February 17  2015, Tuesday
editorial
Who needs anti-viral drugs in swine flu?
Dr KK Aggarwal Facts
  1. In the United States, 0.3% of all cases require admissions.
  2. The mortality rate of flu pandemic is 0.12 deaths per 100,000 population.
  3. Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years
  4. Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features:
    • Flu requiring hospitalization
    • Progressive, severe, or complicated flu
    • Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)
    • Swine flu at high risk for complications:
      • Children <5 years particularly those <2 years
      • Elderly =65 years
      • Pregnant women
      • Women up to 2 weeks postpartum
      • Residents of nursing homes and other chronic care facilities
      • Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases and morbid obesity.
  5. Severity of flu
    • Asymptomatic swine flu: Many contact illnesses may pass off without symptoms. In all 19 percent had serologically confirmed infection and 28 percent of those who were infected may remain asymptomatic.
    • Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)
      • Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting
      • No shortness of breath
      • Little change in chronic health conditions.
    • Progressive illness. Requires hospitalization
      • Above symptoms plus
      • Chest pain
      • Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)
      • Low blood pressure
      • Confusion, altered mental status
      • Severe dehydration
      • Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions
    • Severe or complicated illness requires hospitalization
      • Signs of lower respiratory tract disease
      • Low oxygen requiring supplemental oxygen
      • Pneumonia on x-ray
      • Brain involvement
      • BP lower than 80, organ failure
      • Heart involvement
      • Persistent high fever and other symptoms beyond 3 days
eMedipics
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Sameer Malik Heart Care Foundation Fund Memorial Day
News Around the Globe
  • A new study claims to have found evidence of a link between exposure to air pollution and increased risk of suicide. The study is published in The American Journal of Epidemiology. People exposed to increased levels of air pollution short term, especially men and middle-aged adults, were found to have a higher suicide risk.
  • A new study has shown that a drug already approved to treat epilepsy – retigabine - may also be effective in reducing brain damage for individuals who have ischemic stroke. The study is published in The Journal of Neuroscience.
  • Treatment with silibinin, a constituent of milk thistle seeds, may relieve symptoms of Cushing Disease, suggests a new study published in Nature Medicine.
  • A new study published in the journal ACS Applied Materials and Interfaces has shown that collagen from tilapia fish may offer a safer alternative for wound healing in comparison with collagen from cows and pigs.
  • Even at levels considered to be safe, mercury exposure may be a risk factor for autoimmune disorders among women of childbearing age, suggests a new study published in Environmental Health Perspectives.
Dr KK Spiritual Blog
Think positive and think different

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

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

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

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

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

In other two cases, one was suffering from terminal prostate cancer and the other had terminal brain cancer. The first one lived for 10 years and the other is still alive.

Both were told that they had a very early cancer and that was cured by a surgery.

When you think different, it creates creativity and when it is with positive attitude, it is accepted by all.
Event
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Cardiology eMedinewS
  • Early aggressive treatment of high blood pressure in ischemic stroke patients seems effective in terms of achieving pressure control, but clinical outcomes appear to be no better than in similar patients in whom blood pressure lowering agents were withdrawn at hospital presentation, suggests new research presented at the American Heart Association's International Stroke Conference.
  • Blood pressure-lowering treatment among patients with type 2 diabetes is associated with a lower risk of cardiovascular disease (CVD) and heart disease events and improved mortality, suggested a study published in JAMA.
Pediatrics eMedinewS
  • Positive relations between youth and their parents can be key to preventing adolescent suicide attempts, suggests new research published online in Suicide and Life-Threatening Behavior.
  • A new study has found that more than 40% of adolescents whose urine tested positive for marijuana had symptoms consistent with narcolepsy - extreme bouts of sleepiness. The study was published in the Journal of Clinical Sleep Medicine.
Make Sure
Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

What is exhumation?


In case of foul play, controversy or dispute related with any unnatural or natural death of a person or persons or death allegedly due to any criminal action and where the cremation had been already performed without any legal investigation and postmortem examination or the reliability of the previous investigation or postmortem examination is proved prima facie doubtful, exhumation of the body is done for further investigation.
  • The word exhumation literally means ‘out of ground.’ The word exhumation comes from Latin words ex meaning ‘out of’, and humus, meaning ‘ground.’
  • Exhumation is necessary, when the first post–mortem was inadequate, and it is thought that a second post–mortem may bring some more facts to light means exhumation combined with doing a second meticulous post–mortem.
  • The dead body can only be exhumed when there is a written order from executive magistrate or a higher Court of Law of the land.
  • In exhumation, the concerned police official should approach the appropriate government hospital in writing along with the order of exhumation to constitute a medical board of at least three qualified and experienced doctors.
  • Material found in exhumation/spot and further examination should be done as per law.
  • Resting places and the norm of many cultures is that the dead should not be disturbed. However, for a variety of reasons, they are disturbed through the process of exhumation.
(Ref: Anil Aggrawal’s Internet Journal of Forensic Medicine and Toxicology Volume 2, Number 2, July–December 2001)
Dr Good Dr Bad
Situation: A patient with Mediclaim needed chemotherapy. Dr. Bad: Get admitted for 24 hours.
Dr. Good: Take it as day care.
Lesson: Admission limit of 24 hours is not applicable for chemotherapy, radiotherapy etc.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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Twitter of the Day
Dr KK Aggarwal: Diabetes is a progressive disease http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Recurrent anxiety can have a devastating toll on all aspects of our life. How to deal with anxiety? http://tinyurl.com/mboexab
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.
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
Sonal Namaste

Hand hygiene refers to either handwashing with soap and water or the use of alcohol-based gels or foams that do not require the use of water. Hand hygiene is the single most important measure to reduce transmission of microorganisms from one person to another or one site to another on the same patient
IMA Initiative for Safe Sound (contid...)
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.
Industry and construction
  • Employees should use ear plugs / ear muffs
  • Acoustic barriers
  • Maximum sound should be 75 decibels
  • Check hearing periodically
What IMA Safe Sound Initiative can do
  • IMA Safe Sound Initiative Chapters at State and District levels
  • Involve prominent public persons like Teachers, Lawyers, Journalists, Businessmen, Artists, Religious leaders and Politicians
Medscape Family Physician Lifestyle Report 2015
Are Burnout Family Physicians Religious/Spiritual?

According to a 2014 Gallup Poll, 30% of Americans say that religion is largely out of date, a trend that has increased steadily since the 1950s, when only 7% held this view. In our Medscape poll, instead of asking for specific religious affiliations, we wanted to know whether family physicians have a spiritual belief, regardless of active participation. There were no differences in responses from the burned-out and non–burned-out groups, but family physicians on the whole are less religious/spiritual than the general population. When asked whether they have any religious or spiritual belief, more than 80% of all family physicians reported that they do (85% of non–burned-out family physicians and 81% of those burned out). Less than 20% had no belief system. Some studies have reported that spirituality may be protective against burnout, but the Medscape survey found no association.
Media
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Inspirational Story

The Three Dolls

A sage presented a prince with a set of three small dolls. The prince was not amused. "Am I a girl that you give me dolls?" He asked.

"This is a gift for a future king," Said the sage. "If you look carefully, you’ll see a hole in the ear of each doll." The sage handed him a piece of string. "Pass it through each doll." He said.

Intrigued, the prince picked up the first doll and put the string into the ear. It came out from the other ear. "This is one type of person," said the sage, "whatever you tell him, comes out from the other ear. He doesn’t retain anything."

The prince put the string into the second doll. It came out from the mouth. "This is the second type of person," said the sage, "whatever you tell him, he tells everybody else."

The prince picked up the third doll and repeated the process. The string did not come out. "This is the third type of person," said the sage, "whatever you tell him is locked up within him. It never comes out."

"What is the best type of person?" Asked the prince. The sage handed him a fourth doll, in answer. When the prince put the string into the doll, it came out from the other ear.

"Do it again." Said the sage. The prince repeated the process. This time the string came out from the mouth. When he put the string in a third time, it did not come out at all.

"This is the best type of person," said the sage. "To be trustworthy, a man must know when not to listen, when to remain silent and when to speak out."
Wellness Blog
High fat diet, prostate cancer prone

Diets high in saturated fat increase the risk of prostate cancer. As per a report from University of Texas M. D. Anderson Cancer Center in Houston published in the International Journal of Cancer:
  • Men who consume high saturated animal fat diet are two times more likely to experience disease progression after prostate cancer surgery than men with lower saturated fat intake.
  • There is also shorter "disease–free" survival time among obese men who eat high saturated fat diet compared with non–obese men consuming diets low in saturated fat.
  • Men with a high saturated fat intake had the shortest survival time free of prostate cancer (19 months)
  • Non–obese men with low fat intake survived the longest time free of the disease (46 months).
  • Non–obese men with high intake and obese men with low intake had "disease–free" survival of 29 and 42 months, respectively.
Take home messages
  • High saturated fat diet has been linked to cancer of the prostate
  • Reducing saturated fat in the diet after prostate cancer surgery can help reduce the cancer progression.
  • Cancer prostate has the same risk factors as that of heart blockages and both are linked to high saturated fat intake.
  • With an increase in number of heart patients, a corresponding increase in prostate cancer patients is also seen in the society.
Quote of the Day
Coming together is a beginning. Keeping together is progress. Working together is success. Henry Ford
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Reader Response
 
  1. Sir I most humbly suggest that chili powder or alike, be made mandatory ingredients in all tobacco products. Dr. Ajoy Kumar Singh, Chairman IMA AMS.
  2. Sir, half of the investigations have to be advised for patient satisfaction. Practicing medicine in medical college and private world are two different things. Leaving aside the commercial interest, investigations are advised for legal safety and social safety. Vivek Kumar, Varanasi.
  3. Dear Dr KK Aggarwal, Vanakkam, Thanks for the opportunity to share our views. As the deadline was hardly a day I could do only just share my views on few. LET IMA'S LIGHT ALWAYS SHINE through your efforts to make our IMA RISE & SHINE! Rtn. PHF. Dr LVK Moorthy.
IMA Videos
News on Maps
IMA Humor
There was this man driving along in his car when he suddenly got a flat tire. When he pulled over he was at the fence of a mental hospital. When he got out of the car one of the patients came to the fence and asked "Can I help you?" And the man said "No, I need to figure out how to make it home with only 2 lugs on this wheel." The patient asked again "Are you sure you do not need any help?" And the man said "No." The man tried to figure it out when all of a sudden the patient said "If I were you I would take one lug off the other 3 wheels and put them on that wheel and you should be able to get home." The man asked "How did you think of that?" The patient replied "I am in here because I'm crazy not because I'm stupid."
eMedi Quiz
A 10-year-old girl presents with swelling of one knee joint. All of the following conditions can be considered in the differential diagnosis, except:

1. Tuberculosis.
2. Juvenile rheumatoid arthritis.
3. Haemophilia.
4. Villonodular synovitis.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4. Early menopause.

Correct Answers received from: Dr K Raju.

Answer for 15th Feb Mind Teaser: 2.Full term pregnancy.

Correct Answers receives: Dr Avtar Krishan.
Press Release of the Day
Sameer Malik Heart Care Foundation Fund an initiative by the Heart Care Foundation of India spreads health and happiness on its first anniversary

Over 300 beneficiaries of the fund come together with their families to celebrate the Sameer Malik Memorial day

Sameer Malik Heart Care Foundation Fund – an initiative by the Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease free nation today celebrated its first year anniversary. The Sameer Malik Memorial day saw over 300 beneficiaries of the fund coming together with their families for a lecture by the NGO’s president Dr. KK Aggarwal on health and wellness, a yearly health check up and an afternoon filled with fun, games and food.

Sameer Malik Heart Care Foundation Fund was launched a year back with the basic ideology of ensuring that no person dies of a heart disease just because of their economic background. Any person suffering from heart disease, in need of surgical intervention and who cannot otherwise afford treatment can apply for the benefits of the fund by calling its helpline number +919958771177.

Speaking on the occasion, Padma Shri Awardee, President Heart Care Foundation of India and the Honorary Secretary General of IMA, Dr KK Aggarwal said, “The incidence of congenital heart diseases is very high in India. In fact every year 1.5 lakh children are born in India with a congenital heart defect, a condition that is curable if surgical intervention is done at the right age. Similarly rheumatic heart disease is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. We at Heart Care Foundation of India believe that through the right kind of awareness, timely intervention and financial support, majority of the heart diseases can be prevented and cured. We have successfully saved over 300 lives in the past year through the Sameer Malik Heart Care Foundation of India and our aim is to double this number by the second year. We thank the Malik family for all their support.”

Advances in diagnostic methods and treatment modalities have greatly reduced the mortality associated with congenital heart diseases or rheumatic heart diseases in the developed countries. Surgery has also become much safer. But, in a developing country like India many patients, especially from the underprivileged section of the society die, as they still do not have access to treatment facilities.

In the past one year, Sameer Malik Heart Care Foundation Fund has successfully helped 279 patients from the underprivileged section of the society. It has supported surgeries of 103 patients and averted surgeries of 176 people. The breakup of the surgeries includes 43 CHD, 18 Valve Replacement, 11 Stent, 14 Bypass surgeries, 4 pacemakers and 10 Angiography. All surgeries were performed at the best hospitals of Delhi NCR. 38 surgeries were done in Medanta – The Medicity, 42 surgeries were done in National Heart Institute, 7 surgeries were done in G.B. Pant Hospital, 4 surgeries were done in in Ram Manohar Lohia Hospital, 3 surgeries were done in Fortis and 9 surgeries were done in All India Institute of Medical Sciences.

Addressing the audience, Mr Deep Malik, Advisor of the fund said, “The fund is an initiative of the Heart Care Foundation of India started in memory of my brother Sameer Malik, an unfortunate victim of a sudden cardiac death at a young age. The Foundation was launched with the aim to ensure that no person dies of a heart disease just because he or she cannot afford treatment. I congratulate Dr. KK Aggarwal and his team for helping save the lives of 300 patients. We hope that we can continue to save many more lives in the future”

The helpline number +919958771177 for the Sameer Malik Heart Care Foundation Fund is open from Monday to Saturday from 9 AM to 5 PM. Individuals who wish to apply online can download the application form from the website, http://heartcarefoundationfund.heartcarefoundation.org/. An expert committee comprising of notable individuals would assess all applications received by the fund. Once sanctioned, the funds would be directly deposited in the bank account of the medical establishments treating the patient.
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)