May 18  2015, Monday
editorial
Coffee Consumption Reduces Mortality
Dr KK Aggarwal The largest prospective cohort study evaluated the impact of coffee consumption on all–cause mortality and involved 229,000 men and 173,000 women, who were followed for up to 13 years (N Engl J Med 2012;366:1891).

After adjustment for smoking status and other potential confounders, associations between coffee consumption (either caffeinated or decaffeinated) and reduced all–cause mortality were evident at relatively low levels of consumption (2 to 3 cups/day).

Compared to non–coffee drinkers, the risk of all–cause mortality among men and women who consumed 2 to 3 cups of coffee daily was 0.90 and 0.87.

The apparent benefit of coffee was similar for individuals with high levels of coffee consumption, including those who drank six or more cups of coffee per day. (UpToDate)
Pregnant woman dies due to medical negligence
PTI:  Faridabad  May 16

A pregnant woman today died allegedly due to negligence of doctors at a government hospital here triggering protest by family members, police said.

Sonam, from Palwal was brought to the government-run B K Hospital here by her family on Thursday, for delivery. "At the time of arrival at the night, she was having labour pains," said Lata, a relative of the victim.

The family members alleged that the doctor was not on her duty at that time. The nurse on duty checked the patient and said that she is fine and would be delivering the baby in the morning, they said.
  • The UK-based Arab Organisation for Human Rights has reported that over 170 individuals have been killed due to medical negligence in Egyptian prisons since July 2013. These statistics are based on a list made by the organisation, a copy of which was obtained by Arabi 21.
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Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • Physicians would prescribe opioids less often to patients at high risk for abuse if they had information to help them identify these patients, suggests a new study presented at the American Pain Society (APS) 2015 Annual Scientific Meeting.
  • Intravenous metoclopramide plus diphenhydramine is more effective in reducing headaches in pregnant women than codeine, suggests a new study presented at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.
  • The US Food and Drug Administration (FDA) has warned that sodium-glucose cotransporter-2 (SGLT2) inhibitors used to treat type 2 diabetes may lead to ketoacidosis requiring hospitalization.
  • When patients undergoing spinal surgery swabbed the inside of their noses with a topical antiseptic before the procedure, there was a significant reduction in surgical-site infections, suggested new research presented at the Society for Healthcare Epidemiology of America Spring 2015 Conference.
  • In a viewpoint published online May 11 in JAMA, researchers suggest that asking for permission to preserve organs after an unexpected death would give families more time to decide whether to donate their loved one's organs. The two-step donation is part of a proposal to open up unexpected deaths as a potential source of organ donation.
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Dr KK Spiritual Blog
You are the Temple of God and the Spirit of God dwells in you

This sutra from the Bible reflects the union between the spirit and the soul. The ‘Spirit’ represents the Parmatama or the Brahman and ‘You’ represents the individualized spirit or the Soul (Jivatama).

A temple is a place of worship and also the place where the God resides. Every human being represents a temple (place of worship) where God exists (one’s soul) and this soul is nothing but the essence of God (the spirit).

Every individual should be treated in the same manner as the same spirit dwells in every human being. The soul is also the reflection of the individual’s past and present karmic expressions. Most people look for and search for God in artificial temples, gurudwaras and churches, not realizing that the same God is present within us, provided we undertake the internal journey to look for Him.

He is present amidst thoughts in the silent zone and can be approached by adopting any of the three pathways: Karma Yoga, Bhakti Yoga and Gyana (Gnana) Yoga.

Doing selfless work with detachment about the results; working with the principles of duty, devotion and discipline and/or regularly doing Primordial Sound Meditation or other types of meditations can help one reach the stage of self–realization or meeting one’s true self. Once there, one can have all the happiness in life.
Cardiology eMedinewS
  • Two new implantable cardioverter defibrillators (ICDs) modified for magnetic resonance imaging (MRI) passed a major hurdle as investigators reported that the MRI scanner did not adversely affect device performance or the treatment of ventricular arrhythmias. The report was presented at the Heart Rhythm Society (HRS) 2015 Scientific Sessions.
  • Removal of atrial septal closure devices cleared up persistent symptoms of nickel allergy in a series of 10 consecutive patients reported at the Society for Cardiovascular Angiography and Interventions meeting. Div Verma, MD, of the University of Utah in Salt Lake City, and colleagues reported that all had systemic symptoms for at least a year despite conservative medical therapy, which then resolved after minimally invasive removal of the implanted closure device. Researchers suggest that in patients undergoing percutaneous ASD or PFO closure, particularly those with a history of metal allergy, routine nickel allergy testing should be considered to identify patients at higher risk of an exaggerated inflammatory reaction in whom surgical closure may be favored
Pediatrics eMedinewS
  • Combining three measures, procalcitonin, CRP and lactate, resulted in a negative predictive value (NPV) for bacteremia of 78% and specificity of 85%, Lenore Omesi, MD, of Stony Brook School of Medicine in New York, and colleagues reported in a poster presentation here at the American Society of Pediatric Hematology/Oncology meeting. A normal procalcitonin level correlated with a reduced risk of bacteremia, making it a potential biomarker candidate to risk-stratify pediatric oncology patients for febrile neutropenia.
  • The US Food and Drug Administration (FDA) has approved a combination of sumatriptan and naproxen sodium for the acute treatment of migraine with or without aura in pediatric patients aged 12 years and above.
Make Sure
Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.
Dr Good Dr Bad
Situation: A patient with fever and dengue was not responding to treatment
Dr Bad: Wait for another one week
Dr Good: Rule out typhoid fever
Lesson: Enteric fever can co-exist with dengue

(Copyright IJCP)
Events
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Wellness Blog
What type of a vegetarian are you?

There are 4 main types of vegetarian diets:
  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.
Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.
eMedi Quiz
What lifestyle changes may reduce a woman’s risk of breast cancer?

A. Staying trim as an adult.
B. Drinking a glass of red wine each day.
C. Getting moderate to vigorous physical exercise regularly.
D. A and C.
E. There is little you can do to lower your chances of developing breast cancer.

Yesterday’s Mind Teaser: You’ve had yeast infections before, but in the past year they haven’t really gone away. This could be a sign of:

A. Diabetes
B. Emphysema
C. Stomach ulcers
D. Depression
E. Food allergies.

Answer for yesterday’s Mind Teaser: A. Diabetes

Correct Answers received from: Dr Avtar Krishan, Dr Poonam Chablani, Tukaram Pagad, Dr Shangarpawar, Dr Jainendra Upadhyay

Answer for 16th May Mind Teaser: a) Lignin

Correct Answers received: 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.
eMedinewS Humor
Repairs

When a guy’s printing on his printer began to grow faint, he called a local repair shop where a friendly man informed him that the printer probably needed only to be cleaned. Because the store charged $50 for such cleanings, he told him he might be better off reading the printer’s manual and trying the job himself.

Pleasantly surprised by his candor, he asked, "Does your boss know that you discourage business?" "Actually, it’s my boss’s idea," the employee replied sheepishly. "We usually make more money on repairs if we let people try to fix things themselves first."
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Rabies News (Dr A K Gupta)
What are the various types of modern anti–rabies vaccines?

These are:
  • Purified vero cell rabies vaccine (PVRV)
  • Purified chick embryo cell vaccine (PCECV)
  • Human diploid cell vaccine (HDCV)
  • Purified duck embryo vaccine (PDEV)
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
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IMA Swatch Bharat Swasthya Bharat Campaign: Safe water hygiene
  • Children are exposed to lead in a variety of ways.
  • Since the removal of lead from gasoline, lead-based paint has become the major source of lead exposure for children in the United States.
  • Other exposures include elevated maternal blood lead levels during pregnancy and breastfeeding, soil, food, or water contamination, and excess lead in toys.
  • Primary prevention of childhood lead poisoning involves the removal of lead-based hazards from the environments of children (e.g., lead-painted surfaces, including windows, lead-contaminated soil, lead-soldered pipes).
  • Attempts to remove existing lead-containing paint from surfaces can create more lead dust if not done properly, increasing the risk for lead exposure and causing at least temporary elevation of blood lead levels in family members.
    • Lead in drinking water probably is absorbed more completely than lead in food and may account for more than 50 percent of the lead that is ingested by children
    • Municipal water supplies are controlled and regulated to prevent contamination at the source. However, once the water reaches the home, it is rarely regulated, tested, or treated. The EPA action level for lead in water is 15 parts per billion (ppb).
    • Most lead-contamination of household water is caused by copper plumbing that is joined with lead solder
    • Lead pipes may contribute to lead-contamination, but lead plumbing usually is old enough to have its inner surface coated with mineral deposits, which prevent leaching of lead into the water supply.
    • Other potential sources for lead contamination include storage cisterns, sources of water that are outside the municipal water districts, and aging water coolers and water heaters, particularly in areas where the water has a relatively low pH.
    • Acidity and elevated temperature increase the ability of the water to leach lead from the solder or pipes, as does standing in the pipes for extended periods of time (e.g., overnight).
    • The use of lead solder and other lead-containing materials to connect household plumbing to public water supplies was banned by the EPA in June 1988.
    • Ion-exchange, reverse-osmosis filters, and distillation are effective in removing lead, but the most commonly available home filters (glass fiber and carbon) usually include packaging material that specifies that they do not efficiently remove heavy metals.
    • Water to be used for cooking or drinking should come from the cold tap because hot water is more able to leach lead from the pipes.
    • The water should be run for some time before it is collected; this flushes the water that has a higher lead content (caused by standing in the pipes) down the drain.
Sonal Namaste
Hand sanitizers are not as effective when hands are visibly dirty or greasy.
Progress Report of the Pilot Team of IMA HQs
Day 3: 2nd May, 2015 (Saturday)

Public Holiday
Remote OPD at Kirtipur; Team led by Dr. Ashok Gupta along with Dr. Kanchan Gupta, Dr. Sujit Adsul and Dr. Shashank Shringarpure:
  • Proceeded to a distant Medical Relief Site at Charagadh village Kirtipur District in association with the Designate Hospital
  • Temporary Medical Centre was established at Temple and OPD started.
  • Volunteers from the Designate Hospital and the region made several rounds in the region and made announcements using PAC
  • Over 190 patients of different age group attended the OPD and were duly accorded medical / surgical help
Day 4: 3rd May, 2015 (Sunday)

Remote OPD at Sindhupal Chouk; Team of Dr Kanchan Gupta, Dr. Sujit Adsul and Dr. Shashank Shringarpure:
  • Proceeded to the worst affected area of Raanitar in Sindhupal Chowk to set up Medical Relief OPD in association with Mr. Ashok Tibrewal, the Local NGO / Business House
  • Temporary Medical Centre was established at Temple and OPD started.
  • Volunteers from the Local NGO / Business House and the region made several rounds in the region and made announcements using PAC
  • Over 260 patients of different age group attended the OPD and were duly accorded medical / surgical help
Dr. Ashok Gupta visited the Ministry of Health and obtained the Permission and Photo ID for the IMA Team. As Dr. Kanani and other members had left Nepal for personal reasons, the permission was granted for remaining four members. Thereafter, Dr. Ashok Gupta visited the Indian Embassy at Kathmandu and met H E Mr. Ranjeet Rae, Ambassador of India, First Secretary and Dr. Thakur, Health Attaché and provided details of the activities being undertaken by the IMA Team of Specialists. On the advice of H E Mr. Ranjeet Rae, Ambassador of India, Dr. Thakur, Health Attaché requested Dr. Ashok Gupta to visit two of the hospitals to assess the feasibility of air lifting two of the critically injured patients, which was undertaken on the next day along with the Anaesthesiologist. During the discussions with the H E Mr. Ranjeet Rae, Ambassador of India, Dr. Thakur, Health Attaché it was stressed upon that:
  • IMA (HQs) is keen to support the specialized treatment for patients affected by the earthquake either in Nepal or in India
  • IMA can provide the necessary technical support, manpower as well the supplies needed for such specialized treatment.
  • IMA would be happy to support the advanced specialized treatment at select hospitals in India for the victims of the earthquake.
There was a social get together of some of the leading members of the Indian Community, NGOs from Nepal involved in relief work, officials of the Indian Embassy and chief of NDRF team. Dr. Ashok Gupta was also invited to join. Once again, on behalf of the IMA, Dr. Gupta assured all members that:
  • IMA (HQs) is keen to support the specialized treatment for patients affected by the earthquake either in Nepal or in India
  • IMA would be happy to support the advanced specialized treatment at select hospitals in India for the victims of the earthquake.
  • We can be helpful in providing technical support while airlifting few of patients who require specialised operative treatment in India at certain designate hospitals at India.
Day 5: 4th May, 2015 (Monday)

Dr. Thakur, Health Attaché along with Dr. Ashok Gupta and Dr. Adsul visited two of the hospitals to assess the condition of the patients.
  • At Mervick Hospital: An Indian mountaineer, injured during an avalanche, had severe head injury and was kept on life support system. Craniotomy was performed; he was showing signs of improvements, but was not responding to verbal commands. Following discussions with the treating doctors and the relatives, it was suggested to delay shifting of the patient for a few more days, until he showed signs of further improvements. In the meantime, it was suggested to perform tracheostomy.
  • At Vayodha Hospital: An Indian female aged around 45 years, injured during an earthquake, sustained extensive polytrauma with multiple fractures both legs and foot with extensive soft tissue damage + impending gangrene. She was kept in ICU and was being provided necessary treatment and was showing signs of improvements, but needed multiple procedures including microsurgical reconstructions. In consultations with her husband and two nephews (practicing as doctors at Jaipur), it was suggested to shift her at the desire of the patient either to Jaipur, where they have family support or Delhi / Mumbai for further multiple orthopedic / plastic surgical procedures including microsurgical reconstructions.
  • Dr. Thakur, Health Attaché advised Dr. Ashok Gupta to visit the Trauma Centre and the Bir Hospital and to meet the Hon’ble Vice Chancellor Dr. Ganesh Gurung. Dr. Ashok Gupta visited the Trauma Centre and interacted with Hon’ble Vice Chancellor Dr. Ganesh Gurung and other members of the medical team of the Hospital. Dr. Gupta was also invited to take a lecture on Reconstructive Microsurgery for Post Graduate students the next day.
  • Incidentally, Hon’ble Health Minister of Nepal was also visiting the Hospital and Dr. Ashok Gupta was introduced to Hon’ble Health Minister:
  • Dr. Kanchan Gupta and Dr. Shashank Shringarpure visited the remote OPD under the banner of RED Cross and the B P Eye Foundation at Karyabinayak Municipality area and examined over 100 patients.
Day 6: 5th May, 2015 (Tuesday)
  • Dr. Sujit Adsul and Dr. Shashank Shringarpure visited the Remote OPD under the banner of Red Cross and the B P Eye Foundation at Karyabinayak Municipality area and examined over 70 patients.
  • Dr. Ashok Gupta took a lecture on Reconstructive Microsurgery for Post Graduate students. It was attended by over 40 orthopaedic / trauma surgeons / plastic surgeon at the Trauma Centre. There were lots of interactions and they appreciated the advancements in reconstructive microsurgery in trauma care / salvage of limbs.
  • Dr. Ashok Gupta, then visited the Ministry of Health to seek permission for the members of the IMA team arriving on 5thevening. It was extremely difficult, as the Ministry had stopped any new registrations and were advising all the relief teams to go back. However, as a goodwill, Dr. Lohani, suggested the team to go to the Bhaktapur Civil Hospital.
Our Host Mr. Harsh Garg and Mrs. Namrata Garg were very gracious in making arrangements for escorting all the team members from the Airport to their respective hotels, hospitals as well hosted a dinner / social get together on 5th evening to thank all the members (team 1 + 2) to extend the humanitarian work at Nepal. It was great opportunity to meet and share the experiences with members of both the teams as well thank our generous and magnanimous hosts.

Dr. Ashok Gupta
IMA Team Leader
Nepal Disaster Relief Team
Media
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Inspirational Story
Beginning Today

Beginning today I will no longer worry about yesterday. It is in the past and the past will never change. Only I can change by choosing to do so.

Beginning today I will no longer worry about tomorrow. Tomorrow will always be there, waiting for me to make the most of it. But I cannot make the most of tomorrow without first making the most of today.

Beginning today I will look in the mirror and I will see a person worthy of my respect and admiration. This capable person looking back at me is someone I enjoy spending time with and someone I would like to get to know better.

Beginning today I will cherish each moment of my life. I value this gift bestowed upon me in this world and I will unselfishly share this gift with others. I will use this gift to enhance the lives of others.

Beginning today I will take a moment to step off the beaten path and to revel in the mysteries I encounter. I will face challenges with courage and determination. I will overcome what barriers there may be which hinder my quest for growth and self–improvement.

Beginning today I will take life one day at a time, one step at a time. Discouragement will not be allowed to taint my positive self–image, my desire to succeed or my capacity to love.

Beginning today I walk with renewed faith in human kindness. Regardless of what has gone before, I believe there is hope for a brighter and better future.

Beginning today I will open my mind and my heart. I will welcome new experiences. I will meet new people. I will not expect perfection from myself nor anyone else: perfection does not exist in an imperfect world. But I will applaud the attempt to overcome human foibles.

Beginning today I am responsible for my own happiness and I will do things that make me happy… admire the beautiful wonders of nature, listen to my favorite music, pet a kitten or a puppy, soak in a bubble bath… pleasure can be found in the most simple of gestures.

Beginning today I will learn something new; I will try something different; I will savor all the various flavors life has to offer. I will change what I can and the rest I will let go. I will strive to become the best me I can possibly be.

Beginning today and every day. Just a thought, but as I often think of you and realize how much God loves you, sometimes I think we need to also love ourselves through His eyes.
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Quote of the Day
By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest. Confucius
Reader Response
  • Well Done !!! Congratulation to IMA leaders and participant doctors. Dr. Thomas Philip
  • Thanks sir for valuable information about Mediclaim Dr  Sanjay Ghate
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Press Release
Heart disease may present with asthma like symptoms

Heart disease may present with asthma like symptoms, said said Padma Shri Awardee Dr A Marthanda Pillai, National President, Indian Medical Association (IMA) and 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).

Dr Aggarwal said that the commonest cause of breathlessness is not asthma. Obesity and anemia can cause exertional breathlessness. Uncontrolled high blood pressure, diastolic dysfunction of the heart and enlarged heart can also cause breathlessness.

The rule of thumb is that any breathlessness appearing for the first time in life after the age of 40 is cardiac in nature unless proved otherwise.

Impaired relaxation functions of the heart are a new epidemic of the society where the heart arteries do not have any blockages but the heart cannot relax properly.

Diastolic functions of the heart can be evaluated by tissue Doppler echocardiography examination.

Ordinary echo exam will miss the diagnosis as it usually detects the contracting systolic functions of the heart.