June 13  2015, Saturday
eMedinewS
editorial
Heart Disease Myths
Dr KK Aggarwal Myth No. 1: It is ok to have a high blood pressure in elderly.

Blood pressure tends to rise with age, but it does not mean that this rise is normal. It happens because with age, the arterial walls become stiff and this stiffness cannot be called as a normal stiffness. Stiff arteries make the heart to pump harder. Blood pounding against the artery walls, damages them over time. The overworked heart muscles become less effective and pumps even harder to meet the body demand for blood. This further damages the arteries and invites fats into the artery walls. This results in lipid deposition, formation of blockage and future heart attack and paralysis.

So the fact is, irrespective of age, keep your diastolic blood pressure below 80 and systolic below 120. Start treatment if the blood pressure is more than 140/90.

Myth No. 2: The risk of heart disease can be lowered with vitamins and supplements.

It’s a myth that vitamin C, E and β carotenes lower heart attack risk. The American Heart Association has stated that there is no scientific evidence that these supplements prevent or treat heart diseases. The fact is eat a wide variety of nutritious food which includes all 6 tastes and 7 colors and get natural vitamins and supplements.

Myth No. 3: Women do not suffer from heart disease.

The fact is whether you are a man or a woman, you are at risk, if you do not follow the lifestyle. Heart disease is the leading cause of death in women over age 65. Today more woman get heart disease than combine cancer in them.

Myth No. 4: Heart patients should not eat fat at all.

It is true that you should eat a diet low in saturated fat and zero in transfats but other fats like unsaturated fats in vegetable oil are beneficial. In fact eating fish high in omega-3 fatty acids twice a week can lower the risk of heart disease.
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World Environment Day observed by IMA HQs at IMA House
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News
  • Psychotropic medications, including antidepressants, benzodiazepines, and particularly opiate and nonopiate analgesics, are associated with a significantly increased risk for homicide, suggests new research published online in World Psychiatry.
  • A new study has challenged the simple suggestion that patients who are overweight or obese should just lose weight to reduce their obesity-related breast cancer risk. The findings are published online June 10 in JAMA Oncology.
  • The Pulmonary-Allergy Drugs Advisory Committee of the US Food and Drug Administration (FDA) has unanimously recommended mepolizumab for add-on maintenance treatment in patients aged 18 years or older with severe eosinophilic asthma.
  • In the early stages of rheumatoid arthritis, combination therapy with conventional disease-modifying antirheumatic drugs (DMARDs) enables a large number of patients to achieve sustained remission as early as 6 months, suggested a new study presented at the European League Against Rheumatism (EULAR) Congress 2015.
  • Results of a study presented at SLEEP 2015: Annual Meeting of the Associated Professional Sleep Societies suggest that physical activities, such as walking, as well as aerobics/calisthenics, biking, gardening, golfing, running, weight-lifting, and yoga/Pilates, are associated with better sleep habits compared with no activity. In contrast, physical activity that involved household and childcare is associated with poor sleep habits.
Dr KK Spiritual Blog
Science behind Ganesha worship

While mythological studies knit stories of the Almighty’s existence, the fact remains that human being is bestowed with the untainted potential of recognizing heavenly facets in his own self.

Ganesha, the son of Shiva and Parvati, is likewise the name given to the harmonious Aacharan or characteristic disposition of man. Remembered and ritually worshiped before starting a new venture, the entity of Ganesha has in store the facets of a complete man.

The magnanimous head of the Ganesha, which is that of an elephant, represents wisdom, intelligence and a healthy mind capable of making sound decisions. Not in vain is it said that ‘think before you speak’, which implies Ganesha’s huge head, that is identified with the need for a thoughtful and retrospective attitude.

The big ears of this elephant deity instill among the earthly man the patient channel of lending ears to the echo produced by others’ deeds and speech. It is said that half the dispute is resolved when an ear is lend most patiently.

Ganesha’s extremely small mouth characteristically represents the need for a limited dialogue and the vanity of chattering. Overexpression through words triggers unsought problems many a times which otherwise could be avoided by a tight–lip.

Ganesha also represents the guru of stress affected individuals. Shiva’s most promising son, Ganesha, by virtue of his small eyes, highlights the need of a focused outlook in life. Such an outlook not only redefines and foresees the right goals, but also relieves one from the stress-manifested episodes from the various chapters of life.

The long trunk identifies with the power of discrimination. The sensitivity of Ganesha’s long nose has the strength to uproot a tree and the competency of picking up a pin from the ground. Such should be the approach of an individual who should be capable enough to perceive the good and the bad for himself besides the undaunted strength of overcoming all odds.

The tusks and the small teeth of Ganesha should however, be recollected with the loss and gains in the life of a man. Man similarly ought to engrave his mental stature in such a manner that the ups and downs may not deter him from his honest endeavor and the balance of inevitable bliss and sorrow is maintained to add spice in the earthly existences. This stable healthy mental stature is only possible if the physical, social, spiritual and environmental requirements of the body are fulfilled. For the needful, individuals need to be bestowed upon a complete mental and physical health.

Further the big tummy of Ganapati Deva preaches the need for retaining information. Acquiring knowledge, utilizing it and retaining it for years to come, becomes the crux of ‘big–belly commandment’.

The Char–Bhuja Dhari Ganesha, further represents strength by virtue of the four hands in which the Lord entraps his attachments, desires and greed. Two of the arms of Ganesha, which hold rope, symbolize control over the attachments. The laddoo or sweet in the other two shows command over the desires and earthly delusion. The mouse sitting near the feet of Ganesha represents greed and gluttony upon which the Almighty rides, propagating a control over the evils.

Ganesha’s physical traits are an assembly of the characteristics most required in an individual of substance. Disposition incarnated with the goodness of such features will result in success in life and will positively procure an ailment–free survival.

Specifically for executives, Ganesha’s characteristic principles may be incorporated in a time–table format which will help in the dawn of a conformable work–atmosphere along with congenial relationship between the management and the union of workers.

Deciding the first day of the week to hear all grievance and woes of the workers, the second for thinking and planning strategies to work upon and finally setting targets to be achieved may utilize three days of the week very constructively. Then a day devoted to evaluating losses and gains (Ganesha’s teeth principle) may help additionally in business management. Retaining the information and filing all the pending work can affirmatively call upon the fifth day of the week, which works entirely on the principle of Ganesha’s tummy, which is massive by the virtue of holding tremendous loads of information. Contemplation, discrimination and judging the good and the bad for the entire unit may take another day, leaving the Sunday for self–retrospection through meditation and yoga. One should strive and adopt Ganpati Bappa Maurya’s principles of life management rather than worshiping him with vanity.

Life has much in store besides bothering about unnecessary qualms. Giving into a disciplined attitude may assuredly dawn upon a peaceful life. Heaven is where you are, it’s only a matter of perception which makes life as difficult as hell.
Cardiology eMedinewS
  • After an acute myocardial infarction, patients treated with rapid lowering of body temperature by combined cold saline infusion and endovascular cooling had less heart muscle damage and reduced incidence of heart failure, suggested new research published in Therapeutic Hypothermia and Temperature Management.
  • Handheld ECG monitors offered a practical, noninvasive solution to detecting atrial fibrillation in patients who had been diagnosed with ischemic stroke or transient ischemic attack in a retrospective hospital-based study presented at the annual European Stroke Conference. The study showed an overall detection rate of 7.6%, which is in the same range seen in previous studies of handheld ECG monitors but was higher than in most studies that used 24-hour Holter monitoring.
Pediatrics eMedinewS
  • Cesarean section increases the likelihood of chronic health problems such as asthma, diabetes and obesity in babies, suggested a new study published online June 10 in the British Medical Journal.
  • Leaving one-sided deafness untreated in children leads to reorganization of developing hearing pathways in the brain, and is associated with poorer language development and educational outcomes, suggests new research published online June 8 in Pediatrics.
Make Sure
Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.
Dr Good Dr Bad
Situation: A patient had a strong family history of cancer. 
Dr Bad: Just get regular checkups. 
Dr Good: Take low dose aspirin. 
Lesson: An observational analysis published online in The Lancet reports that long–term daily aspirin may prevent cancer deaths (Lancet 2011 Jan 1;377(9759):31-41).


(Copyright IJCP)
Events
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eMedinewS Humor
Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.
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Rabies News (Dr A K Gupta)
A previously immunized person is bitten again. What is the re–exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory–confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to overtreat than undertreat.
IJCP Book of Medical Records
IJCP’s ejournals
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
eIMA News
  • The NCD Alliance will be holding its next webinar on Thursday 18th June at 10:00 – 11:30 am EST/16:00 – 17:30 CET.
  • The easiest way to prevent an ingrown toenail is to cut your nails straight across, rather than rounding off the corners (as you would with your fingernails). Use a toenail clipper (which is wider and larger than a fingernail clipper) or, if you use scissors, cut the nail in several short movements. Wear shoes that provide enough room at the toes, and wear stockings or socks that allow your toes to move freely (Harvard)
  • In a shocking incident of medical negligence in Madhya Pradesh, eyes donated for transplant were found in a garbage dump of the government J.A. Hospital on Thursday, officials said. The head of the eye department and two others have been suspended.
Harvard 10 tips for finding the right shoes
  1. Take a tracing of your foot with you. If the shoe is narrower or shorter than the tracing, don't even try it on.
  2. Shop for shoes during the afternoon — your foot naturally expands with use during the day.
  3. Wear the same type of socks to the store that you intend to wear with the shoes.
  4. Have a salesperson measure both of your feet — and get measured every time you buy new shoes. Feet change with age, often growing larger and wider. If one foot is larger than the other, buy a size that fits the larger foot.
  5. Stand in the shoes. Press gently on the top of the shoe to make sure you have about a half-inch of space between your longest toe and the end of the shoe. This provides enough room for your foot to press forward as you walk. Wiggle your toes to make sure there's enough room.
  6. Walk around in the shoes to determine how they feel. Is there enough room at the balls of the feet? Do the heels fit snugly, or do they pinch or slip off? Don't rationalize that the shoes just need to be "broken in." Find shoes that fit from the start.
  7. Trust your own comfort level rather than a shoe's size or description. Sizes vary between manufacturers. And no matter how comfortable an advertisement claims those shoes are, you're the real judge.
  8. Pay attention to width as well as length. If the ball of your foot feels compressed in a particular shoe, ask if it comes in a wider size. Buying shoes that are a half-size bigger — but not any wider — won't necessarily solve the problem.
  9. Feel the inside of the shoes to see if they have any tags, seams, or other material that might irritate your foot.
  10. Examine the soles. Are they sturdy enough to provide protection from sharp objects? Do they provide any cushioning? Take note of how they feel as you walk around the shoe store. Try to walk on hard surfaces as well as carpet to see how the shoe feels on both.
Deferred blood donors
Registry of deferred donors are usually computerized, and include identifying information from donors who have been deferred for specified reasons. In most blood centers, the donor's name is checked against the deferral registry prior to donation; no blood is collected if the donor is listed on the registry. The alternate method of complying with the requirements for a donor deferral registry is to collect the unit from the donor and to subsequently, at a central location, check the donor deferral registry prior to placing the unit into inventory. The unit is quarantined and destroyed if the donor's name was found on the registry. Donor deferral registries also include the names of donors who have previously volunteered information (e.g., history of intravenous drug use, hepatitis or high risk AIDS activity) that should have permanently excluded them as blood donors. Donors who volunteer such information at one visit may be tempted to withhold this information at a subsequent visit, especially if their self-assessment is that the history ought not to have precluded them as blood donors.
Donor deferral based upon investigation of disease in the recipient: At time, a hospital or physician will report a case of potential infectious disease or transfusion-related acute lung injury in a recipient to the blood center, so that a donor investigation can be performed. If an implicated (causative) donor is found during the blood center's investigation, that donor will be deferred from future donation. (Source: Uptodate)
Frequency of blood donation
Blood donors may donate one unit of whole blood at a frequency of every 56 days, a time interval sufficient for most donors to have an adequate hemoglobin mass to qualify for a future donation. Automated apheresis technology permits the collection of double red cell units in one sitting (erythrocyte apheresis) with safety, especially in young donors. In the US, donors are required to wait at least 16 weeks between such collections. (Source: Uptodate)
Role of iron supplements after blood donation
About 25-35% of regular blood donors develop iron deficiency, which may make them temporarily ineligible for future donations. Use of low dose oral iron supplements (e.g., 20 to 40 mg of elemental iron orally per day) has been shown to be effective in correcting iron deficiency in regular blood donors. Iron supplementation decreases the time to recovery of the baseline hemoglobin level, regardless of the individual’s iron status. The use of oral iron supplements to allow more frequent blood donation is not standard practice in many countries, including the US. Instead, based on demographic characteristics and donation history, some blood centers recommend that certain groups of donors (pre-menopausal females, frequent repeat donors) consider oral iron supplementation. (Source: Uptodate)
AMENDMENT MCI Ethics Regulations
Chapter 1-B – Duties and responsibilities of the physician in general

Clause 1.5: Use of Generic names of drugs:
Original
MCI Amendment
Final Amendment approved by IMA, MCI, MoH (GoI)
Every physician should as far as possible prescribe drugs with generic names and he/she shall ensure that there is rational prescription and use of drugs.
Every physician should, prescribe drugs with generic names legible and in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.
Every physician should, prescribe drugs with generic names legible and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.
Documents reaffirmed by the 200TH Council Session
WMA Declaration on Euthanasia

Adopted by the 39th World Medical Assembly, Madrid, Spain, October 1987
and reaffirmed by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and reaffirmed by the 200th WMA Council Session, Oslo, Norway, April 2015


Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.
IMA Alipurduar's CME on Obstructive Pulmonary Disease on 21.02.15
IMA Alipurduar organised a grand CME on obstructive pulmonary disease on 21.02.15 at 8pm at Hotel Duars mountain Alipurduar. Eminent speaker was Dr CP Sharma pulmonologist Siliguri.

Fifty doctors were present in the programme.

Dr Saumyajit Datta
Jt Secretary IMA Alipurduar B
Inspirational Story
Competing with others

I was jogging one day and I noticed a person in front of me, about one–fourth of a mile. I could tell he was running a little slower than me and I thought, good, I shall try to catch him. I had about a mile to go my path before I needed to turn off. So I started running faster and faster. Every block, I was gaining on him just a little bit. After just a few minutes I was only about 100 yards behind him, so I really picked up the pace and push myself. You would have thought I was running in the last leg of London Olympic competition. I was determined to catch him. Finally, I did it! I caught and passed him by. On the inside I felt so good.

"I beat him" of course, he didn’t even know we were racing. After I passed him, I realized I had been so focused on competing against him that I had missed my turn. I had gone nearly six blocks past it. I had to turn around and go all back.

Isn’t that what happens in life when we focus on competing with co–workers, neighbors, friends, family, trying to outdo them or trying to prove that we are more successful or more important? We spend our time and energy running after them and we miss out on our own paths to our God given destinies.

The problem with unhealthy competition is that it’s a never ending cycle. There will always be somebody ahead of you, someone with better job, nicer car, more money in the bank, more education, better behaved children, etc. But realize that "You can be the best that you can be, you are not competing with no one."

Some people are insecure because they pay too much attention to what others are doing, where others are going, wearing and driving.

Take what God has given you, the height, weight and personality. Dress well and wear it proudly! You’ll be blessed by it. Stay focused and live a healthy life. There’s no competition in DESTINY, run your own RACE and wish others WELL!
Wellness Blog
Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to a study published in the journal Gastroenterology.
  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or ulcerative colitis (UC).
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of UC was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non-significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD.
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD.
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.
Quote of the Day
Setting goals is the first step in turning the invisible into the visible. Tony Robbins
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Reader Response
Dear Sir, very informative news. Regards: Dr Krishna
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eMedi Quiz
A 30-year-old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1. Medial rectus and superior division of oculomotor nerve.
2. Inferior oblique and inferior division of oculomotor nerve.
3. Lateral rectus and abducent nerve.
4. Superior rectus and trochlear nerve.

Yesterday’s Mind Teaser: A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Proprioception on the ipsilateral side.

Answer for yesterday’s Mind Teaser:3. Pain sensation on the contralateral side.

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 10th June Mind Teaser: 2. Hypovolemia.

Correct Answers received: Dr K Raju, Dr Poonam Chablani, Daivadheenam Jella, Kapil Roy, Dr N SRI HARI, Dr G Madhusudhan, Dr K C Sharma.
Press Release
IMA to organize Blood Donation Camps all over the country

IMA will be organizing minimum 30 Blood Donation Camps starting from 14th June to 1st July 2015.

14th June is World Blood Donor Day and 1st July is Doctors Day.

Giving the details Padma Shri Awardee Dr A.Marthanda Pilla, National President and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA said that apart from Blood Donation Camps, IMA will also make a directory of people with Rare Blood Group and also pledge people who wants to donate blood later.

IMA will also be sensitizing its 2.5 lacs doctors through 30 State Branches and 1700 Local Branches about the blood component. One whole blood should be able to save 3 lives through component.
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