February 18  2015, Wednesday
editorial
5 Ways to Stop A–Salting Your Kidney
Dr KK Aggarwal Eating white salt is like a slow poison. If the amount of salt is reduced to less than one teaspoon per day, a large percentage of people with high blood pressure will have normal blood pressure. High salt intake via increase in blood pressure leads to kidney damage over a period of time and kidney failure. Consume less–anything which is artificially white in feature–white sugar, white maida and white rice.

Most people who have presence of high salt in their body will have characteristic feature of liking to both ice cold as well as boiling beverages.

5 tips to reduce salt in your diet
  1. Make reading food labels a habit. Sodium content is always listed on food labels. Sodium content can vary from brand to brand, so compare and choose the lowest sodium product. Certain foods don’t taste particularly salty but are actually high in sodium, such as cottage cheese, so it’s critical to check labels.
  2. Stick to fresh meats, fruits and vegetables rather than their packaged counterparts, which tend to be higher in sodium.
  3. Avoid spices and seasonings that contain added sodium, for example, garlic salt. Choose garlic powder instead.
  4. Many restaurants list the sodium content of their products on their websites, so do your homework before dining out. Also, you can request that your food be prepared without any added salt.
  5. Try to spread your sodium intake out throughout the day; it’s easier on your kidneys than eating lots of salt all at once.
eMedipics
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Health Check Up and CPR 10 Camp at Govt Boys Sr. Sec. School M.B Road, Pushp Vihar Sec-1 New Delhi on 1st December 2014
News Around the Globe
  • A new study suggests that people being treated for lower back pain with acupuncture are likely to gain less benefit from the treatment if they have low expectations of how effective it is. However, patients who are positive about their back pain experience less back-related disability while receiving acupuncture. The study is published in The Journal of Clinical Pain.
  • Intra-articular injections of both hyaluronic acid and steroids are associated with symptom improvement in knee osteoarthritis, but the pattern of response varies between the two treatments, suggests a prospective, randomized study published online in Open Access Rheumatology: Research and Reviews.
  • Faster reperfusion, local anesthesia, and more severe stroke after thrombolysis predict greater benefit of endovascular thrombectomy, suggest analyses of the MR CLEAN and IMS III trials. The findings were presented at the International Stroke Conference.
  • A high-fiber diet pitted against the traditional American Heart Association (AHA) diet in obese patients leads to similar amounts of weight loss after 1 year, suggests new research published in the Annals of Internal Medicine.
  • Sore throat may be a sign of a bacterial infection in young adults between the ages of 15 and 30, even if they test negative for strep, suggests a paper published in Annals of Internal Medicine.
Dr KK Spiritual Blog
Curses in Mythology

There were no judges in mythological era. The role of judges was performed either by Rishi Munis or by the kings. We have heard lot of examples of curses (shraps) being given by Rishi Munis. In all probability, these were the sentences uttered by them to the guilty or the culprit person. Following are a few examples.
  • The curse (shrap) of Bhasama can be equated to today’s ‘death sentence’ by electrocution.
  • Rishi Gautam giving a Shrap to Lord Indra and made him impotent for some time can be equated to chemical castration. He was later relieved by Lord Ganesha, which can be equated to acquittal from the higher court.
  • Rishi Gautam giving a Shrap to Ahilya of becoming a ‘stone’ can be equated to imprisonment for a number of years in isolation where movements are not possible (solitary confinement). Lord Rama relieving her from imprisonment (converting back to a woman) may mean a Presidential pardon and reducing the imprisonment time.
There are several similar cases of curses (shraps) in mythology that can be equated to today’s judicial system. If you have any, please forward the same to me.
Event
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Cardiology eMedinewS
  • A low-fat, plant-based vegan diet may decrease the risk of heart disease in obese children, suggests a new study published in The Journal of Pediatrics.
  • Several popular standardized risk assessment algorithms used by physicians to calculate a patient's risk for having a heart attack seriously overestimate the likelihood, points an article published in Annals of Internal Medicine.
Pediatrics eMedinewS
  • Oral azithromycin or erythromycin use may increase risk for infantile hypertrophic pyloric stenosis, particularly with exposure in the first 2 weeks of life, suggests a retrospective cohort study published online February 16 and in the March issue of Pediatrics.
  • Children with type 1 diabetes have an increased risk for psychiatric disorders, particularly early on after diagnosis, that appears to be associated with having the disease, rather than a common etiology, suggests a large new study published online in Diabetes Care.
Make Sure
Situation: During evening round in a renal unit, a doctor comes across a patient complaining of headache.
Reaction: Give him a tablet of Nimesulide.
Lesson: Make sure to remember that nimesulide, a selective COX–2 antagonist has minimal potential for renal toxicity.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

Disinterment


Disternment means the act of digging up something (especially a corpse) that has been buried.
  • Many early groups placed the corpse in the ground and exhumed it at a later date for religious rituals, a practice still undertaken by some traditional societies.
  • In fourteenth–century France, it became common procedure to dig up the more or less dried–out bones in the older graves in order to make room for new ones.
  • The high death rate from the European plagues coupled with a desire to be buried in already–full church cemeteries led to old bones being exhumed so that new bodies could be placed in the graves.
  • In earlier times, on rare occasions prior to embalming, the body was removed from the ground. This happened when burial professionals or the authorities suspected that the person might have been buried alive.
  • The French philosopher and death expert Philippe discussed necrophiliacs who disinterred dead bodies for sexual purposes and scientists who dug up corpses to conduct scientific experiments.
Dr Good Dr Bad
Situation: A patient on Mediclaim developed a recurrence of illness after three months.
Dr. Bad: It will not be covered under Mediclaim.
Dr. Good: Yes, it will be covered as it is a fresh illness.
Lesson: Occurrence of the same illness after lapse of 105 days is considered as fresh illness for the purpose of Mediclaim policy.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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Twitter of the Day
Dr KK Aggarwal: longer the life line http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Photons cannot be seen but make seeing possible http://bit.ly/15QdVeB #Health
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Can rabies vaccine be given to a patient with jaundice?

Rabies vaccine can be given to a patient with jaundice.
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
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)
IMA NEWS
IMA National Health Scheme
Constitution & Byelaws, Adopted on27th December 2014, at the 75th Central Council of IMA - Ahmadabad, Gujarat, Dr. S. Alex Franklin

Aims and Objectives of the Scheme
  • To provide financial assistance to the scheme member and his/her spouse, child (ren) and parent(s) on the event of hospitalization, diagnosis and management of diseases
DISEASES COVERED BY THE SCHEME
  • Heart Disease:- Angioplasty, By-pass Surgery and Valve replacement Surgery.
  • Renal Failure, Haemodialysis, Renal Transplantation,
  • All Malignant diseases
  • Brain Tumours
  • Hip and Knee replacement surgery.
DISEASES COVERED BY THE SCHEME
  • Spine surgery
  • Cerebrovascular accidents
  • Road Traffic and other accidents
  • Other major illness requiring hospitalization approved by the scrutinizing committee.
MCI News
Dear Colleague

As per MCI Ethics regulation 1.2.3 "A Physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organisations. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Councils as the case may be"

MCI regulations however does not mention from where this authentic evidence based education must come. The medical college do not entertain past students for yearly updates. The results is that today most of us end up with getting scientific updates from the industry and which is often biased.

IMA feels there is need for evidence based updated and authentic medical information to be available through the digital media.

IMA has evaluated many such updated medical information point to care services available in the country and has selected "DYNAMED" as the latest medical information provider. This digital medical information provider is more clinical oriented and of use to Medical Professionals in day-to-day clinical practice.

Dynamed can be used as a resource for all updates information by medical practitioners and medical students to update their knowledge.

IMA will also come with weekly Dynamed SMS CME for IMA leaders.

IMA will also organize DYNAMED CME programmes so that uniform medical update knowledge is acquired by Medical Practitioners Pan India.

We request all of you to evaluate this resource site.

IMA wants when at PAN India levels we address the press or give lectures there should be oneness in our contents and therefore we need one credible source of information.

Dr A Marthanda Pillai and Dr K K Aggarwal

Note

The website is https://dynamed.ebscohost.com/

The authorize vendor in India is M/s Alliance Books Suppliers (abspl.info@gmail.com)
Media
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Inspirational Story
The Thirst and the Rusty Well

There is a legend of a man who was lost in the desert, dying of thirst. He stumbled on until he came to an abandoned house. Outside the dilapidated, windowless, weather–beaten, deserted shack was a pump. He stumbled forward and began pumping furiously, but no water came from the well. Then he noticed a small jug with a cork at the top and a note written on the side: "You have to prime the pump with water, my friend. P.S. And fill the jug again before you leave." He pulled out a cork and saw that the jug was full of water.

Should he pour it down the pump? What if it didn’t work? All of the water would be gone. If he drank the water from the jug, he could be sure he would not die of thirst. But to pour it down the rusty pump on the flimsy instruction written on the outside of the jug?

Something from inside told him to follow the advice and choose the risky decision. He proceeded to pour the whole jug of water down the rusty old pump and furiously pumped up and down. Sure enough, the water gushed out! He had all he needed to drink. He filled the jug again, corked it and added his own words beneath the instructions on the jug: "Believe me, it really works. You have to give it all away before you can get anything back."

That’s why giving is important…!!!
Wellness Blog
Clinicians should aggressively treat unhealthy lifestyles

Health care providers should treat unhealthy behaviors as aggressively as they treat hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create "interprofessional practices" to connect patients with behavior–change specialists.

They must implement five As when caring for patients
  • Assess a patient’s risk behaviors for heart disease
  • Advise change, such as weight loss or exercise
  • Agree on an action plan
  • Assist with treatment
  • Arrange for follow–up care.
Quote of the Day
Don’t concentrate on what someone else can do that you cannot, concentrate on what you can do that others cannot.
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Reader Response
 
  1. Thanks...very interesting & informative articles. Dr Bharat R Bhatt
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IMA Humor
Salesman

"So, how did you do?" the boss asked his new salesman after his first day on the road. "All I got were two orders."

"What were they? Anything good?" "Nope," the salesman replied. "They were ‘Get out!’ and ‘Stay out!"
eMedi Quiz
Avascular necrosis can be a possible sequelae of fracture of all the following bones, except:

1. Femur neck
2. Scaphoid.
3. Talus.
4. Calcaneum.

Yesterday’s Mind Teaser: 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. Hemophilia.
4. Villonodular synovitis.

Answer for yesterday’s Mind Teaser: 3. Haemophilia.

Correct Answers received from: Dr Pravar Passi, Dr Bharat Bhushan Aggarwal, Daivadheenam Jella.

Answer for 15th Feb Mind Teaser: 4. Early menopause.

Correct Answers receives: Dr K Raju.
Press Release of the Day
Who needs anti-viral drugs in swine flu?

The number of swine flu cases in the country have been increasing. This may lead to a situation where doctors may prescribe antiviral drugs to all patients with suspected swine flu. But, antiviral drugs are not needed for all patients and doctors should know when to prescribe antiviral drugs and which patients require hospitalization, said Padma Shri Awardee Dr A M Pillai National President AND Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K KAggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

If antiviral drugs are needed, then they should be given as early as possible. Starting antiviral drugs after 48 hours of onset of symptoms may not lead to discernible benefit, he further added.

In this regard, some Facts were also released by the IMA. These may help clinicians to select appropriate patients for antiviral drugs and/or hospitalization.

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:
    1. Flu requiring hospitalization
    2. Progressive, severe, or complicated flu
    3. Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)
    4. Swine flu at high risk for complications:
      1. Children <5 years particularly those <2 years
      2. Elderly =65 years
      3. Pregnant women
      4. Women up to 2 weeks postpartum
      5. Residents of nursing homes and other chronic care facilities
      6. 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
    1. 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.
    2. Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)
      1. Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting
      2. No shortness of breath
      3. Little change in chronic health conditions.
    3. Progressive illness. Requires hospitalization
      1. Above symptoms plus
      2. Chest pain
      3. Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)
      4. Low blood pressure
      5. Confusion, altered mental status
      6. Severe dehydration
      7. Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions
    4. Severe or complicated illness requires hospitalization
      1. Signs of lower respiratory tract disease
      2. Low oxygen requiring supplemental oxygen
      3. Pneumonia on x-ray
      4. Brain involvement
      5. BP lower than 80, organ failure
      6. Heart involvement
      7. Persistent high fever and other symptoms beyond 3 days