June 17  2015, Wednesday
eMedinewS
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, according to findings from China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) reported in JAMA. 2014 Feb 5;311(5):479-89.

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.
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“World No Tobacco Day” observed by IMA Nagpur Branch (Maharashtra State Branch) on 31st May 2015
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News
  • Middle-aged adults who are more satisfied with their life are apt to fall asleep faster than their less satisfied peers, suggests a new study presented at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.
  • A diet rich in fermented foods and beverages likely to contain probiotics may help curb social anxiety in young adults, particularly those who are highly neurotic, pointed new research published in the August 15 issue of Psychiatry Research.
  • Aerobic exercise, in the form of twice-a-week treadmill workouts, seems to improve bronchial hyperresponsiveness in adults with moderate or severe persistent asthma, suggests a small study published online in Thorax.
  • Liraglutide treatment during weight maintenance helps maintain bone mass, suggest new findings presented at the American Diabetes Association's annual meeting.
  • Smokers were more likely to quit when primary care physicians used intensive interventions including recommending medications and counseling and arranging follow-up; however, less-intensive interventions were ineffective, suggested new research published online June 15 in JAMA Internal Medicine.
Cardiology eMedinewS
  • A patient-level meta-analysis of individuals with nonvalvular atrial fibrillation treated with the Watchman left atrial appendage closure device confirms that the device provides similar benefit when compared with long-term warfarin use. The findings are published in the June 23 issue of the Journal of the American College of Cardiology.
  • Being overweight or obese starting in early adulthood was associated with increased aortic stiffness and decreased performance in a memory test at around age 60, suggested a new study presented at the European Society of Hypertension (ESH) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • "Silent" celiac disease (CD), or CD without gastrointestinal symptoms, was noted in 2.0% of children presenting for initial pediatric rheumatology evaluation, reported an article published online June 15 in Pediatrics. Researchers suggest that celiac testing should be included in the standard initial laboratory investigations for pediatric rheumatology patients.
  • A new study suggests that low levels of vitamin D may be associated with greater loss of kidney function over time in children. Children with chronic kidney disease who had lower vitamin D levels had higher levels of blood markers related to kidney dysfunction as well as greater kidney function loss over time. The findings are published in the Journal of the American Society of Nephrology (JASN).
Dr KK Spiritual Blog
Get what you give

A son and his father were walking on the mountains. Suddenly, his son falls, hurts himself and screams: "AAAhhhhhhhhhhh!!!"

To his surprise, he hears the voice repeating, somewhere in the mountain: "AAAhhhhhhhhhhh!!!"

Curious, he yells: "Who are you?" He receives the answer: "Who are you?" And then he screams to the mountain: "I admire you!" The voice answers: "I admire you!"

Angered at the response, he screams: "Coward!" He receives the answer: "Coward!"

The boy is surprised, but does not understand. Then the father explains: "People call this ECHO, but really this is LIFE. It gives you back everything you say or do. Our life is simply a reflection of our actions. If you want more love in the world, create more love in your heart. If you want more competence in your team, improve your competence. This relationship applies to everything, in all aspects of life. Life will give you back everything you have given to it. (Shared by Man Mohan Mundra)
Inspirational Story
Peace of Mind

Once, Buddha was walking from one town to another town with a few of his followers. This was in the initial days. While they were traveling, they happened to pass a lake. They stopped there and Buddha told one of his disciples, "I am thirsty. Do get me some water from that lake there."

The disciple walked up to the lake. When he reached it, he noticed that some people were washing clothes in the water and, right at that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy, very turbid. The disciple thought, "How can I give this muddy water to Buddha to drink!" So he came back and told Buddha, "The water in there is very muddy. I don’t think it is fit to drink."

After about half an hour, again Buddha asked the same disciple to go back to the lake and get him some water to drink. The disciple obediently went back to the lake. This time he found that the lake had absolutely clear water in it. The mud had settled down and the water above it looked fit to be had. So he collected some water in a pot and brought it to Buddha.

Buddha looked at the water, and then he looked up at the disciple and said, "See what you did to make the water clean. You let it be… and the mud settled down on its own – and you got clear water… Your mind is also like that. When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless."
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.
Dr Good Dr Bad
Situation: An infant developed pyloric stenosis after erythromycin
Dr Bad: There is no association between the two.
Dr Good: There is a link
Lesson: Treatment with oral erythromycin may increase risk of developing infantile hypertrophic pyloric stenosis especially during the first two weeks of life. (Pediatrics. 2015;135:483-488).

(Copyright IJCP)
Events
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eMedi Quiz
In a patient with a tumor in superior mediastinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:

1. Lateral thoracic vein.
2. Internal thoracic vein.
3. Hemiazygos vein.
4. Vertebral venous plexus.

Yesterday’s Mind Teaser: Beta-oxidation of odd-chain fatty acids produces:

1. Succinyl CoA.
2. Propionyl CoA.
3. Acetyl CoA.
4. Malonyl CoA.

Answer for yesterday’s Mind Teaser: 2. Propionyl CoA.
Correct Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K V Sarma, Dr G Madhusudhan, Dr Avtar Krishan.
Answer for 14th June Mind Teaser: 3. Leaves extension at elbow joint intact.
Correct Answers received: Dr K Raju.
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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 region, anterior abdominal wall and the upper part of thigh.
IJCP Book of Medical Records
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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
  • Ullunda, June 15: In a case of alleged medical negligence in Subarnapur, a 65-year-old man died after being denied treatment at the Community Health Centre here. - See more at: http://www.orissapost.com/two-die-due-to-medical-negligence/#sthash.GEd2VAiy.dpuf
  • The Indian Medical Association Pune branch has announced an essay competition on the topic 'Medical services and public mindset'.
  • Supreme Court scraps AIPMT 2015, orders retest in 4 weeks. Mass cheating, several cases of irregularities reason for cancellation; CBSE counsel says all 44 cheaters identified
  • The Haryana Government will soon put in place a system for practising yoga in the morning assembly at schools and before the start of colleges and offices. This was stated by Anil Vij Health Minister.
Patients taking aspirin for prevention
  • For patients taking aspirin, use of NSAIDS is acceptable in patients for whom they are clearly indicated, despite a concern regarding a potential negative interaction. In these patients, prefer naproxen to other agents.
  • Patients who take aspirin for cardiovascular prevention should be cautioned regarding the use of NSAIDs as over-the-counter medications.
  • Patients who require such NSAIDs on an occasional short-term basis, should take aspirin at least two hours before taking a nonselective NSAID or an alternative agent that does not interfere with the effects of aspirin on platelets (paracetamol) be used instead (Source: Uptodate)
Handling of children with disabilities and referral
No.9-3/CCD/2007/ 15th May, 2008

To

1. Dr. P.C. Kesavankutty Nayar, Acting President, Medical Council of India, Pocket-14, Sector-8, Dwarka, Phase- I, New Delhi - 110 077

2. Dr. M. Abbas, National President, Indian Medical Association, IMA House, Indraprastha Marg, New Delhi - 110 002

Subject: Handling of children with disabilities and referral.

Sir,
  1. It has been brought to the notice of Chief Commissioner for Persons with Disabilities that though most of the doctors are not trained for rehabilitation of persons with disabilities, they often try to treat their disabilities even when medical or surgical interventions are not required. In the process, most critical period of first six years of life is lost which is most important period to train & rehabilitate the child with disability to utilize the residual capacity of the impaired organs. Consequently, it is too late for such children to respond to the rehabilitation therapies even by most qualified & skilled rehabilitation professionals like physiotherapist, speech therapist, audiologist, prosthetic & orthotic engineer, special educator etc.
  2. Chief Commissioner has taken notice of the complaints from parents, Rehabilitation Professionals, NGOs etc. and has directed that appropriate instructions may be issued by Medical Council of India and Indian Medical Association through print and electronic media to the effect that the doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illness/disease or else action be initiated against such .practices under relevant section of MCI. They should refer such children to the qualified rehabilitation professionals to ensure that they get appropriate rehabilitation/therapeutic assistance well in time. The Court of the Chief Commissioner for Persons with Disabilities shall be constrained to initiate action under Section 59 of the Persons with Disabilities Act, 1995 against the doctors who may persist with such practices.
  3. It is requested that action taken in the matter alongwith the copies of the directions issued may please be sent to this office within 30 days of receipt of this communication.
Yours faithfully,

(T.D. Dhariyal)

Dy. Chief Commissioner

Sarojini House, 6, Bhagwan Dass Road, New Delhi - 110001 E-mail: ccpd@hub.nic.in

Telephone: 23386054, 23386154; Telefax: 23386006, Website: www.ccdisabilities.nic.in
World No Tobacco Day
“World No Tobacco Day” was observed by IMA Nagpur Branch (Maharashtra State Branch) on 31st May 2015. On this day, various programmes including sensitization of nursing staff on oral cancer, Rangoli, Poster & Slogan competition for patients & student, Poster exhibition on tobacco-related cancers were arranged. “World No Tobacco Rally” was also organized with formation of Long Human chain along with various organizations in which banners and posters were displayed and nearly 500 delegates were participated.
Wellness Blog
Pollution and diabetes

India may soon become the Diabetes capital of the world. The number of diabetics diagnosed every year is increasing.

If we go back to the era of Ramayana and Mahabharata, we find that none of the Devtas or Asurs suffered from diabetes. Though diabetes does get a mention in Ayurveda, its incidence and prevalence in Indian society was very low.

Today diabetes is considered to be a lifestyle disease and is linked to potbelly obesity. Lord Ganesha and Kuber both had potbelly obesity yet did not suffer from diabetes. Lord Ganesha had an uncontrolled appetite to eat sweets and yet he had no diabetes and same comes from one of his prayers, which talks about why people in that era did not suffer from diabetes. Following is a gist of one of my write–ups on the same: "Gajananam Bhoota Ganadi Sevitam; Kapittha Jambu phalasara bhakshitam; Umasutam Shoka Vinasha karanam; Namami Vighneswara pada pankajam". The Mantra means
  • "Oh Elephant–faced, worshiped by the existing beings, of all living beings, tasting the elephant apple (kaith) and jambolana (jamun), the Son of Uma, destroyer of grief, I bow to the lotus feet of Ganesha who is lord of all" or
  • Gajananam (the big tummy one worshipped by all) Bhoota (Durva grass and Bilva patra used for worshipping Ganesha) Ganadi (in equal quantity) Sevitam (if consumed); Kapittha (Kaith) Jambu (Jamun) phalasara (fruits) bhakshitam (to be consumed); Umasutam (son of Uma) Shoka (diseases) Vinasha karanam (get rid of); Namami (I bow to) Vighneswara (destroyer of grief) pada pankajam (feet of lord)"
The mantra talks about four medicinal herbs: Durva grass and Bilva patra (Bel leaves) used for Ganesha worship; fruit of elephant apple (Kaith) and fruit of Jambolona (Jamun). All four have antidiabetic properties and can be mixed in equal quantities and prepared as a medicinal juice.

Medically, Durva grass (Cynodon dactylon) has been shown to possess antidiabetic, cholesterol–lowering, immunomodulatory, DNA protective, aphrodisiac, male fertility, anti cancer and anti inflammatory activities. Similarly, Bilva Patra has both antidiabetic and fertility-promoting properties.

Elephant apple (Limonia acidissima), also named as Wood Apple, Elephant Apple, Monkey Fruit, Curd Fruit, Koth Bel, Kaitha and Kath Bel, has been shown to possess strong anti diabetic properties.

Jamun (Syzygium cumini) also has DNA protective, antioxidant and antidiabetic properties and is an essential ingredient of most antidiabetic Ayurveda preparations.

Apart from the above, two things have also happened in the current Kalyug era, which deviate from the Vedic era. Firstly, environmental pollution and secondly people have chosen to eat carbohydrates on a daily basis and there is also a shift of complex carbohydrates to refined carbohydrates.

Environmental pollution, especially with high particulate matter PM 2.5 exposure, is linked with diabetes. Any particulate matter that is less than 2.5 µg/m3 in size can be absorbed from respiratory system, enter into the blood and release pro–inflammatory products leading to endothelial dysfunction and resultant diabetes and heart disease.

As per WHO, the air content of PM2.5 should be less than 10 µg/m3. In India, the levels are always more than 60 µg/m3as 60 µg/m3 concentration has been accepted as normal in India. This means that an Indian is already six times more exposed to PM 2.5 particulate.

In India, we can see values as high as 300–400 µg/m3 in selected areas on a daily basis. Constant exposure to PM 2.5 particulate matter leads to endothelial dysfunction, one of the major factors that increase the prevalence of diabetes.

As per Chandok Upanishad, food is Brahman. Food contains the same consciousness as that of human body. Fruits remain alive for up to 40 minutes after they are plucked from the tree unless they are refrigerated or frozen at the same time.

A fruit without consciousness is dead food and does not have protective nutritional value. PM2.5 particulates can also gets absorbed in the fruits, reducing its nutritional value.

If the same food is also devoid of consciousness, it will not be able to prevent and protect human being from various diseases.

To prevent oneself from diabetes, therefore, one should avoid eating refined carbohydrates, omit carbohydrates 80 days in a year from diet and avoid exposure to high PM2.5 pollution matter, exercise more and try to eat a diet full of fruits and vegetables, which are locally grown and seasonal.
Quote of the Day
Man’s troubles are rooted in extreme attention to senses, thoughts, and imagination. Attention should be focused internally to experience a quiet body and a calm mind. Buddha
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eMedinewS Humor
Upset is Unhealthy

The mother of a problem child was advised by a psychiatrist, "You are far too upset and worried about your son. I suggest you take tranquilizers regularly."

On her next visit the psychiatrist asked, "Have the tranquilizers calmed you down?"

"Yes," the boy’s mother answered.

"And how is your son now?" the psychiatrist asked. "Who cares?" the mother replied.
Reader Response
Dear Dr KK, it is a very good idea to maintain a rare blood group register at the IMA HQ. This will go a long way in helping people in need of such group of blood. Hats off to the thinking of IMA, well done and God Bless you all doing such a great job. Ashok Ahooja Sqn Ldr (Retd)
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Press Release
Be with the Nature - IMA

Being with the nature can reduce a large number of life style disorders. One should eat fresh seasonal and locally grown fruits and vegetables to prevent heart diseases. Regular walking not consuming tobacco and alcohol and positive thinking are the ways one can prevent many life style diseases said Padma Shri Awardee, Dr A Marthanda Pilliai, National President, IMA and Padma Shri Awardee, Dr K K Aggarwal, Honorary Secretary General, IMA.

Sitting in the natural sun light will build enough Vitamin-D which in turn will prevent cardiovascular disease.

Safe water, good sleep and respiratory hygiene can prevent many communicable diseases.

In rainy season diseases like diarrhea, typhoid and jaundice continue to happen.

Consumption of safe water and food is the key.
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