January 11 2015, Sunday
editorial
(…Contd.)
 

Waste Disposal...
Dr General waste and Biomedical waste have become a major public health hazard resulting in increased incidence of infection and antibiotic resistance. IMA will start a consultancy service for biomedical waste disposal encouraging IMA State and Local branches to go eco-friendly.

IMA will cooperate with the Government in its efforts for a clean environment through its ‘Swachh Bharath Abhiyan’.
(…Contd.)
Read More ...
eMedipics
IMA,IJCP,HCFI
Health Check Up and
CPR 10 Camp
at G B S S School,
No–2, Ambedkar Nagar
on 19th December 2014
editorial
Tackling Vitamin B12 Deficiency

Dr KK AggarwalVitamin B12 deficiency can be prevented if you are strict vegetarian. 3.2% of adults over age of 50 have a serious low B12 levels and up to 20% may have a borderline deficiency. The common causes of B12 deficiency are being on a vegetarian diet and after a weight loss surgery. Plants do not make Vitamin B12. It is only present in animal food.

Symptoms

  1. Strange sensations, numbness or tingling in the hands, legs or feet.
  2. Difficulty in walking (staggering, balance problem)
  3. Anemia
  4. A swollen inflamed tongue.
  5. Difficulty thinking and reasoning (cognitive difficulties) or memory loss.
  6. Yellowed skin (jaundice)
  7. Paranoia or Hallucinations
  8. Weakness
  9. Fatigue

Ask your Doctor about having a B12 level check if you:

  • Are over 50 years old
  • Take a proton–pump inhibitor or H2 blocker drugs for acidity
  • Take metformin (a diabetes drug)
  • Are a strict vegetarian
  • Had weight loss surgery or have a condition that interferes with absorption of food. 
IMA,IJCP,HCFI
 
Quote of the Day
We are all travelers in the wilderness of this world, and the best we can find in our travels is an honest friend. Robert Louis Stevenson
News on Maps
CPR 10
Total CPR since 1st November 2012 – 101090 trained
IMA in the News
  • IMA slams Delhi Police for delay in Sunanda case: The Hindu
  • Country needs latest labs: IMA: Asian Age
THE DRUGS AND COSMETICS (AMENDMENT) BILL, 2015
(j) "drug" includes–
(i) all medicines for internal or external use of human beings or animals and all substances intended to be used for or in the diagnosis, treatment, mitigation or prevention of any disease or disorder in human beings or animals, including preparations applied on human body for the purpose of repelling insects like mosquitoes;

(ii) such substances, other than food, intended to affect structure or any function of the human body or intended to be used for the destruction of vermin, insects or microbes which cause disease in human beings or animals, as may be specified from time to time by the Central Government by notification;

(iii) all substances intended for use as components of a drug including empty gelatin capsules; and

(iv) any new drug for which licence has been granted by the Central Licensing Authority under sub– section (2) of section 18;

(k) "Drugs Control Officer" means–

(i) in relation to any medical device, the Drugs Control Officer appointed by the Central Government under section 7H;

(ii) in relation to drug other than those specified in sub–clause (iii) or cosmetic, a Drugs Control Officer appointed by the Central Government or a State Government under section 21;

(iii) in relation to Ayurvedic, Siddha or Unani drug, a Drugs Control Officer appointed by the Central Government or a State Government under section 33G;

Explanation.–For the purposes of this Act, the controlling officer and any other officer senior to the Drugs Control Officer shall be deemed to be the Drugs Control Officer;

(l) "Drugs Controller General of India" means an officer appointed by the Central Government under section 33Q;

(m) “Ethics Committee” means the Ethics Committee constituted under section 4E;

(n) "Government Analyst" means–

(i) in relation to drugs other than specified in sub
–clause (ii), cosmetics and medical devices, a Government Analyst appointed by the Central Government or a State Government under section 20;and

(ii) in relation to Ayurvedic, Siddha, Unani drug, a Government Analyst appointed by the Central Government or a State Government under section 33F;

(o) "import" within its grammatical variations and cognate expressions means to bring into India;

(p) "Indian Pharmacopoeia" means the official book of standards for drugs which specifies the standards of identity, purity and strength for the drugs mentioned therein;
Medicolegal
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The Year in Medicine 2014: News That Made a Difference
4. Top HIV/AIDS Researchers Killed on Malaysian Jet

Several of the world’s leading HIV/AIDS researchers and activists were among the 298 people killed on a Malaysian passenger jet that was shot down over Ukraine on July 17.(15) Among the dead were former president of the International AIDS Society Joep Lange, MD (above), a well–known HIV researcher from the Netherlands, his wife and collaborator Jacqueline van Tongeren, and Glenn Thomas, spokesman for the World Health Organization's Western Pacific region. (Source: Medscape)
News around the Globe
  • A new tool, The Healthy Aging Brain Care (HABC) Monitor, may provide a simple and reliable way to detect and monitor cognitive, functional, and psychological symptoms in aging adults, report the tool’s developers in an article published online December 5 in Clinical Interventions in Aging.
  • Two long–acting reversible contraceptive devices, the levonorgestrel intrauterine system (LNG–IUS) and etonogestrel (ENG) subdermal implants, are well-tolerated and are associated with few serious adverse effects, reported a retrospective cohort study published online in the American Journal of Obstetrics and Gynecology. However, researchers noted that these contraceptives were underused.
  • Trends in cataract surgery over a 5–year period, from 2008 to 2012, have shown decreasing thresholds for surgery, decreasing surgical complication rates, and better visual outcomes, pointed an article published in the January issue of Ophthalmology.
  • A new study conducted in Hiroshima and Nagasaki atomic bomb survivors shows that the higher the radiation dose a person was exposed to in childhood, and the younger he or she was when exposed, the more odds he or she has to have large thyroid nodules. The report is published online in JAMA Internal Medicine.
  • A new analysis has shown that men diagnosed with nonmetastatic prostate cancer who consumed more than 140 µg a day of supplemental selenium had over a two–and–a–half–fold increased risk for death from prostate cancer compared with nonsupplement users. The report is published online in the Journal of the National Cancer Institute.
Media
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Inspirational Story
Do not be jealous

We all have experienced how jealousy can disturb our peace of mind. You know that you work harder than your colleagues in the office, but sometimes they get promotions; you do not. You started a business several years ago, but you are not as successful as your neighbor whose business is only one year old. There are several examples like these in everyday life.

Should you be jealous? No. Remember everybody’s life is shaped by his/her destiny, which has now become his/her reality. If you are destined to be rich, nothing in the world can stop you.

If you are not so destined, no one can help you either. Nothing will be gained by blaming others for your misfortune.

Jealousy will not get you anywhere; it will only take away your peace of mind.
Rabies News (Dr A K Gupta)
Is hydrophobia a sign of rabies in dogs?

Hydrophobia is not a sign of rabies in dogs. Rabid dogs can drink water and even swim in water. If a rabid dog is not able to drink water, it is because of paralysis of jaw muscles and not due to hydrophobia.
Cardiology eMedinewS
  • An 800–mg intravenous bolus of andexanet alfa, an antidote for rivaroxaban, immediately and significantly reversed the steady–state anticoagulation activity of rivaroxaban, reported the ANNEXA–R study. The study will be presented at the American College of Cardiology 2015 Scientific Sessions.
  • The US Food and Drug Administration (FDA) has approved edoxaban, a factor Xa inhibitor, for the prevention of stroke and non–central–nervous–system (CNS) systemic embolism in patients with nonvalvular atrial fibrillation (AF).
10 Innovations in Medicines
7. Technology Expands Patient–Generated Data

The concept of patient–generated data is nothing new, but the days of blood pressure cuffs and fingerstick glucose tests are coming to an end. This area is expanding to smartphones and wearable technology. And these new gadgets not only measure data, they immediately interpret that data. Soon smart watches will be available to continuously monitor blood pressure or blood oxygen concentration, and wearable sensors will track hemodynamic metrics like cardiac output and stroke volume. Routine lab work is also moving in the direction of the smartphone. But suddenly clinicians and patients have more data than they know what to do with. There are some concerns. "Will the data be accurate or misleading? How will I deal with my patients getting torrential streams of data and sending these to me for guidance? Or will the computer algorithms bombard me with false or unnecessary alarms?" Dr Topol believes these questions will need to be addressed by regulatory oversight and software programming to foster comfort within the medical community. (Source: Medscape)
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 hemoglobin.

Answer for yesterday’s Mind Teaser: 4. Oxygen affinity of hemoglobin.
Correct Answers received from: Dr Krishna
Answer for 9th Jan Dec Mind Teaser: 1.Criterion validity.
Correct Answers receives: Dr Avtar Krishan
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
https://www.youtube.com/watch?v=Mc3kKDXKWvs

Kishan, SM Heart Care Foundation Fund,
Post CHD Repair
https://www.youtube.com/watch?v=OTEG7toVkAQ

Deepak, SM Heart Care Foundation Fund,
CHD TOF https://www.youtube.com/watch?v=rjOel0aaqt0
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues
h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
WhistleblowerDumped/videoshow/4468283.cms

Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
https://www.youtube.com/watch?v=6Ktz5-iUINE

Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
https://www.youtube.com/watch?v=TGEGauzE0kg
Pediatrics eMedinewS
  • Using a rear-facing car seat until a child is two years old reduces risk of serious injury, but nearly one–quarter of parents report they turned the seat around before their child was even one year old, suggests a new University of Michigan study.
  • Children who are waiting for a heart transplant can safely undergo intravenous home inotropic treatment, suggests new research published online in Circulation: Heart Failure.
IMA in Social Media
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Events
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IMA slams Delhi Police for delay in Sunanda case
NEW DELHI, January 10, 2015: The Hindu: Senior physicians in the country have criticised the delay on the part of the Delhi Police in registering a case of murder in Sunanda Pushkar’s death. They have demanded that the Central Government work at establishing state–of–the–art forensic labs in every district in the country.

The Indian Medical Association (IMA), the country’s largest non–government organisation of doctors with a membership of more than 2.5 lakh physicians, have expressed concern about the state of forensic lab facilities available in the country and has written to the Prime Minister and Union Health Minister.

In their letter, the IMA office bearers have noted that "it has taken over a year after the incident for the police to file a case of murder".

Also the report of the medical board of All India Institute of Medical Sciences (AIIMS) said they do not have all the facilities for forensic examination and the viscera samples need to be sent abroad for further testing.

IMA president Dr. A. Marthanda Pillai said: "We have asked the health ministry to treat this matter on priority and let the Association know what steps are being taken in this regard."

AIIMS in its subsequent report in September named a few poisons, which could not be detected easily by forensic laboratories in the country. Source:
Country needs latest labs: IMA
Jan 10, 2015 | Asian Age | New Delhi

Citing the forensic report submitted by the three-member AIIMS medical board, which suggested further examination of her viscera in a foreign lab, the Indian Medical Association has written to the Union health ministry to set up state–of–the–art forensic labs in every part of the country.

On Friday, the IMA wrote to Union health secretary Luv Verma and urged the government to set up state–of–the–art forensic labs in every district in the country. IMA secretary general Dr K.K. Aggarwal said that due to absence of a state–of–the–art forensic lab it took over a year after the incident for the Delhi police to file a murder case in the Sunanda Pushkar death.

The medical board headed by the chief of AIIMS forensic department, Dr Sudhir Gupta, pointed to the possibility of the use of a few poisons which could not be detected easily by forensic laboratories in the country.

IMA president Dr A. Marthanda Pillai also asked the Union health ministry to treat this matter on priority and let the association know what steps were being taken in this regard. "With a soaring crime rate in the country, every state has a right to have a state–of–the-art forensic lab. Why should there be a need to send samples to other states or countries?" he asked.

Pointing to the medical board report, the IMA said that the report of the medical board had said that they did not have all the facilities for forensic examination and the viscera needs to be sent abroad for further testing.

"Observation made by the medical board consisting doctors from AIIMS means that the country does not have a single lab for complete forensic examination and if it would not have been a high profile case, the matter could have been closed as a case of suicide.

Thousands of such cases of murder today might be getting closed as suicidal cases," added Dr Aggarwal.
Dr Good Dr Bad
IMA,IJCP,HCFI
Dr KK Spiritual Blog
Why are most temples located in faraway places?

Most temples represent God or the spirit or the deity located in the temple or mandir situated in an area at the outskirts of the city. A spiritual atmosphere is one that is devoid of pollution and which promotes rajasik or tamasik behavior. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. The inner journey of being in touch with one’s consciousness requires detachment from worldly pleasures and the withdrawal of the five senses of the body

To be in touch with one’s consciousness one needs to bypass the disturbed state of consciousness controlled by emotion, memories and desires, through mind, intellect and ego. This bypass usually requires a prolonged period of persistence and undertaking the inward journey devoid of external stimuli. The parikrama, which means "the path surrounding something", incorporating many long walks helps to detoxify the mind and thus shifts the consciousness from a disturbed state to an undisturbed, calm state.

A long walk not only offers physical benefits but one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The person is often required to walk bare foot on natural ground, inhale pure air and concentrate and listen to the sounds of the nature, birds and trees. This proximity to nature helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode described by lowering of blood pressure and pulse rate. The final happiness invariably comes from within us at the time of final darshan when a person invariably closes his eyes and experiences God within his heart.

Most temples today are being constructed in residential colonies and provide a holy atmosphere to people right at their doorstep. However, they do not have the same spiritual significance and benefits as a temple located at the outskirts of a city.

There is no way a person can go to a temple in the vicinity of his house and detoxify his mind as this can hardly be achieved in minutes unless you are a siddha yogi, and if you are one, you need not go to a temple as the temple is within you.

In Vedic texts, it has been clearly mentioned that to acquire powers and inner happiness, rishi, munis were also required to do tapasya for months and years together. This tells us that spiritual well-being is acquired over an extended period of time as the process of detoxification is a long drawn process. Cars and other vehicles should not be allowed near temples as the basic motive is to have a pollution–ree atmosphere and to give time and space for the mind to detoxify.
Wellness Blog
Fish Medicine for asthma

The Bathini Goud family, living in Hyderabad, claim that they can cure asthma by making people swallow a 2–inch live fish filled with medicine. They claim that they have been using this treatment for over 160 years.

As per their claim the medicine is stuffed inside the mouth of a live murrel fish, 5–6 cm in size. This fish with the medicine is slipped into the mouth of the asthmatic patient, which can easily be swallowed as the fish is slippery. This needs to be taken for three consecutive years.

The medicine is administered on a specific day Mrigashira Kanthi Nakshatra, which normally coincides with arrival of monsoon rains in the first or second week of June. Three doses are given to the patients after every 15 days.

The Goud family never discloses ingredients of their drug. They provide the medicine free of cost. Some people went to the Court of the Andhra Pradesh on 27.01.2013 but the court declined to interfere and pass any orders regarding the administration of substances popularly known as Fish Medicine. They reasoned that although the treatment had no medicinal value, analysis had shown the samples to not be harmful. They said that "if people flock to have a substance out of faith the courts cannot interfere".

My opinion

Asthma is classified as mild intermittent asthma, moderate persistent asthma and severe persistent asthma. The distinction between intermittent and mild persistent asthma is important because current guidelines for moderate persistent asthma call for initiation of daily control medicine. For moderate persistent asthma, the preferred long–term controller is low–dose inhaled steroid.

Mild intermittent asthma is the largest segment of asthmatic patients and they do not require long term treatment. These are the people who may never require steroid inhalers. Over a period of time, these asthmatics may show improvement. Many mild intermittent asthmatics who are allergic to a particular protein may improve over a period of time.

Homeopaths, Ayurveda physicians, naturopaths and others who claim that they can cure asthma, they work only on patients with mild intermittent asthma. If they can demonstrate their results in severe asthma, then their methods can be believed to be of use.

The very fact that anybody has claimed does not mean that it is not scientific or scientifically validated. If they can prove their claim, there is no reason why they should not get Noble Prize. We have seen a similar claim by a person who gives a medicine for jaundice in Chandni Chowk and another person in Agra who claims that the can cure any type of cancer with a herb mixed with goat milk.
Twitter of the Day
Dr KK Aggarwal: Anger recall is as bad as Anger itself http://bit.ly/15xjAnp #Health

Dr Deepak Chopra: Believing in a personal God who cares for you is one thing; activating God to help you is another http://tinyurl.com/q7ebpvk
Make Sure
Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.
eMedinewS Humor
Proportions

One semester when my brother, Peter, attended the University of Minnesota in Minneapolis, an art–student friend of his asked if he could paint Peter’s portrait for a class assignment. Peter agreed, and the art student painted and submitted the portrait, only to receive a C minus.
The art student approached the professor to ask why the grade was so poor. The teacher told him that the proportions in the painting were incorrect.
"The head is too big," the professor explained. "The shoulders are too wide, and the feet are enormous."
The next day, the art student brought Peter to see the professor. He took one look at my brother and said, "Okay, A minus."
Press Release of the Day
Combo drugs best for lowering blood pressure

A low–dose four–drug combination is more effective for reducing high blood pressure than treatment with a high dose of a single drug, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

Quoting an Irish study published in the journal Hypertension, Dr. Aggarwal said that most people with high blood pressure need 2 to 3 antihypertensive drugs.

Combining low doses of established antihypertensive medicines in one or two drugs can produce better blood pressure control than full doses of individual drugs.

In the study doctors from Dublin, investigated this approach by studying 108 untreated, hypertensive patients. The subjects were randomly allocated to take one of four agents –– a calcium channel blocker, a beta–blocker, a diuretic, or an ACE inhibitor –– or a capsule containing all four drugs at one quarter of the dose used for single-drug therapy.

After 4 weeks, the reduction in pressure with the combination treatment was 19 points, significantly greater than the 6 to 11 points seen with the various individual agents.

In the study 60% of combination-drug patients achieved a normal blood pressure reading compared with 15 – 45% of patients taking individual drugs.

The combination approach has the potential to reduce costs, with possibly fewer side effects and the number of medicines to be taken each day.
IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.
If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
Reader Response
The warning is a good decision sir. But they are leading glorious practices with all allopathic drugs. They use 3rd generation cephalosporins and amoxiclav for cold and cough for example. I request you to stop or inform someone in power to stop this. Heard that PHC doctors can give notice about unauthorized allopathic drug use. But as IMA members we should have meeting involving PHC doctors and encourage them to take action against these people. Kumaragoud Patil
IJCP’s ejournals
  • Indian Journal of Clinical Practice
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  • Asian Journal of Critical Care
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  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat