May 16  2015, Saturday
editorial
Two or more drugs may interact with each other
Dr KK Aggarwal Two or more prescription or over-the-counter drugs may interact negatively with each other and cause adverse drug reactions. To reduce the risk of drug reactions, one must adopt the following guidelines:
  • Read labels carefully
  • Understand the ingredients in each drug.
  • Understand any possible side effects they can cause.
  • Before taking a drug, speak with the doctor or pharmacist if you don't understand the drug label.
  • Make sure the doctor is aware of all the drugs you are taking.
  • Don’t mix pills.
  • Don’t break capsules into any food or drink.
  • Don’t take any medication with alcohol.
  • Don’t take medication at the same time as vitamins or mineral supplements.
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
IMA Nepal Medical relief Team Report
News
  • People over age 50 with persistent depression have double the risk for stroke compared with their nondepressed, age-matched counterparts, according to findings from a nationally representative cohort study of US adults.
  • A new study published online in JAMA Neurology has suggested that having celiac disease, an autoimmune disorder characterized by a sensitivity to gluten, more than doubles the risk for neuropathy.
  • For entecavir-resistant hepatitis B virus (HBV) infection, tenofovir alone appears to be as effective as a tenofovir/entecavir combination, suggests new research published online in Gut.
  • The American College of Obstetricians and Gynecologists (ACOG) maintains that the preponderance of scientific evidence indicates that fetuses do not likely experience pain before the third trimester.
  • The US House has passed a Republican-sponsored bill that would outlaw abortions at 20 weeks of gestation based on the disputed premise that fetuses that young can experience pain. The vote of 242 to 184 closely followed party lines.
Your Daily Sleep Guide (Harvard)
This morning-to-evening, sleep-promoting schedule may help you get the rest you need.
Morning
7:00 a.m.
Wake up at the same time each morning, even on weekends.
8:00 a.m.
Limit yourself to just one cup of caffeinated coffee at breakfast, or drink decaf. Too much caffeine in the morning can stay with you until bedtime. (If you're used to drinking several cups of coffee a day, wean yourself off it gradually over a few weeks.)
9:00 a.m.
Get outside for a 30-minute walk. Both exercise and morning sunlight can help you sleep better.
Evening
6:00 p.m.
Eat a light dinner. A heavy meal can lead to heartburn, which can keep you awake. Avoid caffeinated tea, coffee, and soda, as well as alcohol and chocolate.
9:15 p.m.
Turn off your TV, computer, cell phone, and tablet at least 30 minutes before bed. They stimulate the brain. Read a book (not on a tablet), take a warm bath, or listen to soft music to help your body and mind unwind before bed.
9:45 p.m.
Get your bedroom ready for sleep. Dim the lights, close the curtains, make sure the temperature is cool and comfortable, and cover your alarm clock so you can't see the time if you do wake up in the middle of the night.
10:00 p.m.
Use the bathroom.
10:15 p.m.
Lights out. Try to go to bed at the same time every night. If you can't fall asleep in 15 minutes, leave the bedroom. Sit somewhere quiet, like the couch, and read a book for 15-20 minutes or until you get sleepy. Then go back to bed.
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Dr KK Spiritual Blog
Eating foods in their natural form is always better

An elephant is obese, eats sugarcane and yet does not develop diabetes. I am sure if he is given 10% sugar drinks everyday or made to eat 30% sugar containing sweets, he too would end up with diabetes.

The natural form of sugarcane is eating sugarcane in its raw form, the second form is sugarcane juice, third is gur (jaggery), fourth is shakkar and fifth is white sugar.

The more you eat foods in their natural form, more the health benefits you will get from that food.

Food is Brahmin and contains the same consciousness as you have. Refined food loses its consciousness and is not beneficial to the health.

Similarly, wheat flour with bran is better than flour without bran, which is better than suji, which is better than maida. Maida (refined flour) is the final product and if taken every day, it can cause heart disease, diabetes and high blood pressure.
Cardiology eMedinewS
  • Testing hand-grip strength could be a cheap and simple way of identifying people at increased risk for heart attack, stroke and premature death, according to findings from the Prospective Urban-Rural Epidemiology (PURE) study published online May 13 in the Lancet. Every 11-pound decrease in grip strength was associated with a 16% increased risk of death from any cause, the investigators found. Each decrease was also tied to a 17% raised risk of heart-related death or death from non-heart causes. And, every 11-pound drop in grip strength was also associated with a 9% increased risk of stroke and a 7% higher risk of heart attack. (Medline)
  • If they have been on a new oral anticoagulant (NOAC) for at least a month, patients scheduled for ablation of atrial fibrillation can stay on the NOAC during the procedure, without heparin bridging, and not undergo transesophageal echocardiography (TEE) to screen for atrial thrombus, suggests a multicenter cohort study presented at the Heart Rhythm Society 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Children born to older men, but not to older women, may have heightened risk of developing blood cancers later in life, especially if they also have no siblings, suggests a study published online in the American Journal of Epidemiology.
  • For children with a high-risk form of Wilms' tumor, the augmentation of standard therapy with additional agents may improve outcomes, suggest two new studies presented at the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting.
Make Sure
Situation: A patient with third attack of dengue develop shock

Reaction: Oh my God! Why he was not hospitalized?

Lesson: Make Sure to remember that the second attack of dengue is more serious than the first, and third is more serious than second attack.
Dr Good Dr Bad
Situation: A patient with flu-like symptoms tested positive for dengue antigen.
Dr. Bad: This cannot be dengue
Dr Good: It is dengue
Lesson: Dengue can present with flu-like symptoms.

(Copyright IJCP)
Inspirational Story
Power of Thought: Hitting Unseen Target

Yogi Raman was a true master of the art of archery. One morning, he invited his favorite disciple to watch a display of his skill. The disciple had seen this more than a hundred times before, but he nevertheless obeyed his teacher.

They went into the wood beside the monastery and when they reached a magnificent oak tree, Raman took a flower, which he had tucked in his collar and placed it on one of the branches.

He then opened his bag and took out three objects: his splendid bow made of precious wood, an arrow and a white handkerchief embroidered with lilacs.

The yogi positioned himself one hundred paces from the spot where he had placed the flower. Facing his target, he asked his disciple to blindfold him with the embroidered handkerchief.

The disciple did as his teacher requested.

‘How often have you seen me practice the noble and ancient sport of archery?’ Raman asked him.

‘Every day,’ replied his disciple. ‘And you have always managed to hit the rose from three hundred paces away.’

With his eyes covered by the handkerchief, Yogi Raman placed his feet firmly on the ground, drew back the bowstring with all his might – aiming at the rose placed on one of the branches of the oak tree – and then released the arrow.

The arrow whistled through the air, but it did not even hit the tree, missing the target by an embarrassingly wide margin.

‘Did I hit it?’ said Raman, removing the handkerchief from his eyes.

‘No, you missed completely,’ replied the disciple. ‘I thought you were going to demonstrate to me the power of thought and your ability to perform magic.’

‘I have just taught you the most important lesson about the power of thought,’ replied Raman. ‘When you want something, concentrate only on that: no one will ever hit a target they cannot see.’
Events
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eMedi Quiz
Which of the following is not fermented by colonic bacteria?

a) Lignin
b) Pectin
c) Cellulose
d) None of above

Yesterday’s Mind Teaser: : A recent fitness walk left you breathless, and you’ve been having trouble sleeping. You’ve also been dealing with an upset stomach and occasional dizziness. These could be symptoms of:

A. Depression.
B. Heart disease.
C. Diabetes.
D. High blood pressure.
E. All of the above.

Answer for yesterday’s Mind Teaser: B. Heart disease.

Correct Answers received from: Dr Shangarpawar, Dr K C Sharma, Dr Jainendra Upadhyay, Tukaram Pagad, Dr A K (jain) Diwaker, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella, Dr Prabodh K Gupta, Dr Avtar Krishan, Dr Madhusudhan G.

Answer for 14th May Mind Teaser: B. No, skin-cancer rates and skin-cancer deaths are on the upswing

Correct Answers received: Dr Shangarpawar, Dr K C Sharma, Dr Jainendra Upadhyay, Dr Poonam Chablani, Raju Kuppusamy, Daivadheenam Jella, Tukaram Pagad.
Quote of the Day
Fill the brain with high thoughts, highest ideals place them day and night before you and out of that will come great work. Swami Vivekananda
eMednewS Humor
A housewife goes to an optometrist

A housewife goes to an optometrist and says: Lately I’m seeing grocery items smaller than they appeared till recently. I think I need a change of my eyeglasses.

The optometrist after examining her eyes for refraction and finding no change in dioptric values observes: Manufacturers of grocery items, rather than increasing the prices, have made the packings smaller; and there’s no need for you to change your eyewear.
Rabies News (Dr A K Gupta)
What is "paralytic form" of rabies in animals?

Paralytic or dumb rabies refers to animals in which the behavioral changes are minimal or absent and the disease is manifested mainly by paralysis. This is first manifested by paralysis of the throat and masseter muscles, often with profuse salivation and inability to swallow. Dropping of lower jaw is common in dogs. The animals are not vicious and rarely attempt to bite. The paralysis progresses rapidly to all parts of the body leading to coma and death follows in a few hours.
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IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
eIMA News
IMA,IJCP,HCFI
Greetings from IMA TNSB: You have taken very good initiative by giving Legal Notice to the makers of GABBAR. The movies like these suddenly affect the dignity of our Medical Profession. On behalf of Tamil Nadu IMA we give full support and cooperation:
Gabbar is Back
Dear Sir / Madam

I have watched with interest the movie “Gabbar is Back.” It certainly is a wrong or in the least somewhat exaggerated portrayal of average medical practice. Many of the events in entirety are highly implausible really on the verge of impossibility. However one has to understand that it is just a movie where fiction is very different from facts almost alien to it. We know all about hero rising from dead and jumping around a tree singing song with a heroine changing clothes at each turn. 

My point is that we as Medical Community should not take a hysterical view of it because that way we seem to be siding with wrong and the corrupt. We should just gracefully say that the events depicted in the movie are not possible rather than asking for banning the movie or suing the movie personnel.  On the other hand we should put forth our view that depicting physicians in wrong light, in this way, highly increases the physical risk they are exposed to with the consequences ranging from defensive medicine to even refusal to be posted in emergency wards both of which are harmful to community at large, on long term.  Because there is a huge risk that some “Avenger”, encouraged by the movie will be tempted to take “law into his own hands.” At the same time we should indeed understand that there is a huge perception in public that doctors “overcharge” and treat much beyond the patient is already dead. We should take the opportunity to sensitize ourselves to these facts and work towards dispelling these myths by improving the communication between us and the patients, being transparent and forthright. Finally, I think we should not go against an icon of anti-corruption (who is so adored by masses) but take a firm and dignified stand against the over-exaggeration.

Sir, this is my considered opinion and many like me. Thanking You, Prof Sundeep Mishra
IMA HQ is supporting the National Clean India movement by Alkem Chronic taking place across 135 cities on Saturday, May 23rd, 2015.   Over 20,000 doctors and 3 lakh patients to join Clean India movement Alkem Chronic & IMA in 135 cities. A clean India will deliver a healthy India; join the mass cleanliness drive in your city on Sat, May 23 from 9:30 – 11 am.
To know about the assembly points for the Mission Clean India initiative by Alkem & IMA please visit: 

http://module.ima-india.org/ima/News_Release_29_Final_Location.xlsx
DMC/EC(Misc./2/2015/244452
1st May,2015

The Delhi Medical Council held that the advertisements published by Dr. RKA in Ist Edition of Hindustan Doctor’s Yellow Pages 2013,   was in violation of Regulation 6.1.1  of Indian of Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002, however, since, Dr. RKA expressed regret and has given an undertaking that he will not indulge in such activities in future, he is advised to be careful in future and refrain from indulging in such activities.

(Dr. Girish Tyagi) Secretary
Sonal Namaste
Preventive measures for acute diarrhea among children in resource– limited settings include breastfeeding, consumption of safefood and water, adherence to hygienic practices, and vaccination against rotavirus infection.
SEND PENDING EMERGENCY BILLS TO STATE: MCI

By Jyoti Shelar, Mumbai Mirror | May 15, 2015, 12.01 AM IST

The Medical Council of India (MCI) has asked doctors from across private hospitals to send unpaid bills of emergency cases directly to the state. With a rise in cases of emergency patients not clearing their bills, the statutory medical body has asked the Indian Medical Association to take up the responsibility of getting the bills cleared from the respective state governments.

"We have received an advisory from the MCI. We have already sent circulars to over 2.5 lakh doctors asking them to start billing the state government in cases where emergency patients fail to pay their bills," said IMA president Dr KK Aggarwal.

The advisory by MCI's ethical committee stated that "in case of emergency situations, doctors should attend to the patients and treat them with proper care. With regard to the financial aspect, the state should develop a mechanism to reimburse hospitals as per rates."

The advisory also states if doctors fail to deliver proper treatment immediately to such patients, action will be taken against them by the state medical council and/or the MCI under provisions of the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations, 2002.

Aggarwal added that doctors have reported a spurt in cases where patients often refuse to pay after treatment is offered in emergency cases. A Supreme Court directive in the case of Savelife Foundation v/s Union of India had made it mandatory for doctors to offer emergency treatment first without considering anything else.

"The Supreme Court directive only emphasised on treatment but there was no clarity on how the doctor can recover the amount spent after treatment. Therefore IMA had approached the MCI for clarity."

He also said that the doctors can now start sending bills to the state and the IMA will take full responsibility to get it reimbursed. "Till now, everything was vague. Now with the MCI advisory, we have clarity. Once the doctors start sending their bills, the state will be forced to device a mechanism to pay off," he said, adding that Article 21 of the Constitution clearly states that health is the responsibility of the state.

@ IMA comments: MCI has not said the first para. MCI has only said that "in case of emergency situations, doctors should attend to the patients and treat them with proper care. With regard to the financial aspect, the state should develop a mechanism to reimburse hospitals as per rates."

IMA stand is that doctors should start sending the bills to the government and the state IMA should follow with the government to come out with a defined policy.
IMA Nepal Medical relief Team Report
To,
Dr Chetan Patel
Chairman
Disaster Management Group of National IMA
Subject- Brief of “Disaster management Group team to Nepal

Dear Sir,
Extremely thankful for sending 3 member team, representing the Indian Medical Association, to Nepal as Earthquake Medical Relief team. This gesture of National leadership is highly appreciable, to act as knee jerk response, an answer to the natural disaster.

The group consisted of following members.

Dr Anoop Verma, Pediatrician, Raipur (as team leader)

Dr Ruhi Deol, Gynecologist, Ludhiana

Dr Dilip Sheth, As General Practitioner, Nadiad (at present in London)

The group met at Delhi airport on 5th May and reached to Nepal on 5th.

The group was given the task to visit the “ Bahktpur Hospital” at Dist Bhaktpur, Nepal. This was a district hospital more than a century old. The group contacted the Chief Medical Suprintendent of the hospital Dr Hari Bahadur KC.

The hospitality and gesture of the management was excellent. We were given the charge to see the out patient department patients along with the Local doctors of the hospital.

The group worked for 3 days 6th, 7th and 8th May and at around 500 patients were seen at Bhaktpur hospital The patients were having illness like URI, High fever, ARI, DVD, Typhoid, UTI, Skin diseases, Vitamin deficiency, Hypertension, antenatal cases, assisted LSCS, gynae problems, orthopedic problems etc.

A visit to Kapilakot PHC (a PHC with very good infrastructure but managed by health workers) was made by Dr Roohi Deol along with Dr Jamuna Kiran local Gynaecologist, to see the disaster affected patient, around 230 patients were examined, it was satisfying and wholesome experience.

I am thankful to Mr Harsh Garg, Nepal Local coordinator for rendering a great help to the team. We wish to extend heartfelt gratitude to you sir, as National Chairman of IMA Disaster Management, for your constant concern and guidance all the time to the group. Big Kudos to our National President Dr Marthanda Pillai and Dr K.K.Agrawal, National Secretary IMA for exhibition of excellent leadership in such a ferocious and ruthless situation of Nepal, a real challenging job to provide medical relief to earthquake affected areas, which was unpredictable and devastating.

Please find the some pictures as attachment.

Jai IMA
Dr Anoop Verma
Pediatrician
Team Leader, Disaster Management Group of IMA to Nepal.
Raipur Chhattisgarh
Team IMA at Nepal
Dr. Sujit Damodar Adsul, Anesthesiologist

On day 6, I was taken to Norvik Multi specialty Hospital to examine a patient, who had a head injury, had his craniotomy done and was on the ventilator. After a detailed discussion and examination of the patient, we came to conclusion he needed a Tracheostomy.

On day 7, we were sent along with the BK Eye foundation team to a remote area near Kathmandu where we again treated several victims and dispensed medicines. I left Nepal the next morning and returned to Delhi handing over the work to the second team of doctors sent by the IMA.
Media
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Wellness Blog
Do not ignore breakfast

Taking a good breakfast made of carbohydrates and lean protein, can help lessen cravings and hunger during the rest of the day, which can lead to significant weight loss.

A research by Dr. Daniela Jakubowicz, a clinical professor at Virginia Commonwealth University and an endocrinologist at the Hospital de Clinicas Caracas in Venezuela has shown that sedentary, obese women lost almost five times as much weight on the "big breakfast" diet as did women following a traditional, restrictive low–carbohydrate diet. 

While treating obese people we need to treat carb cravings and hunger.

On waking up in the morning, the body is primed to look for food. The metabolism is revived up, and levels of cortisol and adrenaline are at their highest. The brain needs energy right away, and if one doesn’t eat or eats too little, the brain needs to find another fuel source. To do this, it activates an emergency system that pulls energy from muscle, destroying muscle tissue in the process. Then when you eat later, the body and brain are still in high–alert mode, so the body saves energy from the food as fat.

Also the levels of the brain chemical serotonin are highest in the morning and the craving levels are at the lowest and you may not feel like eating. As the day wears on, serotonin levels dip, and you get cravings for chocolate or cookies, and such similar foods. If you eat these foods, your serotonin levels rise, and your body begins to associate good feelings with them, creating an addictive cycle. 

The high protein, carbohydrate mix in breakfast gives the body the initial energy boost it needs in the morning. Throughout the rest of the day, the meals are made up of protein and complex carbohydrates, like vegetables. Because protein is digested slowly, you won’t feel hungry. 

If you have to eat chocolate or candy, eat them in the morning because having them when serotonin levels are high, they won’t taste as good, and the brain won’t feel the same serotonin boost. This will eventually help cut down on cravings. 

Eating breakfast with high glycemic foods may be harmful. After eating cereal or a doughnut, the blood sugar and insulin levels spike. Once that blood sugar is used up, you’ll still have excess insulin circulating, which makes you hungry and makes you crave carbohydrates.
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Reader Response
  • Respected Dr KK Agarwal sir, the story regarding the auction of the painting brought tears and ablution of all the pent up feelings. God bless you and thank you. This story is really about     life and its meaning. Vandita Bansal, w/o Dr UC Bansal.
  • Dear Dr KK, we too are victims of this apathy. Recently, my wife underwent a Breast Reconstructive Surgery at RGCI, although she has Star Health Insurance, we had to cough out lakhs. Her treatment still continues and we pay through nose. I do not know what happens to the Aam Aadmi. God bless India and the dacoits here.  Sorry to put it, being an Ethics loving Professional Colleague.  Dr NK Bhatia. 
  • Though this can be said to help hospitals also, it is an excellent step by IMA HQs and President and HSG to make a difference to us medicos by allowing more ethical reimbursements and allows increasing the returns from our practice. This is very important to increase the private sector returns on skills and experience so that more people start learning and providing all sorts of skilled techniques and more patients can benefit. Yes, we also need a mechanism for checking the need based provision of such services and to penalize unnecessary and unwanted surgeries also. Thanks a million to all at IMA HQs for starting this and hopefully we will see many more such steps as the value of skills right now in India in the medical field is not enough compared with many other fields in India and if compared with the rest of the world; it is pathetic in many cases. Kind regards, Dr Girish Kumar
  • Me and my doctor friends have seen the movie and haven't found the content derogatory towards all doctors. Hence we do not support IMA's actions of seeking removal of particular segment of the movie or ban on the movie. Also we do not support the demands for apology towards all the doctors. Because we believe IMA is an association for ensuring excellence in medicine not a collectivist organization to "protect sentiments" of all the doctors on topics unrelated to this profession. Dev Kulkarni
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Press Release
Depression, severe mental illness and loneliness not heart friendly

Depression, severe mental illness and loneliness are linked to heart disease and dementia, said Padma Shri, Dr. B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association (IMA).

A 3-year study by Dr Jesse Stewart, formerly of the University of Pittsburgh School of Medicine found a correlation between depression and hardening of the arteries. The arteries of those who are most depressed were narrowed twice as much as those who were least depressed, in the study. Hardening of the arteries is a precursor to a heart attack or stroke.

Depression may also upset the body’s regulation of glands that release chemicals governing energy level and growth, and alter the functioning of cells responsible for blood clotting.

Hardening of the arteries leads to an overreaction of the immune system and the resulting inflammation is known to release chemicals that can cause the disease.

Quoting a British study, Dr Aggarwal said that severely mentally ill people are more than three times as likely to die from coronary heart disease and stroke as those not suffering from mental illness. Mental illness more than doubled the risk of dying from heart disease for people up to the age 75. The risk of dying from heart disease was even higher among those taking antipsychotic medications.

A persistent feeling of loneliness among the elderly doubles the risk of developing Alzheimer's-like symptoms compared to those who felt connected to others.