’s annual meeting, ENDO 2015.
  • A meta-analysis of 62 studies revealed that diabetes and prediabetes increased risk for conversion from mild cognitive impairment (MCI) to Alzheimer's dementia and all-cause dementia. In addition, metabolic syndrome, low dietary folate, the presence of any neuropsychiatric symptoms, and having depressive symptoms all predicted dementia conversion in patients with various forms of MCI, while consumption of a Mediterranean diet decreased risk. The findings are published online in the American Journal of Psychiatry.
Dr KK Spiritual Blog
You can reverse heart disease

Every cell in the body eventually dies and is replaced by a new cell. Every day is a new opportunity to build a new body. The entire body totally rebuilds itself in less than two years with 98% in less than one year.
  • Stomach lining rebuilds itself in 5 days.
  • Your skin rebuilds itself in 1 month.
  • Liver rebuilds itself in 6 weeks.
  • Your DNA rebuilds itself every 2 months.
  • Bone rebuilds the whole new skeleton in 3 months
  • Blood rebuilds itself in 4 months
  • Brain rebuilds itself in 1 year
With every breath, we inhale 1022 atoms coming from all cells present in the universe. We share everything with everybody with every breath. Quadruplet atoms in the last three weeks have gone through our breath. Billion atoms out of them may have been those of Christ or Mohammad.

The very fact that our body rebuilds itself makes it possible to change the Dharma of the new cells and even prevent or regress cancers and heart diseases.
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Cardiology eMedinewS
  • People living in areas with more air pollution face a greater risk of carotid artery stenosis, suggests new research scheduled for presentation at the American College of Cardiology's 64th Annual Scientific Session.
  • A 3-year study of 5,000 patients with moderate or severe depression demonstrated that those treated with antidepressants seemed to show lower rates of death, coronary artery disease and stroke than those who did not take the drugs. The study will be presented on 15 March at the 64th annual scientific session of the American College of Cardiology.
Pediatrics eMedinewS
  • Results from the Trial of Randomised Umbilical and Fetal Flow in Europe (TRUFFLE), published in the Lancet, suggest that babies delivered on the basis of a technique that monitors blood flow in a small vessel below their heart - late ductus venosus changes - had better neurodevelopmental outcomes than babies delivered on the basis of two other techniques.
  • Higher levels of traffic-related air pollution at schools are linked to slower cognitive development in 7- to 10-year-old children, suggests a study published in PLOS Medicine.
Make Sure
Situation: A 70–year–old male with antibiotic–associated diarrhea and TLC of 24000 died.

Reaction: Oh my God! Why was surgery not considered in this case?

Lesson: Make sure that urgent surgical evaluation is done in patients with acute gastroenteritis who are =65 years and have a white blood cell count =20,000 cells/microL and/or a plasma lactate between 2.2 and 4.9 mEq/L.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

World Medical Association Declaration – WMA 5th World Conference on Medical Education

The prime concern of all Medical Associations in every country should be to dedicate themselves to marshalling the resources needed to provide for and guide quality medical education. This should be done in the context of appropriately sized classes with access to adequate faculty member, facilities and funding.
  • To focus professional and public support for medical education, medical associations in all countries should be acutely aware of the needs, opinions, expectations and personal dignity of their citizens.
  • The goal of medical education should be to produce competent and ethical physicians, who respect their roles in the physician patient relationship.
  • The elements of competence must include knowledge, skills, values behaviors and ethics, which provide quality preventive and curative care for individual patients and the community.
  • Research, teaching and ethical patient care are inseparable and essential to achieving the goal of physician competence.
  • An international core curriculum should be developed that will produce and maintain a competent physician whose skills transcend international borders.
  • Internationally standardized methods of assessing professional competence and performance should be developed and applied in undergraduate, graduate and continuing medical education.
  • Free and prompt international dissemination of professionally generated and analyzed medical information should be exchanged on epidemiological and public health problems to guide the development of public policies, the education of physician and the public.
  • International standards should be established for the evaluation of educational programs across the country.
Dr Good Dr Bad
Situation: A senior citizen with an insurance of one lakh came for admission.
Dr. Bad: You should opt for Rs. 1000 room.
Dr. Good: Take any room you want.
Lesson: The 1% room rent clause is not applicable to senior citizens.

(Copyright IJCP)
IJCP Book of Medical Records
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
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Sonal Namaste
When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry.
Media
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Event
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Inspirational Story
Pickup in the Rain

One night, at 11:30 PM, an older African American woman was standing on the side of an Alabama highway trying to endure a lashing rain storm. Her car had broken down and she desperately needed a ride. Soaking wet, she decided to flag down the next car. A young white man stopped to help her – generally unheard of in those conflict–filled 1960s. The man took her to safety, helped her get assistance and put her into a taxi cab. She seemed to be in a big hurry! She wrote down his address, thanked him and drove away.

Seven days went by and a knock came on the man’s door. To his surprise, a giant console color TV was delivered to his home. A special note was attached. It read: "Thank you so much for assisting me on the highway the other night. The rain drenched not only my clothes but my spirits. Then you came along. Because of you, I was able to make it to my dying husband’s bedside just before he passed away. God bless you for helping me and unselfishly serving others."

Lessons
  • Offer help to anyone who needs it
  • Thank others for helping you.
  • If you help someone. Someone will help you.
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Wellness Blog
Prescribing antibiotics

Your doctor is at fault while prescribing antibiotics, when he/she
  • Prescribes antibiotics when no bacterial infection exists.
  • Prescribes the wrong antibiotic or the wrong dose.
  • Prescribes antibiotics for longer than necessary.
  • Prescribes strong antibiotics, when a less strong would be as effective.
  • Prescribes an expensive antibiotic when a cheaper but equally effective antibiotic is available.
You at fault, when
  • You demand antibiotics even when the doctor thinks it is unnecessary
  • You buy an antibiotic without prescription.
  • You buy an antibiotic without a bill
  • You stop antibiotics as your symptoms start improving and do not take a full course of antibiotics.
  • When you change brands without the doctor’s knowledge.
Quote of the Day
The more you recognize and express gratitude for the things you have, the more things you will have to express gratitude for. Zig Ziglar
Reader Response
  • It would be interesting for these so-called upholders of justice to ponder what punishment is meted for those with malpractice amongst the judiciary, police and politicians while they target weaker section of professionals! Sad! Dr Binoy John
  • Warm greetings! kudos to the editor for an extremely useful update. In gratitude: Dr R Gupta
News on Maps
eMedinewS Humor
Skeleton in the Closet

A very large, old, building was being torn down in Chicago to make room for a new skyscraper. Due to its proximity to other buildings it could not be imploded and had to be dismantled floor by floor.

While working on the 49th floor, two construction workers found a skeleton in a small closet behind the elevator shaft. They decided that they should call the police.

When the police arrived they directed them to the closet and showed them the skeleton fully clothed and standing upright. They said, "This could be Jimmy Hoffa or somebody really important."

Two days went by and the construction workers couldn't stand it any more; they had to know who they had found. They called the police and said, "We are the two guys who found the skeleton in the closet and we want to know if it was Jimmy Hoffa or somebody important."

The police said, "It’s not Jimmy Hoffa, but it was somebody kind of important."

"Well, who was it?"

"The 1956 Blonde National Hide–and–Seek Champion."
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: Beel's phenomenon can be seen in the following conditions except

a. Hemiplegia

b. Ramsay hunt syndrome

c. Bell's palsy

d. Leprosy

Answer for yesterday’s Mind Teaser: a. Hemiplegia

Correct Answers received from: Dr Avtar Krishan, Daivadheenam Jella, Dr Shangarpawar, Dr Gopal Shinde.

Answer for 8th March Mind Teaser: d. A combination of store and forward, online discussion group, and author based second opinion teledermatology.

Correct Answers receives: Dr Amit Desai, Dr Avtar Krishan, Daivadheenam Jella, Dr Shangarpawar, Raju Kuppusamy.

8th February is International Woman's Day
Take less salt

A high-salt diet may increase the risk of developing gastric and duodenal ulcers. High concentrations of salt in the stomach can induce gene activity in the ulcer-causing Helicobacter pylori bacterium that causes it to become more virulent. Bacterial cells exposed to increased salt exhibit striking morphological changes. Cells become elongated and form long chains.
Salt restriction also reduces the diastolic blood pressure by 2-8 mmHg, said Padma Shri, Dr BC Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

According to a WHO report, reducing salt intake would be a cost-effective way to reduce the risk of developing high blood pressure directly and reducing the risk of heart attack and stroke indirectly. The report recommends people to reduce consumption of sodium to less than 2 gm per day for each person. Common salt is chemically called sodium chloride (NaCl). About 2.5 gm of table salt contains one gm of Sodium. This would mean that about 5 gm of table salt is the current recommended level of consumption per day.

According to a report published from the All India Institute of Medical Sciences in the year 2000, the average intake of salt in India is 10 gm per day for each person. This would amount to about 4 gm of sodium. The current recommendations suggest reducing this consumption by half.

A research study conducted by researchers at Harvard Medical School and published in the British Medical Journal, found that reducing salt intake by 25% reduced the risk of developing heart disease by 25% and reduced the chance of death from heart disease by 20%.

In 2002, WHO estimated that about 62% of strokes and about 50% of heart attacks globally were attributable to high blood pressure.

Adding a pinch of salt to milk will keep it fresh longer is a common Internet tip for the population but traditional teaching goes against it. As per Charaka Samhita, too much of pipalli, alkali and salt are bad for the health - & totally prohibits taking salt with the milk.
Rabies News (Dr A K Gupta)
What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.
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