April 11  2015, Saturday
Ten ways to ease neck pain
Dr KK Aggarwal
  1. Don’t stay in one position for too long
  2. Keep the computer monitor at eye level.
  3. Use the hands–free function of the phone or wear a headset.
  4. Prop your touch–screen tablet or the ipad on a pillow so that it sits at a 45° angle, instead of lying flat on your lap.
  5. Keep your prescription up to date, if you wear glasses to prevent leaning your head back to see better.
  6. Don’t use too many pillows as it can stifle your neck’s range of motion.
  7. Before you move a big wardrobe across the room, consider what it might do to your neck and back, and ask for help.
  8. Sleep well.
  9. Call your doctor if neck pain is associated with radiating pain, weakness, or numbness of an arm or leg.
  10. Also call the doctor if you have fever or weight loss associated with your neck pain, or severe pain.
Heart Care Foundation of India & Indian Medical Association trained over 4000 people in hands only CPR 10 & essential food safety measures on World Health Day
  • Adding erythropoietin (EPO) to radiation therapy (RT) in patients with head and neck squamous cell carcinoma (HNSCC) is not helpful and may be harmful, report long-term results of the Radiation Therapy Oncology Group (RTOG) 9903. The findings are published in the International Journal of Radiation Oncology Biology and Physics.
  • Compared with proton pump inhibitor (PPI) treatment for gastroesophageal reflux disease (GERD), transoral incisionless fundoplication (TIF) brings on improvements in quality of life and reflux, but normalization of pH does not persist at 12 months, suggests a new trial published online in The American Journal of Gastroenterology.
  • A new study suggests that any amount of leisure-time physical activity is associated with a significantly lower risk of death when compared with no physical activity at all. The findings are published online in the Journal of the American Medical Association: Internal Medicine.
  • Engaging in arts and crafts and social activities in mid-life and late life and using a computer in late life were associated with a reduced risk for mild cognitive impairment (MCI) in elderly patients, suggested a new study published online April 8 in Neurology.
  • A 15-year study of more than 1300 men and women who were initially free of early or late age-related macular degeneration (AMD) has shown that overall, 13.9% of the participants developed medium drusen, and older people and those with risk alleles in the CFH and ARM2 genes had a greater risk of developing medium drusen. The findings are published online in JAMA Ophthalmology.
Dr KK Spiritual Blog
Mindfulness meditation

Sit on a straight–backed chair or cross–legged on the floor.

Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.

Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas.

Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
Cardiology eMedinewS
  • High parathyroid hormone levels and bone loss may predict progression of coronary artery calcification (CAC) in patients receiving dialysis, suggests a study published online in the Journal of the American Society of Nephrology.
  • There seems to be no important clinical benefit from preferring red blood cells (RBC) that have been stored for <10 days vs at least 3 weeks for use in patients undergoing major cardiac surgery, suggests a randomized trial published in the April 9 issue of the New England Journal of Medicine.
Pediatrics eMedinewS
  • In an extended phase 3 study of 36 children with central precocious puberty, up to six successive yearly implants that delivered histrelin for 12 months was safe and effective. The study was published online in the Journal of Clinical Endocrinology & Metabolism.
  • With increasing use of more sophisticated brain and spinal cord diagnostic technology, more children are being referred to pediatric neurosurgeons for unexpected findings on MRI. The report discussing these incidental findings is published in the April issue of Pediatrics.
Make Sure
Situation: A patient with acute heart attack died on the way to the hospital.

Reaction: Oh my God! Why was the patient not accompanied by the doctor?

Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.
Dr Good Dr Bad
Situation: A patient on Mediclaim developed a recurrence of illness after three months.

Dr. Bad: It will not be covered under Mediclaim.

Dr. Good: Yes, it will be covered as it is a fresh illness.

Lesson: Occurrence of the same illness after lapse of 105 days is considered as fresh illness for the purpose of Mediclaim policy.

(Copyright IJCP)
eMedi Quiz
The following statements about meningococcal meningitis are true, except:

1. The source of infection is mainly clinical cases.

2. The disease is more common in dry and cold months of the year.

3. Chemoprophylaxis of close contacts of cases is recommended.

4. The vaccine is not effective in children below 2 years of age.

Yesterday’s Mind Teaser: A measure of location which divides the distribution in the ratio of 3:1 is:

1. Median.

2. First quartile.

3. Third quartile.

4. Mode.

Answer for yesterday’s Mind Teaser: 3. Third quartile.

Correct Answers received from: Dr Jainendra Upadhyay, Dr Vasanti Thote, Dr G Madhusudhan, Daivadheenam Jella, Dr Avtar Krishan, Dr Prabodh K Gupta, Tukaram Pagad, Viswanatha Sarma, Dr Shangarpawar.

Answer for 9th April Mind Teaser: 3. Sound referral system.

Correct Answers receives: Dr Avtar Krishan, Daivadheenam Jella, Raju Kuppusamy.
Rabies News (Dr A K Gupta)
How to approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

The first three doses of modern rabies vaccine must be very timely and for the fourth and fifth, one or two days of variation is permissible.
eMedinewS Humor
Water in the Carburetor

Wife: "There’s trouble with the car. It has water in the carburetor."

Husband: "Water in the carburetor? That’s ridiculous."

Wife: "I tell you the car has water in the carburetor."

Husband: "You don’t even know what a carburetor is. I’ll check it out. Where’s the car?" Wife: "In the pool."
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
IMA News
What are the principles of natural justice?
The two essential elements of Natural Justice are
  • No man shall be Judge in his own cause (the judge should not have any interest or bias in any party)
  • The Court / Tribunal must act honestly and impartially and not under the dictation of other persons to whom authority is not given by Law
  • Audi alteram partem (Both sides shall be heard)
    • That no one should be condemned unheard.
    • Party to an action is prima facie entitled to be heard in his presence.
    • He is entitled to dispute his opponent’s case, cross examine his opponent’s witnesses and entitled to call his own witnesses and give his own evidence before Court.
    • He is entitled to know the reasons for the decision rendered by a Court / Tribunal.
Sonal Namaste
Preventive measures for acute diarrhea among children in resource-limited settings include breastfeeding, consumption of safe food and water, adherence to hygienic practices, and vaccination against rotavirus infection.
Facts about Tuberculosis (TB)
How is it ensured that a TB patient initiated on treatment completes the treatment?
  • Once a patient has been diagnosed to be suffering from TB a home visit is undertaken by the health worker for address verification and for counseling and educating the patient and family members on the disease and importance of regular treatment.
  • Contact details of the patient and a responsible family member/neighbor/friend/relative are recorded on the patient’s treatment card in case the patient interrupts treatment.
  • If a patient misses a dose the DOT provider contacts the patient by a house visit and encourages him to return for treatment. In case the DOT provider fails to retrieve the patient the supervisory staff (i.e. the Senior TB supervisor, Medical Officer etc.) are informed for taking necessary action.
Public consultation invited on health databases and biobanks
An open consultation on the ethical issues surrounding health databases and biobanks has been announced by the World Medical Association.

Starting today (Thursday) for a two month period, the WMA is inviting comments on its proposed principles for the ethical use of data in health databases and human biological material in biobanks. This follows the successful public consultation procedure adopted two years ago by the WMA when it revised its Declaration of Helsinki.

The WMA is taking this step because of the need for the medical profession to have guidance about how to ethically approach the rapidly growing agendas of health databases and biobanks. It is hoped the final guidance will benefit both the medical and wider research communities, as well as all those affected by such research by avoiding possible abuse or endangering the trust of those whose data is held.

In a joint letter sent out today to national medical associations and interested outsiders, Dr. Jón Snædal, Chair of the WMA’s Workgroup on Health Databases and Biobanks, and Dr. Otmar Kloiber, WMA Secretary General, refer to the risks and advantages of health databases and the need for guidance on the way forward.

They write: ‘Informed consent, although not perfect, is the strongest instrument for protecting personal autonomy, and with it self-determination and dignity. It is the primary means for all potential research subjects to express their will and/or preferences. We consider it a crucial instrument for protection and respect.

‘Research is changing. Large collections of data and human specimens allow for the development of new research strategies and models, as well as new predictive types of research and analysis. The combination of large amounts of data, the possibility of combining large databases and the application of information technology are already changing all aspects of our lives. Research is no exception.

‘The potential of such databases is vast, but so are the dangers. While there is a strong possibility of finding solutions, cures and remedies for a multitude of medical problems, illnesses and suffering, the challenge lies in the high potential for the abuse and misuse of health databases and biobanks. We are convinced that the answer to this dilemma is to be found in an ethically correct process which takes into account the willingness and trust of those donating and sharing their data (or specimens) as well as acknowledging the obligation to apply high standards of protection.

Accompanying the letter are draft guidelines drawn up by a WMA Workgroup, which, say the authors of the letter, amount to a balanced approach by requesting broad consent from the donors of data or specimens indicating their preparedness to share or donate their data or material for later use.

Dr. Snædal, Chair of the Workgroup, said: ‘We concluded that the major risk scenarios do not result from science, but from the commercial, administrative or political use of this data. Limiting our guidelines to research only would have left us blind to the imminent risk of abuse from outside the field of medicine, from commercialisation, cost-cutting and potential political abuse.

‘So in contrast to the Declaration of Helsinki, this proposed policy aims to address any use of health databases and biobanks and is not restricted to research.’

Public comments on the draft guidelines are invited up until June 5

Report of TB Programme in IMA Mumbai Branch on occasion of World TB Day
IMA Mumbai Branch has held TB programme in IMA House, Haji Ali on occasion of World TB Day to educate IMA members on recent advances and treatment of Tuberculosis. (Photos attached)
IMA Mumbai Branch has made a professional video for awareness of TB and treatment for public education and all actors in the video are from IMA Mumbai Branch. This was launched at the IMA-RNTCP National Review Workshop Programme, Gurgaon by National President IMA HQ, Padmashree Prof. Dr. A. Marthanda Pillai, Hon. Secretary General IMA HQ, Padmashree Dr. K.K. Aggarwal and CTD Director (Central TB Division) Dr. Niraj Kulshrestha.
Inspirational Story
Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.

The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said “you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one.”

You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.
Quote of the Day
Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength. Charles Spurgeon
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Wellness Blog
Work–related Stress can kill

Job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest stress–induced biological changes may play a more direct role than previously thought.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability – a sign of a poorly–functioning weak heart and higher than normal levels of cortisol, a "stress" hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart.
Reader Response
Dear Dr KK Aggarwal ji I am IMA Nizamabad National Rep. I wanted to add your statement in diarrhea free Nation but the adulterated pod especially milk 30 to 40 percent in your country kindly pay attention to it Dr J BAPU Reddy MD Nizamabad Telangana
IMA Videos
News on Maps
Do not text while driving: IMA
On the road, off the phone

Taking your eyes off the road – even for a few seconds – can cost life

Do not text while driving as it can be as dangerous as driving under the influence of alcohol said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India. Texting while driving is the act of composing, sending, reading text messages, email, or making other similar use of the web on a mobile phone while operating a motor vehicle. Some statistics
  • As per US National Highway Traffic Safety Administration : Driver distraction is the cause of 18 percent of all fatal crashes
  • Forty percent of all American teens say they have been in a car when the driver used a cell phone in a way that put people in danger
  • Virginia Tech Transportation Institute: Text messaging creates a crash risk 23 times worse than driving while not distracted. Eleven percent of drivers aged 18 to 20 who are involved in an automobile accident and survived were sending or receiving texts when they crashed.
  • Hand held phone: In the US 14 states, D.C., Puerto Rico, Guam and the U.S. Virgin Islands prohibit all drivers from using "hand-held cell phones" while driving.
  • All cell phone use: No state bans " all cell phone use" for all drivers, but 38 states and D.C. ban all cell phone use by novice drivers, and 20 states and D.C. prohibit it for school bus drivers.
  • Text Messaging: Washington was the first state to pass a texting ban in 2007. Currently, 45 states, D.C., Puerto Rico, Guam and the U.S. Virgin Islands ban text messaging for all drivers.
  • In India a phone offender can be booked under Section 184 of the Motor Vehicles Act-1988, and punished with a jail term extending up to six months and a fine of Rs 1,000.

    Section 184 in The Motor Vehicles Act, 1988: Driving dangerously.—Whoever drives a motor vehicle at a speed or in a manner which is dangerous to the public, having regard to all the circumstances of the case including the nature, condition and use of the place where the vehicle is driven and the amount of traffic which actually is at the time or which might reasonably be expected to be in the place, shall be punishable for the first offence with imprisonment for a term which may extend to six months or with fine which may extend to one thousand rupees, and for any second or subsequent offence if committed within three years of the commission of a previous similar offence with imprisonment for a term which may extend to two years, or with fine which may extend to two thousand rupees, or with both.
  • Using mobile phone while driving a vehicle: Rule 21 (25) of the Central Motor Vehicles Rules read with Section 177 of the MV Act. punishment: Rs. 100 for first offence and Rs. 300 for second or subsequent offences.