May 1  2015, Friday
editorial
Every arthritis is not same
Dr KK AggarwalEvery arthritis is not the same. While osteoarthritis, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called rheumatoid arthritis, if not treated early and aggressively can cause serious deforming complications.

Any arthritis in young women of child–bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease–modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1–2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of 50+age group and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight–bearing joints like the knees, hips, neck and lower back joints. Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout, which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing Padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing pushups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise. Most patients of serious arthritis end up with treatment with other systems of medicines or with quacks.
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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
  • The US Food and Drug Administration (FDA) has approved deoxycholic acid to help reduce double chins. The drug is administered as an injection into the fat tissue in the submental area. Patients may receive up to 50 injections in a single treatment, with up to six single treatments administered about 1 month apart.
  • Minocycline is effective for treating recurrent and chronic erythema nodosum leprosum (ENL), suggests a pilot study in 10 patients with multibacillary leprosy. The findings were published online in JAMA Dermatology.
  • Adherence to the Mediterranean diet (MeDi) may prevent brain atrophy in old age, points new research presented at the American Academy of Neurology (AAN) 67th Annual Meeting.
  • Older women treated with nitrofurantoin for urinary tract infection (UTI) had higher rates of treatment failure than those who received other first-line antibiotics, suggests a study published online April 27 in the Canadian Medical Association Journal.
  • The management of hypertension in a patient with asthma or chronic obstructive pulmonary disease (COPD) may be made difficult by the asthma-exacerbating effect of some antihypertensive drugs.
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Dr KK Spiritual Blog
Why do we not offer Vanaspathi Ghee at the time of cremation or worship?

Vanaspati Ghee is never offered to God at the time of Aarti in the Diya or to the dead body at the time of cremation. Only pure ghee is offered.

It is considered a bad omen to offer Vanaspati ghee at the time of the last cremation ritual even though the consciousness has left the body.

What is not offered to God should not be offered to our consciousness and that was the reason for this ritual in a temple. Vanaspati ghee increases bad cholesterol and reduces level of good cholesterol in the blood. On the other hand, pure ghee only increases bad cholesterol but does not reduce the level of good cholesterol. The medical recommendation is that one should not take more than 15 ml of oil, ghee, butter or maximum ½ kg in one month.

It is a spiritual crime to offer vanaspati ghee to God.
Cardiology eMedinewS
  • Individuals with chronic obstructive pulmonary disease (COPD) have more than one third overall increased risk for sudden cardiac death (SCD) compared with healthy age- and sex-matched adults, suggests new research from the Rotterdam Study published online April 28 in the European Heart Journal.
  • Two new studies highlight some of the poor clinical outcomes following the implantation of a left ventricular assist device (LVAD) in patients with heart failure and underscore the importance of patient-physician discussions about the device's risks and benefits. The studies will be presented at the American Heart Association Quality of Care and Outcomes Research (AHA-QCOR) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Children who are bullied by their peers may be more likely to suffer mental health problems later in life than kids who are abused by adults, suggests a study published in The Lancet Psychiatry.
  • Nearly one in 14 toddlers diagnosed with autism spectrum disorder (ASD) lose the diagnosis by the time they're in elementary school, but most of these children continue to have some special educational and behavioral needs, suggested a study presented at the Pediatric Academic Societies' annual meeting.
Make Sure
Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.
Dr Good Dr Bad
Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low–dose aspirin.
Lesson: In dengue, lose–dose aspirin needs to be stopped.
(Copyright IJCP)
Inspirational Story
All Good Things

He was in the first third grade class I taught at Saint Mary’s School in Morris, Minn. All 34 of my students were dear to me, but Mark Eklund was one in a million. Very neat in appearance, but had that happy–to–be–alive attitude that made even his occasional mischievousness delightful.

Mark talked incessantly. I had to remind him again and again that talking without permission was not acceptable. What impressed me so much, though, was his sincere response every time I had to correct him for misbehaving. "Thank you for correcting me, Sister!" I didn’t know what to make of it at first, but before long I became accustomed to hearing it many times a day.

One morning my patience was growing thin when Mark talked once too often, and then I made a novice–teacher’s mistake. I looked at Mark and said, "If you say one more word, I am going to tape your mouth shut!" It wasn’t ten seconds later when Chuck blurted out; "Mark is talking again." I hadn’t asked any of the students to help me watch Mark, but since I had stated the punishment in front of the class, I had to act on it.

I remember the scene as if it had occurred this morning. I walked to my desk, very deliberately opened my drawer and took out a roll of masking tape. Without saying a word, I proceeded to Mark’s desk, tore off two pieces of tape and made a big X with them over his mouth. I then returned to the front of the room. As I glanced at Mark to see how he was doing, he winked at me. That did it!! I started laughing.

The class cheered as I walked back to Mark’s desk, removed the tape, and shrugged my shoulders. His first words were, "Thank you for correcting me, Sister." At the end of the year, I was asked to teach junior-high math.

The years flew by, and before I knew it Mark was in my classroom again. He was more handsome than ever and just as polite. Since he had to listen carefully to my instruction in the "new math," he did not talk as much in ninth grade as he had in third. One Friday, things just didn't feel right. We had worked hard on a new concept all week and I sensed that the students were frowning, frustrated with themselves – and edgy with one another.

I had to stop this crankiness before it got out of hand. So I asked them to list the names of the other students in the room on two sheets of paper, leaving a space between each name. Then I told them to think of the nicest thing they could say about each of their classmates and write it down. It took the remainder of the class period to finish their assignment, and as the students left the room, each one handed me the papers. Charlie smiled. Mark said, "Thank you for teaching me, Sister. Have a good weekend." That Saturday, I wrote down the name of each student on a separate sheet of paper, and I listed what everyone else had said about that individual.

On Monday I gave each student his or her list. Before long, the entire class was smiling. "Really?" I heard whispered. "I never knew that meant anything to anyone!" "I didn’t know others liked me so much."

No one ever mentioned those papers in class again. I never knew if they discussed them after class or with their parents, but it didn't matter. The exercise had accomplished its purpose. The students were happy with themselves and one another again.

That group of students moved on. Several years later, after I returned vacation, my parents met me at the airport. As we were driving home, mother asked me the usual questions about the trip - the weather, my experiences in general. There was a lull in the conversation. Mother gave Dad a side–ways glance and simply says, "Dad?" My father cleared his throat as he usually did before something important.

"The Eklunds called last night," he began. "Really?" I said. "I haven’t heard from them in years. I wonder how Mark is." Dad responded quietly. "Mark was killed in Vietnam," he said. "The funeral is tomorrow, and his parents would like it if you could attend."

To this day I can still point to the exact spot on I–494 where Dad told me about Mark. I had never seen a serviceman in a military coffin before. Mark looked so handsome, so mature. All I could think at that moment was, Mark I would give all the masking tape in the world if only you would talk to me.

The church was packed with Mark’s friends. Chuck's sister sang "The Battle Hymn of the Republic." Why did it have to rain on the day of the funeral? It was difficult enough at the graveside.

The pastor said the usual prayers, and the bugler played taps. One by one those who loved Mark took a last walk by the coffin and sprinkled it with holy water. I was the last one to bless the coffin. As I stood there, one of the soldiers who acted as pallbearer came up to me. "Were you Mark’s math teacher?" he asked. I nodded as I continued to stare at the coffin. "Mark talked about you a lot," he said.

After the funeral, most of Mark's former classmates headed to Chuck’s farmhouse for lunch. Mark’s mother and father were there, obviously waiting for me. "We want to show you something," his father said, taking a wallet out of his pocket. "They found this on Mark when he was killed. We thought you might recognize it."

Opening the billfold, he carefully removed two worn pieces of notebook paper that had obviously been taped, folded and refolded many times. I knew without looking that the papers were the ones on which I had listed all the good things each of Mark’s classmates had said about him. "Thank you so much for doing that," Mark’s mother said. "As you can see, Mark treasured it."

Mark’s classmates started to gather around us. Charlie smiled rather sheepishly and said, "I still have my list. It’s in the top drawer of my desk at home." Chuck’s wife said, "Chuck asked me to put his in our wedding album." "I have mine too," Marilyn said. "It’s in my diary."

Then Vicki, another classmate, reached into her pocketbook, took out her wallet and showed her worn and frazzled list to the group. "I carry this with me at all times," Vicki said without batting an eyelash. "I think we all saved our lists."

That’s when I finally sat down and cried. I cried for Mark and for all his friends who would never see him again.
eMedi Quiz
All of the following regarding aromatase inhibitors are correct except:

1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.
2. AIs have been shown to reduce bone density, and increase the risk of fractures.
3. Aromatase inhibitors are not indicated in premenopausal women.
4. The musculoskeletal symptoms associated with the AIs are transient.

Yesterday’s Mind Teaser: Which factors may increase your risk of having a stroke?

A. Hypertension and aging.
B. Being female and Caucasian.
C. Being female and African-American.
D. Menopause.
E. B and C.

Answer for yesterday’s Mind Teaser: A. Hypertension and aging
Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Raju Kuppusamy, Dr Shangarpawar, Dr Pandit Hantodkar, dr poonamchablani, Dr K V Sarma, Dr MadhuSudhan G, Dr Avtar Krishan.
Answer for 29 April Mind Teaser: D. Unusual geographic clustering of disease
Correct Answers received: Daivadheenam Jella, Dr Shangarpawar, Dr Pandit Hantodkar, Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G.
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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
IMA asks the government to act on Ramdev for violation of PCPNDT act
As per the media reports, there was uproar in Rajya Sabha after Janata Dal-United MP KC Tyagi flashed a packet labeled 'Putrajeewak Beej' (son-bearing seeds) allegedly produced by Baba Ramdev's company, Patanjali Yoga Peeth.

Supported by many other members including Jaya Bachchan and Javed Akhtar, Tyagi asked how the government is allowing the sale of such herbs.

"Ramdev is the brand ambassador of BJP-ruled Haryana. This is against the PMs Campaign of Beti Bachao, Beti Padhao."

Union minister Mukhtar Abbas Naqvi said the government will find out more about it.

Health Minister JP Nadda called it a serious matter and assured the House of appropriate action.

Commenting on the subject Dr A Marthanda Pillai National President and Dr KK Aggarwal Honorary Secretary General IMA said that if doctor does it, it's a violation of PCPNDT act and a confirmed jail. Will the government put him to the jail.

As per the act section 22: Prohibition of advertisement relating to pre-natal determination of sex and punishment for contravention.

(2) No person or organization shall issue, publish, distribute, communicate or cause to be issued, published, distributed or communicated any advertisement in any manner regarding prenatal determination or pre-conception selection of sex by any means whatsoever, scientific or otherwise.

(3) Any person who contravenes the provisions of sub-section (2) shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees.

For the purposes of this section, "advertisement" includes any notice, circular, label, wrapper or any other document including advertisement through internet or any other media in electronic or print form and also includes any visible representation made by means of any hoarding, wall-painting, signal, light, sound, smoke or gas.
Team IMA to Nepal
Team IMA led by Dr Ashok Gupta has reached Nepal. Heart Care Foundation of India has made all the arrangements. Nepal was lacking super specialist services. Tremors are still on. OTs are make shift. Custom clearances are required before we take anything. Team IMA has started doing surgeries. IMA is looking for hospitals who are willing to take cases in India and provide free surgeries. IMA will ae arrangements for their safe transfer.
  • A free Medical Health Check-up camp was organised by Global Association of Physicians of Indian Origin (GAPIO) in collaboration with Remedial Foundation from 10:00 AM to 02:00 PM on 18th April 2015 at Allahabad Bank, Jasola Branch, New Delhi.
  • Shri Shripad Yesso Naik, Union Minister of State, Ministry of Health and Family Welfare to be the Chief Guest at the event and inaugurate ETHealthWorld.com. Panelists on the dais include Shivinder Mohan Singh, Executive Vice-Chairman, Fortis Healthcare, Shobana Kamineni, Executive Vice Chairperson, Apollo Hospitals, Dr K K Aggarwal, Secretary General, Indian Medical Association (IMA), Dr Srinath Reddy, President, Public Health Foundation of India (PHFI), K G Ananthakrishnan, Vice President and Managing Director, MSD India and Girindre Beehary, country director, India, Bill and Melinda Gates Foundation.

    Rajendra Pratap Gupta, public policy and healthcare expert, associated with BJP will be moderating the session.

    Agenda for Discussion: Dreaming up a Healthy Billion: The right pathways for universal healthcare

    Day & Date: Wednesday, 6th May 2015
    Time: 4 pm to 6 pm
    Venue: Le Meridien (Desire), Janpath Road, New Delhi
  • Sir Richard Roberts, British biochemist and the 1993 Nobel Laureate for Physiology or Medicine announced a joint statement of 23 Nobel Laureates “to protect Iranian refugees in Camp Liberty-Iraq.” Amongst these highly distinguished academicians are also 4 laureates on medicine including Sir John Gurdon, Professor Gunter Blobel, Professor Edmond H. Fischer and Professor Harald zur Hausen.

    Joining in, our colleagues from World Medical Association, ICN, CPME, UEMS, BMA… stated “From the beginning of 2009 when the responsibility to protect nearly 3,000 Iranian refugees in Iraq was transferred from US forces to the Iraqi government, these individuals have been targeted time and time again…”. They called on “the US government, the European Union and the United Nations to take urgent action to guarantee the safety and security of these refugees” and to require “the Iraqi government to lift the blockade and any restrictions on medical and logistical services for Camp Liberty residents…”

    Dealing with the consequences of violence

    Violence may occur in the workplace in spite of preventive measures. Employers should be prepared to deal with the consequences of this violence by providing an environment that promotes open communication and by developing written procedures for reporting and responding to violence. Employers should offer and encourage counseling whenever a worker is threatened or assaulted.

    MCI: 6.8 h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way.”

    Burn waste in open, pay Rs.5000 fine: National Green Tribunal

    Imposing a complete ban on burning of waste in the open including garbage, leaves, plastic and crop residues, the National Green Tribunal (NGT) said violators will be fined Rs.5,000. A Bench headed by NGT chairperson Justice Swatanter Kumar passed a slew of directions, including an order to the civic authorities and state governments of Delhi, Haryana, Rajasthan and Uttar Pradesh to immediately spread mass awareness regarding ill-effects of burning waste materials in open areas. "It is on record before us that burning of garbage and other materials is not only source of air pollution but forms 29.4 per cent of air pollution with reference to PM10. Burning of material also causes serious respiratory problems and is even carcinogenic... There shall be complete prohibition on burning of any kind of garbage, leaves, waste, plastic, rubber or any such other materials in open areas in NCR-Delhi," the Bench said. "We direct that for every incident of burning of such material, the person who is found burning or responsible for burning would be liable to pay compensation in terms of Section 15 of the National Green Tribunal Act, 2010 under the principle of polluter pays," the Bench said, adding that the money collected would be used for restoration of environment. (India Today)

    Last Call for Nominations for Prince Mahidol Award - Deadline May 31

    There are just two weeks left to submit nominations for The Prince Mahidol Award 2014, the international award recognizing the accomplishments of individual (s) or institution (s) for their outstanding performance and/or research that contributes directly to the betterment of society. Two Prince Mahidol Awards will be conferred on an annual basis, one in medicine and one in public health, each prize consists of a medal, a certificate and $US 100,000.

    The nominations are due May 31, 2014; details and the online nomination form are available at http://www.princemahidolaward.org/nomination-form.th.php Kindly noted that Self-nominations are NOT ACCEPTED.

    The cure for medical malpractice, whether through negligence or error, just may be a good lawyer.
Workplace Violence
Violence may occur anywhere in the hospital, but it is most frequent in the following areas:
  • Psychiatric wards
  • Emergency rooms
  • Waiting rooms
  • Geriatric units
Did you know?
That one should avoid ciprofloxacin in those with high caffeine intake as it can further increase caffeine levels.
Sonal Namaste
Preventive measures for acute diarrhea among children in resource-limited settings include breastfeeding, consumption of safe food and water, adherence to hygienic practices and vaccination against rotavirus infection.
Media
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Wellness Blog
Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.
Events
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Quote of the Day
The greatest gift you can give another is the purity of your attention. Richard Moss
IMA in Social Media
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IMA Humor
What is lucid interval?

Lucid interval is the period during which the mentally unsound person behaves very much like a normal person. During this period all the signs and symptoms of insanity are absent. The person is responsible for all his acts performed during the period of lucid interval.
Reader Response
Sir, in patients with epilepsy, hard objects should not be put as it may lead to dental fracture so it is advisable to use cloth pad. Prakash Puranik
IMA Videos
News on Maps
Travelers to Nepal must take precautions to prevent cholera
Post earthquake the biggest fear is cholera epidemic. One must learn lessons from the Haitri cholera epidemic where ten months after the largest urban disaster in modern history, a devastating 7.0-magnitude earthquake on January 12, 2010 that killed over 316,000 and affected 3 million, Haiti faced an outbreak of cholera.

By the end of 2011, the outbreak resulted in over 500,000 infections and 7,000 deaths. Cholera also spread to the Dominican Republic which by end of 2011 recorded over 21,000 cholera cases and 363 deaths. In the epidemic patient zero was identified as a 28-year-old Haitian who was exposed to cholera while bathing in, and drinking from, a river near the peacekeepers.

Ending the epidemic requires a concerted, multi-sectoral effort; reconstruction of water, sanitation and hygiene (WASH) infrastructure; hygiene education and free access to cholera treatment.

Cholera is a bacterial disease that can cause diarrhea and dehydration. It spreads through the ingestion of contaminated food or drinking water.

Indian Travelers to Nepal need to protect themselves, said Dr Aggarwal. Travelers should take their own supplies to help prevent the disease and to treat it. Items to pack include a prescription antibiotic to take in case of diarrhea; water purification chlorine tablets; oral rehydration salts, said Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical Association.

Travelers should drink and use safe water. Bottled water with unbroken seals and canned/bottled carbonated beverages are safe. One should use safe water to brush teeth, wash and prepare food, and make ice. One should clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse. One should not use piped water, drinks sold in cups or bags, or ice. All drinking water and water used to make ice should be boiled or treated with chlorine.

Safe water can be prepared by boiling it for one minute or treating the water with chlorine purification tablets or household bleach.

One can add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking.

One should always store your treated water in a clean, covered container.

Washing hands is the best bet. One should wash hands often with soap and safe water before eating food, before preparing prepare food, before feeding children, after using the latrine or toilet, after cleaning child’s bottom and after taking care of someone ill with diarrhea. If no soap is available one can scrub hands often with ash or sand and rinse with safe water.

One should use latrines or bury the feces. One should not defecate in open. One can use chemical toilets. One should clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water.

One should defecate at least 30 meters away from any body of water and then bury the feces. One should dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water.

Regarding cooking food, one should cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables.

Remember the formula, Boil it, cook it, peel it, or leave it.

Sea food precautions, be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through.

Wash children, diapers, and clothes at least 30 meters away from drinking water sources.
Rabies News (Dr A K Gupta)
A patient received two doses of modern vaccine (on days 0 and 3) and the dog was well on days 5 and 7 (third injection due, but not given). However, the dog dies on any day between 8 and 15. What should be done?

In case, day 0 and 3 injections were given and the dose due on day 7 was postponed because the dog was kept under observation but the dog dies between 8 and 15 days, three doses of vaccine must be given as close to the original dates of the schedule and all five injections must be completed by day 28.