September 15   2015, Tuesday
Harvard’s Medical School’s 4 Exercising Tips For People with Diabetes
Dr KK Aggarwal
  1. Get a "preflight" check
    • Talk with your doctor before you start or change a fitness routine, especially if you are overweight or have a history of heart disease, peripheral vascular disease, or diabetic neuropathy.
    • Go for a complete physical exam and an exercise stress test for people if you are 35 or older and who have had diabetes for more than 10 years. The results can help determine the safest way for you to increase physical activity.
  2. Spread your activity throughout the week
    • Adults should aim for a weekly total of at least 160 minutes of moderate aerobic activity, or 80 minutes of vigorous activity, or an equivalent mix of the two.
    • Be active at least 3 to 5 days a week.
  3. Time your exercise wisely
    • The best time to exercise is 1 to 3 hours after eating, when your blood sugar level is likely to be higher.
    • If you use insulin, it’s important to test your blood sugar before exercising. If it is below 100 mg/dL, eat a piece of fruit or have a small snack to boost it and help you avoid hypoglycemia. Test again 30 minutes later to see if your blood sugar level is stable.
    • Check your blood sugar after any particularly grueling workout or activity.
    • If you use insulin, your risk of developing hypoglycemia may be highest 6 to 12 hours after exercising.
    • Do not exercise if your blood sugar is too high (over 250).
  4. Be prepared
    • Should you experience a medical problem while exercising (or at any time) it is important that the people who care for you know that you have diabetes.
    • Keep card handy or glucose tablets with you while exercising in case your blood sugar takes a sudden nosedive.
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
A new study shows that luteolin, present in vegetables such as celery, could counter the risk of breast cancer caused by the combination of natural estrogen and synthetic progestin used in hormone replacement therapy (HRT). The study is published in Springer Plus.

Diabetes and Endocrinology
Marijuana use in early adulthood was associated with an increased risk for prediabetes, but not diabetes, by middle adulthood in an adjusted analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, published in Diabetologia.

A clinical trial, published in Neurology, has revealed that the compound resveratrol stabilizes a biomarker found to decline alongside the progression of the disease in people with mild to moderate Alzheimer's disease.

In contrast with widespread misperceptions, older adults with arthritis are less likely than their younger counterparts to report worse outcomes, suggested Canadian research published in BMC Musculoskeletal Disorders.

Infectious Diseases

A new study by UC Davis pathologists suggests that many patients are mistakenly diagnosed with Clostridium difficile infection and do not need antibiotic treatment. Researchers suggested that patients are likely being over diagnosed and over treated on the basis of positive results on molecular tests, adding to concerns about antibiotic resistance. The findings are published in JAMA Internal Medicine.
Cardiology eMedinewS
  • A new study, published in the journal Arteriosclerosis, Thrombosis and Vascular Biology, suggests that for young and middle-aged adults, inadequate sleep may increase the risk of early signs of heart disease developing, especially elevated coronary artery calcium levels and arterial stiffness.
  • A structured program of intervals of high-intensity cycling helped both cardiac structure and function in type 2 diabetes (T2DM), suggested new research published in Diabetologia.
Pediatrics eMedinewS

New research reveals that seizures are frequent in childhood brain tumor survivors. The findings are published online in Epilepsia.


Anxiety about doing math problems can be relieved with a one-on-one math tutoring program, suggested a new study published in The Journal of Neuroscience. Researchers noted that tutoring fixed abnormal responses in the brain's fear circuits.
Pulmonary Embolism
Most emboli arise from lower extremity proximal veins (iliac, femoral, and popliteal).They may also originate in right heart, inferior vena cava or the pelvic veins, and in the renal and upper extremity veins. The most common presenting symptom is dyspnea followed by pleuritic pain, cough, and symptoms of deep venous thrombosis.
Dr KK Spiritual Blog
The Vedic meaning of Mahamritunjaya Mantra and the Gayatri Mantra

Any activity should always engage the 3 H model of Heart, the Head, and the Hand. The same has been advocated by the western scholars of today. The concept is that before doing any work, one should ask the head for choices and then refer these choices to the heart to choose one and finally order the hands to carry out that action. In his book ‘The Seven Spiritual Laws of Success’, Deepak Chopra also talks about this. He writes that conscious–based decisions are the best decisions. Before taking any decision he recommends asking the body for the signals of comfort or discomfort and if the signals of discomfort are perceived, then one should not carry out that action. All the above concepts come from our ancient Vedic knowledge. The two main mantras of our times are the Mahamritunjaya Mantra and the Gayatri Mantra.The Mahamritunjaya Mantra is from the Rig Veda and needs initiation for attaining any Siddhi. This is the greatest reliever from all evils and reads as under: Aum Trayambakam Yajamahe, Sugandham Pushtivardhanam; Urva Rukamiva Bandhanan, Mrityor Mokshiye Mamritat. It means we worship Shiva – The Three–Eyed Lord; who is fragrant and nourishes all beings; May he protect us (bandhanan) from all big (urva) diseases (aarookam). May he liberate us (mokshiye) from death (mrityor), For the sake of immortality (mamritat, amrit); as the cucumber is automatically liberated, from its bondage from the creeper when it fully ripens.

The meaning of the mantra is the importance of the third eye and the benefits of its opening. The two eyes are at the level of the physical body. The third eye means the eyes of the mind and the eyes of the soul. It also indicates that in difficulty one should look inward from the eyes of the mind and ask for the choices. Like the cucumber, one should chose the good ones and drop the bad choices.

The mantra for the conscious–based decision comes from Gayatri mantra: Om Bhur Bhuvaha Suvaha Thath Savithur Varenyam Bhargo Devasya Dheemahi Dhiyo Yonaha Prachodayath. It means we meditate on the glory of the Creator; who has created the Universe; who is worthy of Worship; who is the embodiment of Knowledge and Light; who is the remover of all Sin and Ignorance; may He enlighten our Intellect. The Gayatri mantra talks about the importance of conscious–based decisions and its directions to the intellect to choose the right and not the convenient actions. The Gayatri mantra is the Vedic prayer to illuminate the intellect. Gayatri is considered as Vedasara –– "the essence of the Vedas." Veda means knowledge, and this prayer fosters and sharpens the knowledge–yielding faculty. As a matter of fact, the four mahavakyas or ‘core–declarations’ enshrined in the four Vedas are implied in this Gayatri mantra.

Choosing the right decision from the consciousness was later defined by Buddha. He taught that before any action ask yourself the following four questions and if the answer to any of the question is no, not to indulge in that actions. These four questions are: Is it the truth, is it necessary, will the actions bring happiness to you and to the others.
Wellness Blog
PCI often done at low-volume centers

About 25% of all percutaneous coronary interventions (PCI) in the US are performed at low–volume centers that do 200 or fewer procedures per year; 49% are done at centers that do no more than 400 such procedures annually, Gregory Dehmer, MD, of Scott & White Healthcare in Temple, Texas, and colleagues reported in the Journal of the American College of Cardiology. They also found that on–site cardiac surgery was not available at 83% of centers that did 200 or fewer PCIs annually. The 2011 PCI guidelines stated that facilities doing 200 or fewer PCIs per year need to take a closer look at whether they should continue doing such procedures.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N. P. CO. ED. Secondary School, Babu Market, Sarojani Nagar, New Delhi
Make Sure
Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are observed for gum hypertrophy. Gingival hyperplasia is a known side effect of amlodipine.
Dr Good Dr Bad
Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Go for Echo test.
Dr. Good: Go for Tissue Doppler Echo test.
Lesson: A patient with heart failure must go for Tissue Doppler Echo Test for evaluation of diastolic functions.

(Copyright IJCP)
eMedinewS Humor
Teacher: This is the fifth time this week that I have had to punish you. What do you have to say?

Student: "Thank God, Saturday and Sunday are holidays, Sir!"
HCFI Videos
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
  • Among patients scheduled for coronary CT angiography, those with "uncomplicated" hypertension had higher levels of pericardial-fat volume, coronary artery calcium (CAC) scores, extracoronary calcification, and Gensini scores (an indication of severity of coronary artery disease) than patients with no hypertension, in a new observational study by Dr Azza Abd El Moneim Farrag (Cairo University, Egypt). (ESC 2015)
  • A study led by Siobhan O'Donnell, MSc, an epidemiology researcher at the Centre for Chronic Disease Prevention in Ottawa found that in contrast with widespread misperceptions, older adults with arthritis are less likely than their younger counterparts to report worse outcomes. (BMC Musculoskeletal Disorders)
  • A review of 281 melanoma cases showed that two-thirds of the patients had fewer than 50 nevi (moles), a low-risk trait, and many of them also had no atypical or dysplastic nevi, another low-risk trait. However, melanomas associated with the low-risk features were significantly thicker, exhibited a trend toward a faster growth rate, and were significantly more likely to have ulceration.
  • GreenLight Laser vaporization is as safe and effective as transurethral resection of the prostate (TURP) for benign prostatic obstruction, according to two-year follow-up data from the GOLIATH trial.
  • Lung cancer rates are increasing in people who have never smoked, according to two new studies presented at the 16th World Conference on Lung Cancer.
  • A study of people with rheumatoid arthritis (RA) published in the Annals of the Rheumatic Diseases finds that those in wealthy nations are more troubled by it, even though people in poor countries have more severe symptoms. The results, tallied from 17 countries, suggest that cultural factors may influence patients' perception of their illness, and possibly even the results of clinical trials in different locations.
  • Researchers from UK studying prion diseases led by John Collinge, MD, MRC Prion Unit, University College London, have raised the possibility that Alzheimer's disease could be transmitted by surgical procedures.
  • Bariatric surgery is more effective than medical treatment alone for the long-term control of type 2 diabetes in obese patients, finds the first 5-year follow-up study, published in the September 5 issue of the Lancet, prompting a call for a rethinking of the diabetes care pathway with more emphasis on surgery. Overall, 50% of patients who underwent surgery showed sustained remission of type 2 diabetes (HbA1c less than 6.5%) without any medication upon 5-year follow-up, compared with none in the medically treated group.
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Inspirational Story

Once upon a time there was a child ready to be born. So one day he asked God: “How am I going to live on earth being so small and helpless?” God replied, “Among the many angels, I chose one for you. She will be waiting for you and will take care of you.”

“But tell me, here in Heaven, I don’t do anything else but sing and smile, that’s enough for me to be happy.” “Your angel will sing for you and will also smile for you every day. And you will feel your angel’s love and be happy.”

“And how am I going to be able to understand when people talk to me, if I don’t know the language that men talk?” “Your angel will tell you the most beautiful and sweet words you will ever hear, and with much patience and care, your angel will teach you how to speak.”

“And what am I going to do when I want to talk to you?” “Your angel will place your hands together and will teach you how to pray.”

“I’ve heard that on earth there are bad men. Who will protect me?” “Your angel will defend you even if it means risking its life.”

“But I will always be sad because I will not see you anymore.” “Your angel will always talk to you about me and will teach you the way for you to come back to me, even though I will always be next to you.”

At that moment there was much peace in Heaven, but voices from earth could already be heard, and the child in a hurry asked softly: “Oh God, if I am about to leave now, please tell me my angel’s name.”

“Your angel’s name is of no importance, you will call your angel: Mommy.”
eIMA Quiz
Bell's phenomenon can be seen in the following conditions except

a. Hemiplegia
b. Ramsay Hunt syndrome
c. Bell's palsy
d. Leprosy

Yesterday’s Mind Teaser: Hoigene's phenomenon is seen due to which of the following components?

a. Benzylpenicilloyl
b. Procaine penicillin
c. Crystalline penicillin
d. Benzathine penicillin

Answer for Yesterday’s Mind Teaser: b. Procaine penicillin

Correct answers received from: Daivadheenam Jella, Dr Poonam Chablani, VISWANATHA SARMA, Dr Avtar Krishan.

Answer for 13th September Mind Teaser: b. Combination of store and forward and video conference

Correct Answers received from: VISWANATHA SARMA, Dr Avtar Krishan.
Quote of the Day
You have to learn the rules of the game. And then you have to play better than anyone else. Albert Einstein
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Reader Response
Dear Sir, Very informative news. Regards: Dr Krishna
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Rabies News (Dr A K Gupta)
Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.
Press Release
National Food Fortification Policy- Need of the hour to tackle the alarming rise of Vitamin D deficiency in the country

Under its Rise & Shine campaign, the Indian Medical Association trains doctors in Delhi about the growing Vitamin D deficiency epidemic

A CME was organized in Delhi by the Indian Medical Association (IMA) to discuss the growing concern about the rising prevalence of Vitamin D deficiency amongst the Indian population. Vitamin D, known for its crucial role in calcium and bone metabolism, also plays an important role in protecting the body against cognitive disorders, diabetes, cancer and heart diseases like congestive heart failure and left ventricular hypertrophy. The deficiency is found to be present in over 80-90% of Indians causing a huge concern amongst the medical fraternity. The CME was an initiative under IMA’s Rise and Shine campaign and was attended by leading doctors of the city.

The Rise and Shine campaign is a National movement initiated by the Indian Medical Association under an unconditional educational grant from USV. It aims to create sensitivity in its 2.5-lakh members across 30 states and 1700 branches over a period of two years about the need to raise awareness of Vitamin D deficiency. The campaign also aims at providing soft skills training to all doctors on topics such as public speaking, managing patient records online, adapting to the new mobile app culture, how to break the news of death to a patient's family.

Addressing the media, Padma Shri Awardees Dr A Marthanda Pillai National President IMA and Dr KK Aggarwal Honorary Secretary General IMA in a joint statement said, “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. People with low circulating 25-hydroxyvitamin D (25(OH) D) have a higher incidence of high blood pressure and diabetes, conditions that are associated with heart diseases. The need of the hour is for the government to consider a National food fortification policy like those in place in the USA & UK since decades. In the meanwhile, people must be encouraged to consume vitamin D-rich foods, spend more time out in the sun, and take supplements as and when required.”

Adding to this, Dr Ambrish Mithal, Chairman, Division of Endocrinology and Diabetes, Medanta – The Medicity said, “Sunlight is a major source of Vitamin D and over 95% of the body’s requirements can be met from cutaneous synthesis from sun exposure. The UVB spectrum of sunlight (290-315 nm) leads to skin synthesis of vitamin D. Despite the presence of ample sunlight in the country most of the year, the fact remains that around 80 to 90% of the population is vitamin D deficient. There exists ample Indian data from across age groups and gender that establish the high incidence of vitamin D deficiency amongst Indians. The reasons for this include a predominantly sun-shy behavior of Indians, primarily a vegetarian diet, long-working hours in closed spaces, over-dependence on technology as modes of entertainment as opposed to engaging in outdoor activities and an overall lack of awareness. Patients at risk of low bone density, such as those with amenorrhea, chronic kidney or liver disease, inflammatory bowel disease, immobilized patients and pregnant or lactating women should be screened for vitamin D deficiency. The need of the hour is to raise awareness about this problem and possible prevention measures.”

Dr VK Arora, Hony Secretary, IMA South Delhi Branch said, “Adequate vitamin D levels help in the maintenance of healthy bones and teeth, have a protective effect against multiple diseases and conditions such as cancer, diabetes mellitus and multiple sclerosis and help regulate calcium and phosphorus absorption. The most accurate way to determine vitamin D deficiency is through a blood test. All doctors must notice the signs of vitamin D deficiency amongst their patients including vague aches and pains and counsel them on the importance of sunbathing, consuming Vitamin D rich food and taking necessary supplementation to cure the ailment. We are extremely happy that this initiative has been taken by the IMA National body to educate doctors and the public about this issue as early diagnosis and treatment can help save numerous lives.”

The IMA Rise and Shine campaign in addition to conducting CMEs and soft skill training workshops across 128 cities also comprises of a National daily SMS campaign for doctors, awareness through an active Facebook page, regular State and National Body meetings and public sensitization events.