March 13  2015, Friday
editorial
Obesity gastric bands may cause more complications than weight loss
Dr KK AggarwalAlmost half of patients undergoing gastric banding for obesity need to have the device removed, according to a study published in the Archives of Surgery.

About 60 percent of the 82 patients with the device, Allergan Inc.’s Lap–Band, followed over 12 years or more needed additional operations. The minimally invasive surgery led to weight loss in roughly 18 percent of the patients. About 40% of the 82 patients had major complications. Another 22 percent experienced relatively minor complications, and almost 50 percent had to have the bands entirely removed. In all but a few cases, inadequate weight loss or device breakdown was the reason for band removal. The mean reduction in body mass index was 7.8 points.
eMedipics IMA,IJCP,HCFI
Health Check Up and CPR 10 Camp at S K V I.A.R.J Pusa Road School 2nd February 2015
News
  • Gout was associated with a 24% lower risk for Alzheimer's disease (AD) in a population-based study published online in the Annals of the Rheumatic Diseases.
  • Readmissions within 90 days of hospitalizations for severe sepsis are common, suggests a research letter published in the March 10 issue of JAMA. However, just more than 40% of the readmissions were for diagnoses that could potentially be prevented or treated early to avoid hospitalization.
  • DNA from bacterial species normally found in the intestinal tract was present in blood samples from some patients with plaque psoriasis during disease flares, researchers reported in an article published online March 11 in JAMA Dermatology.
  • A modified Mediterranean diet with local foods may be easier for some people to stick with and also result in weight loss, suggests a new study from Germany published online in the European Journal of Clinical Nutrition.
  • For patients with hepatocellular carcinoma who meet the Milan criteria, rates of disease-free and overall survival are similar after treatment with surgical resection or radiofrequency ablation, reported a European study presented at the European Congress of Radiology 2015.
Dr KK Spiritual Blog
Positive Attitudes

All those out there who feel you are at your wits’ end wondering how things don’t ever work out for you can now relax and dwell on all those failures that life has taken you through and turn failure into success.

Positive Attitudes
  1. Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
  2. Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
  3. Failure doesn’t mean you have been a foolish. It does mean you had a lot of faith.
  4. Failure doesn’t mean you’ve been discouraged. It does mean you were willing to try.
  5. Failure doesn’t mean you don’t know what to do. It does mean you have to do it in a different way.
  6. Failure doesn’t mean you are inferior. It does mean you are not perfect.
  7. Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
  8. Failure doesn’t mean you should give up. It does mean you must try harder.
  9. Failure doesn’t mean you'll never make it. It does mean it will take a little longer.
  10. Failure doesn’t mean God has abandoned you. It does mean God has a better idea.
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Cardiology eMedinewS
  • Alogliptin is not associated with an increased risk for heart-failure–related outcomes in patients with type 2 diabetes, suggest new data from the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care in Patients with Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE) study published online March 10 in the Lancet.
  • Each added hour spent sitting was associated with a 14% increase in coronary artery calcium (CAC) score, independent of traditional risk factors, including physical activity, reported a study of middle-aged subjects without cardiovascular disease. The study will be presented at the American College of Cardiology (ACC) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • The use of the selective serotonin reuptake inhibitor (SSRI) sertraline to treat anxiety disorders in children and adolescents is safe and is associated with a tolerable adverse event (AE) profile, suggest the results of an in-depth analysis of four treatment conditions in the Child/Adolescent Anxiety Multimodal Study (CAMS). The findings are published in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
  • A new research suggests that maternal levels of DDE (indicating the levels to which the foetuses were exposed to in utero) are significantly associated with rapid growth in early life. Additionally, the levels of PCB153 in milk and the amount transferred through breastfeeding are associated with decreased infant growth and falling below expected growth curves. The findings are published in Environmental Health Perspectives.
Event
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Make Sure
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 suggest that this intervention is much better than thrombolytic therapy in such patients.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

Sudden death due to cardiac origin–autopsy

Right coronary artery supplies blood to electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 was coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in AIIMS Mortuary.
  • The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
  • A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 cases out of hundreds, the clots were seen in right coronary artery supplying the electrical area of heart.
  • Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
  • The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.
Dr Good Dr Bad
Situation: A patient with hernia wanted to claim Mediclaim in the first year.
Dr. Bad: You will get a claim.
Dr. Good: This claim is not sustainable.
Lesson: During the first year of the policy, the expenses on treatment of diseases like hydrocele, hernia, congenital diseases etc.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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eMedi Quiz
Isotopic response is seen in scars of which condition

a. Orolabial herpes
b. Herpes genitalis
c. Pyoderma gangrenosum
d. Eosinophilic pustular folliculitis

Yesterday’s Mind Teaser: 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

Answer for yesterday’s Mind Teaser: d. Epitope spreading phenomenon

Correct Answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Poonam Chablani.

Answer for 11th March Mind Teaser: b. Medina-Ramirez reaction

Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan.
eMedinewS Humor
Misbehaving Phone Call

Seven year old Johnny had finished his summer vacation and gone back to school.

Two days later his teacher phoned his mother to tell her that John was misbehaving.

"Wait a minute," she said. "I had Johnny here for two months and I never called you once when he misbehaved."
Rabies News (Dr A K Gupta)
Are pregnancy and lactation contraindications for IDRV?

Pregnancy and lactation are not contraindications for IDRV.
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
More Suggestions for Medical Emblem
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IMA NEWS
One lady called me day before yesterday that she was working in the past in my hospital with the lady consultant and wanted to refer a patient for bypass surgery to me at my hospital and wanted me to spell out the commission. I said I do not indulge into these activities. If some hospital gives you commission I have nothing to do with it. I can only see the patient, charge my fee and advise about the surgery. These types of calls keep coming. The so-called agents come under no law. Something need to be done so that the image of the medical profession is not harmed.

Facts about Tuberculosis (24th March World TB Day)

What are the types of TB?
  • TB is of two types: Pulmonary and extra pulmonary.
  • TB of the lungs is called pulmonary TB and accounts for 80% of all TB cases.
  • TB affecting any other part/organ of the body like brain, lymph nodes, bones, joints, kidneys, larynx, intestines, eyes etc. is called extra pulmonary TB.
  • About 50% of the patients suffering from pulmonary TB are sputum-positive i.e. TB bacteria can be seen in the sputum of such patients by microscopic examination. The other half in which the bacteria cannot be seen in the sputum are called sputum-negative.
  • Only sputum-positive pulmonary TB patients are infectious.
  • Patients can suffer from both pulmonary and extra pulmonary TB simultaneously. Such cases are labeled as pulmonary TB.
Sonal Namaste
Hands should be cleaned thoroughly with soap and water or an alcohol-based hand sanitizer.
Media
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Inspirational Story
3 Attitudes

Three people were laying bricks. A passerby asked them what they were doing.

The first one replied, "Don’t you see I am making a living?"

The second one said, "Don’t you see I am laying bricks?"

The third one said, "I am building a beautiful monument."

Here were three people doing the same thing who had totally different perspective on what they were doing.

They had three very different attitudes about their work. And would their attitude affect their performance? The answer is clearly yes.

Reflection

Excellence comes when the performer takes pride in doing his best. Every job is a self–portrait of the person who does it, regardless of what the job is, whether washing cars, sweeping the floor or painting a house.

Michelangelo had been working on a statue for many days. He was taking a long time to retouch every small detail. A bystander thought these improvements were insignificant and asked Michelangelo why he bothered with them. Michelangelo replied, "Trifles make perfection and perfection is no trifle."

Most people forget how fast you did a job, but they remember how well it was done.

Pride of performance does not represent ego. It represents pleasure with humility.

"The quality of the work and the quality of the worker are inseparable."

Half–hearted effort does not produce half results; it produces no results!
Wellness Blog
All about depression
  • Depression is a major public health problem as a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  • A non–psychiatric physician, 50% of times misses the diagnosis of the depression.
  • All depressed patients must be specifically asked about suicidal ideations.
  • Suicidal ideation is a medical emergency
  • Risk factors for suicide are either psychiatric known disorder, medical illness, prior history of suicidal attempts, family history of attempted suicide.
  • The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • World over 1 million people commit suicide every year.
  • About 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only one-third contact their mental health service provider.
  • Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  • In the US, suicidal rate is 10.5 per 100,000 people.
  • In America suicide is increasing in middle aged adults.
  • There are 10–40 non–fatal suicide attempts for every one completed suicide. The majority of suicides completed in US are accomplished with fire arm (57%), the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  • Fifty percent of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are successful three times more often.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  • Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.
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Quote of the Day
If you are depressed you are living in the past. If you are anxious you are living in the future. If you are at peace you are living in the present. Lao Tzu
Reader Response
Dear Sir, please find enclosed for Slogan competition on ‘Prevention of TB in India’
  1. Chalo Bharat ka bhaar ghatayen, mil kar TB ko desh se bhagayen!
  2. TB ko desh se hatana hai to, DOTS ko hame apnana hai!
Swagat Kumar Khamari
News on Maps
Indian Medical Association clears misconceptions about the safety and efficacy of common Painkillers on the occasion of World Kidney Day
An initiative to dispel the myths surrounding controversial Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like Aspirin, Paracetamol and Nimesulide amongst others

The Indian Medical Association (IMA) has released pointers on the safety and efficacy of common non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers in an attempt to clear common misconceptions that people have regarding their usage for pain and fever management. The most prominent members of this group of drugs are Paracetamol, Aspirin, Ibuprofen and Nimesulide.

Pain is one thing, which is bound to affect each and every individual at some point of life. Mild pain can often be ignored but when it becomes severe, NSAIDs become indispensable. NSAIDs suppress pain by inhibiting the enzyme cyclo-oxygenase and reducing synthesis of prostaglandins, which promote the inflammatory process. Since a few years, NSAIDs have been under constant scrutiny and criticism due to their alleged negative effects on the liver, kidney and heart.

Clearing these misconceptions, Dr A Marthanda Pillai – National President and Dr KK Aggarwal – Honorary Secretary General, Indian Medical Association in a joint statement said, “The Indian Medical Association is of the view that it is not right to classify certain NSAIDs safe and others as unsafe for they all have different functions and if used for the right duration, they can be extremely effective in providing pain relief. It is however important to raise awareness amongst the public that they must not self-medicate themselves for the underlying condition as it can cause more harm than good”.

It is a common perception that OTC drugs like Paracetamol or Aspirin can be taken for pain relief without consulting a doctor. Paracetamol has little anti-inflammatory activity and should be used more to manage fever than pain relief. It also is the number one suicidal agent in the west and the US FDA recommends that not more than 325mg of the drug should be used in any combination tablet.

Similarly, Aspirin, if self-administered in children, can precipitate liver failure, a condition called Reye’s syndrome. IMA believes that both Paracetamol and Aspirin should be used under medical supervision.

The Government of India is envisaging that AYUSH doctors be given the right to prescribe over the counter available painkillers such as Paracetamol and Aspirin. However, the same may not be in the public interest as they have little knowledge about when not to use these drugs.

IMA’s statement said that both Nimesulide and Aspirin should be administered only to people above the age of 12 years. Nimesulide is an analgesic NSAID that was approved by Drug Controller General of India (DCGI) in 1993 for fever, pain and inflammation. It can be safely prescribed to adults up to 15 days.

According to Dr Ramesh Hotchandani, Nephrologist, Moolchand Medcity, “Pain is a condition that affects almost everybody at some point of time in his or her life. In India itself, 76% of professionals who are regular computer users suffer from muscular pain, 15%-20% from acute pain and 25%-30% from chronic pain at least once in their lifetime. This makes effective and safe pain management an extremely important topic of debate around the globe today. However painkillers should be used judiciously as even one tablet can precipitate kidney failure in susceptible individuals.”

“Every year 12th March is observed as World Kidney day, and this day should be dedicated to creating awareness about drugs, which can precipitate kidney failure”, added Dr Hotchandani.

The IMA wants to educate people about the fact that all NSAIDs and other medicines come with some side effects making it extremely important to take them under the guidance of a doctor. Some molecules sometimes do not suit a person’s biological composition and in cases where one sees any evident side effects, they must immediately consult their doctor.

IMA Guidelines on NSAIDS
  • Do not administer Aspirin to children as it can cause fatal liver failure. Children and teenagers recovering from chickenpox or flu-like symptoms should never take Aspirin
  • Paracetamol should not be taken without medical consultation. It is number one suicidal agent in the west. As per US FDA, combination products that contain paracetamol should not contain paracetamol salt dose more than 325 mg in each tablet or capsule
  • Drug Controller General of India (DCGI) approved Nimesulide on 13th January 1995 for painful and inflammatory conditions as well as fever and it can be safely prescribed to people above the age of 12 years for up to 15 days.
  • Nimesulide is a European drug and is available and approved in 54 countries worldwide. It has never been banned in India. It is not available in USA, being a European drug, and has never been banned there
  • In general, painkillers are safe drugs when used in patients who are not at high risk for gastrointestinal, renal, or cardiovascular reactions
  • All heart patients should consult their doctor before taking a painkiller, especially if they are on low dose aspirin.
  • Even one tablet of painkiller in susceptible kidney patients can precipitate kidney failure.