April 1  2015, Wednesday
editorial
Fish Medicine for asthma
Dr KK AggarwalThe Bathini Goud family, living in Hyderabad, claim that they can cure asthma by making people swallow a 2–inch live fish filled with medicine. They claim that they have been using this treatment for over 160 years.

As per their claim the medicine is stuffed inside the mouth of a live murrel fish, 5–6 cm in size. This fish with medicine is slipped into the mouth of the asthmatic patient, which can easily be swallowed as the fish is slippery. This needs to be taken for three consecutive years.

The medicine is administered on a specific day Mrigashira Kanthi Nakshatra, which normally coincides with arrival of monsoon rains in the first or second week of June. Three doses are given to the patients after every 15 days.

The Goud family never discloses ingredients of their drug. They provide the medicine free of cost. Some people went to the Court of the Andhra Pradesh on 27.01.2013 but the court declined to interfere and pass any orders regarding the administration of substances popularly known as Fish Medicine. They reasoned that although the treatment had no medicinal value, analysis had shown the samples to not be harmful. They said that "if people flock to have a substance out of faith the courts cannot interfere".

My opinion

Asthma is classified as mild intermittent asthma, moderate persistent asthma and severe persistent asthma. The distinction between intermittent and mild persistent asthma is important because current guidelines for moderate persistent asthma call for initiation of daily control medicine. For moderate persistent asthma, the preferred long–term controller is low–dose inhaled steroid.

Mild intermittent asthma is the largest segment of asthmatic patients and they do not require long term treatment. These are the people who may never require steroid inhalers. Over a period of time, these asthmatics may show improvement. Many mild intermittent asthmatics who are allergic to a particular protein may improve over a period of time.

Homeopaths, Ayurveda physicians, naturopaths and others who claim that they can cure asthma, they work only on patients with mild intermittent asthma. If they can demonstrate their results in severe asthma, then their methods can be believed to be of use.

The very fact that somebody has claimed does not mean that it is not scientific or scientifically validated. If they can prove their claim, there is no reason why they should not get Noble Prize. We have seen a similar claim by a person who gives a medicine for jaundice in Chandni Chowk and another person in Agra who claims that the can cure any type of cancer with a herb mixed with goat milk.

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On the occasion of Indian Medical Association’s Measles Immunization Day, emphasis was laid on the need and correct dosage of vaccination for measles
News
  • Treatment of chronic migraine with a sphenopalatine ganglion block using intranasal technology effectively reduces the frequency and severity of pain associated with the headaches up to a month after treatment, suggests a new trial presented at the American Academy of Pain Medicine (AAPM) 31st Annual Meeting.
  • Panic disorder responds well to drug therapy, but almost all patients relapse when drugs are withdrawn, suggests a long-term study presented at the European Psychiatric Association (EPA) 23rd Congress.
  • Probiotic nose drops reduced the probability of students being colonized with the bacteria that cause meningitis, suggested a study published online March 25 in Clinical Infectious Diseases.
  • Fish oil intake does not appear to have a protective effect against the development of colorectal cancer overall, although it may be associated with a lower risk for one particular subtype, suggests new research published in the Journal of the National Cancer Institute.
  • The link between metabolite profiles and insulin resistance and diabetes is stronger in ethnic-minority groups, resulting in earlier and more aggressive diabetes and worse clinical outcomes, suggest several presentations at the recent Diabetes UK Professional Conference.
Dr KK Spiritual Blog
Why Spirituality is Friendly to wellbeing
  • What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  • Positive thinking produces nearly a 30 percent drop in perception of pain.
  • Spirituality and the practice of religion are associated with a slower progression of Alzheimer’s disease.
  • Those who regularly attend organized religious activities may live longer than those who do not. Regular participation lowers mortality rate by about 12 percent a year.
  • People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  • Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  • Spirituality stimulates the relaxation response. When the body is relaxed, the heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  • Spirituality can affect function of the immune system. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  • Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  • Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.
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Cardiology eMedinewS
  • Obese individuals undergoing bariatric surgery for weight reduction may experience a significant reduction in subclinical atherosclerosis 1 month following the surgery, suggests a small study presented at EAS 2015: the European Atherosclerosis Society 2015 Congress.
  • Exploratory analysis of data from the phase 3 REGULATE-PCI trial (that was halted due to concerns about serious allergic reactions with the novel agent REG1) suggests that if future research can solve the allergy and bleeding complications, the drug may provide effective, reversible anticoagulation for patients undergoing PCI. The findings were presented at the American College of Cardiology 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Three major causes account for more than 80% of coughs lasting more than four weeks in children referred to otolaryngologists, suggests a review of data from a major health center. These etiologies, namely infection, airway hyperreactivity, and gastroesophageal reflux, should be high in differential diagnosis when evaluating these patients. The report is published online in JAMA Otolaryngology-Head & Neck Surgery.
  • To reduce errors and increase precision of drug administration, milliliter-based dosing should be used exclusively when prescribing and administering liquid medications, suggests the AAP's Committee on Drugs Policy in a statement published online March 30 in Pediatrics.
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Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.

Reaction: Oh my God! Why was additional insulin given?

Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.
Dr Good Dr Bad
Situation: A patient wanted to know if his pre-hospital bills are covered under claim.

Dr. Bad: They are not covered.

Dr. Good: They are covered.

Lesson: All expenses incurred related to the diseases upto 30 days prior to hospitalization are covered under Mediclaim.

(Copyright IJCP)
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Inspirational Story
Black or White

When I was in elementary school, I got into a major argument with a boy in my class. I have forgotten what the argument was about, but I have never forgotten the lesson I learned that day.

I was convinced that "I" was right and "he" was wrong – and he was just as convinced that "I" was wrong and "he" was right. The teacher decided to teach us a very important lesson. She brought us up to the front of the class and placed him on one side of her desk and me on the other. In the middle of her desk was a large, round object. I could clearly see that it was black. She asked the boy what color the object was. "White," he answered.

I couldn’t believe he said the object was white, when it was obviously black! Another argument started between my classmate and me, this time about the color of the object. The teacher told me to go stand where the boy was standing and told him to come stand where I had been. We changed places, and now she asked me what the color of the object was. I had to answer, "White."

It was an object with two differently colored sides, and from his viewpoint it was white. Only from my side it was black.

Sometimes we need to look at the problem from the other person’s view in order to truly understand his/her perspective.
eMedi Quiz
The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

1. Transitional
2. Stratified squamous
3. Stratified cuboidal
4. Stratified columnar

Yesterday’s Mind Teaser: A 30-year-old man came to the outpatient department because he had suddenly developed double vision. On examination, it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1. Medial rectus and superior division of oculmotor nerve.
2. Inferior oblique and inferior division of oculomotor nerve.
3. Lateral rectus and abducent nerve.
4. Superior rectus and trochlear nerve.

Answer for yesterday’s Mind Teaser: 3. Lateral rectus and abducent nerve.

Correct Answers received from: Dr Madhusudhan G, Daivadheenam Jella, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Answer for 30th March Mind Teaser: 3.Pain sensation on the contralateral side.

Correct Answers receives: Dr Madhusudhan G, Daivadheenam Jella, Dr Avtar Krishan, Dr K Raju, Dr KV Sarma, Dr Jainendra Upadhyay.
Rabies News (Dr A K Gupta)
Is observing the dog for 10 days without initiating treatment risky or justifiable?

Observing the dog for 10 days without initiating treatment is risky and not at all justifiable. It is mandatory to start treatment soon after exposure. The vaccination must be started immediately irrespective of the status of the biting animal. Improper treatment to animal bite victims may lead to rabies death and litigation under Consumer Protection Act (COPRA). According to Consumer Protection Act, the animal bite should be considered as "medical urgency" and treated with due care.
eMedinews Humor
Under the wagon

A farm boy accidentally overturned his wagonload of wheat on the road. The farmer that lived nearby came to investigate.

"Hey, Willis," he called out, "forget your troubles for a while and come and have dinner with us. Then I’ll help you overturn the wagon."

"That’s very nice of you," Willis answered, "but I don’t think Dad would like me to."

"Aw, come on, son!" the farmer insisted.

"Well, OK," the boy finally agreed, "but Dad won’t like it."

After a hearty dinner, Willis thanked the host. "I feel a lot better now, but I know Dad's going to be real upset."

"Don’t be silly!" said the neighbor. "By the way, where is he?"

"Under the wagon," replied Willis.
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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
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Sonal Namaste
The SAVE LIVES: Clean Your Hands annual initiative is part of a major global effort led by the World Health Organization (WHO). It includes the "My Five Moments for Hand Hygiene", which define the key moments when healthcare workers should perform hand hygiene.

This evidence-based, field-tested approach is applicable in a wide range of settings. The WHO approach recommends HCWs clean their hands:
  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings
Facts about Tuberculosis (TB)
What is XDR TB?

Extensively drug resistant TB (XDR TB) is a severe form of MDR TB, which is also resistant to second- line drugs, especially fluoroquinolones and at least 1 of the 3 injectables (capreomycin, kanamycin or amikacin).
Don't post surgery visuals on social media, Maharashtra Medical Council tells doctors
Tuesday, 31 March 2015: DNA/ Santosh Andhale

The Maharashtra Medical Council (MMC) plans to issue an advisory to doctors asking them to refrain from posting visuals of their surgical work on social networking sites like Facebook.

The Maharashtra Medical Council (MMC) plans to issue an advisory to doctors asking them to refrain from posting visuals of their surgical work on social networking sites like Facebook.

The trend has been catching up of late as doctors find it as the best way for self-promotion. Many doctors justify the act saying they have the permission from patients.

The MMC has now made it clear: no more posting of surgery visuals – with or without the permission of patients. It's a breach of the Medical Council of India's (MCI) code of conduct.

Snake and scorpio venom vaccine researcher Dr Himmatrao Bawaskar, who fought the practice of doctors getting cuts through referrals, said: "This is completely unethical."

Is there any exception to the rule?

Doctors can use pictures of surgical work without revealing patient identity in scientific journals and for medical education with patient permission. Posting visuals on social networking websites is completely unethical. "Every doctor knows that patient privacy is very important. It is taught in MBBS course," said Dr Kishor Taori, president, MMC.

What does the law say?

"The Medical Council of India Act came into force in 1956 and the rules and regulation of medical ethics and etiquette were amended in 2002. That time, there was no social networking site. Now, there is a need to change the law. We will also talk to IMA," Dr Taori said. MMC enjoys the power to suspend a doctor's licence if s/he is found guilty. Only doctors registered with MMC can practise in Maharashtra. Over 70,000 doctors are registered with MMC.

Can patients complain?

Yes. Patients can file complaints against doctors if they feel their identities are being revealed, said Dr Taori. "Anything revealing patient identity has to be with his consent. But we have seen lots of doctors in Maharashtra sharing patient stories and surgical work online," he said.

Do patients give consent?

That's what many docs say. But recently, one Chennai-based surgeon had to tender an apology and remove visuals of a surgery from a site after the patient objected. Three Kerala-based doctors were suspended last year after they posted the visual of a Cesarean procedure on WhatsApp. In this case, the woman had given birth to triplets. Recently, one surgeon from Thane posted one picture on WhatsApp, and we had to apologise, said Dr Shivkumar Utture, central working committee member, IMA.
Patients with TB should be tested for HIV
NEW DELHI, March 31, 2015 | The Hindu | Bindu Shajan Perappadan

The Indian Medical Association (IMA) has recommended HIV screening for all TB patients unless the patient declines (opt-out screening).

The Association general secretary K.K. Aggarwal noted that persons with TB disease and persons with latent TB infection should also be covered. “Routine HIV testing is also recommended for persons suspected of having TB disease, persons diagnosed with latent TB infection, and contacts to TB patients," noted IMA.

A resolution was passed by IMA during its annual national review meeting on TB held in the city recently. The Association has released a set of points for discussion among the policy makers and physicians.

"HIV infection is the most important known risk factor for progression from latent TB infection to TB disease," noted Dr. Aggarwal. He added that progression to TB disease is often rapid among people infected with HIV and can be deadly. TB outbreaks can rapidly expand in patient groups infected with HIV.
IMA plans new surveillance system to warn doctors about new outbreaks
Sushmi Dey, TNN | Mar 31, 2015, 04.02 AM IST

NEW DELHI: With virus or bacterial infections puzzling doctors every now and then, Indian Medical Association (IMA) has decided to set up an integrated surveillance system for new disease outbreaks.

Many new diseases such as dengue, swine flu, chikungunya, Japanese encephalitis, bird flu etc have hit India over past decade. However, most of these diseases are initially limited to a state or two.

"In the absence of a proper surveillance mechanism, doctors as well as government agencies are unable to track the spread of such disease in its initial stage and therefore, also fail to prepare in advance to tackle them," says IMA secretary general Dr K K Aggarwal.

IMA is now working to set up a system which will enable doctors, regulators as well as government authorities from across the country to report, interact and be informed about any new outbreaks. While the system will track symptoms of particular diseases, doctors registered with IMA or Medical Council of India will also be able to report cases of new diseases from different parts of the country.

The doctors' association, representing over 2.5 lakh doctors from across the country, also plans to track neighbouring countries through the proposed mechanism.

"It is also important because there is a lot of migrated population from one state to other or even from other countries. So, if a patient with a new disease visits from other state, where there is outbreak of a certain disease, the doctor here should be aware of the disease symptoms and be able to diagnose," Dr Aggarwal explains.

The new mechanism would also enable government agencies to compile more accurate data in case of outbreaks.

IMA is in talks with various state governments as well as with the Union health ministry to take the project forward. "To make it a pan India programme, it requires coordination between different state governments, doctors as well as regulatory agencies," Dr Aggarwal said
Only 1% opt for breast reconstruction in Ahmedabad
TNN | Mar 31, 2015, 02.23 AM IST

Ahmedabad: It was April 10, 2013, when city dentist Siya Shah underwent breast cancer surgery. Almost two years later, Shah has survived cancer but has not been able to opt for breast reconstruction. Reason: Lack of awareness. When she got to know about breast conservation, it was too late - insurance firms refused to include her claim under the ambit of primary surgery due to the gap between the two procedures.

Hers is not the lone case. Nearly 1,000 breast cancer surgeries are performed in government and private hospitals across Ahmedabad every month and only 1% of them undergo breast reconstruction. According to plastic surgeon Dr Bijal Parikh, most of the survivors are unaware of reconstruction option and others are caught in financial and insurance issues.

Indian Medical Association (IMA) has written to insurance firms to include breast reconstruction into the bracket of primary treatment and not cosmetic surgery, as it is listed now. It has reasoned that most breast cancer patients cannot opt for breast reconstruction since it is out of the ambit of health insurance, said Dr K K Aggarwal, the honorary secretary general of IMA.

Dr Parikh said, "Survivors rarely undergo breast reconstruction as insurance firms refuse to consider breast conservation as part of the primary surgery when there's a gap between the two procedures. They consider it as secondary operation, but actually it's a reconstructive surgery."

Cosmetic surgeon Dr Vishal Patel said, "Doctors usually don't disclose the option of breast reconstruction to patients as they're already under too much trauma. Another surgery after one painful operation is too much for any human. It's high time insurance firms should include reconstructive process under primary surgery."

According to breast cancer surgeon Dr D G Vijay, "Health isn't a priority for Indian women. For every patient, priority is to get back to work as the earliest. Very few women undergo breast reconstruction and those who opt for it have to bear the entire expense."
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Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship. Buddha
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Reader Response
Pathology Lab Practice must have qualified MD / DCP doctor. It should not be practice by other branch MD, MBBS or DMLT Technicians! Insurance company must object seriously for their bills! Today's world, there should not be any excuses for speciality practice. Dr Khandwala
Wellness Blog
Dark Chocolate good for the heart

Dark chocolate thought to promote relaxed arteries, also has biochemical effects that may discourage atherosclerosis suggests a report published in the March 2014 issue of the FASEB Journal.

In a randomized, double–blind study, eating dark chocolate—acutely and over weeks—not only improved objective measures of endovascular function, it also improved biochemical markers that reflect leukocyte activation, inflammation, and other signs of atherogenesis.

Changes in endothelial function were reflected in improved flow–mediated dilation (FMD), blood pressure, and augmentation index (AIX), while "changes in leukocyte–cell counts, plasma cytokines, and leukocyte adherence markers after chocolate consumption point toward a less–activated state of cellular adherence and, hence, a less atherogenic milieu, according to the authors, led by Dr Diederik Esser (Top Institute Food and Nutrition and Wageningen University, the Netherlands).
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Improving measles control in India: Indian Medical Association
On the occasion of Indian Medical Association’s Measles Immunization Day, emphasis was laid on the need and correct dosage of vaccination for measles

March 31st is observed as Indian Medical Association’s Measles Immunization Day. Addressing a press conference organized on the occasion, Padma Shri Awardee Dr A Marthanda Pillai - National President and Padma Shri Awardee Dr KK Aggarwal - Honorary Secretary General IMA in a joint statement said, “India should build on its polio eradication campaign experience to ensure that more children get vaccinated against measles. In a single polio vaccine strategy, 2.3 million vaccinators should go door-to-door, visiting 191 million homes to vaccinate 172 million children a year.”

Co addressing the press were renowned pediatricians Dr. Anupam Sachdeva, Chairman, Pediatrics, Director, Pediatric Hematology Oncology and Bone Marrow Transplantation Institute For Child Health, Sir Ganga Ram Hospital and Dr. Ajay Gambhir, Head Neonatology & Pediatrics, Saroj Hospital & Heart Institute. In a joint statement they said, “Measles is still one of the leading causes of death in young children. A highly contagious disease, measles spreads like wildfire in communities where children are unvaccinated. Since the virus reduces immunity, children who have had measles – especially those who are undernourished – may die of pneumonia, diarrhea and encephalitis later on. More than one third of all measles deaths worldwide (around 56, 000 in 2011) are among children in India. Awareness needs to be created about the need and safety of measles vaccination.
Four percent of the under-five mortality in India is due to measles.”

Every year around 3 million cases of measles occur and about 900,000 children die because of measles around the world. In India, 500 children die every day because of measles.

All unvaccinated newborns are at danger from measles. Usually children become susceptible to measles around the age of nine months, probably because they are protected up to this period by the antibodies (proteins that protect against a disease) against measles, received from their mothers.

Measles is a highly contagious disease, which spreads through air. Mere sneezing by an infected child in a group of children can easily spread this virus. It spreads so easily that any child who is exposed to it and is not immune will probably get it. One can get measles from an infected person who coughs or sneezes around you or even talks to you.

The good news is that a safe and effective measles vaccine exists. Because measles is so infectious, a country needs to ensure that at least 95% of all children receive two doses of the vaccine. About 15% of vaccinated children fail to develop immunity from the first dose, meaning that if only 80% are fully immunized, an outbreak is likely.

“The first dose of measles vaccine should be given at the age of 9 months. However, it has been observed that a single dose of measles vaccine is not enough for effective eradication of this disease. Therefore, a second dose against Measles as MMR should be administered at the age of 15 months” Dr Anupam Sachdeva added.

With support from WHO, in November 2010, India launched a massive polio-style measles vaccination project in 14 high-burden states, in a three-phase campaign. The government established a system to ensure that every child who receives the first dose of the vaccine routinely gets a second. They also initiated ‘catch-up’ campaigns in areas where first-dose coverage was less than 80%.