August 15  2015, Saturday
eMedinewS
editorial
eMedinewS wishes all its readers a very Happy Independence Day
Dr KK AggarwalAll about tea

When we speak of tea, it is commonly assumed to be black tea with milk and sugar. However, the word ‘Tea’ means any herb. This means even hot Tulsi water is Tulsi tea or hot mint water is Mint tea. Many herbs can be converted into tea such as jasmine tea, lemon tea, lemon grass tea, masala tea, sounf tea etc.

When the leaves are boiled in water and reduced to 50%, it is called Kadha (decoction). Black tea without milk and sugar is much healthier than black tea with milk and sugar.

Classical tea without sugar and milk has an astringent taste. But according to Ayurveda, this is good for health as it reduces Kapha imbalance. When sugar and milk are added, both of which have sweet taste, they neutralize the weight-reducing and kapha–relieving properties of the black tea. Therefore, milk or sugar should not be added to tea. For the purpose of taste, one can add Gur or jaggery or artificial plant sweetener Stevia.

Black tea is also a mild diuretic and increases urination as it contains caffeine, which is also a stimulant. This is the reason why tea is used when there is a need to stay awake. In this regard, coffee is stronger than tea. When taken in moderation, black tea is good for the heart and general health. If one has to choose tea then jasmine, lemon and lemongrass teas are better.

In Ayurveda, different teas have been prescribed for different personalities. Therefore, you can get vata–pacifying tea, pitta–pacifying tea and kapha–pacifying tea.
IMA,IJCP,HCFI
eMedipics
IMA,IJCP,HCFI
ICON 2015 IMACGP International Conference of Family Medicine organized by IMA HQs, New Delhi
IMA,IJCP,HCFI
News
  • Infectious Diseases. The WHO has reported that Guinea and Sierra Leone each recorded a single cases of Ebola in the past week, putting a year-end goal of ending the deadly epidemic within reach, although risks remain. WHO Assistant-Director Bruce Aylward said that tight surveillance and tracing contacts of infected people remain crucial. They are especially challenging during the heavy rains in August. In the previous week to July 26, the two countries had seven confirmed cases, which was the lowest in the past year up until then.
  • Neurology. Two studies have reported that measuring tau protein or brain-derived neurotrophic factor (BDNF) in blood may provide prognostic information in people with traumatic brain injury (TBI). Frederick Korley, MD, PhD, of Johns Hopkins University School of Medicine, Baltimore, Maryland report that day-of-injury BDNF blood levels are associated with TBI severity and outcome. The other study reports that elevated levels of tau are related to chronic neurologic symptoms in military personnel with TBI.
  • Surgery. Injecting a long-acting local anesthetic between the mesh and the peritoneum after laparoscopic ventral hernia repair (LVHR) significantly reduces postoperative pain. A recent study published online July 8 in JAMA Surgery, found during hospitalization patients reported less pain and required less postoperative narcotics when long-acting local anesthetic was used.
  • Ophthalmology/Diabetology. The most recent National Health Interview Survey (NHIS) in the US, published online August 5 as an E-Stat, shows that the number of people with diabetes who have visited an ophthalmologist or an optometrist to have their eyes checked within the last 12 months increases with age and longer disease duration but is still not optimal.
  • Dermatology/Ophthalmology. A newly identified bidirectional association between psoriatic disease and uveitis has led researchers to suggest that patients with psoriasis and psoriatic arthritis should be closely evaluated for eye symptoms. And, patients with prior or current uveitis should be closely evaluated for skin and joint symptoms (JAMA Dermatology).
Forthcoming DST school camps
  • Sulabh Public School, Mahavir Enclave on 17th August
  • Mt Abu School, Rohini Sector 5, on 19th August
  • St Mathew School, Paschim Vihar, D Block on 20th August
Cardiology eMedinewS
  • An abnormal troponin T level of 14 ng/L or higher, as measured using a high-sensitivity assay, doubles the risk of cardiovascular events and death among patients who have stable ischemic heart disease and type 2 diabetes, according to a report published online Aug. 13 in the New England Journal of Medicine.
  • Maurice Enriquez-Sarano, MD, of the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic (Rochester, MN) and colleagues suggest early repair should be preferred to rescue surgery in patients with mitral regurgitation (MR). Guideline triggers for MR surgery based on symptoms and complications are linked to excess postoperative mortality and morbidity versus early surgery. Early surgery in this era of low operative risk and high repair rates provides the best long-term outcomes after MR surgery (Journal of Thoracic and Cardiovascular Surgery).
Pediatrics eMedinewS
  • Pediatrics Cardiology. Using a fetal electrocardiogram (ECG) ST-segment analysis along with conventional fetal heart-rate monitoring did not improve fetal outcomes or reduce the rate of operative deliveries, according to a randomized trial published in the August 13 issue of the New England Journal of Medicine. ST-segment analysis technology tracks fetal heart electrical activity.
  • Dr. Stephanie Doupnik report that pediatric pneumonia patients were found to have a significantly longer length of hospital stay and a higher rate of complications when they also had mood or anxiety disorders. The odds of experiencing any complication were significantly higher in children with mood and anxiety disorders, regardless of age. The older children saw an odds ratio of 1.8 (95% confidence interval, 1.3-2.0) and the younger children, 1.6 (95% CI, 13-2.0) (P less than 0.001 for both). Length of stay also was prolonged among the patients with mood and anxiety disorders by 11% in the younger children and by 13% in the adolescents and young adults.
Dr KK Spiritual Blog
Spiritual Prescriptions – Controlling the Inner Noise

Yoga Sutras of Patanjali define yoga as restraint of the mental states (Chapter 1.2). In the state of total restraint, the mind is devoid of any external object and is in its true self or the consciousness. To control the mind many Vedic scholars have given their own formulas.

Being in touch with one’s own consciousness requires restraining of the mind, intellect and ego on one hand and the triad of rajas, tamas and satwa on the other hand. Every action leads to a memory, which in turn leads to a desire and with this a vicious cycle starts.

The mental turmoil of thoughts can be equated to the internal noise and the external desires and objects to an external noise.

The process of withdrawing from the external noise with an aim to start a journey inwards the silent field of awareness bypassing the internal noise is called pratihara by Yoga Sutras of Patanjali. It involves living in a satwik atmosphere based on the dos and don’ts learnt over a period of time or as told by the scriptures.

To control the inner noise, we either need to neutralize negative thoughts by cultivating opposite thoughts or kill the origin of negative thoughts.

Not allowing thoughts to occur has been one of the strategies mentioned by the scholars. One of them has been neti–neti by Yagnayakya.

The other method is to pass through these inner thoughts and not get disturbed by it and that is what the process of meditation is. This can be equated to a situation where two people are talking in an atmosphere of loud external noise. For proper communication one will have to concentrate on each other’s voice for long till the external noise ceases to disturb. In meditation, one concentrates on the object of concentration to such an extent that the noisy thoughts cease to bother or exist.

One of the ways mentioned by Adi Shankaracharya in Bhaja Govindam and by Yoga Sutras of Patanjali (Chapter 2.35) is that whenever one is surrounded by evil or negative thoughts one should think contrary thoughts. For example, if one is feeling greedy, one can think of donating something to somebody. Deepak Chopra in his book Seven Laws of Spiritual Success talks in detail about the importance of giving and sharing. He says you should never visit friends or relations empty handed. You should always carry some gift of nature, which if nothing is available can be a simple smile, compliment or a flower. By repeatedly indulging into positive behavior and thoughts, you can reduce the internal noise, which helps in making the process of meditation or conscious living a simpler one.

Washing out negative thoughts is another way mentioned by many Vedic scholars. Three minutes writing is one such exercise which anybody can do. Before going to bed, take three minutes to write down all your emotions and then discard the paper. Another exercise is to reward or punish oneself at bed time for the activities done during the day by either patting or slapping yourself.
Inspirational Story
Joy of Giving

A woman who was traveling alone in the mountains found a precious stone in a stream. The next day she met another traveler who was hungry; the woman opened her bag to share her food.

The hungry traveler saw the precious stone and asked the woman to give it to him. She did so without hesitation. The traveler left, rejoicing in his great fortune. He knew the stone was worth enough to give him security for a lifetime. But a few days later he came back to return the stone to the woman.

"I’ve been thinking," he said, "I know how valuable the stone is, but I give it back in the hope that you can give me something even more precious. Give me what you have within you that enabled you to give me the stone."

The woman smiled, "The joy of giving!"
Events
IMA,IJCP,HCFI
Make Sure
Situation: A patient went into acute cardiac arrest within 3 hour of developing chest pain.
Reaction: Oh my God! Why was water–soluble aspirin not given at the time of chest pain?
Lesson: Make sure that all patients with suspected MI are given water–soluble aspirin to reduce chances of death.
Dr Good Dr Bad
Situation: A patient with COPD needed oxygen.
Dr. Bad: Use binasal cannula.
Dr. Good: Use Venturi mask.
Lesson: Venturi mask helps to wash out carbon dioxide.
(Copyright IJCP)
eIMA Quiz
Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of:

a. Diuretics
b. Antihypertensive
c. Steroids
d. Anticonvulsants

Yesterday’s Mind Teaser: What is a healthy blood pressure level?

A. 110/70.
B. 125/85.
C. 135/90.
D. 140/95.
E. 150/95.

Answer for Yesterday’s Mind Teaser: A. 110/70.
Answers received from: Dr G Madhusudhan, Dr Shangarpawar, Viswanatha Sarma, Dr Poonam Chablani, Dr K Raju, Dr B R Bhatnagar, Dr Bitaan sen & Dr Jayashree Sen.
Answer for 12th August Mind Teaser: E. All of the above and more.
Correct Answers received from: Dr B R Bhatnagar, Dr Bitaan Sen & Dr Jayashree Sen.
eMedinewS Humor
Threatening Letters

The fellow stormed into the postmaster’s office in a fury. "I’ve been getting threatening letters in the mail for months and I want them stopped."

"Of course," said the postmaster. "Sending threatening letters through the mail is a federal offense. Do you know who’s sending them?"

"Yes," shouted the man. "It’s those idiots down at the Internal Revenue Service."
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
What are the various brands of RIG available in India?

The different RIGs available in India

HRIG Brands
  • Berirab–P– manufactured by CSL Behring GmbH, Germany and marketed by Bharat Serum & Vaccines Ltd.
  • Kamrab – manufactured by Kamada Ltd., Israel and marketed by Synergy.
ERIG Brands
  • Anti Rabies Serum – manufactured by CRI – Kasauli.
  • Equirab – manufactured and marketed by Bharat Serum & Vaccines Ltd.
  • Abhayrig – manufactured by VINS Bioproducts and marketed by Human Biologicals Ltd.
  • Vinirig – manufactured and marketed by VINS Bioproducts.
IJCP Book of Medical Records
IJCP’s ejournals
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
Another victory for IMA
Me N Moms withdraws the name IMA from the campaign

Dear Dr. Aggarwal,

Sub: Legal notice sent on behalf of Indian Medical Association (Regd.), IMA House, Indraprastha Marg, New Delhi to M/s Me N Moms Pvt. Ltd. against illegal and unauthorized use of the words “Recommended by IMA Indian Medical Academy”.

Be kindly informed and updated for your records that after we had sent the aforementioned legal notice dated 15.7.2015 the opposite side had sent a short reply on 24.7.2015 followed by detailed reply dated 7.8.2015 (received in our office on 13.8.2015) through their lawyers Cyril Amarchand Mangaldas. In the last para of the said reply it has been mentioned that the company has decided to remove the letters “IMA” from its products / packaging and further assurance given that all advertisements referring to IMA on their products and business shall also be withdrawn. Rahul Gupta (Advocate)

Team IMA Note: They were using IMA for Indian Medical Academy
High cost of microscopes is deterrent to cheap medical care
Dr. K.K.Aggarwal
Honorary Secretary IMA
IMA Headquarters, New Delhi

Subject: High cost of microscopes is deterrent to cheap medical care

Dear Dr. Aggarwal

Let me start by saying that I am an ardent fan of yours. May God bless you always and give the strength to carry on the good work you are doing for society at large and medical community in particular for years to come.

You have been rightly emphasizing eradication of tuberculosis which has reached epidemic proportions in our country. You are already waging a war against tuberculosis.

The other war we are fighting these days is extremely high incidence of cancer which is increasing by the day.

As a pathologist I have certain observations to make and require your support to fight these two dreaded diseases.

For diagnosis of pulmonary tuberculosis, examination of sputum for acid fast bacilli is imperative. Every PHC should have equipment and trained manpower to detect AFBs.

Equipment wise, every centre should have good binocular microscope with built in good illumination and not the rickety monocular microscopes using day light reflected from mirror for illumination. I hope you will agree on this point.

Similarly, cancer diagnosis is dependent on good microscopes whether diagnosed on FNAC or on biopsy.

I was deliberating on this point, why we cannot provide good microscopes and reason came out to be the cost. Good microscopes are imported and there is heavy import duty of 28% in addition to the 14.0 % VAT on the microscopes raising the cost almost one and a half times the original cost.

Sir, microscopes are not luxury items and are used in providing health care and for education of biological sciences in schools, colleges, medical, dental and paramedical institutions. Our motto is to provide affordable health care and good quality medical education. I think we should persuade government to remove import duty from microscopes and to levy minimal tax as is applicable to school stationery.

I am ready to take up this cause but as a standalone pathologist, no one in the government is going to pay heed to my pleadings. I seek you co-operation. If we raise this issue from the banner of IMA, authorities are going to take immediate notice of the points.

Please guide me and take up this cause for the common public to provide good affordable health care.

With Sincere regards

Dr. Mithilesh Chandra
Former Deputy Director,
National Institute of Pathology (ICMR)
Safdarjang Hospital, New Delhi

Team IMA: Kindly prepare a representation for the government
Dr ML Sharma passes away
Dr ML Sharma, one of the greatest teachers at MGIMS, died at his home after a prolonged illness on August 10, 2015. He was 85.

Associated with MGIMS almost right from its inception, Dr ML Sharma taught Pharmacology to a generation of medical students. Medical students at MGIMS (batches from the early 1970s to late 2000s) can never forget his passion and enthusiasm. No one could surpass his unique style, his theatrical mannerisms, his wit and humour, his deliberate silences, and the jokes he used to enliven into what many perceived a dull and drab subject. Gifted with a charming face—square jaw, chiselled nose, thick bushy eyebrows, large eyes, high cheekbones and pouting lips—he was the emperor of sixty minutes he would take to teach Pharmacology.

He demystified drugs, simplified complex classifications and taught tips and tricks that would greatly help students remember what the drugs do, how they act and how they adversely impact the human body. Even after he had formally retired, he continued to walk to his class from his home. “In my class, I am the conductor and the class is my orchestra. I make all students play different instruments and at varying proficiencies,” Dr Sharma would explain his style.

Years after they had left MGIMS, the alumni would make it a point during their silver jubilee reunion to ask Dr Sharma take their classes. He never turned down their request. Even in his late 70s, he would enter the class packed with alumni and their families, and would be greeted with a thundering applause. “ He was a gifted teacher who precisely knew what the students needed to master this subject and pass their examinations,” said a former student.

“He was not purely theoretical but spiritually infectious. He inspired, encouraged, engaged and enthused his students. A day before the examination, he would take a special class to kill our fear and restore our confidence,” recalled his former student. “He envisioned helping students learn who struggled, and was always eager to see the excitement in a student’s eyes when they finally understood the content, recalled a student.” Another student said, “ Not only did his enthusiasm made the subject more enjoyable and entertaining for students, but his fun classes also helped us retain larger amounts of information.”

When a former student asked him to explain the method of his madness, he said, “Teaching is as much about my growth as a teacher, as it is about participating in the academic and social growth of the MGIMS students. It’s about being self-deprecating and not taking myself too seriously. It’s often about making innocuous jokes, mostly at my own expense so that the ice breaks and students learn in a more relaxed atmosphere. I show them I am human too with my own share of faults and shortcomings.”

Dr Sharma also served as the principal of the Institute. He knew perfectly well how to discipline the vagabonds, how to balance discipline with freedom and how to overlook mischiefs. “Boys will be boys. I will be surprised if I do not hear boys breaking rules and benches in the hostel, “ he would often say. He would discipline them in his trademark style. Mocking anger on his stern face, he would reprimand them, remind them that this their last chance to get away scot free and would earn a promise from them that they won't repeat the mischiefs. And no sooner did the boys left his office, he would burst into un uncontrollable laughter. He was also a disciplinarian, because, as he often said, “ I have to be harsh to be kind.” He handled the faculty and residents with superb aplomb—always telling them that he was on their side— and mixed well with orderlies, drivers and lab technicians. His office was open to everyone who wanted to see him, and he had a unique knack of satisfying everyone who needed his advice or help.

The medical students from the 70s and 80s shall also remember Dr ML Sharma for the Sharma- special jokes that he would crack during Holi, the festival of colours. He would freely mix with students, let them drench him with colours and would sit with them, cross-legged. The students would be all ears and eyes to him- most of them can vividly recall his jokes even thirty years later......(Dr S P Kalantri)
New model of care (Pre-emptive care model)
News
NIH: Between one-third and one-half of individuals in the United States who were infected with HIV around the time of birth may not have sufficient immunity to ward off measles, mumps, and rubella—even though they may have been vaccinated against these diseases. This estimate, from a National Institutes of Health research network, in collaboration with the Centers for Disease Control and Prevention, is based on a study of more than 600 children and youth exposed to HIV in the womb.

Fetal electrocardiographic (ECG) monitoring used in conjunction with conventional fetal heart rate monitoring did not reduce complications during childbirth, according to a large U.S. clinical trial funded by the National Institutes of Health
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
IMA Digital TV – Webcast Done So far
23rd July 2015 – TB Notification

6th August 2015 - Breastfeeding and Neonatal Skin Care

13th August 2015 - All About Vitamin D - IMA USV Initiative
IMA,IJCP,HCFI IMA Digital TV IMA Digital TV
IMA Digital TV
IMA Digital TV
IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
Media
IMA,IJCP,HCFI
Quote of the Day
High achievers spot rich opportunities swiftly, make big decisions quickly and move into action immediately. Follow these principles and you can make your dreams come true. Robert H. Schuller
IMA in Social Media
https://www.facebook.com/ima.national 28677likes
https://www.facebook.com/imsaindia 46774 likes
https://www.facebook.com/imayoungdoctorswing 1770 likes
Twitter @IndianMedAssn 1106 followers
http://imahq.blogspot.com/
www.ima-ams.org
http://www.imacgpindia.com/
http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
Reader Response
Dear Sir, Very informatory news. Regards: Dr Kalpana
Wellness Blog
Is caffeine good for health?
  • Caffeine is the most consumed stimulant in the world.
  • It is consumed in the form of coffee and tea.
  • At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  • Short term benefits include mental alertness and improved athletic performance.
  • Short–term adverse effects including headache, anxiety, tremors and insomnia.
  • Long–term adverse affects include generalized anxiety disorder and substance abuse disorders.
  • Long–term benefits are dose–dependent. Caffeine is associated with a reduced risk of Parkinson’s disease, Alzheimer’s disease, alcoholic cirrhosis and gout. Coffee, both caffeinated and decaffeinated, is also associated with a lower risk of type 2 diabetes.
  • Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long–term risk factor for myocardial disease.
  • Most studies show a modest inverse relationship between coffee consumption and all–cause mortality.
  • Caffeine withdrawal is a well–documented clinical syndrome, with headache being the most common symptom. (Source: Uptodate)
IMA Videos
News on Maps
Press Release
Vitamin D deficiency increasingly being associated with a rise in incidence of cardiovascular disease

Indian Medical Association organizes a one of its kind webcast on the various ailments caused by Vitamin D deficiency

Cardiovascular disease continues to be one of the leading causes of mortality and morbidity around the globe. Research in the recent times has indicated a close relationship between Vitamin D deficiency and an increased risk of cardiovascular disease. Keeping in mind the growing epidemic status of Vitamin D deficiency, which is being diagnosed in 80-90% Indians, the Indian Medical Association today organized a one of its kind webcast for doctors. An initiative under the IMA Rise in Shine Campaign, the webcast was viewed by over 2000 doctors.

While Vitamin D is known for its contribution to maintaining a good bone health in the human body, its deficiency has extra-skeletal consequences as well. It makes a person more vulnerable to Cardiovascular Disorder triggers such as diabetes and hypertension. It can in the long-term cause congestive heart failure and myocardial infarction.

Speaking about the issue, Padma Shri Awardee Dr A Marthanda Pillai, National President & Padma Shri Awardee, Dr KK Aggarwal, Honorary Secretary General IMA & President HCFI in a joint statement said, “A serious concern for us is the under-diagnosis of people suffering from Vitamin D deficiency. It is important that all medical practitioners recognize the common signs of Vitamin D deficiency including complaints of fatigue muscular aches and pains and educate their patients about prevention and the cure. Vitamin D helps our body to absorb calcium and phosphorus from the food thereby helping maintain good bone health. Research also indicates that people with low circulating 25-hydroxyvitamin D (25(OH)D) levels have higher chances of developing and diabetes. Lately, the deficiency of Vitamin D has been identified as a risk factor for various cardiovascular ailments such as ischemic heart diseases, congestive heart failure, heart attacks and strokes. For the next two years, the IMA Rise & Shine campaign will raise awareness about Vitamin D deficiency and address the skill gap that exists in the healthcare sector. We are extremely pleased by the high attendance of the webcast and will continue to organize more such webcasts in the near future.“

There are two forms of Vitamin D, Vitamin D3, which is synthesized in the body through the ultraviolet rays of the sun, and Vitamin D2, which is produced by the irradiation of ergosterol. The major source of Vitamin D in humans is sunlight (95%) and the remaining amounts are derived from dietary sources.

Speaking about the issue, Dr Ambrish Mithal and Dr Nishi Jain Gupta in a joint statement said, “Thirty minutes of exposing the skin of the face and arms (without sunscreen) to sunlight during peak time (10 am to 3pm) daily is adequate to prevent Vitamin D deficiency. However given the sun-shy behavior of Indians, dietary sources of Vitamin D including fish oils, egg yolks and mushrooms are recommended along with supplementation as required and directed by the physician. In the long run a National policy on Vitamin D deficiency is recommended like that in practice in Canada and the US. Fortification of milk products with Vitamin D is a great way to deal with the large prevalence of the deficiency in the country. We urge Indians to start going out in the sun more often as that is the best possible way to eliminate risks of Vitamin D deficiency.”

The IMA Rise and Shine campaign is a National movement initiated by the Indian Medical Association under an unconditional educational grant from leading pharmaceutical company USV. It aims at sensitizing its 2.5-lakh members across 128 cities and 1500 branches over a period of two years about the need to raise awareness of Vitamin D deficiency. The campaign also provides soft skills training to doctors on essential topics. There include public speaking, managing patient records online, adapting to the new mobile app culture and how to break the news of a patient's death to their family.