September 11   2015, Friday
eMedinewS
Sunlight can reduce weight
Dr KK Aggarwal A study from the Northwestern University reports that the timing, intensity and duration of light exposure during the day are linked to body weight.

People who had most of their daily exposure to even moderately bright light in the morning had a significantly lower body mass index than those who had most of their light exposure later in the day.

"The earlier this light exposure occurred during the day, the lower the individuals’ body mass index," said co–lead author Kathryn Reid, research associate professor of neurology at Northwestern University Feinberg School of Medicine. "The later the hour of moderately bright light exposure, the higher a person’s BMI."

The influence of morning light exposure on body weight was independent of an individual’s physical activity level, caloric intake, sleep timing, age or season. It accounted for about 20 percent of a person’s BMI.

"Light is the most potent agent to synchronize your internal body clock that regulates circadian rhythms, which in turn also regulate energy balance," said study senior author Phyllis C. Zee, M.D. "The message is that you should get more bright light between 8 a.m. and noon." About 20 to 30 minutes of morning light is enough to affect BMI. (Science Daily)
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Neurology
Anesthesiology
Epidural corticosteroid injections offer limited short-term relief for radiculopathy and no clear benefit for spinal stenosis, suggested a systematic review and meta-analysis of published studies. The results were published online in Annals of Internal Medicine.

Diabetes
Neurology

Older people with type 2 diabetes have an elevated level of tau protein in their cerebrospinal fluid (CSF) whether they have normal cognition, mild cognitive impairment, or dementia, suggests a new study published online in Neurology.

Oncology
Pulmonary Medicine

The checkpoint inhibitor nivolumab has continued to outshine the chemotherapy docetaxel in lung cancer, suggested the updated results of a phase 3 trial presented at the 16th World Conference on Lung Cancer.

Rheumatology
Obesity

A new study, published in the journal Rheumatology, suggests that a high body mass index in men may reduce the risk of rheumatoid arthritis, though the same cannot be said for women.

Obstetrics and Gynecology
Infectious Diseases

Among women in a malaria-endemic region, daily iron supplementation during pregnancy did not result in an increased risk of malaria, suggested a study published in JAMA.
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Cardiology eMedinewS
  • Individuals who have a low resting heart rate are more prone to become violent criminals, victims of crime, and even have more accidents as adults compared with those who have normal resting heart rates, suggest new research published online September 9 in JAMA Psychiatry.
  • Antihypertensive treatment with the angiotensin II receptor blocker (ARB) telmisartan improved the levels of two important biomarkers of cardiovascular and renal risk compared with treatment with non-ARBs, in 3-year results from the Trial of Telmisartan Prevention of Cardiovascular Disease (ATTEMPT-CVD). The findings were presented at the European Society of Cardiology (ESC) 2015 Congress.
Pediatrics eMedinewS
Pediatrics
Psychiatry

In newly released draft recommendations, the US Preventive Services Task Force (USPSTF) continues to recommend screening children for major depressive disorder (MDD) starting at age 12 years, provided that adequate systems are in place for diagnosis, treatment, and monitoring.

Pediatrics
Radiology

A new decision rule will help emergency department physicians determine when to use radiography in young children with minor head injuries. The Canadian-developed rule is published in CMAJ (Canadian Medical Association Journal). The two predictors identified for the development of the rule were parietal or occipital swelling or hematoma and age less than 2 months.
Pulmonary Embolism
Echocardiography in pulmonary embolism

About 30 to 40 percent of patients with PE have echocardiographic abnormalities, as follows, indicative of RV strain or overload, higher in those with massive PE.

• Increased RV size
• Decreased RV function
• Tricuspid regurgitation
Dr KK Spiritual Blog
How to remove negative thoughts

Darkness is absence of light and similarly, negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring back positive thoughts. An idle mind is the devil’s workshop and so will always think negative. Here are some ways by which you can get rid your negative thoughts.
  • Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.
  • Think opposite as taught by Patanjali. For example, if you are having a thought to steal, silently start thinking of charity.
  • Think positive as taught by Buddha. Make a list of positive actions to be done today as the first thing in the morning and concentrate on that list. Divert your mind to your list of pending jobs. This is a type of behavioral therapy.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Maharaja Aggarsain Adarsh Public School, N P CO ED. Sr. Sec. School, Bapu Dham, New Delhi-21, 9-9-15
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Make Sure
Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make Sure to prescribe nimesulide as it is safer in acid peptic disease.
Dr Good Dr Bad
Situation: A 34-year-old male with stable heart failure and heart rate 100 per minute was not responding
Dr Bad: Increase the dose of beta blocker
Dr Good: Add ivabradine
Lesson: Ivabradine can be used for patients with chronic stable heart failure with left ventricular ejection fraction (LVEF) ≤35 percent, in sinus rhythm with a resting heart rate ≥70 beats per minute and who are either on a maximum tolerated dose of a beta-blocker or who have a contraindication to beta-blocker use.

(Copyright IJCP)
eMedi Quiz
A client has undergone with penile implant. After 24 hours of surgery, the client’s scrotum was edematous and painful. The nurse should:

a. Assist the client with sitz bath
b. Apply warm soaks in the scrotum
c. Elevate the scrotum using a soft support
d. Prepare for a possible incision and drainage.

Yesterday’s Mind Teaser: Halfway through the administration of blood, the female client complains of lumbar pain. After stopping the infusion, the nurse should:

a. Increase the flow of normal saline
b. Assess the pain further
c. Notify the blood bank
d. Obtain vital signs.

Answer for Yesterday’s Mind Teaser: a. Increase the flow of normal saline
Answers received from: Dr Poonam Chablani, Dr Prabodh K Gupta, Dr B R Bhatnagar, Raghavendra Chakurkar, Dr Shangarpawar, Dr K Raju, Dr A C Dhariwal, Aarthi Markandan, Dr Aarthi Markandan, Dr Avtar Krishan, Daivadheenam Jella.
Answer for 9th September Mind Teaser: c. Steroids
Correct Answers received from: Dr Shangarpawar, Dr Avtar Krishan, Dr K V Sarma, Dr Poonam Chablani, Dr K Raju, Daivadheenam Jella, Raghavendra Chakurkar.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Stress management programs for heart patients are a must

Drugs such as beta-blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rise in the threshold for ventricular fibrillation.

"In patients at risk of cardiovascular events because of increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy. In a premature heart attack, the mean age is 53-54 yrs,", said Padma Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India and Honorary Secretary General IMA.

In general, the goal of stress management programs is to reduce the impact of stressful environmental events in the individual and to regulate better the stress response.

Interventions may be considered at several levels:
  • Removal or alteration of the stressor
  • Change in perception of the stressful event
  • Reduction in the physiologic sequelae of stress
  • Use of alternative coping strategies
Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg.

Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.
eIMA News
Governments Urged to Provide Full Health Care to Refugees and Migrants
(09.09.2015) Governments around the world have been urged by doctors’ leaders to ensure that migrants and refugees receive full access to health care. Dr. Xavier Deau, President of the World Medical Association, said it was essential that the health care of migrants and refugees was not neglected in a bid to save money.

Dr. Deau quoted new evidence from the European Union Agency for Fundamental Rights suggesting that migrants in the EU often found themselves cut off from health screening and preventive treatment.

‘Yet this same research shows that European Union member states would spend less on migrant health by treating them earlier rather than waiting until they required emergency treatment. ‘The WMA’s Declaration of Geneva makes it absolutely clear that the duty of doctors is to cure all patients without considerations of ethnic origin, gender, nationality or political affiliation. Health is a human right and it is essential that all the migrants and refugees should be welcomed with dignity and respect.

‘I repeat the call by the WMA to all parties in the Syrian conflict to ensure the safety of healthcare personnel and their patients, as well as medical facilities and medical transport.

‘The WMA calls again on its members to approach their governments in order to facilitate international cooperation in the United Nations, the European Union or other international bodies with the aim of ensuring the safe provision of health care to the Syrian people and to other refugees and migrants.'
IMA Lybrate Digital Initiative
IMA Position Statement on Telemedicine
  • IMA supports the expanded role of telemedicine as a method of health care delivery that may enhance patient–doctor collaborations, improve health outcomes, increase access to care and reduce medical costs when used as a component of a patient's longitudinal care.
  • Telemedicine can be most efficient and beneficial between a patient and doctor with an established, ongoing relationship.
  • Telemedicine is a reasonable alternative for patients who lack regular access to relevant medical expertise in their geographic area.
  • Episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs.
  • A valid patient–doctor relationship must be established for a professionally responsible telemedicine service to take place. A telemedicine encounter itself can establish a patient–physician relationship through real-time audio-visual technology.
  • A doctor using telemedicine who has no direct previous contact or existing relationship with a patient must take appropriate steps to establish a relationship based on the standard of care required for an in-person visit, or consult with another doctor who does have a relationship with the patient and oversees his or her care.
  • Doctors should use their professional judgment about whether the use of telemedicine is appropriate for a patient.
  • Doctors should not compromise their ethical obligation to deliver clinically appropriate care for the sake of new technology adoption.
  • If an in-person physical examination or other direct face-to-face encounter is essential, telemedicine may not be appropriate.
  • Doctors should ensure that their use of telemedicine is secure and compliant with security and privacy regulations.
  • Telemedicine should be held to the same standards of practice as if the doctors were seeing the patient in person.
  • Doctors who use telemedicine should be proactive in protecting themselves against liabilities and ensure that their medical liability coverage includes provision of telemedicine services.
Tele Medicine
ACP Position Statements and Recommendations
  1. ACP supports the expanded role of telemedicine as a method of health care delivery that may enhance patient–physician collaborations, improve health outcomes, increase access to care and members of a patient's health care team, and reduce medical costs when used as a component of a patient's longitudinal care.
    • ACP believes that telemedicine can be most efficient and beneficial between a patient and physician with an established, ongoing relationship.
    • ACP believes that telemedicine is a reasonable alternative for patients who lack regular access to relevant medical expertise in their geographic area.
    • ACP believes that episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs.
  2. ACP believes that a valid patient–physician relationship must be established for a professionally responsible telemedicine service to take place. A telemedicine encounter itself can establish a patient–physician relationship through real-time audiovisual technology. A physician using telemedicine who has no direct previous contact or existing relationship with a patient must do the following:
    • Take appropriate steps to establish a relationship based on the standard of care required for an in-person visit, or
    • Consult with another physician who does have a relationship with the patient and oversees his or her care.
  3. ACP recommends that telehealth activities address the needs of all patients without disenfranchising financially disadvantaged populations or those with low literacy or low technologic literacy. In particular, telehealth activities need to consider the following:
    • The literacy level of all materials (including written, printed, and spoken words) provided to patients or families
    • Affordability and availability of hardware and Internet access
    • Ease of use, which includes accessible interface design and language
  4. ACP supports the ongoing commitment of federal funds to support the broadband infrastructure needed to support telehealth activities.
  5. ACP believes that physicians should use their professional judgment about whether the use of telemedicine is appropriate for a patient. Physicians should not compromise their ethical obligation to deliver clinically appropriate care for the sake of new technology adoption.
    • If an in-person physical examination or other direct face-to-face encounter is essential to privacy or maintaining the continuity of care between the patient's physician or medical home, telemedicine may not be appropriate.
  6. ACP recommends that physicians ensure that their use of telemedicine is secure and compliant with federal and state security and privacy regulations.
  7. ACP recommends that telemedicine be held to the same standards of practice as if the physician were seeing the patient in person.
    • ACP believes that there is a need to develop evidence-based guidelines and clinical guidance for physicians and other clinicians on appropriate use of telemedicine to improve patient outcomes.
  8. ACP recommends that physicians who use telemedicine should be proactive in protecting themselves against liabilities and ensure that their medical liability coverage includes provision of telemedicine services.
  9. ACP supports the ongoing commitment of federal funds to establish an evidence base on the safety, efficacy, and cost of telemedicine technologies.
  10. ACP supports a streamlined process to obtaining several medical licenses that would facilitate the ability of physicians and other clinicians to provide telemedicine services across state lines while allowing states to retain individual licensing and regulatory authority.
  11. ACP supports the ability of hospitals and critical access hospitals to “privilege by proxy” in accordance with the 2011 Centers for Medicare & Medicaid Services final rule allowing a hospital receiving telemedicine services (distant site) to rely on information from hospitals facilitating telemedicine services (originating site) in providing medical credentialing and privileging to medical professionals providing those services.
  12. ACP supports lifting geographic site restrictions that limit reimbursement of telemedicine and telehealth services by Medicare to those that originate outside of metropolitan statistical areas or for patients who live in or receive service in health professional shortage areas.
  13. ACP supports reimbursement for appropriately structured telemedicine communications, whether synchronous or asynchronous and whether solely text-based or supplemented with voice, video, or device feeds in public and private health plans, because this form of communication may be a clinically appropriate service similar to a face-to-face encounter.
IMA News
  • Offering women money, paid time off, or other incentives to undergo mammography screening is "ethically troubling," contends the author of a viewpoint published in the September 8 issue of JAMA. (Medscape)
  • A tax on sugar-sweetened drinks will help combat type 2 diabetes, according to the Canadian Diabetes Association. "Evidence-based studies conclusively demonstrate that excessive consumption of sugar-sweetened beverages directly increases the risk of developing type 2 diabetes," said Rick Blickstead, president and CEO of the CDA.
  • In China, almost one-quarter of all cancers in men can be attributed to smoking, according to a study by Zheng-Ming Chen, DPhil, from the University of Oxford, United Kingdom, which was published in a September 1 supplement to Cancer that focuses on lung cancer in China.
  • The new PCSK9 inhibitors are far too expensive to be broadly used in eligible populations without restrictions, according to Institute for Clinical and Economic Review.
  • The use of chloroquine appeared to mitigate the high prevalence of metabolic syndrome in young premenopausal women with systemic lupus erythematosus (SLE), even when they take glucocorticoids, according to a cross-sectional study from Brazil. (Arthritis Care & Research)
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Inspirational Story
Never leave the mind vacant

An empty mind is the devil’s workshop. All evil actions start in a vacant mind. Keep your mind occupied in something positive, something worthwhile. Actively follow a hobby. Do something that holds your interest. You must decide what you value more: money or peace of mind. Your hobby, like social work or religious work, may not always earn you more money, but you will have a sense of fulfillment and achievement.

Even when you are resting physically, occupy yourself in healthy reading or chanting of God’s name.
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and pledge your organs. Unless we do it, the public will not listen to us.

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Quote of the Day
Only those who dare to fail greatly can ever achieve greatly. Robert F. Kennedy
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Reader Response
Dear Dr Aggarwal, Many thanks. I read eMedinewS and also your spiritual blog…will write again. This is just to say thanks. Regards, Dr Mira Shiva.
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Wellness Blog
Duration of CPR May Be a Factor in Kids’ Survival

Some children with in–hospital cardiac arrest can benefit from longer duration of cardiopulmonary resuscitation (CPR), a study has found. In the study among survivors, neurological outcome was favorable for the majority of patients. Of the 3,419 children included in the study, 28% survived to hospital discharge, and 16.6% of these survivors had CPR longer than 35 minutes, according to Renée Matos, MD, MPH, of the University of Pittsburgh School of Medicine, and colleagues. A total of 60% of these survivors with longer–duration CPR achieved a favorable neurologic outcome, they reported in the study published in Circulation, a journal of the American Heart Association.

In the mid–1990s, authorities considered pediatric CPR futile beyond 20 minutes’ duration or when more than two doses of epinephrine were provided.

Even though longer–duration CPR can benefit some children, the reality is that after the first 15 minutes of CPR, survival rate declines rapidly. Survival decreased by 2.1% for every minute of chest compressions over 15 minutes.

When CPR was longer than 35 minutes, those in the Surgical Cardiac category had the best survival to hospital discharge rate (25%), followed by Medical Cardiac – 21%; General Surgical –– 13%; General Medical – 10% and Trauma – 8%. (Medpage Today)
IMA Humor
Preacher’s Wish from God

A preacher went into his church and he was praying to God. While he was praying, he asked God, "How long is 10 million years to you?" God replied, "One second." The next day the preacher asked God, "God, how much is 10 million dollars to you?"

And God replied, "A penny." Then finally the next day the preacher asked God, "God, can I have one of your pennies?" And God replied, "Just wait a sec."
Rabies News (Dr A K Gupta)
Is there a one–shot ARV? Is there any ARV that offers lifelong protection?

There is no single dose vaccine or a vaccine that gives lifelong immunity.
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