February 16  2015, Monday
editorial
Lowering BP no help in acute stroke
Dr KK Aggarwal Use of antihypertensive drugs to lower systolic blood pressure by close to 13% as part of acute treatment of ischemic stroke did not reduce early mortality or disability compared with patients who did not receive antihypertensive therapy.

At 14 days after randomization, there were 683 events among patients who received early aggressive antihypertensive therapy versus 681 events in the control group and at 3 months, there were 500 additional events in the treatment arm versus 502 among controls, said Jiang He, MD, PhD, of Tulane University School of Public Health in New Orleans.

He reported the findings from China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) at the American Heart Association scientific sessions here and the results were simultaneously published online by the Journal of the American Medical Association. (MedPage)
eMedipics
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Health Check Up and CPR 10 Camp at NP CO-ED Sr Sec School Bapu Dham, New Delhi on 4th August 2014
News Around the Globe
  • A new study has shown that healthy older adults with elevated levels of amyloid-beta (Aß) and symptoms of anxiety had a greater decrease in various cognitive functions, including verbal memory and language, over time than those without anxiety symptoms. The study is published online in JAMA Psychiatry.
  • The inability to regulate emotion in patients with autism spectrum disorders (ASDs) appears to be due to impaired brain activity, suggests a new research published online in the Journal of Autism Developmental Disorder.
  • Autologous hematopoietic stem cell transplant seemed "unequivocally" superior to mitoxantrone in reducing imaging evidence of disease activity in patients with multiple sclerosis refractory to conventional therapy in a phase 2 randomized controlled trial published online February 11 in Neurology.
  • The US Food and Drug Administration has recently approved lenvatinib for refractory differentiated thyroid cancer (DTC) which has progressed despite radioactive iodine therapy.
  • HIV-positive patients with end-stage renal disease (ESRD) can safely receive kidney transplants from HIV-positive donors, suggests new research published online February 11 in The New England Journal of Medicine.
Dr KK Spiritual Blog
Always Respect Others Viewpoints

It is an old saying that one is proud of his or her own intelligence and somebody else’s partner and wealth. Most of the disputes occur when there is ego clash and that occurs when you want your point to be noticed by everybody. But remember that for every situation, invariably, there will be multiple opinions.

In one of my meetings, I asked my lifestyle students-cum-colleagues to imagine Rahul Gandhi as the Prime Minister of the country. Following were the views of various people:
  1. He is too young.
  2. He is immature.
  3. He is childish
  4. It will be failure of democracy
  5. He has no political will
  6. He has no strength for taking decisions
  7. He has no experience
  8. He is open minded
  9. He will bring youth to politics
  10. He has experienced team behind him
  11. He will bring a new approach to politics etc etc.
The message is very clear that everybody has his or her own perception and we should learn to respect them all.
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Cardiology eMedinewS
  • In a pooled analysis of five major clinical trials that randomized patients to receive implantable cardioverter defibrillators (ICDs) or usual care for primary prevention, ICD patients of all ages had improved survival. Additionally, age did not have any effect on rehospitalization after ICD implantation. The study was published in Circulation: Cardiovascular Quality and Outcomes.
  • A new observational real-world study, being presented at the American Stroke Association's International Stroke Conference 2015, suggested that using long-term, continuous cardiac monitoring with Reveal LINQ Insertable Cardiac Monitor (ICM) led to an AF detection rate of 12.2% at 182 days, which was nominally 37% higher than the rate observed in CRYSTAL AF at the same time point.
Pediatrics eMedinewS
  • Low levels of 25-OH vitamin D in childhood are associated with subclinical atherosclerosis over 25 years later in adulthood, reported a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.
  • A new study led by researchers at Washington University School of Medicine indicates that supplementary feeding for a set time period of 12 weeks makes an impact as an approach to malnutrition but may not be as important as treating children until they reach target weights and measures of arm circumference. The study is published online in the Journal of Pediatric Gastroenterology and Nutrition.
Make Sure
Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.
Medicolegal
What is the medicolegal importance of age up to 15 to 21 years?
  • 15 years of age: Even if a wife, a girl below 15 years of age cannot give valid consent for sexual intercourse.
  • 16 years of age: Any girl below 16 years of age cannot give valid consent for sexual intercourse. It will amount to rape even if the sexual intercourse was with consent.
  • Age 18–21 years:
    • In accordance with Indian Majority Act 1875, a person attains majority on completion of 18 years.
    • In accordance with Child Marriage Resistance Act, a female under 18 years and male under 21 years cannot contract marriage.
    • In accordance with Section 366 B of IPC, importation of any girl from Jammu & Kashmir or a foreign country under the age of 21 years for illicit intercourse is a criminal offence.
Dr Good Dr Bad
Situation: A patient with skin diseases needed circumcision and wanted to know whether mediclaim covers it or not.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Circumcision is excluded unless it is necessary for treatment of a disease.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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eMedinewS Humor
This older man was on the operating table awaiting surgery and he insisted that his son, a renowned surgeon, perform the operation as he was about to receive the anesthesia he asked to speak to his son. "Yes dad, what is it?"

"Don’t be nervous, son. Do your best and just remember, if it doesn’t go well and if something happens to me, your mother is going to come and live with you and your wife."
eMedi Quiz
All of the following are known risk factors for development of endometrial carcinoma except:

1. Obesity.
2. Family history.
3. Use of hormone replacement therapy
4. Early menopause.

Yesterday’s Mind Teaser: A case of gestational trophoblastic neoplasia belongs to high risk group if disease develop after:

1. Hydatidiform mole.
2. Full term pregnancy.
3. Spontaneous abortion.
4. Ectopic pregnancy.

Answer for yesterday’s Mind Teaser: 2.Full term pregnancy.
Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr U C Vasavada.
Answer for 14th Feb Mind Teaser: 2. Cesarean section.
Correct Answers receives: Raju Kuppusamy, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr U C Vasavada.
Twitter of the Day
Dr KK Aggarwal: Do not misuse Navratri diet By Dr k k Aggarwal http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Emotional intelligence begins when you feel what you feel without labels or evaluation.
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Does kissing a rabies patient call for anti-rabies vaccination?

Kissing a rabies patient may transmit disease because there may be contact with rabies patient’s saliva. Full post–exposure immunization must be given either by intramuscular (IM) or intradermal (ID) route.

If there are ulcers in the mouth of the exposed person, then rabies immunoglobulins (RIG) must be given by IM route.
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
IMA NEWS
IMA Initiative for Safe Sound
PREVENTION
  • Restriction of loud speakers
    • Duration / loudness.
    • Avoid loud speakers in open spaces
  • Crackers
    • Time restriction.
    • Use of noiseless fire crackers.
  • Traffic
    • Restrict extra and air horns
    • When giving fitness certificate, measure the noise levels of engines.
    • Discourage using horns as much as possible.
    • Enforce silent zones strictly.
Clinician – Patient Communication
Vinay Sharma, New Delhi
Breaking Bad News
  1. Ensure privacy
  2. Enquire whether the patient is aware of the seriousness of his/her condition
  3. Enquire whether the patient wants to know more details
  4. Warn that bad news is coming
  5. Empathize
  6. Summarize and plan for next action
"Our wounds are healed when we touch them with compassion." Buddha
Medscape Family Physician Lifestyle Report 2015
Do Burnout Family Physicians Have Less in Savings?

Burnout appears to have some association with family physicians' view of their assets—or lack of them. In the current report, 47% of burned-out family physicians consider themselves to have minimal savings to unmanageable debt, compared with a third of their less stressed peers. And 47% of burned-out family physicians believe that they have adequate savings or more, compared with 61% of their less stressed peers. These percentages are lower than those in the overall physician population, where over half (56%) of burned-out respondents and fully two thirds (66%) of non–burned-out ones reported more comfortable financial status (About 6% of physicians in both groups opted not to answer this question). These findings are essentially unchanged from the 2013 report.
Media
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Event
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Inspirational Story
Mom’s Last Laugh

Consumed by my loss, I didn’t notice the hardness of the pew where I sat. I was at the funeral of my dearest friend — my mother. She finally had lost her long battle with cancer. The hurt was so intense; I found it hard to breathe at times.

Always supportive, mother clapped loudest at my school plays, held a box of tissues while listening to my first heartbreak, comforted me at my father’s death, encouraged me in college, and prayed for me my entire life.

When mother’s illness was diagnosed, my sister had a new baby and my brother had recently married his childhood sweetheart, so it fell on me, the 27–year–old middle child without entanglements, to take care of her. I counted it an honor.

"What now, Lord?" I asked sitting in church. My life stretched out before me as an empty abyss. My brother sat stoically with his face toward the cross while clutching his wife’s hand.

My sister sat slumped against her husband’s shoulder, his arms around her as she cradled their child. All so deeply grieving, no one noticed I sat alone. My place had been with our mother, preparing her meals, helping her walk, taking her to the doctor, seeing to her medication, reading the Bible together. Now she was with the Lord. My work was finished and I was alone.

I heard a door open and slam shut at the back of the church. Quick footsteps hurried along the carpeted floor. An exasperated young man looked around briefly and then sat next to me. He folded his hands and placed them on his lap. His eyes were brimming with tears. He began to sniffle. "I’m late," he explained, though no explanation was necessary. After several eulogies, he leaned over and commented, “Why do they keep calling Mary by the name of ‘Margaret’?"

"Oh" "Because that was her name, Margaret. Never Mary. No one called her ‘Mary,’ I whispered. I wondered why this person couldn’t have sat on the other side of the church. He interrupted my grieving with his tears and fidgeting. Who was this stranger anyway?

"No, that isn’t correct," he insisted, as several people glanced over at us whispering, "Her name is Mary, Mary Peters." "That isn’t who this is, I replied." "Isn’t this the Lutheran church?" "No, the Lutheran church is across the street." "Oh." "I believe you’re at the wrong funeral, Sir."

The solemnest of the occasion mixed with the realization of the man’s mistake bubbled up inside me and came out as laughter. I cupped my hands over my face, hoping it would be interpreted as sobs.

The creaking pew gave me away. Sharp looks from other mourners only made the situation seem more hilarious. I peeked at the bewildered, misguided man seated beside me. He was laughing too, as he glanced around, deciding it was too late for an uneventful exit.

I imagined mother laughing. At the final "Amen," we darted out a door and into the parking lot.

"I do believe we’ll be the talk of the town," he smiled. He said his name was Rick and since he had missed his aunt’s funeral, asked me out for a cup of coffee. That afternoon began a lifelong journey for me with this man who attended the wrong funeral, but was in the right place.

A year after our meeting, we were married at a country church where he was the assistant pastor. This time we both arrived at the same church, right on time. In my time of sorrow, God gave me laughter. In place of loneliness, God gave me love. This past June, we celebrated our twenty–second wedding anniversary. Whenever anyone asks us how we met, Rick tells them, "Her mother and my Aunt Mary introduced us, and it’s truly a match made in heaven."
Wellness Blog
Cancer survival rates can increase the anxiety

One of the first questions many people ask when first diagnosed with cancer is their prognosis. They want to know whether their cancer is relatively easy or more difficult to cure. The doctor cannot predict the future, but often he/she gives the estimates based on the experiences of other people with the same cancer. Survival statistics can be confusing and frightening. Survival rates cannot tell about the situation specifically. The statistics may be impersonal and not very helpful.

Cancer survival rates or survival statistics indicate the percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use a five–year survival rate. For instance, the five–year survival rate for prostate cancer is 99 percent. That means that of all men diagnosed with prostate cancer, 99 of every 100 lived for five years after diagnosis. Conversely, one out of every 100 will die of prostate cancer within five years. Cancer survival rates are based on research that comes from information gathered on hundreds or thousands of people with cancer. An overall survival rate includes people of all ages and health conditions diagnosed with the cancer, including those diagnosed very early and those diagnosed very late. Only the treating doctor may be able to give more specific statistics based on the stage of cancer. For instance, 49 percent, or about half, of people diagnosed with early–stage lung cancer live for at least five years after diagnosis. The five–year survival rate for people diagnosed with lung cancer that has spread (metastasized) to other areas of the body is 2 percent. Overall and relative survival rates don’t specify whether cancer survivors are still undergoing treatment at five years or if they’ve become cancer free (achieved remission). The five year survival rates for all men is 47.3–66%% and for all women is 55.8–63%

Other terms
  • Disease–free survival rate: This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies.
  • Progression–free survival rate: This is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but their cancer hasn’t disappeared completely.
Quote of the Day
If you can’t excel with talent, triumph with effort. Dave Weinbaum
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Reader Response
 
  1. Nice guidelines . .. good initiative ... needs to be implemented .... drsudhirss
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Press Release of the Day
Can’t avoid anger: take aspirin

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute heart attack.

Episodes of anger are capable of triggering the onset of acute heart attack and aspirin can reduce this risk said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Angry people who cannot control their anger should ask their doctors to consider taking aspirin.

Quoting a Harvard study Dr Aggarwal said that doctors at the Deaconess Hospital, Harvard Medical School, Boston, interviewed 1623 patients (501 women) an average of 4 days after a heart attack.

The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of heart attack. The relative risk of heart attack in the 2 hours after an episode of anger was 23.

Regular users of aspirin had a significantly lower relative risk (1.4) than nonusers (2.9).

Anger in response to stress is also of particular importance for the development of premature heart attack in young men. An episode of anger may also trigger an acute heart attack in the next 2 hours.
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)