March 12  2015, Thursday
editorial
5 foods that fight high cholesterol
Dr KK Aggarwal
  • Oats give you soluble fiber. Add a banana or some strawberries to get more soluble fibers.
  • Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal.
  • Nuts: Eating almonds, walnuts, peanuts and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL by about 5%. Nuts have additional nutrients that protect the heart in other ways.
  • Foods fortified with sterols and stanols. They are being added to foods ranging from margarine and granola bars to orange juice and chocolate. They’re also available as supplements. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%.
  • Fatty fish. Eating fish 2 to 3 times a week can lower LDL in two ways: by replacing meat, which has LDL–boosting saturated fats and by delivering LDL–lowering omega–3 fats.
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CPR-10 Training Camp at Press Club-8th March 2014
News
  • Family history is a significant risk factor for breast cancer, especially in women who have first-degree relatives with the disease. The risk might be even higher if there is a first-degree relative with prostate cancer, suggests a new study published online March 9 in Cancer.
  • Getting too little sleep is linked to poor health, but short naps might partly offset that effect, suggests a small study published online in the Journal of Clinical Endocrinology and Metabolism.
  • A US Food and Drug Administration (FDA) advisory committee unanimously voted to recommend approval of a new injectable to help reduce double chin. The Dermatologic and Ophthalmic Drugs Advisory Committee reported that ATX-101 (deoxycholic acid) injection for improvement in the appearance of moderate-to-severe convexity or fullness associated with submental fat in adults is safe and effective.
  • In postmenopausal women with osteoporosis, the third generation selective estrogen receptor modulator (SERM) bazedoxifene seems to protect against new vertebral fractures across 7 years, suggest new data from a randomized controlled trial published online in the journal Menopause.
  • In HIV-infected patients on modern antiretroviral therapy (ART), postoperative death rates are low and influenced as much by age and nutritional status as immune system function (CD4 cell counts), points new research published online in JAMA Surgery.
Dr KK Spiritual Blog
Spiritual Prescription: The Role of Prayer in Healing

Religious beliefs may have a powerful influence on the health of our patients, and we need to know about them.

A large and growing number of studies have shown a direct relationship between religious involvement and positive health outcomes, including mortality, physical illnesses, mental illness, health-related quality of life and coping with illness.

Studies also suggest that addressing the spiritual needs of patients may facilitate recovery from illness. A majority of the nearly 350 studies of physical health and 850 studies of mental health that have used religious and spiritual variables have found that religious involvement and spirituality are associated with better health outcomes.

Although the relationship between religious involvement and spirituality with health outcomes seems valid, it is difficult to establish causality. The benefits of religious and spiritual involvement are likely conveyed through complex psychosocial, behavioral and biological processes that are incompletely understood.

All physicians should take a spiritual history of their patients, which could help discern their spiritual needs during treatment.

According to Dr. Harold Keonig of Duke University Medical Center, in majority of cases, the doctor should not attempt to address complex spiritual needs of patients. When the patient is reluctant to talk with clergy and prefers to discuss spiritual matters with a trusted physician, taking a little extra time to listen and be supportive is usually all that is required.

Providing support for religious beliefs and practices that do not conflict with medical care may be appropriate, but when beliefs conflict with medical care, it is important not to criticize the belief, but rather to listen, gather information, enter into the patient’s world view and maintain open lines of communication, perhaps enlisting the help of the patient’s clergy.

Recently a study published in the journal Mayo Clinic Proceedings confirmed the importance of religion and spirituality for many patients undergoing medical treatment. The single–center, randomized, double–blind trial was conducted at the Mayo Clinic in Rochester, Minn. from July 4, 1997 to Oct. 21, 1999 and involved 799 male and female coronary care patients aged 18 years or older.

Earlier too, a number of published studies have already assessed the effects of spiritual factors on health care outcomes: 75 percent report a positive effect; 17 percent report no effect; and 7 percent report a negative effect.

In the study, the patients were randomized into the intercessory prayer group and the control group. Intercessory prayer was administered at least once a week for 26 weeks by five intercessors per patient. After 26 weeks, a medical setback (such as death, cardiac arrest, re–hospitalization, coronary revascularization or an emergency department visit for cardiovascular disease) occurred in 25.6 percent of the prayer group and 29.3 percent of the control group. Among high–risk patients, such a setback occurred in 31 percent of the prayer group and 33 percent of the control group. Among low–risk patients, the difference between the groups was 17 percent for the prayer group and 24 percent for the control group.

Though the results were in favor of prayer yet the study had some limitations, which might have influenced the low positive results. It did not measure the ‘power of God,’ nor was the prayer offered for patients by loved ones, relatives and friends. The researchers said most patients have a spiritual life and regard their spiritual health and physical health as equally important. People may have greater spiritual needs during illness and are looking to have those needs met.

Prayer works on the principle that in the relaxed state, the mind becomes suggestive. The inner healing starts when the intent reaches the inner consciousness or a state of stillness.

Prayer is different from meditation. In prayer, one is talking to the GOD and in meditation, GOD is talking to you. Meditation is much stronger than prayer as it bypasses the mind and deals with the spirit or the consciousness. In prayer, the mind is in an active working phase. Meditation is the phase of restful alertness.

It all works at the level of autonomic nervous system. The parasympathetic state of mind is the healing state. Both prayer and the meditation take one from sympathetic to the parasympathetic state.
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Cardiology eMedinewS
  • The US Food and Drug Administration (FDA) has granted premarket approval to the ResQCPR system, a new compression-decompression device designed to aid in the performance of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest.
  • A recent study led by a University of Missouri School of Medicine cardiologist found that use of a newer blood thinner significantly decreased the risk of strokes for patients with atrial fibrillation who require both types of medication. Researchers noted that the rate of stroke or blood clot to the body was 39% lower in those patients taking the amiodrarone-apixiban drug combination, compared to taking the amiodarone-warfarin combination. The findings were published in the Journal of the American College of Cardiology.
Pediatrics eMedinewS
  • Intermittent pulse oximetry was effective for children hospitalized with asthma or bronchiolitis who were stable on room air but did not decrease the time until the child was medically ready for discharge, suggested a new report from a quality improvement effort. The findings are published online March 9 in Pediatrics.
  • Deformational plagiocephaly and brachycephaly were corrected in 77.1% of infants with conservative repositioning therapy as a first-line treatment, reported a retrospective cohort study. Moreover, 94.4% of the infants who had helmet therapy as a first-line treatment achieved complete correction. The study is published in the March issue of Plastic and Reconstructive Surgery.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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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 safe in acid peptic disease.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

Q. I outsource samples to larger laboratories and give the test reports to the patients on my own letterhead. Sometimes the patients want me to provide the original report from the laboratories concerned but the latter do not want me to do so. Please let me know the legal implications.

A.
  • If you are a doctor and collect samples and give reports on your own letterhead without clearly stating that you are merely a collecting agent for the specified laboratory, giving out openly its name and contact details etc., you are apparently holding out that the test has been carried out directly or indirectly by you and, thereby, you assume the role of service provider to a consumer of services. The patient will be legally entitled to sue you for any perceived deficiency in service. He will also be entitled to sue the laboratory concerned.
  • If the laboratories concerned do not want you to give their details to the patients/consumers, it amounts to lack of transparency and deficiency in service. The patient has full right to know who carried out the tests and in what manner.
  • If you do not have a qualification in Pathology, you would be further compounding your fault.
Dr Good Dr Bad
Situation: A patient with Mediclaim needed chemotherapy.
Dr. Bad: Get admitted for 24 hours.
Dr. Good: Take it as daycare.
Lesson: Admission limit of 24 hours is not applicable for chemotherapy, radiotherapy etc.

(Copyright IJCP)
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eMedi Quiz
Formation of antibody against acetyl choline receptor in pemphigus can be explained by

a. Desmoglein compensation theory
b. Antibody excess prozone phenomenon
c. Anti idiotypic
d. Epitope spreading phenomenon

Yesterday’s Mind Teaser: The exaggerated lepromin test seen in cases of Lucio phenomenon is called as:

a. Mitsuda's reaction
b. Medina-Ramirez reaction
c. Fischer's test
d. Fernandez reaction

Answer for yesterday’s Mind Teaser: b. Medina-Ramirez reaction

Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan.

Answer for 10th March Mind Teaser: b.2-12 weeks

Correct Answers receives: Raju Kuppusamy, Dr Gopal Shinde, Daivadheenam Jella, Dr Jainendra Upadhyay.
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
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IMA NEWS
Facts about Tuberculosis (TB)
  1. What is Tuberculosis?
    • Tuberculosis (TB) is an infectious disease caused by bacterium ‘Mycobacterium tuberculosis’.
Dear Colleague,

Trans Gender is now a legal entity. In all our gender column we must add M/F/TG. Our medical establishments must have a separate toilet for them. Following are the minutes of a meeting held on "White Paper on trans Gender" for comments. Once approved, it will be the IMA stand on the issue. Indian Passport office has recently use the symbol 'TG'.

Dr A Marthanda Pillai                       Dr KK Aggarwal

IMA White Paper on Trans Gender

Dr A Marthanda Pillai National President IMA, Dr K K Aggarwal Honorary Secretary General IMA, Dr Jugal Kishore Professor of Community Medicine Maulana Azad Medical College, D A P Dubey Director Professor of Pediatrics Maulana Azad Medical College, Dr Rajeev Sood, Professor and Head Urology RML Hospital, Dr Rashmi Sharma, Gynecologist and Dr Vanga Ashwita Siri, President IMA Students Wing, Delhi Chapter
  1. Transgender is the term used as an umbrella term for persons whose gender identity, gender expression or behavior does not conform to their biological sex.
  2. TG may also takes in persons who do not identify with their sex assigned at birth, which include Hijras/Eunuchs who describe themselves as “third gender” and they do not identify as either male or female. Hijras can be emasculated (castrated, nirvana) men, non-emasculated men (not castrated/akva/akka) and inter-sexed persons (hermaphrodites).
  3. TG also includes persons who intend to undergo Sex Re-assignment Surgery (SRS) or have undergone SRS to align their biological sex with their gender identity in order to become male or female. They are generally called transsexual persons.
  4. TG also includes persons who like to cross-dress in clothing of opposite gender, i.e. transvestites.
  5. The gender symbols used should be M/F/TG (some countries write '0' in place of TG)
  6. Transgender persons have a legal right to decide their self-identified gender. In situations where a TG person wants to choose the gender as male or female then it should be written in bracket (declared sex)
  7. TGs are in the category of socially and educationally backward classes of citizens and will be under reserved category for educational admissions and other government appointments.
  8. Governments should operate separate HIV Sero-surveillance Centres since Hijras/ Transgenders face several sexual health issues.
  9. Medical Professionals should seriously address the problems being faced by Hijras/Transgenders such as fear, shame, gender dysphoria, social pressure, depression, suicidal tendencies, social stigma, etc. and any insistence for SRS (Sex Re-assignment Surgery) for declaring one’s gender is immoral and illegal.
  10. Medical establishments should take proper measures to provide medical care to TGs in the hospitals and also provide separate public toilets and other facilities for them.
  11. Medical Profession should also take steps to frame various social welfare schemes for their betterment.
  12. Medical Profession should take steps to create public awareness so that TGs will feel that they are also part and parcel of the social life and be not treated as untouchables.
  13. Medical profession should also take measures to regain their respect and place in the society which once they enjoyed in our cultural and social life.
Definitions of some terms used

Hijras: Hijras are biological males who reject their ‘masculine’ identity in due course of time to identify either as women, or “not-men”, or “in-between man and woman”, or “neither man nor woman”. There are regional variations in the use of terms referred to Hijras. For example, Kinnars (Delhi) and Aravanis (Tamil Nadu).

Eunuch: Eunuch refers to an emasculated male and intersexed to a person whose genitals are ambiguously male-like at birth. Once this is discovered the child previously assigned to the male sex, would be re-categorized as intesexed – as a Hijra.

“Aravanis and ‘Thirunangi’ – Hijras in Tamil Nadu identify as “Aravani”.

Tamil Nadu Aravanigal Welfare Board, a state government’s initiative under the Department of Social Welfare defines Aravanis as biological males who self-identify themselves as a woman trapped in a male’s body.
Some Aravani activists want the public and media to use the term ‘Thirunangi’ to refer to Aravanis.

Kothi
Kothis are a heterogeneous group. ‘Kothis’ can be described as biological males who show varying degrees of ‘femininity’ – which may be situational. Some proportion of Kothis have bisexual behavior and get married to a woman. Some proportion of Hijra-identified people may also identify themselves as ‘Kothis’. But not all Kothi identified people identify themselves as transgender or Hijras.

Jogtas/Jogappas
Jogtas or Jogappas are those persons who are dedicated to and serve as a servant of goddess Renukha Devi (Yellamma) whose temples are present in Maharashtra and Karnataka. ‘Jogta’ refers to male servant of that Goddess and ‘Jogti’ refers to female servant (who is also sometimes referred to as ‘Devadasi’).

Sometimes, the term ‘Jogti Hijras’ is used to denote those male-to-female transgender persons who are devotees/servants of Goddess Renukha Devi and who are also in the Hijra communities. This term is used to differentiate them from ‘Jogtas’ who are heterosexuals and who may or may not dress in woman’s attire when they worship the Goddess. Also, that term differentiates them from ‘Jogtis’ who are biological females dedicated to the Goddess. However, ‘Jogti Hijras’ may refer to themselves as ‘Jogti’ (female pronoun) or Hijras, and even sometimes as ‘Jogtas’.

Shiv-Shakthis
are considered as males who are possessed by or are particularly close to a goddess and who have feminine gender expression. Occasionally, Shiv-Shakthis crossdress and use accessories and ornaments that are generally/socially meant for women. Most people in this community belong to lower socio-economic status and earn for their living as astrologers, soothsayers, and spiritual healers; some also seek alms.” (See Serena Nanda, Wadsworth Publishing Company, Second Edition (1999)

IMA activities for World TB Day 2015
As a part of World TB Day, following series of activities are being undertaken by IMA jointly with CTD Division, DGHS, Govt. of India.
  1. TB Health messages being sent to over 1.5 lakh doctors every day.
  2. TB Health sensitization material emailed to 2 lakh doctors on a daily basis.
  3. A sensitization programme for Nurses on 18th March at 1:00 pm at IMA HQs.
  4. A School Principals’ workshop on 19th March from 1:00 to 3:00 pm at IMA HQs.
  5. Rally to create awareness on TB on 19th March starting at 11 am by IMA through Delhi Medical Association and Delhi IMA Student wing starting from IMA Building to Nirman Bhawan.
  6. Press Conference on 20th March at 1:00 pm at IMA HQs.
  7. Celebrity Padma Awardee Forum meeting on 20th March at 8:00 pm at IMA HQs. where various Padma Celebrities will pledge on TB Care.
  8. A Continuing Medical Education Programme for General Practitioners on 22nd March from 9:00 am to 11 am at IMA HQs
  9. Nursing Home Forum owners in NCR Delhi to sensitize on PHI on 22nd March.
  10. A symposium on TB diagnostics on 24th March at IMA HQs.
  11. TB Hoardings to be displayed in various places in Delhi in association with NDMC.
  12. National TB Review workshop on 29th March.
  13. TB Exhibition on 29th March in Country Inn, NCR.
  14. All India Inter Medical College TB Slogan Contest. Results to be declared on 24th March.
  15. Closing ceremony on 7th April on the occasion of “WHO Day”. A tableau will roam around in Delhi & NCR to create awareness on TB.
Sonal Namaste
Hand hygiene is as important in the community as in the hospital.
Media
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Inspirational Story
Only One Move

A 10–year–old boy decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move. "Sensei,"(Teacher in Japanese) the boy finally said, "Shouldn’t I be learning more moves?" "This is the only move you know, but this is the only move you’ll ever need to know," the sensei replied. Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals.

This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time–out. He was about to stop the match when the sensei intervened. "No," the sensei insisted, "Let him continue." Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion. On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind. "Sensei, how did I win the tournament with only one move?"

"You won for two reasons," the sensei answered. "First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm." The boy’s biggest weakness had become his biggest strength. Sometimes we feel that we have certain weaknesses and we blame God, the circumstances or ourselves for it but we never know that our weaknesses can become our strengths one day.

Each of us is special and important, so never think you have any weakness, never think of pride or pain, just live your life to its fullest and extract the best out of it!"
Wellness Blog
Stay away from saturated and trans fats

Saturated fats are found in red meat, milk and other dairy foods and coconut and palm oils. Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. Trans fats boost LDL as much as saturated fats do. They also lower protective HDL, rev up inflammation and increase the tendency for blood clots to form inside blood vessels.
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Quote of the Day
Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader. Paul J. Meyer
Reader Response
  • In my opinion we all should support these doctors. Mere clerical mistakes should not lead to such harsh punishments. Dr Shaila Milton Philip, Bilaspur, CG.
  • Dear Dr KK Aggarwal, eMedinewS is really great in educating medical community. I know that a great deal of efforts are required to bring it on regular basis. Dr SK Bichile
News on Maps
IMA Humor
There was this man driving along in his car when he suddenly got a flat tire. When he pulled over he was at the fence of a mental hospital. When he got out of the car one of the patients came to the fence and asked "Can I help you?" And the man said "No, I need to figure out how to make it home with only 2 lugs on this wheel." The patient asked again "Are you sure you do not need any help?" And the man said "No." The man tried to figure it out when all of a sudden the patient said "If I were you I would take one lug off the other 3 wheels and put them on that wheel and you should be able to get home." The man asked "How did you think of that?" The patient replied "I am in here because I'm crazy not because I'm stupid."
Kidney stone of less than 5mm size needs no treatment
A stone less than 5mm in size, in the kidney passage, should not be treated as it will invariably pass out in the next four weeks, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone that is more than 10mm size invariably requires a non-medical intervention.

Dr. Aggarwal said that new avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are nifedipine (calcium channel blocker), alpha-blockers and steroids.

Intravenous pyelography has been thought to be the best investigation for renal stone. But now it has been proven beyond doubt that when a patient presents with kidney pain and if a renal stone is suspected, the undisputed investigation of choice is unenhanced CT scan of the abdomen. Open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.

North India is considered a stone belt, with maximum cases of kidney stones in India.
Rabies News (Dr A K Gupta)
What does humanizing your dog mean?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.