September 1   2015, Tuesday
eMedinewS
editorial
To screen or not to screen all young athletes with ECG to discover problems hiding within the heart
Dr KK AggarwalGuidelines from the American Heart Association (AHA) (endorsed by the American College of Cardiology) and the European Society of Cardiology (ESC), both recommend a screening before sports participation, but the Americans favor a detailed medical history combined with a physical examination only, while the Europeans favor the addition of the 12–lead ECG.

The controversy was evident in the results of a poll conducted during a debate session at the AHA meeting last year, which were published in the New England Journal of Medicine by James Colbert, MD, of Harvard Medical School.

Of the audience members who voted –– an unscientific sample, to be sure –– 70% favored some type of screening for cardiac disease in young athletes. And in a scenario where screening was already a foregone conclusion, 60% said it should include an ECG. A similar online poll on the NEJM website was even more informative, showing that the differences in opinion exist on both sides of the Atlantic.

Of the 1,266 people who voted on the site –– again, not a scientific sample –– 18% didn’t want any mandatory screening, 24% wanted screening with a medical history and physical exam, and 58% favored screening that included an ECG. The percentage of voters who endorsed an ECG was higher among Europeans than among Americans (66% versus 45%), but that still indicates a substantial amount of controversy regardless of geography.
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eMedipics
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Diabetes
Rheumatology

Dipeptidyl peptidase-4 (DPP-4) inhibitors for type 2 diabetes may cause joint pain so intense it is disabling, warned the US Food and Drug Administration (FDA). It was, however, stated that the pain goes away, usually in less than a month, once patients stop taking the medicine.

Neurology
Using a multistep Delphi consensus process, a comprehensive scoring model for managing unruptured intracranial aneurysms (UIAs) has been developed that considers many factors including, young age, modifiable risk factors, aneurysm morphology, reduced life expectancy due to comorbidities (such as cancer), and factors influencing the risk of treatment (such as patient age and aneurysm size or complexity). The paper was published online in Neurology.

Oncology
Obstetrics and Gynecology
Women of childbearing age who have breast cancer seem to be refusing to take tamoxifen out of concern that it will affect their chance of having children, reported a study published online August 25 in the Journal of the National Cancer Institute.

Geriatrics
Psychiatry

Updated findings from the Prolonging Remission in Depressed Elderly (PRIDE) study further support the use of right unilateral electrode placement and ultrabrief pulse stimuli as an optimal means of achieving a rapid response, and even remittance, within a week of delivering three courses of electroconvulsive therapy (ECT) in geriatric patients with major unipolar depression. The findings were presented at the 28th European College of Neuropsychopharmacology (ECNP) Congress.

Dermatology
An old cardiovascular drug has emerged as a key option for hormonal management of acne, with recognized safety caveats. Researchers said at the American Academy of Dermatology summer meeting that keeping the safety issues at the forefront, spironolactone has well documented efficacy in difficult cases of acne.
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Cardiology eMedinewS
  • Patients who have no evidence of obstructive coronary artery disease (CAD) experience at least as great a burden of angina following an MI as those with obstructive CAD, affecting one in four such patients over a follow-up interval of 1 year, suggested two large contemporary multicenter MI registries. The findings were published online in the European Heart Journal—Quality of Care and Clinical Outcomes.
  • A new type of probe that lights up blood clots in a single scan of the whole body promises to significantly speed up the process of finding blood clots in patients. The probe has been successfully tested in rats and should enter human trials later this year. The new probe - developed by researchers at Massachusetts General Hospital (MGH) in Boston - featured at the national meeting of the American Chemical Society (ACS).
Pediatrics eMedinewS
Pediatrics
Diabetes & Endocrinology

For children who engage in long periods of sitting, taking short walking breaks can reduce their blood glucose, insulin, and free fatty acid levels without increasing subsequent total energy intake, suggests a new study published online August 27 in the Journal of Clinical Endocrinology and Metabolism.

Pediatrics
A new study on children's health has found that fourth and fifth graders who are exposed to toxic air pollutants at home are more likely to have lower GPAs. The findings were published in the journal Population and Environment.
Dr KK Spiritual Blog
The lips of truth shall be recognized forever; a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is everlasting and always ends up in internal happiness and self-realization and in the long run always gives you happiness and an all–win situation. On the contrary, a lying tongue will only give you a momentarily pleasure but will lead to some difficulty later in life.

Spoken words cannot come back as in the case of a released arrow from the bow. Once lost one cannot get back their youth, respect; similarly, bad words once spoken cannot be taken back and will create negative waves in the other person’s (on whom they were spoken) mind which will persist as repressed thoughts or memories in the minds of people forever. Such bad memories will keep on coming back in the person’s mind causing damage to the personal relationships.

A spoken word is a karmic expression. For every karmic action there is an opposite and equal reaction. For every negative karmic expression one has to pay the debt either now or in future. The law of karma says that every debt has to be paid. It is always better to avoid indulging into negative language both in spoken words as well as in the mind. The yoga sutras of Patanjali describe thinking, speaking or doing anything wrong as having the same karmic significance. We should not only purify ourselves in actions and spoken words but also in the mind. If a person keeps negative thoughts in mind, sooner or later they will be reflected to the outside world.

The momentary pleasure which one gets by "lying" has no spiritual significance as it only satisfies your ego sense or makes you attached to any of the five senses. The transient pleasure experienced by the body stimulates a chain of reactions, consisting of action, memory and desire leading to action again, which will only intensify the greed & attachments. In the Mahabharata, Lord Krishna has given only two examples, which work as an exception to such a situation. Any truth which harms others may not be spoken and any lie which does not harm anyone but benefits a few may be spoken. Truth is the opposite of doubt and it is always better to clear all doubts from the mind as any repressed doubts can end up into causation of heart attack, paralysis and cancer.

Truth also means taking conscious-based decisions as the consciousness will never lie. While taking any decision one should always ask oneself: Is it the truth? Is it necessary? And will it bring happiness to me and the people around?

Lord Krishna is also described as "SATCHITANAND" which only indicates qualities like truthfulness, conscious-based decisions and internal happiness. The practice of truthfulness has to be practical over a period of time and made a part and parcel of your daily life. To start with a person may have bad experiences but in the long run truthfulness will always win.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N. P. CO. ED. Secondary School, Babu Market, Sarojani Nagar, New Delhi-31-8-15
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Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 g of carbohydrates.
Dr Good Dr Bad
Situation: A patient with burn injury on the hand came with blisters.
Dr. Bad: I will puncture them.
Dr. Good: Be careful to not puncture them.
Lesson: Blisters are a natural dressing and should not be punctured.

(Copyright IJCP)
eIMA Quiz
Which of the following is true about ulcerative colitis with malignancy?

a) It has a better prognosis.
b) It is related to disease activity.
c) It is related to duration of ulcerative colitis.
d) Malignancy is more in anorectal ulcerative colitis.

Yesterday’s Mind Teaser: Which of the following is not true for malignancy of Familial Adenomatous Polyposis?

a) Adrenals
b) Thyroid
c) Astrocytomas
d) Hepatoblastomas

Answer for Yesterday’s Mind Teaser: c) Astrocytomas
Answers received from: Dr Ridu Kumar Sharma, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Shangarpawar, Dr B R Bhatnagar, Daivadheenam Jella, Dr Poonam Chablani, Dr K V Sarma.
Answer for 30th August Mind Teaser: c) It is associated with APC mutation
Correct Answers received from: Dr Kailash Sharma, Asha Yahoo, Dr B R Bhatnagar, Dr Avtar Krishan, Dr K V Sarma, Daivadheenam Jella.
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Rabies News (Dr A K Gupta)
How is rabies transmitted?

Rabies is transmitted by infected secretions. Most commonly, transmission to humans takes place through exposure to saliva following a bite by an infected animal. Rabies virus can be excreted in saliva, urine, nasal discharge and respiratory secretions.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Press Release
Good sanitation practices are a must to significantly reduce the risk of Ascaris, one of the most common worm infections in India

Extra precautions must be taken during the monsoon season that provides ideal breeding environment for the infectious roundworms

Ascariasis is one of the most common helminthic human infections in India. It is estimated that more than one billion people are infected with the disease globally. A disease caused by the parasitic roundworm Ascaris lumbricoides, the incidence of Ascariasis is extremely high in India due to its wet-tropical climate that makes for an ideal breeding ground for the parasite.

The prevalence of Ascariasis is greatest in areas where suboptimal sanitation practices lead to increased contamination of soil and water. The majority of individuals with Ascariasis live in Asia (73 percent), Africa (12 percent) and South America (8 percent), where the infection prevalence rates can be as high as 95 percent. While Ascariasis occurs among all age groups, it is most common in children 2 to 10 years old, and the prevalence of infection decreases over the age of 15 years. Infections tend to cluster in families, and worm burden correlates with the number of people living in a home.

The parasitic infection in more than 85% of cases has no symptoms, especially if the number of worms is small. Symptoms increase with the number of worms present and may include shortness of breath and fever at the beginning of the disease. These may be followed by symptoms of abdominal swelling, abdominal pain and diarrhea.

Infection with the roundworm occurs by eating food or drink contaminated with Ascaris eggs from feces of the infected individual. The eggs hatch in the intestines, burrow through the gut wall, and migrate to the lungs via the blood. The larvae mature in the alveoli and pass up the trachea, where they are coughed up and subsequently swallowed. The larvae then pass through the stomach for a second time into the intestine where they become adult worms.

According to Padma Shri Awardee, Dr KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General Indian Medical Association, “The diagnosis of Ascariasis is usually established via stool microscopy. In regions where Ascaris worms are abundant in soil, prevention of re-infection is extremely difficult. Good and healthy sanitation practices including improving access to toilets, proper disposal of feces, educating people about effective hand washing techniques can go a long way in the prevention of the disease.“

Anthelminthic therapy is warranted for the intestinal, biliary and pancreatic disease. In general, anthelminthic therapy should not be administered at the time of pulmonary symptoms because inflammation associated with dying organisms may cause more harm than symptoms associated with larval migration. Targeted treatment for individuals with symptomatic infection helps reduce the morbidity of infection but does not have a substantial effect on transmission.
eIMA News
Report of the Meeting on “Migration of Doctors and Nurses” arranged by WHO
&
Ministry of Health & Family Welfare
IMA was invited as a stakeholder in this meeting and Dr N V Kamat, Principal Advisor and the undersigned participated in it. The issue was concerning the WHO Global Code of Practice on International Recruitment of doctors and nurses in various parts of the globe.

Codes have already been drafted by WHO and it is to be enforced in the next few months. The purpose of the Code is to ensure the safety and dignity of health personnel migrating from one to another country. In the afternoon, there was a panel discussion where IMA was also on the panel, the topic of the panel was “How to Move Forward in India on the issue of international health workforce migration?” The following issues were taken up by IMA during the discussion:-
  1. There is no statistical evidence of shortage of doctors and nurses in the country. The shortage whatever in the rural sector exists because of wrong policies of the Govt & non Governmental agencies. Back door entry to Ayurveda and Homeopathy doctors to practice allopathy by various unrecognized courses/rampant quackery in the country was also highlighted.
  2. Everyone wants to have a better life and status and people migrate from villages to cities from smaller cities to bigger cities and from bigger cities to better international cities where they have better avenues of growth. In today’s world migration has become a necessity.
  3. At present, Govt of India does not have any data of health personnel who have migrated to other countries of the world in the past, so without the data we can not know the status and their working conditions.
This Code will be useful only when the Govt has comprehensive data of the same.

Our Constitution gives freedom to work and earn a livelihood, so putting break on migration from one place to another country will be contrary to the provisions of our Constitution.

Some refer to such migration as brain drain. In fact it can be converted into brain gain, if sufficient free opportunities and facilities are provided to people who want to come back to India after a certain period of time. This can be done by improving the working environment and culture in various Govt & Non Governmental health systems.

These issues were very much appreciated by the Govt. and other delegates. In fact Joint Secretary of Health & Family Welfare, Mr Ali Raza Rizvi and Dr. Arun Kumar Panda, Addl. Secretary also spoke about these issues in their concluding points.

                                                      Dr V K MONGA
                                                      Dean (Elect) IMA CGP
City witnesses alarming rise in dengue cases
31 August 2015, New Delhi: With the cases of dengue in the city rising at an alarming rate, the doctors have advised citizens to take precautionary steps to avoid mosquito bite during the day.

“The Dengue mosquito which is otherwise known as the Aedes mosquito bites only during the day while the malaria causing mosquito bites during the night. People do everything in their power to avoid mosquito bites during the night but are not serious about preventing mosquito bites during the day hours which is the main cause of the disease,” said Padma Shri Awardee Dr KK Aggarwal, President HCFI & Honorary Secretary General Indian Media Association (IMA). As per the data released by three MCDs in the city, the rate of dengue disease this time around is five times higher than the previous year.

The spokesperson of South MCD, Mukesh Yadav cautioned the residents not to collect fresh water in their locality due to the possibility of the dengue carrying mosquito breeding there.

“We have directed our mosquito breeding checkers to identify and issue chalans,” said Yadav.

“People feel that they are safe in clean urban environments without realizing that mosquitos could be breeding in the clean water filled bucket kept in their backyard,” he added.

He also advised people to wear clothes that cover most of the body as well as to use an effective mosquito repellent. The symptoms of dengue include severe abdominal pain, persistent vomiting, an abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation. (Source: http://www.millenniumpost.in/)
A second attack of dengue can be more dangerous than the first one
New Delhi, August 29, 2015: If a person has suffered from dengue in the past year, they must take additional precautions to prevent the disease because a second attack of dengue may be more dangerous than the first attack, said Padma Shri Awardee, Dr K K Aggarwal, President HCFI & Hony. Secretary General IMA.

Elaborating on this, Dr. Aggarwal further said that there are four different types of dengue and one can, therefore, suffer from dengue four times in his or her lifetime. The second or subsequent dengue infections tend to be more serious. A person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to a dangerous level leading to complications. One must however always remember that platelet transfusion in dengue patients can cause more harm than good and must only be administered if a person’s platelet count is less than 10,000 and he has active bleeding.

In a monsoon season, everyone should avoid taking aspirin for fever as it can precipitate bleeding if the person is infected with dengue.

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rashes. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks.

In dengue, most complications occur within two days of the fever subsiding and most people are casual during this period. Any abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to a shift of blood volume and patient requires a rapid infusion of oral or intravenous fluids in large quantities.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season. (Source: http://tennews.in/new-delhi-news-98/)
India fixes health goals for next 15 years
Sushmi Dey, TNN | Aug 31, 2015

New Delhi: India has set itself a challenging target to reduce maternal mortality rate to 70 per 1000 live births, and for neonatal and under-five to 12 and 25 per 1,000 births respectively under the Sustainable Development Goals (SDGs) to be achieved over the next 15 years. The consensus over the new targets was achieved within the government in a recent meeting of the health ministry and other concerned departments, an official source said. India will present the new targets, which will replace the Millennium Development Goals (MDGs), in the upcoming United Nations General Assembly session scheduled next month. India's infant mortality rate (IMR) is currently 40 per 1000 live births as against the target set by MDG of 27 by 2015 end. Under-5 mortality rate is 49 compared to the MDG target of 42. The maternal mortality rate is 167 per 1,00,000 births as against the MDG goal of 109 by the end of 2015.
ESC 2015 Update
  • A high-sensitivity troponin I test showed great accuracy in ruling out MI in patients with chest pain, with triage times reduced to 1 hour, and also showed better positive predictive ability than some other studies. Presenting the data from the Biomarkers in Acute Cardiovascular Care (BACC) study, Dr Dirk Westermann (University Heart Centre Hamburg, Germany) concluded: "Use of this test in patients with suspected MI allows for highly accurate and rapid rule-out as well as rule-in, enabling safe discharge or rapid treatment initiation." If tests at both admission and 1 hour later are negative, patients can be safely discharged. The current trial used a cutoff value of 6 ng/L and a change of 12 ng/L between the two tests for a positive result, whereas traditional tests use a much higher level of about 27 ng/L (99th percentile of a healthy reference population).
  • Line Melgaard (Aalborg University Hospital, Denmark) report that the CHA2DS2-VASc score, which is already used to assess stroke and thromboembolic risk in patients with atrial fibrillation (AF), may also be useful for this purpose in patients with heart failure. Cautioning that these results need to be confirmed in a randomized trial, she suggested that heart-failure patients without AF who have a CHA2DS2-VASc score of 3—that means they have two additional risk factors—could be good candidates for anticoagulant therapy.
  • Findings from a cohort of middle-aged patients with well-controlled hypertension suggest that patients who slept 60 minutes, typically after a midday meal, had an average 24-hour blood-pressure reading that was 4 mm Hg lower, and while they slept at night, they had a 2% greater dip in blood pressure. They also tended to use fewer blood-pressure medications. (Dr Manolis Kallistratos (Asklepieion Voula General Hospital, Athens, Greece)
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
The Power of Good Words

A group of frogs were traveling through the woods, and two of them fell into a deep pit.

All the other frogs gathered around the pit. When they saw how deep the pit was, they told the unfortunate frogs they would never get out. The two frogs ignored the comments and tried to jump up out of the pit.

The other frogs kept telling them to stop, that they were as good as dead. Finally, one of the frogs took heed to what the other frogs were saying and simply gave up. He fell down and died.

The other frog continued to jump as hard as he could. Once again, the crowd of frogs yelled at him to stop the pain and suffering and just die. He jumped even harder and finally made it out. When he got out, the other frogs asked him, "Why did you continue jumping? Didn't you hear us?"

The frog explained to them that he was deaf. He thought they were encouraging him the entire time.

This story holds two lessons:

1. There is power of life and death in the tongue. An encouraging word to someone who is down can lift them up and help them make it through the day.

2. A destructive word to someone who is down can be what it takes to kill them. Be careful of what you say. Speak life to those who cross your path.

The power of words… it is sometimes hard to understand that an encouraging word can go such a long way. Anyone can speak words that tend to rob another of the spirit to continue in difficult times.

Special is the individual who will take the time to encourage another.
Quote of the Day
Life begets life. Energy becomes energy. It is by spending oneself that one becomes rich. Sarah Bernhardt
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Wellness Blog
Exercise impact on the knee

Different exercises produce different impacts on the knee joints. The best and safest exercises causing minimum impact on the knee after knee replacement or patients with knee arthritis are walking, biking, hiking, riding an exercise bike, riding an elliptical trainer and walking on the treadmill. In sports one can play doubles tennis and not singles. One can also participate in downhill or cross–country skiing.

The maximum stress–producing exercises are jogging and golf swings.

Impact
  • Biking generates the least force, producing impact of about 1.3 times the person’s body weight.
  • Treadmill walking was next best, producing forces of 2.05 times the body weight.
  • Walking on level ground generated forces of 2.6 times the body weight.
  • A game of tennis produces forces of 3.1 to 3.8 times the body weight; serving produces the highest impact.
  • Jogging produced forces of 4.3 times body weight.
  • Golf swings produces forces of 4.5 times body weight on the forward knee and 3.2 times body weight in the opposite knee.
IMA Humor
Men Don’t Listen

A young man was driving up a steep, winding and narrow mountain road. Going round a tight corner, he notices a woman driver, who is coming in the opposite direction, begin to lean out of her window. As they pass each other she yells at him – "PIG!!!!"

The man immediately leans out of his window and screams back at her, "WITCH!!!"

Each continues on their way, and as the man rounds the next bend he crashes into a pig, right in the middle of the road…

If only men would listen…
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