June 10  2015, Wednesday
eMedinewS
editorial
Nail Hygiene
Dr KK Aggarwal
  • Nails can harbor dirt and germs and contribute to the spread of many infections.
  • Keep nails short.
  • Trim nails often.
  • Scrub the underside of nails with soap or water each time you wash your hands.
  • Clean any nail grooming tools before use.
  • Nail grooming tools should be sterilized before use in saloon.
  • Avoid biting nails.
  • Avoid chewing nails.
  • Avoid cutting cuticles as they act as barriers to prevent infection.
  • Never rip or bite a hang nail, instead clip it with a clear sterilized nail trimmer (a hang nail is small torn piece of skin next to finger nail or toe nail).
  • Infections of the finger nails or toe nails are often characterized by swelling of the skin or thickening of the nail. In some cases these infections may be serious and need to be treated by a doctor.
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eMedipics IMA,IJCP,HCFI
World Environment Day was observed by IMA Tinsukia Branch by cleaning the premises of IMA House and by cleaning the surroundings of the existing plants and trees around the building. Fourteen members were present on the occasion.
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News
  • Beginning treatment with a statin was associated with a nearly fourfold increased risk of developing acute memory loss within 30 days in a retrospective cohort study in JAMA Internal Medicine, but a similar increase in risk was seen in patients starting non-statin lipid-lowering drugs.
  • Smoking and obesity have opposite associations with thioguanine nucleotide levels in patients receiving thiopurines for treatment of inflammatory bowel disease (IBD), suggests new research published online in the Journal of Crohn's and Colitis.
  • Supplementation with calcium and vitamin D may not influence the number of menopause-related vasomotor, mood, or sleep symptoms in older women, reported a new study published online in Maturitas.
  • A four-drug anti-HCV regimen provides sustained virological responses (SVR) in most individuals coinfected with HCV and HIV, suggests new research published online in Clinical Infectious Diseases.
  • Debridement, antibiotics, irrigation, and retention (DAIR) should be considered a viable treatment option when a well-fixed and functioning prosthetic joint becomes infected, according to new research presented at the 16th European Federation of National Associations of Orthopaedics and Traumatology Congress.
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Dr KK Spiritual Blog
Managing grief by free expressive writing

The loss of a loved is often painful. The resultant grief makes it hard to eat, sleep and leads to loss of interest in routine life affecting behavior and judgment.

Some can feel agitated or exhausted, to sob unexpectedly, or to withdraw from the world and others may find themselves struggling with feelings of sorrow, numbness, anger, guilt, despair, irritability, relief, or anxiety.

It is well known that disclosing deep emotions through writing can boost immune function as well as mood and well–being. Conversely, the stress of holding in strong feelings can ratchet up blood pressure and heart rate and increase muscle tension.

One can write on a piece of paper, in your personal book, on the open website with nick name or keep it in the mind. One doesn’t have to preserve the emotions and can through away the writings

In absence of deeply troubling situations, such as suicide or a violent death which are best explored with the help of an experienced therapist, one can choose writing as a way to express out the grief.
  • Start writing for 15 to 30 minutes a day for three to four days
  • Continue up to a week if it is helping.
  • Continue writing for 15 to 30 minutes once a week for a month.
  • Writing has stronger effects when it extends over more days.
  • Remember writing about grief and loss can trigger strong emotions (one may cry or feel deeply upset).
  • Many people find journal writing valuable and meaningful and report feeling better afterward.
  • Don’t worry about grammar or sentence structure.
  • Truly let go. Write down how you feel and why you feel that way. You’re writing for yourself, not others.
(Source Harvard Newsletter)
Cardiology eMedinewS
  • The TECOS trial, presented at the American Diabetes Association (ADA) 2015 Scientific Sessions, revealed that in patients with type 2 diabetes and cardiovascular disease, the use of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor used to lower HbA1c levels, is not associated with an increased risk of cardiovascular events.
  • The US Food and Drug Administration (FDA) has noted that the proprotein convertase subtilisin kexin 9 (PCSK9) inhibitor alirocumab is both effective and well-tolerated in lowering LDL cholesterol in patients at risk for CV events, according to early briefing documents released by the Endocrinologic and Metabolic Drugs Advisory Committee.
Pediatrics eMedinewS
  • Children who underwent surgery with general anesthesia before 4 years of age, later scored lower on tests for listening comprehension and performance IQ than children who did not undergo anesthesia, suggested a study published online June 8 in Pediatrics.
  • Bladder and bowel dysfunction and vesicoureteral reflux may be risk factors for recurrent urinary tract infection in children, especially when both problems occur simultaneously, suggests a study published online June 8 in Pediatrics.
Make Sure
Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.

Reaction: Oh my God! Why was the prophylaxis not started?

Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.
Dr Good Dr Bad
Situation: A 60-year-old male wanted to know if he needed an annual urine check

Dr Bad: It's not necessary

Dr Good: It's a must

Lesson: Get a simple urine test done if you have any of the following risk factors for kidney disease: Diabetes, high blood pressure, age 60 and over and/or family history of kidney failure

(Copyright IJCP)
eMedinewS Humor
A Texas millionaire

A Texas millionaire had fallen ill. The doctors consulted did not seem to understand what ailed him. The millionaire let it be known that any doctor who could heal him could have whatever he desired.

A country doctor was finally able to cure him, and as the doctor was leaving after a week’s stay, the Texan said, "Doc! I am a man of my word. You name it, and if it is humanly possible I’ll get it for you."

"Well," said the doctor, "I love to play golf, so if I could have a matching set of golf clubs, that would be fine." With that the physician left.

The doctor didn’t hear from the Texan millionaire for some months. Then, one day, he got a phone call from the millionaire.

"Doc, I bet you thought that I had gone back on my word. I have your matching set of golf clubs. The reason it took so long is that two of them didn’t have swimming pools, and I didn’t think they were good enough for ya. So I had pools installed and they're all ready for you now!"
Events
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eMedi Quiz
At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1. Pancuronium.
2. Gallamine.
3. Atracurium.
4. Vecuronium.
Yesterday’s Mind Teaser: An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of haemoglobin.

Answer for yesterday’s Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct Answers received from:: Dr K Raju, Dr Jainendra Upadhyay, Dr K V Sarma, Tukaram Pagad, Dr Poonam Chablani, Dr Amit Desai, Dr K C Sharma, Dr G Madhusudhan, Daivadheenam Jella.

Answer for 8th June Mind Teaser: 1. Criterion validity.

Correct Answers received: Dr Jainendra Upadhyay, Dr Poonam Chablani, Raju Kuppusamy, Tukaram Pagad, Daivadheenam Jella, Dr G Madhusudhan, Dr K C Sharma, Dr Avtar Krishan.
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IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
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
eIMA News
Professional Indemnity Policy for Doctors and Medical Practitioners
Highlights:  This policy is meant for professionals to cover liability falling on them as a result of errors and omissions committed by them whilst rendering professional service. The policy offers a benefit of Retroactive period on continuous renewal of policy whereby claims reported in subsequent renewal but pertaining to earlier period after first inception of the policy, also become payable. Group policies can also be issued covering members of one profession. Group discount in premium is available depending upon the number of members covered.

Scope: The policy covers all sums which the insured professional becomes legally liable to pay as damages to third party in respect of any error and/or omission on his/her part committed whilst rendering professional service. Legal cost and expenses incurred in defence of the case, with the prior consent of the insurance company, are also payable, subject to the overall limit of indemnity selected. Only civil liability claims are covered. Any liability arising out of any criminal act or act committed in violation of any law or ordinance is not covered

Who can take the policy?: Doctors and medical practitioners; Medical establishments (covers legal liability falling on the medical establishment such as hospitals and nursing homes, as a result of error or omission committed by any named professional or qualified assistants engaged by the medical establishment.)

How to select the sum insured: In Professional Indemnity Policy, the sum insured is referred to as Limit of Indemnity. This limit is fixed per accident and per policy period which is called Any One Accident (AOA) limit and Any One Year (AOY) limit respectively. The ratio of AOA limit to AOY limit can be chosen from the following: 1:1, 1:2, 1:3, 1:4. The AOA limit, which is the maximum amount payable for each accident, should be fixed taking into account the nature of activity of the insured and the maximum number of people who could be affected and maximum property damage that could occur, in the worst possible accident.

How to claim: The term "liability" means responsibility and "legal liability" means responsibilities which can be enforced by law. Legal Liability may be classified into Criminal Liability and Civil Liability. Only Civil Liability claims are payable.

Civil Liability claims will arise if there is prima facie evidence of negligence by the insured resulting in injury or death to any third party or resulting in damage to property belonging to a person other than insured.

Negligence will be proved only when following conditions are satisfied: Existence of duty of care; Breach of this duty and Injury suffered by a person or property damaged as a result of that breach.

In case of any event likely to give rise to a liability claim as described above, insurance company should be informed immediately. In case any legal notice or summons is received, it should be sent to the insurance company. The company has the option of arranging the defence of the case.

The event giving rise to the claim should have occurred during the period of insurance or retroactive period and the claim first made in writing against the insured during the policy period. The maximum amount payable including defence cost will be the AOA limit selected. The Any One Year limit will get reduced by the amount of claim or indemnity paid for any one accident. Any number of such claims made during the policy period will be covered subject to the total indemnity not exceeding the Any One Year limit.

The policy will not pay for claims arising out of contractual liability, intentional non-compliance of any statutory provision, loss of goodwill, slander, fines, penalties, libel, false arrest, defamation, mental injury etc.

Loophole: The insurance will only pay if medical negligence is proved.

Most doctors do not want the label of medical negligence on their practice.

They often settle by paying compensation, not claiming from insurance company, and asking the court not to pass strictures against him in the judgment. Courts also often oblige.
5 truths about protecting your eyes
Myth: Staring at a computer screen all day is bad for the eyes.

Fact:
Using a computer does not damage your eyes. However, staring at a computer screen all day can contribute to eyestrain or tired eyes. People who stare at a computer screen for long periods tend not to blink as often as usual, which can cause the eyes to feel dry and uncomfortable.  To help prevent eyestrain, adjust the lighting so it doesn't create a glare or harsh reflection on the screen, rest your eyes briefly every 20 minutes, and make a conscious effort to blink regularly so that your eyes stay well lubricated.
What is Jan Aushadhi Store?
  • Jan Aushadhi Store is a government scheme and not an initiative of IMA.
  • Under this scheme, 118 drugs are sold at highly subsidized prices.
  • Drugs are quality controlled by BPPI.
  • Price is decided by the ministry.
  • IMA is only a pharmacy licensed to sell drugs at the price decided.
  • Government buys these drugs from standard companies under a tender.
  • The scheme will include 504 drugs in the coming few months.
  • IMA will procure these drugs from the government Jan Aushadhi department
  • IMA stand on drugs: Cheap quality drugs
  • Why: 70% of the treatment budget goes in procuring drugs.
The City Commissioner of Police, Vadodara Police, Police Bhavan, Vadodara
GUJARAT MEDICARE SERVICE PERSONS AND MEDICARE SERVICE INSTITUTIONS (PREVENTION OF VIOLENCE AND DAMAGE OR LOSS OF PROPERTY) ACT, 2012.

Sir,

As per enclosed Newspaper report, a cognizable crime was committed on night of Friday, 5th June, 2015 at Makarpura Hospital, however it has not been registered as cognizable. Earlier the undersigned had written to your office on (Date) with copy of The Gazette of State of Gujarat, where this act and rules are published in 2012.

1. On noon of 14th December, 2014, relatives damaged property and assaulted Doctors (Dr. Vishnukant Kansara, Dr. Rajul Vala and Nursing Personnel) at Sterling Hospital. Undersigned later met the PI of Gotri Police Station also in this connection, after our above letter with act and rules was sent to him by your office. CCTV footage of this incident are with Gotri Police.

2. On 6th February, 2015 relatives of patient Asha Pandya assaulted Dr. Abhishek Kalla at R. C. Gandhi Dental Hospital. Gujarat Medicare Act and Rules were given to Investigating Officer at Karelibagh Police Station by Dr. Abhishek Kalla. Video footage of this incident were viral immediately after incident on You Tube and are with Karelibagh police.

3. Now on night of 5th June, 2015, yet another assault on Dr. Rakshit Patel and others took place at Makarpura Hospital with damage to property, and police was informed of existence of this act, however from newspaper it is evident that only Non Cognizable offence has been recorded in all these three crimes.

It is requested that under GUJARAT MEDICARE SERVICE PERSONS AND MEDICARE SERVICE INSTITUTIONS (PREVENTION OF VIOLENCE AND DAMAGE OR LOSS OF PROPERTY) ACT, 2012 and rules, copies of which are enclosed, these three crimes be registered as cognizable and non bailable; and culprits be presented before magistrate of appropriate court for further legal action.

Thanking you

Sincerely Yours: Dr. Bakulesh Chauhan / Dr.  Atulkumar Shah

Indian Medical Association, Vadodara Branch
Media
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Inspirational Story
The Doctor and the Father

A doctor entered the hospital in hurry after being called in for an urgent surgery. He answered the call ASAP, changed his clothes & went directly to the surgery block. He found the boy’s father pacing in the hall waiting for the doctor.

On seeing him, the dad yelled: "Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have any sense of responsibility?"

The doctor smiled & said: "I am sorry, I wasn’t in the hospital & I came as fast as I could after receiving the call…… And now, I wish you’d calm down so that I can do my work"

"Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do??" said the father angrily

The doctor smiled again & replied: "I will say what Job said in the Holy Book "From dust we came & to dust we return, blessed be the name of God". Doctors cannot prolong lives. Go & intercede for your son, we will do our best by God’s grace"

"Giving advises when we’re not concerned is so easy," murmured the father.

The surgery took some hours after which the doctor went out happy,

"Thank goodness! your son is saved!" And without waiting for the father’s reply he carried on his way running. "If you have any questions, ask the nurse!!"

"Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state" Commented the father when seeing the nurse minutes after the doctor left.

The nurse answered, tears coming down her face: "His son died yesterday in a road accident, he was at the burial when we called him for your son’s surgery. And now that he saved your son’s life, he left running to finish his son’s burial."

Moral of the story
  • Never judge anyone…… because you never know how their life is & what they’re going through"
  • People who jump the gun in most cases happen to be foul mouthed - just keep away from them.
Wellness Blog
Harvard 4 simple ways to boost your energy
 
  1. Pace yourself: Keep going, but don’t risk overtaxing yourself. Instead of burning through all your battery life in 2 hours, spread it out between morning tasks, afternoon tasks, and evening activities — with rest and meals between.
  2. Take a walk or a nap: However, if you have trouble sleeping at night, napping can make the insomnia worse. If that’s the case for you, get moving instead. Get up and walk around the block, or just get up and move around. If you are not an insomniac, enjoy that 20– to 30–minute power nap.
  3. Skip most supplements. There is no evidence that they works.
    • DHEA: There is no evidence that DHEA offers any real benefits.
    • Iron. Iron only improves energy if you are clearly deficient.
    • B vitamins. It is true that B vitamins (B1, B2, B6, B12) help the body convert food into the form of energy that cells can burn, but taking more B vitamins doesn’t supercharge your cells.
  4. Fuel up wisely. A sugary bakery roll delivers plenty of calories, but your body tends to metabolize them faster, and then you can end up with sinking blood sugar and fatigue. You’ll maintain a steadier energy level by eating lean protein and unrefined carbohydrates. Try low–fat yogurt with a sprinkling of nuts, raisins, and honey.
Quote of the Day
Turn every problem into a wonder, every adventure in to a joy. And this starts happening inside you with the very glimpse and experience of this deep, pure, Divine Love. Sri Sri Ravi Shankar
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Reader Response
  • Well done, Dr KK Aggarwal  and Dr Pillai: Dr Anil Bansal
  • Dear Dr Aggarwal, Thank you for the detailed information on Nepal earthquake and our efforts in helping them. I was wondering what prevented us from displaying IMA or India in our tents or service stations. Congratulations for your timely interference and action. Wish you all the best. Dr Babu Ravindran, Kerala. (Comment: IMA displayed all its banners)
  • Respected Sir, Congratulations for the right step to help the community to get good quality but cheap medicines through IMA! We at IMA Pune are desirous of starting Jan Aushadhi Medical Store in IMA premises in Pune and we have been working on it for a long time. Can you please guide us about all the licenses needed and precautions while starting this service? Please also furnish us the list of market names, manufacturers' list and methodology to procure such medicines. With regards, Yours sincerely, Dr. Jayant Navarange, Governing Council Member, IMA Pune.
  • Some messages are being spread through the social media claiming that test results on soft drinks by IMA has shown pesticides in the drinks. Is this true. Is there a report? If yes where can I find it? Amalraj Abraham (Comment: IMA has done no such study).
  • Sir, I have a WhatsApp message about pesticide percentage in cold drinks. If possible, please send me the report or a pdf copy of the same. Prof Dr Rakesh Patel, Gujarat (Comment: IMA has no such study data)
  • Dear Hony Secy General, Visibility is also important as the relief work. People will not know who is helping because the work is in an alien country. China succeeded to show their visibility. People do not know which country is providing help to them. Dr Alex Franklin
  • Thanks sir, for a detailed correct, honest report, compiled by your team, knowing ground relief realities. A similar thing happened during Kashmir floods. Nobody gave you exact report, to expose our state/national media hype without anything on ground.  If the Central govt. had allowed other countries to help, we would have not faced lot of trauma due to disaster. Even after many months central govt. is not sanctioning relief to our worst hit areas except sending MPs, to enjoy Kashmir beauty along with families under umbrella of relief sanctioning. Dr GM Malik
  • Delighted. Congratulations. It makes me very happy.I have cut down my going out as I am completing my book but my thoughts are with you.   Ranjit Roy Chaudhury
IMA Videos
News on Maps
Press Release
World Population Day : IMA to focus on the youths

With 365 million people between the age of 10-24 years, India has the world’s largest youth population.

This population will cross 464 million by 2021. The time for today is to invest in the youth said Padma Shri Awardee Dr. A.Marthanda Pillai, National President and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA in a joint statement.

IMA is sensitizing its 2.5 lacs members through its 1700 local branches and 30 State Branches :
  • To open adolescent clinics all across the country and provide them counseling about obesity, mental health problems and sexual health.
  • To create a national campaign to change the life style habits of youngsters as it is now confirmed that heart blockage process start right at this stage.
  • To sensitize all to be married girls to vouch at the time of marriage that they will not indulge in the sex selective abortions.
  • To have youth focus on nature rather than the preserved and artificially flavored food.
  • To sensitize Youngsters to learn to say no to tobacco related products.
  • To sensitize youngsters to participate in daily exercise programme to remain fit.
Rabies News (Dr A K Gupta)
What is the criterion for "protection" after immunization?

The rabies virus neutralizing antibody (RVNA) titer of 0.5 IU/ml of serum in the vaccinated person is considered protective.

The facility for this test is available at NCDC, Delhi, CRI, Kasauli, Pasteur institute, Coonnor, NIV, Pune and NIMHANS, Bangalore.