September 12   2015, Saturday
Clinicians Should Aggressively Treat Unhealthy Lifestyles
Dr KK Aggarwal Health care providers should treat unhealthy behaviors as aggressively as they treat hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create "interprofessional practices" to connect patients with behavior-change specialists.

They must implement five As when caring for patients
  1. Assess a patient’s risk behaviors for heart disease
  2. Advise change, such as weight loss or exercise
  3. Agree on an action plan
  4. Assist with treatment
  5. Arrange for follow–up care.
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
The US Food and Drug Administration (FDA) has approved a new insulin pump/continuous glucose monitor (CGM) product, t:slim Insulin Pump and Dexcom G4 PLATINUM CGM System. It is the first insulin pump/continuous glucose monitor combination that uses a touch screen interface that displays both glucose trend and insulin delivery information and is approved for use by people 12 years of age or older who use insulin.

The first follow-up after a negative biopsy of an asymptomatic breast lesion does not need to be as early as six months, suggests new research published online in The American Journal of Surgery.

New research, published in Neurology, found that among women with episodic migraine, total levels of ceramides in blood were decreased in comparison with the women who did not report having headaches.

Infectious Diseases
A new study suggests that a class of drugs called Smac mimetics, already being tested in clinical trials for the treatment of cancer, may also hold the key to complete eradication of HIV. The findings are published in the journal Cell Host & Microbe.

Sleep Disorders

Patients with chronic rhinosinusitis and obstructive sleep apnea report a poor quality of life, which is substantially improved following endoscopic sinus surgery, suggested a study published online in JAMA Otolaryngology-Head & Neck Surgery.
Cardiology eMedinewS
  • The use of digoxin was associated with a slightly improved survival but no difference in rate of rehospitalization in a new study based on a nationwide propensity-matched cohort of Danish patients with heart failure and atrial fibrillation (AF). The results were presented at the European Society of Cardiology (ESC) 2015 Congress.
  • Preliminary results from the RE-VERSE AD study suggest that idarucizumab (Boehringer Ingelheim) is safe and effective in rapidly reversing effects from an anticoagulation agent in patients with atrial fibrillation (AF) who need emergency surgery or intervention.
Pediatrics eMedinewS
Infectious Diseases

The influenza vaccine can protect for 6 months and last throughout the flu season, longer than previous studies have found, and reduce hospitalization in children, suggest two studies presented at the International Conference on Emerging Infectious Diseases.


For children, lower consumption of sugary beverages was linked with an increase of healthy HDL cholesterol over a 12 month period, suggested new research published in the Journal of Nutrition.
Pulmonary Embolism
Pulmonary embolism can be
  • Hemodynamically unstable or stable
  • Acute, subacute, or chronic
  • Saddle, lobar, segmental, subsegmental
  • Symptomatic or asymptomatic
Dr KK Spiritual Blog
Why should we eat seasonal fruits and vegetables?

God has allowed for only those fruits and vegetables to grow in any area, which are necessary in a season in that particular location. For example, during summer, the body requires more liquids and regular flushing of the kidney because of extreme heat so that dehydration does not damage kidney. To prevent this, nature produces vegetables and fruits in this season that are juicier and increase urination.

All summer fruits like mango, lichi, watermelon, musk melon, wood apple (bel), etc. are juicy fruits. All summer vegetables such as bottle gourd (ghiya), snake gourd (torai), apple gourd (tinda) grow on creepers and they all have a mild diuretic action.

In summer, where the humidity is not so high like in Delhi, one need not take coconut water, which is only required as a treatment of humidity–related diseases. Therefore, nature grows coconuts only in the coastal areas.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Maharaja Aggarsain Adarsh Public School, N P Co. Ed. Sr. Sec. Shool, Lodhi Road, New Delhi-3, 11-9-15
Make Sure
Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.
Dr Good Dr Bad
Situation: A patient was diagnosed with spontaneous bacterial peritonitis.
Dr Bad: Watch and wait.
Dr Good: Start antibiotics immediately.
Lesson: Patients with spontaneous bacterial peritonitis who develop septic shock have high mortality rates, but early initiation of antimicrobial therapy may result in improved outcomes.

(Copyright IJCP)
eMedinewS Humor
A walking economy

This guy is walking with his friend, who happens to be a psychologist. He says to this friend, "I’m a walking economy."

The friend asks, ‘How so?"

"My hairline is in recession, my stomach is a victim of inflation, and both of these together are putting me into a deep depression!"
HCFI Videos
Rabies News (Dr A K Gupta)
If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule?

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.
IJCP Book of Medical Records
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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
eIMA News
Prof. (Dr) K K Aggarwal
Honorary Secretary General, IMA

Sub: WP (C) No.8706/2015 titled "Indian Medical Association (IMA) V/s Union of India & NCERT" before Delhi High Court, New Delhi

In the above matter listed today for hearing before the court (Hon'ble Mr Justice Rajiv Shakdher) the court has been pleased to issue notices to UOI and also to NCERT. The counsel appearing on behalf of UOI on taking instructions from NCERT has submitted before the court that the subject matter in issue and the grievance of the IMA shall be referred before the Complaints Committee in NCERT and some decision shall be taken within 8 weeks period. The writ petition filed on behalf of IMA and averments made therein shall also be considered by the said Complaints Committee. The matter has now been posted for next date of hearing on 24.11.2015.

Rahul Gupta
  • There is general consensus that screening is not necessary for asymptomatic patients at low risk for Coronary Heart disease (absence of multiple coronary risk factors: TC > 240, SBP > 140, DBP > 90, Smoking, DM< history of premature MI or sudden cardiac death in a first-degree relative under age 60). Initial screening with exercise ECG testing is the most prudent approach in high-risk individuals who can exercise and who do not have ECG abnormalities that can limit the detection of ischemic changes. Additionally, an exercise test provides information about the exercise capacity, which may be more predictive of outcome than ST segment changes.
  • The NCD Alliance will host a side event in the margins of the UN Sustainable Development Summit 2015 and the 70th General Assembly. Entitled "Translating the Post-2015 Agenda: Action on NCDs for a Sustainable Future", this event will be held on Saturday 26 Sept. from 13:15 - 14:45, and will focus on interlinkages between NCDs and broader sustainable development priorities, the necessary approaches and responses to ensure "win-win" solutions for health and other sectors, and the investments needed to drive these actions forward.
  • After 12 weeks of high-intensity intermittent exercise training, left ventricular wall mass and end-diastolic blood volume increased, systolic and diastolic function improved, and peak torsion lessened, reported a team of investigators headed by Michael Trenell, PhD, of Newcastle University in the U.K. Medpage Today
  • 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 (MCI), or dementia (September 2 in Neurology.)
  • Routine vaccination against herpes zoster in 50-year-old adults with healthy immune systems does not appear to be cost-effective (September 8 in the Annals of Internal Medicine.)
  • Lung cancer rates are increasing in people who have never smoked (16th World Conference on Lung Cancer.)
  • Catherine L. Hill, MD, of the University of Adelaide in Australia, and colleagues report in the Annals of the Rheumatic Diseases that contrary to expectations, fish oil taken in low doses was more effective than when given in high doses for improving pain and function in knee osteoarthritis (OA).
Duke Treadmill score
The Duke Treadmill score uses three exercise parameters:

Duke prognostic treadmill score = Exercise time (minutes based on the Bruce protocol) -

(5 x maximum ST segment deviation in mm) - (4 x exercise angina (0 = none, 1 = nonlimiting, and 2 = exercise limiting))

Patients are classified as low, moderate, or high risk according to the score:
  • Low-risk – score ≥+5
  • Moderate-risk – score from -10 to +4
  • High-risk – score <-11
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Inspirational Story

A well-known speaker started off his seminar by holding up a $20 bill. In the room of 200, he asked, "Who would like this $20 bill?" Hands started going up.

He said, "I am going to give this $20 to one of you but first, let me do this." He proceeded to crumple the dollar bill up. He then asked, "Who still wants it? “Still the hands were up in the air.

"Well," he replied, "What if I do this?" And he dropped it on the ground and started to grind it into the floor with his shoe.

He picked it up, now all crumpled and dirty. "Now who still wants it?" Still the hands went into the air.

"My friends, you have all learned a very valuable lesson. No matter what I did to the money, you still wanted it because it did not decrease in value. It was still worth $20. Many times in our lives, we are dropped, crumpled, and ground into the dirt by the decisions we make and the circumstances that come our way.

We feel as though we are worthless. But no matter what has happened or what will happen, you will never lose your value. You are special - Don't ever forget it
Quote of the Day
Put your heart, mind, and soul into even your smallest acts. This is the secret of success. Swami Sivananda
IMA in Social Media 28768 likes 46913 likes 1795 likes
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Reader Response
Dear Sir, Very informative newspaper. Regards: Dr Kanan
Wellness Blog
Caffeine–Alcohol combination in paralysis

A drug caffeinol containing caffeine and alcohol may help stroke patients recover.

In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.

Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.

The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.

Will these findings be applicable to heart attack? Only time will tell as heart attack treatment is also done with tPA.
eIMA Quiz
Which of the following is a basic teledermatology tool?

a. Videoconference
b. Hybrid teledermatology
c. Store-and-forward teledermatology
d. Mobile teledermatology

Yesterday’s Mind Teaser: A client has undergone 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.

Answer for Yesterday’s Mind Teaser: c. Elevate the scrotum using a soft support

Correct answers received from: Dr BR Bhatnagar, Dr Poonam Chablani, Raju Kuppusamy, Dr Shangarpawar, Dr Ridu Kumar Sharma, Dr Avtar Krishan, Daivadheenam Jella.

Answer for 10th September Mind Teaser: a. Increase the flow of normal saline

Correct 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.
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Press Release
What people must keep in mind if they have a family history of high cholesterol

Typically if someone is diagnosed with cardiovascular ailments when they are below the age of 55 years (men) and 65 years (women) they are believed to be suffering from premature heart disease. “In such patients, the prevalence of dyslipidemia, a condition characterized by high cholesterol levels without any evident symptoms is about 75-85%”, said Padma Shri Awardee Dr A Marthana Pillai, National President IMA & Padma Shri Awardee Dr K K Aggarwal, President, Heart Care Foundation of India and Honorary Secretary General IMA.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Screening for lipids is therefore recommended for first-degree relatives of patients with MI (particularly if premature). Screening should begin with a standard lipid profile, and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

Approximately 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a), or apo B. Elevated apo A-1 and HDL are likewise associated with decreased CHD risk.

First-degree relatives refer to brothers, sisters, father, mother; Second-degree relatives are aunts, uncles, grandparents, nieces, or nephews. The third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL (or the bad cholesterol) levels, and premature heart disease. Patients may develop the premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, one must do the universal screening at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

Awareness must be created about the fact that food of plant origin has no cholestrol and it is only the food derived from animal by-products which is high in cholestrol. In addition to that trans fat is more dangerous than saturated fat and it reduces good cholestrol and increases bad cholestrol in the body. People who have family history must not only take treatment but also should make lifestyle changes in order to prevent other associated risk factors of heart disease such as diabetes, hypertension and obesity.