August 13  2015, Thursday
eMedinewS
editorial
Smoking
Dr KK Aggarwal• Cigarette smoking is a leading preventable cause of death in the country.
• Six million deaths occur worldwide because of smoking.
• About 50% of smokers are expected to die because of tobacco–related illnesses.
• The three most important cigarette–related illnesses, which may be potentially fatal, are heart diseases, lung cancer and chronic obstructive pulmonary disease (Chronic bronchitis or asthma of the adult).
• Smoking cessation is associated with substantial health benefits.
• Smoking cessation can reduce risk of heart diseases, cancer and COPD.
• Quitting smoking can help even after development of smoking–related heart diseases, cancer or COPD.
• Stopping smoking before age 40 is associated with a larger benefit than stopping it at later stage.
• Smoking exaggerates bone loss and is a risk factor for hip fracture. Cigarette smoking is responsible for more than 10% of heart blockage diseases all over the world.
• Cigarette smoking is responsible for 33% of all cardiac deaths.
• Quitting smoking even after age 60 is associated with lower risk of deaths.
• Smoking cessation also reduces risk of paralysis.
• Smoking cessation also reduces the progress of blockages in the leg vessels.
• Smoking is associated with premature aging in women.
• Even in smokers older than 80 years, quitting smoking reduces mortality.
• Quitting smoking means no smoking for three years.
• Bidi smoking is as bad as cigarette smoking.
• Tobacco chewing is as bad as cigarette smoking.
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News
Medicine
Health Ministry launches ‘Call to Action for TB Free India’ Initiative: Toll free number for TB patients soon.

The Union Minister for Health & Family Welfare Shri J. P. Nadda launched ‘Call to Action for TB Free India’ programme and also announced that a toll-free number will be soon launched to reach out to all suspected TB patients for counselling and treatment.

“In addition to this number, we will use mobile and other telecommunication tools in an innovative manner in this programme,” added Sh. Nadda.

Further, he stated that one of the biggest challenges faced by the TB Control Programme is in reaching out to the TB patients. The toll-free services will help the patients to be incorporated in the TB Control Programme. The Health Minister also informed that a massive mass awareness campaign through multi-media campaign will be taken up as part of the Call to Action for a TB Free India.

Novel CETP Inhibitor Appears Safe, Effective in Lowering LDL-C in Patients with Dyslipidemias: A Phase 2 TULIP study results.

TA-8995 in Patients with Mild Dyslipidemia (TULIP): In a phase 2 randomized, parallel-group trial of 364 total participants from Denmark and the Netherlands it has been observed that LDL-C was reduced by 27% to 45% for those receiving TA-8995 in doses ranging from 1 mg to 10 mg for 12 weeks vs those receiving placebo.

The reduction was even greater when the drug was combined with statins. Thus, the novel cholesterol esterase transfer protein (CETP) inhibitor TA-8995 (Dezima) may provide a safe and effective option for modifying lipids in adults with dyslipidemias. This study was published in august issue of Lancet.

The researchers, led by Dr G Kees Hovingh (University of Amsterdam, the Netherlands), found that this new CETP inhibitor is a "potent" treatment for this patient population—as monotherapy or with a statin. However, "the translation of the antiatherogenic potential of TA-8995 warrants formal testing in a cardiovascular-outcomes trial."

Orthopedics
Ankylosing Spondylitis: Role of Smoking

Smoking might interact with epigenetic factors and promote radiographic progression in patients with ankylosing spondylitis, according to a recent first of its kind study.

The researchers led by Proton Rahman, MD, from Memorial University in St. John's, Newfoundland evaluated clinical, radiographic, and DNA information of 76 patients from the University of Toronto.

The findings of the study were highlighted at the European League Against Rheumatism Congress 2015. In investigating the link between spondylitis and epigenetic variants, the researchers "uncovered a significant association between smoking, methylation status, and radiographic progression". All the patients under study had undergone serial radiographic imaging on average every 3 years, and among those 35 had evidence of radiographic progression, defined as any change in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).

On multiple linear regression with seven most relevant variants, among the 20 previously identified epigenetic variants that potentially affect ankylosing spondylitis, progression was 0.13 units higher in smokers than in non-smokers, although the effect of smoking itself on radiographic progression was not statistically significant.

Endocrinology
Type 2 Diabetes Treatment: Promising Role of Stem Cells

Findings from a pilot multicenter, dose-escalating randomized placebo-controlled trial in 61 adults with inadequately controlled type 2 diabetes suggested that targeting inflammation, adult allogeneic bonemarrow-derived mesenchymal precursor cells (MPCs) may represent a novel treatment for type 2 diabetes mellitus. Given as a single intravenous infusion, the cell product, called rexlemestrocel-L (Mesoblast) produced no serious adverse events over the subsequent 12 weeks, including anti-HLA antibodies or sensitization. And the agent was associated with significant reductions in HbA1c compared with placebo infusion.

The study was published online July 7 in Diabetes Care by Jay S Skyler, MD, deputy director for clinical research and academic programs at the Diabetes Research Institute, Miami, Florida, and colleagues.

Dr Skyler further added that "This is just a preliminary study. There was no safety issue, which is good, and there may be some beneficial effect….It wasn't powered for that but showed there might be. We're pretty excited about that".

Because of their anti-inflammatory effects the mesenchymal stem cells reduce the inflammatory component associated with Type 2 diabetes. There's evidence that by reducing inflammation beta cells might work better and certainly there is decrease in insulin resistance.

Urology
Laser BPH Therapy Improved Bladder Blood Flow

According to Japanese researchers holmium laser enucleation of the prostate (HoLEP) may provide beneficial increase in bladder blood flow, in addition to its role in easing the passage of urine in benign prostatic hypertrophy (BPH) patients.

In a June 19 online paper in PLoS One, Dr. Shigeo, of Juntendo University, Tokyo, and colleagues investigated 72 patients for the blood flow in the urinary bladder mucosa before and after HoLEP.
The researchers observed that “In patients with BPH there is often continuous over-distention of the bladder due to incomplete voiding. This sustained increase in residual urine results in decreased bladder blood flow.” These and other findings indicate that chronic bladder ischemia is associated with irritative and/or storage symptoms of the lower urinary tract in BPH. Following laser treatment, the median bladder blood flow increased from 9.57 mL/sec to 17.60 mL/sec at the trigone area. In 48 patients bladder perfusion was significantly increased, although the change was less than 5% in the remaining 26 patients. The median International Prostate Symptom Score fell significantly from 20 to 3 and the storage symptoms score decreased significantly from 13 to 3.

Forthcoming DST school camps

1. DAV School, Sector 9, R K Puram on 13th August

2. Sulabh Public School, Mahavir Enclave on 17th August

3. Mt Abu School, Rohini Sector 5, on 19th August

4. St Mathew School, Paschim Vihar, D Block on 20th August
Cardiology eMedinewS
Poor Adherence to BP Medicines Ups Heart-Failure Risk: A 'Real-world' scenario

According to a new study from Italy patients with greater compliance to BP medication may have a lower risk of early heart failure, though non-compliance is common in patients with newly diagnosed hypertension.

Specifically, in 6.6 years of follow-up, in comparison to patients who filled their prescriptions less than a quarter of the time (very low adherence), those who filled their prescriptions more than three-quarters of the time (high adherence) had a 34% lower risk of being hospitalized for heart failure.

Dr Giovanni Corrao (University Milano-Bicocca, Milan, Italy) and colleagues wrote in their study published July 27, 2015 in Hypertension that "in the real-life setting, achieving a suitable adherence with antihypertensive medication is effective for the primary prevention of hospitalization for heart failure". Thus, adherence to antihypertensive medications needs to be improved, which should be "a fundamental goal to pursue for protecting patients against HF".
Pediatrics eMedinewS
Antibiotic Approved for Infant Abdominal Infection Treatment
The antibiotic Meropenem approved by the U. S. Food and Drug Administration for treating abdominal infections in children less than 3 months of age. The approval came after a study by the National Institutes of Health research network evaluated the drug in treating children in this age group.
The study was undertaken under the terms of the Best Pharmaceuticals for Children Act, which directed NIH to conduct studies on drugs used in children but not previously tested in children or in specific pediatric age groups.

The study was described in the May 28th issue of The Federal Register and supported the approval of meropenem for “complicated intra-abdominal infections” in children under 3 months of age. Among preterm infants, intestinal perforation or leakage, which is part of complicated intra-abdominal infections, may be life threatening.

A New Subunit Vaccine to Protect Against Shingles
According to a study published in the May 28, 2015, issue of the New England Journal of Medicine there is efficacy of a new vaccine to protect against shingles.

This new vaccine is different from the current chicken pox vaccine, as it is a subunit vaccine while the current one is a live attenuated vaccine.

The investigators tested this vaccine prospectively in 15,000 older adults who were stratified by age: 50-59 years of age, 60-69 years of age, and older than 70 years. They looked at the acquisition of shingles in these three groups over about a 3-year period. They found that in the placebo group, there were about 210 cases of shingles, whereas the vaccine group only had six. That is an efficacy of about 97%. That efficacy was found in all three groups.
Dr KK Spiritual Blog
Think positive and think different

The Mantra to acquire spiritual health is to think positive and differently. Positive thinking produces positive hormones and takes you from sympathetic mode to parasympathetic mode. When you think different, it gives you several opportunities and then from the multiple options available, you can ask your heart to choose one of them.

Thinking positive was a message given by Lord Buddha and thinking different by Adi Shankaracharya.

The candle light march, which was held to fight for justice in the Jessica Lal murder case, has been picked up by most protest campaigns because it was positive and different.

I have seen three examples in my life where I used this mantra and prolonged the life of those persons.

My grandfather–in–law at the age of 85 thought it was time to go but when we made him work positively and differently, he died at the age of 100 years. He was asked to teach youngsters law, write to the Prime Minister everyday on certain issues and find matrimonial matches for the youngest persons in the family.

In other two cases, one was suffering from terminal prostate cancer and the other had terminal brain cancer. The first one lived for 10 years and the other is still alive. Both were told that they had a very early cancer and that was cured by a surgery.

When you think different, it creates creativity and when it is with positive attitude, it is accepted by all.
Make Sure
Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure , that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis
Dr Good Dr Bad
Situation: A patient came with black stools.
Dr. Bad: It is lower GI bleeding.
Dr. Good: This is upper GI bleeding.
Lesson:Black stools usually indicate upper GI bleeding.

(Copyright IJCP)
eMedinewS Humor
Everything happens for a Reason, The hard part is finding the Reason
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Rabies News (Dr A K Gupta)
Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier..
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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
Govt. of NCT of Delhi, State Blood Transfusion Council

Mail-dirsbtc@gmail.com

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

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 up to 15th November 2015, unless extended further.

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

UP Government circular to allow AYUSH restricted prescriptions: UP IMA to protest

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Memorandum to Chief Minister for Protest against allowing AYUSH Doctors to practice allopathy.

Protest against allowing AYUSH Doctors to practice allopathy

Demand by aryvedic doctor to practice modern medicine

Minister of Health and Family Welfare Govt. of U.P.
 
News
• Very little research addresses the best ways to disinfect and sanitize the hard surfaces in a hospital room, investigators report in the Aug. 11 issue of Annals of Internal Medicine. Hand-washing receives much attention for preventing spread of germs, but disinfecting the hard surfaces in an examination room or hospital suite can be just as important. Many dangerous germs are spread by touching counters, floors, tray tables, bed rails, IV pulls, light switches, toilets, and even call buttons.

• The RAND Corporation has reported that within the next 10 years, we will save $1 trillion with biosimilars, which are usually 30% lower in cost.

• Individuals eating foods typical to the Southern region in the US -- fried chicken, fried okra, sweet tea, buttered biscuits, and lots of gravy -- showed a 56% increase in cardiovascular disease, compared with those rarely eating such foods, in the national, population-based, observational Reasons for Geographic and Racial Differences in Stroke (REGARDS) trial.

• Do not hesitate to use epinephrine for possible anaphylaxis, even in the absence of proof that patients' symptoms are the result of an allergic reaction, experts agree. Epinephrine in appropriate doses is safe, and there are no absolute contraindications for its use in treating anaphylaxis, according to a consensus statement prepared by an expert panel of emergency physicians and allergists. Delay in administration of epinephrine may lead to more severe and treatment resistant anaphylaxis, the authors report in an article published online August 6 in the Annals of Allergy, Asthma and Immunology. (Medscape)

• The novel adjunctive use of clonidine (multiple brands), an agent traditionally used to treat hypertension, appears to prolong abstinence in opioid-dependent patients, new research shows. (Medscape)

• The MIND diet ? a hybrid of the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet ? may slow cognitive decline in elderly adults, according to researchers from Chicago's Rush University Medical Center who developed the MIND diet who report their findings in the journal Alzheimer’s and Dementia.
FDA Approves New Drug for Heart Failure
The U.S. Food and Drug Administration approved Entresto (sacubitril/valsartan) tablets for the treatment of heart failure. The drug has been shown to reduce the rate of cardiovascular death and hospitalization related to heart failure.

Entresto was studied in a clinical trial of more than 8,000 adults and was shown to reduce the rate of cardiovascular death and hospitalizations related to heart failure in comparison to ACEI, enalapril. Most patients were also receiving concurrent medications including beta-blockers, diuretics, and mineralocorticoid antagonists.

“Heart failure is a leading cause of death and disability in adults,” said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research. “Treatment can help people with heart failure live longer and enjoy more active lives.”
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All About Vitamin D IMA USV Initiative
Speakers:
Dr Nisha Jain Gupta, Dr. Rajeev Sighla
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Kindly go to http://module.ima-india.org/ipmo/
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ICON 2015
Inspirational Story
Never leave the mind vacant

An empty mind is the devil’s workshop. All evil actions start in a vacant mind. Keep your mind occupied in something positive, something worthwhile. Actively follow a hobby. Do something that holds your interest. You must decide what you value more: money or peace of mind. Your hobby, like social work or religious work, may not always earn you more money, but you will have a sense of fulfillment and achievement.

Even when you are resting physically, occupy yourself in healthy reading or chanting of God’s name.
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Dreams aren’t those that you have when you are asleep, dreams are those that don't let you sleep till they are fulfilled. Dr APJ Abdul Kalam
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Dear Sir, Very informative news. Regards:Dr Kanana
Wellness Blog
Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipid levels, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. Those who drive cycles for more than 3 hours a week should do so in reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs. Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

A less obvious factor, but of increasing importance, has been the possible association of erectile dysfunction with bicycling.

Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence, is primarily a problem of serious cyclists. The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than three hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.
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eIMA Quiz
Which of the following may cause your hair to fall out by the fistful?:

A. A medical condition like lupus, a thyroid disorder, or a recent high fever or case of the flu.
B. A fungal infection on the scalp.
C. Tight hairstyles (braids, extensions, cornrows, ponytails).
D. Hormonal shifts caused by pregnancy, changes in birth-control–pill use, or menopause.
E. All of the above and more.

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: a. Ineffective health maintenance

Answers received from: Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr.Bitaan Sen & Dr.Jayashree Sen, dr poonam chablani, Dr Shangarpawar, Dr. G. Madhusudhan

Answer for 11th August Mind Teaser: C. At age 40.

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr. Vishnu Mulchandani, Dr. G. Madhusudhan, Dr Pandit Hantodkar
Press Release
HCFI to conduct a training camp at the ABAS Global Exhibition at Pragiti Maidan from August 14 – 16, 2015

New Delhi, August 12, 2015: Heart Care Foundation of India (HCFI), a leading National non-profit organization working towards spreading health awareness in the country and making it a healthier one will be conducting an all day Hands Only CPR training camp at the ABAS Global Exhibition. A three day event scheduled between August 14 – 16, 2015, ABAS Global Exhibition is the first ever International trade fair aimed at showcasing the strengths and business acumen of the Vaish Community. A large number of industrialists, traders, foreign delegates, franchisers and buyers are expected to visit the event from across industries.

The key purpose behind the initiative by HCFI is to spread awareness about the increasing incidence of sudden cardiac arrest in the country and how a simple to learn yet effective method such as hands-only CPR 10 can help revive a person till 10 minutes after their death.

Speaking about the initiative, Padma Shri Awaredee Dr KK Aggarwal who is the President of Heart Care Foundation of India said, “Around 240,000 people die every year due to heart attacks and we believe that 50% of them can be saved if 20% of the population learns hands only CPR. The technique is easy to learn, can be performed by anyone and is extremely effective. What people need to remember is two things, one CPR must not be practiced on a person who is breathing, has a pulse rate and is clinically alive. It must be administered within ten minutes of someone’s death and continued till the ambulance arrives or the person is revived. A cardiac arrest can happen to anyone at anytime and a simple formula can help save a loved one’s life. We have successfully trained over 1.2 lakh people in this life-saving technique in the past 1 year. We also hold three world records in the Limca Book for the maximum number of people trained in this technique in one place, in one hour and at the same time”.

“The HCFI Hands- Only CPR 10 mantra is: Within 10 minutes of death (earlier the better), for a minimum of 10 minutes (adults 25 minutes and children 35 minutes), compress the center of the chest of the deceased person continuously and effectively with a speed of 10×10 = 100 per minute” he added

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heartbeats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death. Continuous compression only CPR compresses the heart between the sternum and the back bone and builds up the pressure that keeps the oxygenated blood flowing to the brain and keeps the person alive until a defibrillator becomes available or expert medical help arrives. Therefore, if you see someone collapse from sudden cardiac arrest, acting promptly can save his or her life. It is important to act quickly for every minute lost reduces the chances of revival by 10%. So, if you wait 5 minutes, the chances of surviving are 50% less. The earlier you give CPR to a person in cardiac arrest, the greater the chance of a successful resuscitation. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.