July 10  2015, Friday
Judicious use of cardiac screening
Dr KK AggarwalUnnecessary screening can have a considerable cost beyond that of the test itself. As reported in the January 17, 2012 issue of the Annals of Internal Medicine, screening tests should be performed judiciously, and the committee has assembled a list of common clinical situations in which more testing is unlikely to be helpful and may be harmful.

The American College of Physicians (ACP) committee has identified 37 clinical scenarios in which screening does not promote patient health, and might even have adverse consequences. Those related to cardiac scenarios are as follows:
  • Performing coronary angiography in patients with chronic stable angina who have well–controlled symptoms on medical therapy, or who lack specific high–risk criteria on exercise testing
  • Routinely repeating echocardiography in asymptomatic patients with mild mitral regurgitation and normal left ventricular size and function
  • Obtaining ECG to screen for cardiac disease in patients at low to average risk for coronary artery disease.
  • Obtaining exercise electrocardiogram for screening low–risk, asymptomatic adults
A CME on ‘Medicolegal cases: how we can prevent them’ was organized by IMA Banswara Branch on 13-6-15
The 3rd Annual meeting of the Endocrine Society of Tamil Nadu and Puducherry will be held in Kodaikanal on 11th and 12th of July 2015. TRENDO 2015 is proposed to address latest updates, emerging concepts, clinical applications and controversies in diabetes, thyroid disorders, gonadal problems, pituitary disorders, metabolic bone disease and adrenal diseases.
Top News from ADA 2015
Highlights of the conference were:
  • TECOS: No heart failure with sitagliptin in high-risk diabetic patients
  • No CV benefit with lixisenatide in ELIXA, but results reassure
  • Artificial pancreas: Progress on varying approaches
  • Weight drops, muscle mass stays: 5-year "Why WAIT" success
  • Four diabetic ketoacidosis episodes triples risk of early death
  • Obstructive sleep apnea common in type 1 diabetes
  • No mortality risk with sulfonylureas, meta-analysis shows
(Source: Medscape)
Cardiology eMedinewS
  • An updated meta-analysis has shown that individuals who took a proton-pump inhibitor (PPI) in addition to clopidogrel had a significantly increased risk of adverse cardiovascular events, including all-cause mortality, MI, acute coronary syndrome, cerebrovascular accident, stent thrombosis, and the need for revascularization. The findings are published in Open Heart.
  • Diabetes, stroke, and myocardial infarction (MI) each double the risk of death alone and multiply the risk further when the trio is combined, suggests a new study published in the July 7 issue of the Journal of the American Medical Association.
Pediatrics eMedinewS
  • How much a child's pupil dilates in response to seeing an emotional image can predict his or her risk of depression over the next two years, suggests new research published in the Journal of Abnormal Psychology.
  • New study suggests that both lean body mass and body fat are linked to how kids' brains respond to food. The findings were presented at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB).
Dr KK Spiritual Blog
What are the two basic truths of Vedanta?

Two Hindu principles that symbolize the outcome of freedom of thought were conceptualized some 4000 years back by unnamed rishis in Rig–Veda which say, "This world is one family" (Vasudaiva Kutumbakam) and that "The Universal Reality is the same, but different people can call it by different names" (Ekam Sat Viprah Bahuda Vadanti).

In these two statements made in ancient Hindu India, we see the seeds of globalization and freedom of thought.

Most religions teach belief in one God. Judaism, Christianity and Islam are, in fact, Semitic religions essentially speaking of One God. Even Hinduism that talks of many gods, in its highest form speaks only of One God.

This was defined in the Sanskrit verse in the Rig Veda: Ekam Sat Vipra Bahuda Vadanti (The Truth is One, but scholars call it by many names).

"Vasudaiva Kutumbakam" defines that you and me are not different from each other and we are the part of the same web of life. The same spirit is shared by you and me and we are just the two sides of the same coin. And hence, it adds on to say, how can there be any conflict between us?

The truth is one, but is perceived differently because different people are at different levels of evolution in spiritual terms. Everybody perceives it with their level of understanding and perception. For an uneducated village society, even an entry of intelligent person in the village will be perceived as of GOD.

Vedanta upholds the reality of this indivisible, immanent and transcendent truth called Spirit. Vedanta denotes one’s identity with the rest of humanity. According to it, there is no stranger in this world. Everyone is related to one another in the kinship of the Spirit. In Vedanta, there is no ‘I’ and ‘for me’, but is ‘ours’ and ‘for us’; and ultimately ‘His’ and ‘for Him’.

If the Vedanta philosophy is rightly followed upon, it will obliterate all evils. It is the science of right living and it is not the sole monopoly of the Hindus. It is for all and it has no quarrel with any religion. It preaches universal principles and Vedanta is the only universal, and eternal religion. It is a great leveler and it unites all, giving room to all
Make Sure
Situation: A 40–year–old mild hypertensive complained of ED after a beta blocker.
Reaction: Oh my god! What was the need of starting the drug so early?
Lesson: Make sure that all mild hypertensives are first advised lifestyle modifications like exercise, low salt diet, high fiber diet, decreasing stress, etc. before advising anti-hypertensive medications.
Dr Good Dr Bad
Situation: An elderly patient with diabetes was found to have high insulin levels.
Dr. Bad: It has no significance.
Dr. Good: It is related to cognitive dysfunction.
Lesson: A prospective Japanese study has suggested that higher insulin and glycohemoglobin levels may be associated with diabetes-related cognitive dysfunction in the elderly diabetic patient (Dement Geriatr Cogn Disord Extra 2011 Jan;1(1):1-9).

(Copyright IJCP)
eMedi Quiz
The earliest immunoglobulin to be synthesized by the fetus is:

1. IgA.
2. IgG.
3. IgE.
4. IgM.

Yesterday’s Mind Teaser: In postoperative intensive care unit, five patients developed postoperative wound infection on the same day. The best method to prevent cross infection occurring in other patients in the same ward is to:

1. Give antibiotics to all other patients in the ward.
2. Fumigate the ward.
3. Disinfect the ward with sodium hypochlorite.
4. Practice proper hand washing.

Answer for yesterday’s Mind Teaser: 4. Practice proper hand washing.

Correct Answers received from: Dr Nikhil Mohanty, Dr K Raju, Dr Poonam Chablani, Dr Bitaan Sen & Dr Jayashree Sen, Dr K V Sarma, Dr Prabodh K Gupta, Daivadheenam Jella, Dr Kailash Sharma, Dr Lopa Dalal, Dr Smita Uday Shevade, Dr G Madhusudhan.

Answer for 8th July Mind Teaser: 4. Bronchogenic carcinoma.

Correct Answers received: Dr Poonam Chablani, Dr Avtar Krishan, Dr. Sushma Chawla.
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
Press Release
250 PCR Van Staff trained in CPR

Another batch of 250 PCR van staff was trained in CPR 10, the life-saving technique of hands-only cardiopulmonary resuscitation (CPR). Giving the training, Padma Shri Awardee, Dr K K Aggarwal, President, Heart Care Foundation of India and Honorary Secretary General, Indian Medical Association (IMA) said that CPR can revive a person only if the heart has stopped functioning. Clinically the person will not be breathing and will not have any response to painful stimuli.

To administer CPR, one need not be a paramedic, he further added. Even the general public can become the first responder.

CPR is effective in sudden cardiac arrest, electric current death, death due to drowning or any other sudden death. CPR is effective only in the first 10 minutes of stoppage of the heart.

The only requirement is to compress the center of the chest by one inch with a speed of at least 100 per minute on the dead person.

CPR should only be done by laying the person on a hard surface.
eIMA News
Digital IMA Inauguration: Sunday 26th July
Dear Colleague,

Digital IMA Inauguration: Sunday 26th July

Multi location CME and live webcast on IMA website

Program Schedule: 11-12 Noon

11-11.30 AM: Interaction with National President and HSG (Dr Marthanda Pillai and Dr KK Aggarwal)

11.30-11.50 AM: Lecture by Dr Banshi Saboo, Diabetologist, Scientific Committee Chair - Diabetes Education Program (DEP), Congress Chairman: Diabetes India, Hon. Secretary: AIAARO (Indian Obesity Society)

11.50-12 Noon: Conclusion

CME Grant: USV

City Name
Andhra Pradesh
EB Section 1st Floor, TE Madhapur
CTO building, Ground Floor, PAN Bazaar, Guwahati.
Room adjacent to media centre room, ground floor,
O/o CGM, BSNL Bihar Telecom Circle, Sanchar Sadan, CTO building, Near GPO, Patna – 800001
Grond Floor Adjoining CSC, Sector -17, Chandigarh
Room no.F-207, 1st Floor, Telephone Bhavan, Fafadih, Raipur
Ground Floor, Central Repair Shop, Navrangpura, TE, Navrangpura
Ground Floor, Karimabad, Admin Building, Ghod Road
Alkapuri TE Building, Ground Floor, BB Helpdesk room, Near Race Course Circle, Vadodara
TE Building, Sector-11, 1st Floor, CRS room, Gandhinagar
1st Floor Room, Sector 44, Plot No.42, CSC BSNL Gurgaon
CTO Building, Ground floor, Adjacent to CSC
Madhya Pradesh
BSNL Bldg No.3, 1st Floor, Nehru Park, Indore
Madhya Pradesh
CTO BSNL Building, New market, TT Nagar, Bhopal
Ground Floor, CSC, TE Building, Model Colony
Room no. 64 SFMS, Ground Floor, CTO Bldg, Civil Lines
SDELC, 1st Floor, Canada Corner, BSNL Nasik
1st Floor, CTO building, CSC, PMG Square, Bhubaneshwar
CTO Building BSNL Cuttack
1st Floor, Dugri Urban Estate, BSNL Ludhiana
1st floor, CTO Building, MI road, BSNL, Jaipur
Ground Floor, E-10B, BSNL Building, Road no.2, Indraprastha Area, Kota
EB Section 1st Floor, TE Madhapur
Uttar Pradesh
TE Kaiser Bagh, Lucknow
Uttar Pradesh
108, 1st floor, BSNL Admin building, Sanjay Place

Yours sincerely

Dr A Marthanda Pillai                              Dr K K Aggarwal
IMA HBI Update
Why should medical establishments be accredited with NABH?

The Indian Medical Association (IMA) is of the view that all nursing homes or medical establishments should be accredited with NABH. IMA is felicitating IMA members who own establishments and wants their establishment to be NABH accredited.

With NABH accreditation, you will be able to:
  • Propagate that your establishment offers facilities that are of better quality.
  • Propagate that your premises provide high standards of care with high level of patient safety.
  • Provide better quality of services, which in turn, will generate more business
  • Get empanelment with CGHS, ECHS, PSUs and State Government.
  • Apply for empanelment with UN institutions
  • Recruit qualified staff, residents and nurses
  • Apply for government projects and grants
  • Apply for international grants.
  • Collaborate with other recognized health care establishments
  • Generate faith in public that your hospital does not sell fake/spurious drugs.
  • Generate faith in public regarding the accuracy of laboratory tests
  • Generate faith in public regarding transparency in billing with no hidden costs.
  • Provide an infection free, clean, hygienic environment (with minimal hospital acquired infections) to the patients
  • Get your establishment recognised for DNB, Internship, fellowship programs
  • Strengthen the faith that the hospital complies with standard procedures of care with minimum errors.
  • Strengthen the faith that the hospital follows a policy of rational use of drugs including antibiotics, investigations and treatment.
  • Strengthen the public faith that their rights will be respected and protected.
  • Similarly, the hospital doctors will have a faith that their rights are also being respected.
  • Public will be confident that the hospital will provide a safe and secure environment for them.
  • Public will have faith that the technicians in the establishment are well-trained and qualified.
  • Public will be assured that the hospital maintains and strictly follows its infection control policy. Hence, they will be less apprehensive of acquiring infections like Hepatitis B, Hepatitis C, HIV and TB when they come to your hospital.
  • Public will be assured that any news story from the establishment, on TV or in print, will be scientific.
  • Public will be confident that their right to confidentiality will be respected. And, their medical records would be preserved
  • Accreditation means better quality of services, so you have a marketing advantage in terms of costs of treatment or services provided compared to those who are not accredited.
  • Accreditation will lead to a process of continuous learning and improvement, which will further enhance the skills and knowledge of your staff.
  • Accreditation will facilitate empanelment with insurance agencies and other third parties.
  • NABH accreditation means that the medical establishment will adhere to standard treatment guidelines. As a result, there will be less opportunities for people filing cases for medical negligence. You will have a stronger defence against malpractice litigations.
  • Accreditation also reduces liability insurance costs.
  • Poorer lung function in early adulthood may be sufficient to predispose an individual to chronic obstructive pulmonary disease (COPD) later in life, suggests a retrospective cohort study published July 9 in the New England Journal of Medicine.
  • Identifying women who might have maturity-onset diabetes of the young (MODY) is feasible during pregnancy using new pregnancy-specific screening criteria, suggests Australian research published online in Diabetes Care.
  • Relationships outshine treatment when it comes to beating the odds in advanced cancer, reported a small group of patients who have far outlived their prognoses. These patients with advanced lung or pancreatic cancer attributed their longevity to their relationships with their doctor and their family, rather than the type of treatment they received. The findings are published online in Future Oncology.
  • Novel evidence supports cognitive-behavior therapy for insomnia (CBT-I) when the difficulty sleeping occurs with another medical or psychiatric condition. The study was published online July 6 in JAMA Internal Medicine.
  • New research suggests that chromosomal abnormalities in human embryos created for in vitro fertilization (IVF) can be predicted within the first 30 hours of development at the cell-1 stage which results from the union of a female egg and male sperm. The findings, published online in the journal Nature Communications, could improve IVF success rates.
Inspirational Story
TRUST and RESPECT can only be EARNED

A little girl and her father were crossing a bridge. The father was kind of scared so he asked his little daughter, "Sweetheart, please hold my hand so that you don’t fall into the river."

The little girl said, "No, Dad. You hold my hand."

"What’s the difference?" Asked the puzzled father.

"There’s a big difference," replied the little girl. "If I hold your hand and something happens to me, chances are that I may let your hand go. But if you hold my hand, I know for sure that no matter what happens, you will never let my hand go."

Moral: TRUST and RESPECT cannot be LEARNED, PURCHASED or ACQUIRED. They can only be EARNED.
Quote of the Day
Failure will never overtake me if my determination to succeed is strong enough. Og Mandino
IMA in Social Media
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Reader Response
Dear Dr K K, it is a credit worthy initiative taken by you to train the Police Personnel in CPR which will help the people of Delhi in emergency. Keep doing this noble work and God will bless you. Regards. Ashok Ahooja. Sqn. Ldr (Retd).
Wellness Blog
Top 10 Ways to Keep the Kidneys Healthy

We all want our kidneys to last for a lifetime. We should all show our love for kidneys by adopting a 10–step program for protecting kidney health.

One should begin with monitoring blood pressure and controlling weight and then move on to the rest of the kidney–healthy tips
  • Monitor blood pressure and cholesterol.
  • Control weight.
  • Don’t overuse over–the–counter painkillers.
  • Monitor blood glucose.
  • Get an annual physical exam.
  • Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.
  • Don’t smoke.
  • Exercise regularly.
  • Follow a healthy diet.
  • Get tested for chronic kidney disease if you're at risk.
IMA Humor
A man came running in the office and yelled, "Doctor, doctor! My son just swallowed a roll of film!" The doctor calmly replied, "Well let’s just wait and see what develops."
Rabies News (Dr A K Gupta)
How is RIG life saving?

Administration of anti–rabies vaccine stimulates production of neutralizing antibodies by the patient’s immune system. Protective levels of antibodies (more than 0.5 IU/ml of serum) are seen 7 to 14 days after the initial dose of vaccine (window period). Moreover when the bites are on the head, neck, face and hands, the incubation period will be shorter.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.
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