August 12  2015, Wednesday
eMedinewS
editorial
In Paralysis, Act Fast
Dr KK AggarwalA brain attack should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack.

All patients with paralysis should be tested for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery which can cause future paralysis.

Facts
  • Rule out brain hemorrhage as soon as possible.
  • Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
  • Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL start insulin.
  • Maintain normothermia for at least the first several days after an acute stroke.
  • For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre–eclampsia/eclampsia).
  • For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is ≤185 mmHg and diastolic blood pressure is ≤110 mmHg.
  • Antithrombotic therapy should be initiated within 48 hours of stroke onset.
  • For patients receiving statin therapy prior to stroke onset, it should be continued.
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News
Psychiatry

Depression, Bipolar Disorder in Teens Are CVD Risk Factors

Based on several recent studies, adolescent mood disorders should also now be included in list of risk factors. Studies have shown evidence of a link between paediatric depression and/or bipolar disorder with premature CV mortality and endothelial dysfunction.  Inflammation, oxidative stress, autonomic dysfunction may be implicated for this. (AHA)



Neurology

Statins used after a stroke reduces post stroke seizure risk

Statin taken after a stroke especially in acute phase reduces the risk for early onset seizure and may even present the progression of these seizures to chronic epilepsy. These effects could be attributed to different mechanisms like statins might decrease glutamatergic synaptic transmission, inhibition of neural apoptosis, lowering permeability of blood brain barrier and brain inflammation and also reduction of infarction volume by Anti inflammatory and antioxidative effects.

Diabetes

Getting lipids, triglycerides, glucose, blood pressure, and tobacco use under control was associated with substantially better outcomes in type 2 diabetes in an analysis of the BARI 2D trial.

Hypertension

Hypertensive patients with significant changes in blood-pressure readings over several office visits had an increased risk of stroke, MI, heart failure, and death during [MEDSCAPE]

CNS

A large Danish epidemiologic study supports the theory that Parkinson's disease (PD) may begin in the gastrointestinal tract and spread through the vagus nerve to the brain. Researchers found that patients who have had the entire vagus nerve severed were less apt to develop PD. [MEDSCAPE]
Forthcoming DST school camps are:
  1. Balwant Rai School, Lajpat Nagar on 12th August
  2. DAV School, Sector 9, R K Puram on 13th August
  3. Sulabh Public School, Mahavir Enclave on 17th August
  4. Mt Abu School, Rohini Sector 5, on 19th August
  5. St Mathew School, Paschim Vihar, D Block on 20th August
Cardiology eMedinewS
Edoxaban, a factor Xa inhibitor has been approved by US FDA for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.  It has been approved for the treatment of deep vein thrombosis (DVT) and pulmonary embolism in parents treated with parenteral anticoagulant for 5 to 10 days, as is seen from the (ENGAGE-TIMI 48) trial to VTE study.
Pediatrics eMedinewS
All persons at least 6 months of age should have routine annual influenza vaccination unless they have specific contraindications, according to updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for the 2015 to 2016 influenza season.
Dr KK Spiritual Blog
Why do We Burn Camphor in Any Pooja?

No aarti is performed without camphor. Camphor when lit burns itself out completely without leaving a trace.

Camphor represents our inherent tendencies or vasanas. When lit by the fire of knowledge about the self, the vasanas burn themselves out completely, not leaving a trace of ego.

Ego is responsible for a sense of individuality that keeps us separate from the Lord or consciousness.

In addition, camphor when burns, emits a pleasant perfume. This signifies that as we burn our ego we can only spread love and nothing else.
Make Sure
Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.
Dr Good Dr Bad
Situation: A patient with positive malaria came with severe thrombocytopenia.
Dr Bad: This is classical malaria. 
Dr Good: Also look for dengue.
Lesson: Malaria and dengue may co exist in the same patient.
(Copyright IJCP)
eMedi Quiz
A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be:

a. Ineffective health maintenance
b. Impaired skin integrity
c. Deficient fluid volume
d. Pain

Yesterday’s Mind Teaser: When should most women have their first mammogram?

A. At age 30.
B. At age 35.
C. At age 40.
D. At age 45.
E. At age 50.

Answer for yesterday’s Mind Teaser: C. At age 40.

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr. Vishnu Mulchandani, Dr. G. Madhusudhan, Dr Pandit Hantodkar

Answer for 10th August Mind Teaser: C. Once a year after age 21 and every two years after 30.

Correct Answers received: Dr Shangarpawar,
eMedinewS Humor
Laundry

One day, a housework–challenged husband decided to wash his sweatshirt. Seconds after he stepped into the laundry room, he shouted to his wife, "What setting do I use on the washing machine?"

"It depends," she replied. "What does it say on your shirt?"

He yelled back, "Texas A & M."
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Inspirational Story
Saying Grace in a Restaurant!

Last week I took my children to a restaurant. My six–year–old son asked if he could say grace.

As we bowed our heads he said, "God is good. God is great. Thank you for the food, and I would even thank you more if Mom gets us ice cream for dessert. And Liberty and justice for all! Amen!"

Along with the laughter from the other customers nearby I heard a woman remark, "That’s what’s wrong with this country. Kids today don’t even know how to pray. Asking God for ice–cream! Why, I never!"

Hearing this, my son burst into tears and asked me, "Did I do it wrong? Is God mad at me?"

As I held him and assured him that he had done a terrific job and God was certainly not mad at him, an elderly gentleman approached the table. He winked at my son and said,

"I happen to know that God thought that was a great prayer."

"Really?" my son asked.

"Cross my heart," the man replied.

Then in a theatrical whisper he added (indicating the woman whose remark had started this whole thing), "Too bad she never asks God for ice cream. A little ice cream is good for the soul sometimes."

Naturally, I bought my kids ice cream at the end of the meal. My son stared at his for a moment and then did something I will remember the rest of my life. He picked up his sundae and without a word, walked over and placed it in front of the woman. With a big smile he told her, "Here, this is for you. Ice cream is good for the soul sometimes; and my soul is good already."
Rabies News (Dr A K Gupta)
If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule for rabies vaccine?

The vaccine on Day 0 (first injection) must be doubled and given at two sites (deltoids or thigh in young children). In category II exposures, it is recommended to administer even RIGs along with vaccine. Rest of the schedule is same as for any other patient.
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
Wellness Blog
Seven behaviors cut heart deaths

Seven heart–healthy behaviors can reduce the risk of death from cardiovascular disease. In a prospective study by Enrique Artero, PhD, of the University of South Carolina and colleagues and published in the October issue of the Mayo Clinic Proceedings, those who met 3–4 of the American Heart Association’s ‘Simple Seven’ heart–health criteria had a 55% lower risk of cardiovascular mortality than those who met no more than two of those practices over 11 years.

Four core behaviors
  1. No smoking
  2. Normal body mass index
  3. Engaging in physical activity
  4. Eating healthfully
Three parameters
  1. Cholesterol lower than 200 mg/dL
  2. Blood pressure lower than 120/80 mm Hg
  3. Not having diabetes
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 113241 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
eIMA News
New model of care (Pre-emptive care model)
This 15 minute talk will give a new perspective to how we look at health and healthcare

https://www.facebook.com/rajendragupta
/posts/10205629272125631?pnref=story
Vit-D deficiency can cause cancer: Study
Tribune News Service excerpts

Mandi, August 10


The Indian Medical Association today organised a continuing medical education (CME) on the rising number of Vitamin D deficiency cases in India.

Lately, studies have revealed that in addition to the known skeletal effects of Vitamin D deficiency, it can also have a serious long-term impact on a person’s health. The deficiency can make people vulnerable to diseases such as heart attacks, cognitive disorders, diabetes and cancer.

The campaign also aims to provide essential soft skills training to all doctors on topics such as public speaking, managing patient records online, adapting to the new mobile app culture and how to break the news of death to a patient’s family.

Consultant physician Dr Parmod Sinha said, “Vitamin D deficiency is slowly taking the form of an epidemic and yet it is the most under-diagnosed and under-treated nutritional deficiency in the world. Over 80-85 per cent Indians are found to be suffering from the disease.”

“The reasons for this include a predominantly vegetarian diet, sun-shunning behaviour, high levels of melanin in the skin and increased lifestyle stresses confining people to closed workspaces,” he said.

The biggest concern for the medical fraternity was that most people are not aware about or do not take the deficiency seriously causing complications in the future, he said, adding that Vitamin D rich diet, routine sun-bathing, fortification of common food items and supplementation.
GOVT. OF NCT OF DELHI
State blood transfusion council
Office of the director, room no, 533, blood bank
Guru Tegh Bahadur Hospital, Delhi
Tel/fax:011-22130973
E Mail-dirsbtc@gmail.com


F.37/SBTC/DF-14/2015/5901-5912                                                                          Dated:30/7/15

OFFICE ORDER


In Supersession of the previous order no-F9/SBTC/2002/22675-81, dated 08/10/2007, and keeping in view the rise in Dengue Fever cases and the increasing demand for platelets, the Govt. of NCT of Delhi has decided to wave off the cost of disposable sets of Single Donor Platelets Pheresis for the patients admitted in Govt. of NCT of Delhi Hospitals.

The processing charge and cost of the kit for the patient admitted in private hospital and nursing home will remain as per the previous order.

Medical Superintendent of all concerned hospitals should procure adequate no. of SDP kit for their internal use after following codal formalities.

This order issues with concurrence from Finance Department Govt. of NCT of Delhi(F.D, 93/DSI, dated 09/06/2015), and will be valid upto 15th November 2015, unless extended further.

Sd/-
Amar Nath, IAS
Secretary(H&FW)

Copy for information and necessary action to:-

PA to Minister of Health & Family Welfare, GNCT Delhi
 
  1. Project Director, DSACS, BSA Hospital, Rohini Sec-6, Delhi-110086
  2. Secretary, Health & Family Welfare, Govt of NCT of Delhi
  3. Medical Superintendent, LokNayak Hospital, Govt of NCT of Delhi
  4. Medical Superintendent, DeenDayalUpadhayay Hospital, Govt of NCT of Delhi
  5. Medical Superintend, GTB Hospital, Govt of NCT of Delhi
  6. Medical Superintendent, GB Pant Hospital, Govt of NCT of Delhi
  7. Medical Superintendent, B S A Hospital, Govt. of NCT of Delhi
  8. Medical Superintendent D H A S, Karkardooma, Delhi-110092
  9. Medical Superintendent, Sanjay Gandhi Hospital, Mangolpuri, Delhi
  10. Secretary General, Indian Medical Association, IMA House, New Delhi
  11. President, Delhi Medical Association, Darya Ganj, Delhi

    Dr. Bharat Singh
‘Create dedicated organ transfer corridor’
Bindu Shajan Perappadan

India needs 200,000 kidneys; 50,000 hearts; 50,000 livers for transplantation each year: doctors

The many successfully green corridor creation for organ transfers has city planners and doctors wondering why the ambitious ‘ambulance lane’ for the city has been shelved.

K .K Kapila, chairman, International Road Federation (IRF), speaking about the need for robust transport facilities for ambulances and organ donation and transport cases said, “Traffic congestion is a reality in Delhi. Ambulances and other traffic is often slowed down because of ongoing metro rail construction, indiscriminate digging, poor drainage infrastructure, and failure of public transport system.’’

The term, ‘green Corridor’, means an obstruction-free route for transporting organs quickly is becoming popular worldwide. “At present a dedicated lane from place of organ donation (hospital/airport etc) is created by traffic police and NGO’s to ensure snarl free traffic, it is mostly done without disrupting the normal traffic flow. A permanent dedicated organ corridor is not possible in city like Delhi, which has almost highest number of vehicles in the country and narrow roads at most of the places,’’ said Mr. Kapila.

He suggests that the best measure possible is to create dedicated organ transfer corridor.

“This is the concept worldwide also. The signage’s come up and vehicle owners leave one dedicated lane for organ transplant This will help in non-disruption of traffic as well as help organ transportation timely,’’ he adds.

Meanwhile it isn’t just lack of clear transportation facilities that is hampering the process of saving lives through organ donation.

“Lack of awareness, absence of effective and comprehensive policies and myths and misconceptions are major issues in preventing people to adopt donation as a practice,’’ say city doctors who add that India needs 200,000 kidneys, 50,000 hearts and 50,000 livers for transplantation each year.

Dr. (Prof) Sandeep Guleria, senior consultant surgeon, General Surgery, GI Surgery and Kidney Transplantation Apollo Hospital said: “It is a global fact that demands for organs far exceed their supply. But, in India the difference is exceedingly more striking.’’

There is poor organ donation rate- 0.26 per million in India. One person dies of kidney failure every 5 minutes. These numbers suggest that with adequate systems in place, people succumbing to accident-prone injuries could meet a major portion of the demand.

“With a 1 per million-donation rate, India would have 1,100 organ donors or 2,200 kidneys, 1,000 hearts, 1,100 Livers, 1,100 Pancreas and 2,200 Eyes. This should take care of almost all current demands for organs,’’ he added.

Doctors also add not all deceased can donate their organs.

“Organs can be retrieved from the body of a patient who is brain dead but his/her heart is still beating. Lack of awareness about organ transplant and the way the process is conducted lead many people to believe different things,’’ noted Dr. Anil Bansal, of Delhi medical Association.

To be able to donate your organs you have to pledge them while you are still alive.

Dr. Sameer Gupta, cardiologist, Metro Hospital and Heart Institute noted that organ donation has been one of the biggest medical breakthroughs.

“Today we have multiple agencies working for patients and green corridors help in ensuring that organ transfers happen fast. Sadly even in Delhi 90 per cent on the wait list die waiting for an organ. United States has "Organ Donor" specified on your driving license which should be adopted in India too,’’ said Dr. Gupta.

He added that there are many myths that need to be dissolved about organ donation. “Not everybody can be a donor. If a person dies at home, only the eyes and skin can be a donated,’’ he explained.

Solid organs such as lungs, heart, liver, kidney etc. can only be brain-dead in an ICU.

Doctors added that 80 per cent patients agree to the donation if counselled properly.

“Saving a life is probably the ultimate act of giving. You are literally giving life to someone. Simple effective steps help make the common man aware of the possibility of helping other human beings even after their death,’’ said Dr. K.K. Aggarwal of Indian Medical Association.
News
  • A new survey finds more than eight in 10 adults admit to sending or receiving a sexually explicit text message -- commonly known as "sexting" -- and many say the practice leads to increased sexual satisfaction, particularly when couples are involved. (HealthDay News)
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs
unless we do it public will not listen to us

Team IMA
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Reader Response
Dear Dr. Aggarwal, Congratulations on a really useful and interesting editorial effort!! Kudos to you for making this bulletin so interesting and informative! A suggestion- just as you have small corners for various kinds of news, how about starting a column for 'Bioethical Dilemmas'? Apart from bringing bioethics to the fore and educating your leadership about these issues, it will also create a library of ethical dilemmas that doctors in India face day to day. I will be glad to help in this effort. Regards: Dr Smita Deshpande

eMedinewS Response: Thank you, Smita, Send me a few write ups. Dr KK Aggarwal
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Follow a healthy diet for a healthy heart
New Delhi, August 11, 2015: Every wondered why wild animals do not suffer from common lifestyle disorders such as a high blood pressure, diabetes, obesity, cancers, osteoporosis, heart attack, metabolic syndrome, fatty liver and polycystic ovarian disease amongst others. The reason for this is that they live in accordance with the laws of the nature.

Speaking about the issue, Padma Shri Awardee, President HCFI & Honorary Sec. Gen IMA, Dr. KK Aggarwal said, “A balanced and healthy lifestyle is the key to preventing and reversing any of the diseases mentioned above. And the first step towards living a healthy life is to maintain an ideal weight”.

A fad of going on crash diets, stressful work environments encouraging people to eat comfort foods, all day desk jobs and size zero concept have increasingly distorted a person’s definition of an ideal weight and wholesome eating. What most people do not understand is that a healthy diet not just requires consuming calories equivalent to thirty times their current weight; it also means that the right balance of macro and micronutrients should be eaten.

While macronutrients are the chemical components of food such as carbohydrates, proteins and fats that provide the body with energy and are needed in large quantities; micronutrients are required in small amounts and include several minerals and vitamins. When consumed in the right quantities and balanced with adequate physical exercise, these can help a person prevent most common lifestyle disorders.

“My formula for ensuring a healthy diet is to consume a mixture of seven colours and six tastes in every meal. Each food colour represents a type of vitamin so red apples are a source of lycopene, green leafy vegetables and fruits provide the body with B complex and orange food items are a source of vitamin C. Similarly the sweet, sour and salt taste promotes weight gain and on the contrary pungent, astringent and bitter tastes reduce weight” he added.

Diet tips for a healthy heart

• An ideal diet should also be low in sodium and no person should consume more than 6 gm of sodium chloride in a day.

• The consumption of trans fat, which is found in hydrogenated oils or vanaspati ghee, should be minimal as it is bad for the heart and reduces the good HDL cholesterol levels and increases the bad LDL cholesterol.

• A person should avoid eating out as much as possible since the food in most restaurants and hotels is high on trans fat and usually will be bad for the heart

• Refined carbohydrates like white bread, white flour, white rice and refined sweetened cereals and white sugar should be avoided and replaced with options like whole grain flour, healthy green cereals and oat meal

• Any sweet item containing more than 10% sugar should be limited. On an average the sugar content in soft drinks is 10%, Indian sweets is 30-50% sugar

An ideal diet should be

1. One only fruits meal

2. One meal which has a mix of besan products, fruits, salads and a portion of fish, chicken or mix vegetables

3. And the third meal should be a regular meal comprising of two mixed grain chapattis/brown rice with vegetables and dal

In between meals, one can consume fruits, salads, black tea/coffee and dark chocolates without added sugar or milk