March 17  2015, Tuesday
editorial
Fruit salad and blood sugar meters don’t mix
Dr KK AggarwalInvisible bits of fruit on the hands can mess up the finger–prick blood tests, making the blood sugar level look higher than it really is. That’s because sugars from fruit will stay on the fingers until you wash them with tap water. Even alcohol swabs do not solve the problem. Peeling fruit right before you use a blood sugar meter, or eating some juicy fruit with the hands, could lead to an inaccurate reading even if you rub your finger with alcohol first. (Journal Diabetes Care, Dr. Takahisa Hirose of the Juntendo University Graduate School of Medicine in Tokyo)

When fruit peeling was followed by hand washing, blood sugar readings were the same as before volunteers had peeled any fruit. But when volunteers peeled fruit and took a blood sugar reading right away, the levels shown by the blood sugar meter shot up (from baseline 90) –– to about 170 mg/dL on average after peeling an orange, 180 mg/dL after peeling a kiwi, and 360 mg/dL after peeling a grape. And if the peelers swabbed their finger with alcohol in between peeling and finger pricking, the readings were still higher than normal. Even swabbing five times didn’t produce correct results. In the directions that come with blood sugar meters, the manufacturers generally tell users to wipe their finger with an alcohol swab before taking a reading.

Earlier tPA in hospital saves lives

Thrombolysis within an hour of a stroke patient’s arrival at the emergency boosts its survival advantage. Administration of tissue plasminogen activator (tPA) within an hour was associated with lower in-hospital mortality (adjusted odds ratio 0.78, P<0.0003) and less frequent symptomatic intracranial hemorrhage (4.7% vs 5.6%, P<0.0017) than getting it later. Every 15 minute reduction in door–to–needle time predicted a 5% lower odds of in-hospital mortality (adjusted OR 0.95, P=0.0007) in a multivariate model, Gregg C. Fonarow, MD, of UCLA Medical Center, and colleagues reported here at the American Stroke Association’s International Stroke Conference and simultaneously online in Circulation: Journal of the American Heart Association. (Medpage)
eMedipics IMA,IJCP,HCFI
Represented as Resource person IMA Punjab in the Regional Workshop "Child Sexual Abuse - Prevention & Response" with longest lecture of more than 3 hours in my life. My pleasure to share. Diwan Singh Bhular
News
  • Prostatic artery embolization provides excellent symptom control in men with lower urinary tract symptoms related to benign hyperplasia, suggests a new study presented at the European Congress of Radiology 2015.
  • A study conducted in athletes suspected of having exercise-induced bronchoconstriction (EIB) treated with inhaled bronchodilators revealed that the self-reports of respiratory changes did not correlate with changes in airway caliber. The findings are published online in Medicine & Science in Sports & Exercise.
  • The US Food and Drug Administration (FDA) has cleared for marketing the Simpliciti ultra short-stem shoulder system for arthroplasty in patients with limited shoulder function and severe pain resulting from osteoarthritis or traumatic arthritis. The device is a total shoulder arthroplasty system that minimizes bone removal and soft-tissue disruption associated with use of long-stem devices.
  • Contrary to previous studies, the antimetabolite mitomycin does not seem to be associated with an increase in complication rates in trabeculectomy, suggests a study published online in JAMA Ophthalmology.
  • A novel device that stimulates the vestibular system may benefit patients with Parkinson's disease, particularly those with balance and gait problems, suggests a preliminary study published in the journal Brain Stimulation.
Dr KK Spiritual Blog
Bhoot, Pret and Pishach = Myths or Facts

In mythology, ‘Bhoot’ means the memories of known people whose unfulfilled desires keep on disturbing us. ‘Pret’ means the memories of unknown people whose unfulfilled desires keep coming to our mind during sleep and disturbing us. These unfulfilled desires of unknown people are instances that we may have forgotten but still reach us through the cloud internet. When these memories start disturbing our day to day life, they are defined as Pishach.

Bhoot, Pret and Pishach are seen only by some people and not everyone. This means that their attachment will only be with those with whom their unfulfilled desires were linked to.

This attachment disorder where the unfulfilled desires of the deceased person keep on coming to our mind during day time, night and in our dreams can be understood by a computer IT model used by porn sites.

People who own porn sites develop software by which a specific program can get transferred to our computer and whenever we open these sites the program file gets embedded in our computer in a secret location in such a way that whenever we open the computer, the specific will appear on the desktop or will become the preferred sites whenever we open the internet. The specific site only will automatically open even if we do not wish to open it.

These files are difficult to delete unless the computer is reformatted or an experienced IT professional is able to delete these files.

The attachment disorders and the unfulfilled desires of the deceased persons can be compared to this technology and can be explained why those thoughts keep on coming in our mind. Not only the thoughts, even the images of people keep coming into mind and they are difficult to get deleted.
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Cardiology eMedinewS
  • Patients who survive an MI may be at significant risk for overall and specific types of cancer, suggests a study presented in a poster at the American College of Cardiology (ACC) 2015 Scientific Sessions.
  • At a late-breaking clinical-trial session at the American College of Cardiology (ACC) 2015 Scientific Sessions, investigators from the first and second Open-Label Study of Long-Term Evaluation Against LDL-C (OSLER-1 and OSLER-2) reported that evolocumab plus standard therapy reduced LDL cholesterol by 61% after 11 months of use vs. standard therapy alone.
Pediatrics eMedinewS
  • In just 10 days, restricting the amount of fructose children consumed through sugary drinks and juices resulted in dramatic reductions in liver fat, suggested new research presented at The Endocrine Society annual meeting.
  • Racial/ethnic minority children residing in low-resource areas may benefit the most from school-based opportunities for moderate-to-vigorous physical activity (MVPA), suggests a new study from researchers at Washington University School of Medicine and St Louis Public Schools. The study is published in Preventing Chronic Disease.
Events
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Make Sure
Situation: A diabetic patient’s wound was not healing.
Reaction: Oh my God! Why is his A1c still more than 8?
Lesson: Make sure to control diabetes in such cases. Every 1% increase in hemoglobin A1c is associated with almost a 0.03 cm2 reduction in daily rate of wound resolution.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

What is the medicolegal importance of age up to 14 years?
  • 7 years age: In accordance with Section 82 of Indian Penal Code, any act that is done by a child under 7 years of age is not an offence.
  • 7–12 years of age: In accordance with Section 83 of Indian Penal Code, a child between 7–12 years of age is presumed to be capable of committing an offence, if he attained sufficient maturity of understanding to judge the nature and consequences of his conduct on that occasion. This maturity is presumed in a child of 7–12 years age until the contrary is proved.
  • 10 years age: In accordance with Section 369 of Indian Penal Code, kidnapping or abducting child less than 10 years of age with intention to steal from its person is a criminal punishable offence.
  • 14 years age: A child below 14 years of age cannot be employed to work in any factory or mine under Indian Factory Act 1948. A person completing 15 and up to 18 years is allowed to work as adolescent employee in a factory if a fitness certificate is issued by a competent registered doctor.
Dr Good Dr Bad
Situation: A patient with Mediclaim was advised to get admitted in a 5–bedded hospital.
Dr. Bad: It does not matter.
Dr. Good: Go to a 15-bedded hospital.
Lesson: Mediclaim requires admission in hospital with minimum 15 beds (in C–Towns, it can be 10 bedded).

(Copyright IJCP)
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eMedi Quiz
Which one of the following is a recognized X-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Yesterday’s Mind Teaser: High resolution computed tomography of the chest is the ideal modality for evaluating:

1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Answer for yesterday’s Mind Teaser: 2. Interstitial lung disease.
Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy, Dr Sushma Chawla.
Answer for 15th March Mind Teaser: 4.Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma.
Correct Answers receives: Dr Sushma Chawla, Dr Karan, Dr Pradeep
Rabies News (Dr A K Gupta)
Are there any survivors of human rabies?

These patients survived not due to any specific antirabies therapy but following intensive life support and excellent nursing care. These patients survived for variable periods with residual neurological deficits. All the survivors had paralytic form of rabies and majority had history of some anti–rabies vaccination in the past.
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
IMA NEWS
Facts about Tuberculosis (TB)
What are the risk factors for TB?
  • Close prolonged contact with a sputum positive pulmonary TB patient
  • Overcrowding
  • Smoking
  • HIV infection
  • Malnutrition
  • Diabetes mellitus
  • Patients on immunosuppressive drugs (anti-cancer, corticosteroids etc.)
  • Certain lung diseases like silicosis
Most TB patients don’t disclose status
Mar 16, 2015 - SHASHI BHUSHAN | Asian Age

Fearing the social stigma associated with the disease, most TB-positive patients do not disclose their TB status. According to the Indian Medical Association (IMA), despite TB being a notifiable disease, over 10 lakh TB patients treated in India every year are not reported the disease to the appropriate authorities as per municipal laws and government orders.

The IMA, in association with the central TB division, director general health services (DGHS) and the government has been able to notify 1,04,670 TB patients in the last year. “Most TB-positive patients do not disclose their TB status as they fear the associated social stigma and so keep spreading the disease to others.

Over 10 lakh TB patients treated in India every year are not reported to the appropriate authorities. The public needs to be informed that every open sputum case of TB will infect and be responsible for 15 new more cases of TB if not taken care of with early treatment,” said secretary general of the IMA, Dr K.K. Aggarwal.
National president of the IMA, Dr A. Marthanda Pillai, said that not notifying TB is a violation of the medical council of India (MCI) code of medical ethics regulations under Sections 5.2 and 7.14 and can lead to suspension of the licence of the doctor.

The IMA has asked the government to come out with a policy in which a person with sputum-positive TB cases are given paid leave, so that such patients do not hide their illness. In India, 2.1 million new TB cases occur annually and 2,40,000 deaths occur every year due to TB.

“All TB patients are not contagious, but those who are need to be taken care of. IMA’s fight in TB is not limited to notification of TB cases. IMA has sensitised more than one lakh doctors in providing a standard TB regimen in accordance with the standard guidelines,” added Dr Aggarwal.

Dr Pillai has appealed to 2.5 lakh doctors associated with the IMA to notify each and every TB patient and the same can be done through IMA’s website.
Stringent action if guidelines are not followed: KMC
Stringent action if guidelines are not followed: KMC

STAFF REPORTER

The Karnataka Medical Council (KMC) has warned of stringent action against medical practitioners who do not follow the guidelines for issued a year ago. Veerabhadiriah T A from the KMC, at a press conference here on Saturday, said, “Doctors would be first warned and if found to be flouting norms repeatedly, their registration with KMC would be cancelled and not further authorised to practise further.” The guidelines, issued a year ago, mandate that all medical practitioners to get their degrees registered with the KMC and exhibit their registration certificate at their clinic or hospital. The KMC registration number has to be printed on their prescription slips as well. The registration has to be renewed once in every five years. Those who have registered with KMC before May 1, 2011 must renew their registration by April, 2016.

IMA Comments: These are against the MCI guidelines.

Ketamine remains available for medicine

United Nations Commission on Narcotic drugs postponed decision on Ketamine to next year.
Friday 13th, 2015 the 58th Session of the United Nations Commission on Narcotic Drugs in Vienna postponed a decision on scheduling Ketamine as a narcotic drug. China had originally requested to put Ketamine under international surveillance, but later moved to postpone a decision to next year.

WMA had joined a group lobbying against the scheduling of Ketamine. WMA President Dr. Xavier Deau and WMA Chairman of Council Dr. Mukesh Haikerwal AO explained WMA’s objections against scheduling Ketamine in a letter to the 50 delegations at the conference:

“Ketamine is a powerful, easy to use and relatively safe anaesthetic drug allowing its use especially in rural settings and in low-income nations. Scheduling Ketamine would effectively hinder many patients in under-developed countries from receiving necessary, often life-saving surgery. Ketamine has also proven as a highly useful psychiatric drug. Scheduling Ketamine would make it difficult for many patients around the world to receive effective treatment with it.

We are convinced that other measures, like better controlling of the production and distribution lines and foremost introducing (where not existent) and enforcing prescription regulations can do better to achieve the envisaged goal. The World Medical Association is prepared to assist governments to improve their systems of prescription and safeguarding medications.
We urge you not to schedule Ketamine at all. Scheduling, even in class IV will very like result in large numbers of unnecessary suffering. Doing so would increase suffering of patients who would benefit from using it.”

The lobbying action was echoed by the opinion of the World Health Organization, which also said that there is currently not need to put Ketamine under international control, but that it was important to have it available for use in human and veterinary medicine. (WMA Press Release)
Media
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Inspirational Story
This is Good!

The story is told of a king in Africa who had a close friend with whom he grew up. The friend had a habit of looking at every situation that ever occurred in his life (positive or negative) and remarking, "This is good!"

One day the king and his friend were out on a hunting expedition. The friend would load and prepare the guns for the king. The friend had apparently done something wrong in preparing one of the guns, for after taking the gun from his friend, the king fired it and his thumb was blown off.

Examining the situation the friend remarked as usual, "This is good!" To which the king replied, "No, this is NOT good!" and proceeded to send his friend to jail.

About a year later, the king was hunting in an area that he should have known to stay clear of. Cannibals captured him and took them to their village. They tied his hands, stacked some wood, set up a stake and bound him to the stake. As they came near to set fire to the wood, they noticed that the king was missing a thumb. Being superstitious, they never ate anyone that was less than whole. So untying the king, they sent him on his way.

As he returned home, he was reminded of the event that had taken his thumb and felt remorse for his treatment of his friend. He went immediately to the jail to speak with his friend. "You were right," he said, "it was good that my thumb was blown off."

And he proceeded to tell the friend all that had just happened. "And so I am very sorry for sending you to jail for so long. It was bad for me to do this." "No," his friend replied, "This is good!"

"What do you mean, 'This is good'? How could it be good that I sent my friend to jail for a year?" "If I had NOT been in jail, I would have been with you."

Situations may not always seem pleasant while we are in them, but the promise of God is clear. If we love Him and live our lives according to His precepts, even that which seems to be bleak and hopeless will be turned by God for His glory and our benefit.

Hold on, God is faithful! May God bless you this week as you seek His will in every situation.
Wellness Blog
Nine Modifiable Risk Factors for Heart Attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, lack of adequate fruits and vegetables in diet and sedentary lifestyle. These account for over 90 percent of the population–attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. The risk of heart attack and death from heart disease is reduced by one–half one year after quitting, and after several years it begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. The Heart Care Foundation of India recommends walking 80 minutes in a day with a speed of 80 steps per minute.
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Quote of the Day
Where there is determination there is success

Think of all that you wanted to achieve in the past few days. Now check if you have achieved it or are still trying for it. Check if you have left anything midway. Pick out one of the things that you wanted to achieve or create an aim for yourself and think, "I am the one who is victorious and I will achieve whatever I set out to. I will not leave any task unfinished."
Reader Response
  1. Dear KK, IMA has argued its case with reasons against the government’s proposal to license AYUSH doctors to practice MTP. Government, however, is likely to ignore this advice and proceed with the proposal. How can you bring to bear more influence on the folly of the scheme? Can you sensitize all the Honb'le MPs both of Lok Sabha and Rajya Sabha? Would online petitions to them by the netizens make a difference? With best wishes, yours sincerely: Er Anuj Sinha.
  2. Dear editor, We as Specialists, after MBBS and then MS in Orthopedics, can examine patients with confidence and command, but frequently I have found that another breed of Physiotherapist have come in and they claim to be "Doctors" and are writing that in front of their names; they even contest that they are equally learned and at par ..I have even seen some of them prescribing drugs and treatment plan ...It’s similar to AYUSH case. Someday these AYUSH doctors will claim as these Physiotherapist Doctors … who will check are they following norms or are in their practice limit…Its sound alarming ...stop all these quacks...Dr Rajesh Bhalla
News on Maps
IMA Humor
The Power of Belief

After the teams for the 2003–2004 MBHL Hockey Season our team was thought to be the worst team in the league. My team battled throughout the whole season losing to teams. Everyone got down on themselves and thought that we couldn’t do it. With six games left in the season we had to win all of them to make it to the playoffs. Our coach told us that if we wanted to show everyone that we were a good team we had to make it to the playoffs. My team battled hard and we did it we made it to the playoffs.

We made two huge upsets in the playoffs to make it to the League Championship against the #1 team who was undefeated and had beaten us 12-0. Before the game our coach got us motivated and prepared for the biggest game of our lives.

We came out with heart and we were determined to win and we did 3–2 in overtime and we shocked the whole league. We had pulled a huge upset and won the 2003-2004 League Championship with heart, hard work and never losing sight of our dream.
Does TB infection differ from TB disease?
In most people who breathe in TB bacteria, the body's immune system is able to fight the TB bacteria and stop them from multiplying. This is called TB infection. People who are infected with TB do not feel sick, do not have any symptoms and cannot spread TB.

But on the other hand if the infected person's immune system cannot stop the bacteria from multiplying, the bacteria eventually cause symptoms of active TB, which is called TB disease.

Only 10% of all people with TB infection may suffer from TB disease, said Padma Shri Awardee Dr A Marthanda Pillai National President Indian Medical Association (IMA) and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

Dr Aggarwal said that people with conditions like HIV, diabetes mellitus, malnutrition and those on treatment with immunosuppressant drugs (anti-cancer, corticosteroids etc) are at a greater risk of developing TB disease once infected.

TB is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year.

Indian Medical Association has been able to notify over one lakh TB patients in the last one year, which prevented at least 10 lakh TB infections in the country.