February 20  2015, Friday
editorial
Do not treat mild hypertension with low risk for heart disease
Dr KK Aggarwal The benefit from antihypertensive therapy is unproven in patients with mild hypertension and no preexisting cardiovascular disease.

A meta-analysis combined four placebo–controlled trials adding together 8912 patients with mild hypertension and no preexisting cardiovascular disease.

Up to 5 years of follow–up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of heart attacks.

Low–risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.
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CPR 10 Utsav 15th December 2013
News Around the Globe
  • Noninvasive brain imaging may help predict the effectiveness of a specific type of psychotherapy in patients with major depressive disorder (MDD), suggests new research published online in Neuropsychopharmacology.
  • Long–acting opioids are associated with a more than 2-fold risk for unintentional overdose compared with short-acting formulations, suggests a cohort study published online February 16 in JAMA Internal Medicine. The risk was more than 5–fold greater in the first 2 weeks of using a long–acting opioid.
  • The US Food and Drug Administration (FDA) has cleared for marketing the Eclipse System for treatment of fecal incontinence (FI) in adult women who have had four or more FI episodes in a two–week period. The device includes an inflatable balloon, which is placed in the vagina, and when inflated, the balloon puts pressure through the vaginal wall onto the rectal area, thus reducing the number of FI episodes.
  • A new study, presented at the International Stroke Conference (ISC) 2015, has shown that patients who have had a stroke are at higher risk for cancer. The study revealed that the incidence of cancer is 1.4 times higher among stroke survivors at 2 years than the general population, and that having cancer increases the risk for death by 3–fold in stroke survivors.
  • Corticosteroids are associated with reduced treatment failure among people with severe community–acquired pneumonia and excessive inflammatory response, suggests a study published in the February 17 issue of JAMA.
Dr KK Spiritual Blog
Why spiritual gurus do not suffer?

Most spiritual gurus do acquire disease but they do not suffer from them. This means that they have learnt the art of facing or fighting a disease without mental suffering. They face any adversity as an opportunity to do something different in their life.

Classical examples are Lord Krishna who suffered from a nonhealing wound and Jesus Christ who at the time of his crucifixion was calm yet positive in his approach.
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Cardiology eMedinewS
  • For men with atrial fibrillation (AF) who tick at least one box on the CHA2DS2–VASc risk-factor score sheet, the risk of ischemic stroke ranges from 1.96% per year to as high as 3.50%, suggests a new analysis. For women with AF and at least one additional risk factor, the risk of stroke ranges from 1.91% to 3.34% per year. The report is published in the February 24 issue of the Journal of the American College of Cardiology.
  • Young and middle–aged women experience more stress than their male counterparts, which could contribute to worse recovery from acute myocardial infarction (AMI), suggest new findings by Yale School of Medicine researchers. The findings appear in the current issue of Circulation.
Pediatrics eMedinewS
  • Children with attention-deficit/hyperactivity disorder (ADHD) are at lower risk of injury when they are on medication, especially brain injury, suggest new findings published online in JAMA Pediatrics.
  • A vast majority of healthcare providers in Bihar province of northern India interviewed for a study were unaware of the appropriate treatments for diarrhea and pneumonia, the biggest contributors to child mortality. Those who were aware failed to prescribe the correct treatment. The results of the new study are published online in JAMA Pediatrics.
Make Sure
Situation:A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.
Medicolegal
(Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS)

What is World Medical Association Declaration – Principle V – Clinical Education?


The clinical component of medical education must be centered on the supervised study of patients and must involve direct experiences in the diagnosis and treatment of disease. The clinical component should include personal diagnostic and therapeutic experience with gradual access to responsibilities. An adequate relation of the numbers of students admitted for training and teaching at the bedside of the individual patient must be observed.
  • Before beginning independent practice, every physician should complete a formal program of clinical education. This program, usually of at least one year’s duration, should be characterized by a supervised increase of responsibility for the management of clinical problems.
  • The faculty is responsible for determining that students who receive the first professional degree, have acquired a basic understanding of clinical medicine the basic skills needed to be evaluated.
  • Addressing clinical problems and to take appropriate action independently, and have the attitude and character to be an ethical physician.
Dr Good Dr Bad
Situation: A patient with Mediclaim for the last seven years came for executive checkup.
Dr. Bad: You will have to pay from your pocket.
Dr. Good: You can claim it from Mediclaim.

Lesson: In addition to cumulative bonus, the insured shall be entitled for a reimbursement of the cost of medical checkup once at the end of block of every four underwriting years provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount of 1% of the total amount of the average sum insured during the block of four claim free underwriting years.
(Copyright IJCP)
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Wellness Blog
Work-related Stress can kill

Job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest stress–induced biological changes may play a more direct role than previously thought.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability – a sign of a poorly–functioning weak heart – and higher–than–normal levels of cortisol, a “stress” hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart.
Twitter of the Day
Dr KK Aggarwal: Inhaling diesel exhaust Fumes causes heart attack or stroke http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra: : Fear is the memory of pain. Addiction is the memory of pleasure. Freedom is beyond both. http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Why is rabies an important disease?

Rabies is one of the oldest and most feared zoonotic diseases, and has been a threat to human health for more than 4000 years. Rabies is a neglected and severely under–reported disease killing each year an estimated 55,000people (24,000 to 90,000 deaths) worldwide (WHO 2007). All mammals, but mainly carnivores and bats, are susceptible and can transmit rabies virus. Human exposures are most frequently associated with bites by rabid dogs and transmission of virus from dogs’ saliva. The Association for the Prevention and Control of Rabies in India (APCRI) estimated in 2004 that in India, there were 20,565 reported human deaths every year. About half of the world’s population lives in areas in which rabies is enzootic. Rabies is practically 100% fatal even today but easily preventable.
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
IMA NEWS
Sonal Namaste
When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.
Prefer Half-Dose Influenza Vaccine in view of the shortage of the vaccine
From a public health standpoint, it would be better to vaccinate many people with lower doses than fewer people with full doses when vaccine supplies are scarce, said Padma Shri Awardee Dr A M Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.
A study published in 2009 in Archives of Internal Medicine  has shown that half dose flu shots are effective in adults, especially in women and those younger than 50, and offer a viable way to stretch supplies during vaccine shortages.
 Earlier in June 2000, a NIAID conducted trial, published in journal Vaccine concluded that the immune responses to the full dose were higher, on average, than immune responses to the half dose vaccine but should a public health emergency arise, half-dose influenza vaccines for healthy adults might be an acceptable strategy if the vaccine supply is substantially limited.
Provide telephonic consultations for patients with mild swine flu: IMA
Follow the triad of respiratory hygiene, cough etiquette, and hand hygiene for prevention
19 February 2015, 2:55 AM IST: http://health.economictimes.indiatimes.com

New Delhi, 18th February, 2015: The mean incubation period for flu is 1.5 to 3 days and the virus shedding begins the day prior to symptom onset and often persists for five to seven days or longer in immuno-competent individuals. Even longer periods of shedding may occur in children, elderly adults, patients with chronic illnesses, and immuno-compromised hosts.

It is important to protect people from getting infections from each other. As mild flu does not require any investigations and treatment doctors should avoid calling them in the clinics. Instead they should encourage telephonic consultations. One can use smart phones like iphone, skype or other media for communication, said Dr A M Pillai National President and Dr K K Aggarwal, Honorary Secretary general IMA.

Dr Aggarwal said that respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes and prevention lies in implementing respiratory hygiene, cough etiquette, and hand hygiene.

Respiratory hygiene and cough etiquette applies to all patients and accompanying family or friends who have signs of respiratory illness such as cough, congestion, nasal discharge or increased volumes of respiratory secretions.

Maintain a distance of 3–6 feet from a person who is coughing or sneezing , cover coughs and sneezes with disposable tissues and wash hands if get spoiled with respiratory secretions, added Dr Aggarwal.

Never cough in the hands or cloth handkerchief instead use tissue paper or cough on the sides of your sleeves, warned Dr Aggarwal.

Frequent hand hygiene should be performed, including before and after every patient contact, contact with potentially infectious material, and before putting on and after taking off personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol–based hand rubs. If hands are visibly soiled, they should be washed with soap and water.

In clinics all doctors should provide face masks to patients with signs and / or symptoms of respiratory infection and provide them space and encourage patients with respiratory symptoms to sit as far away from others as possible. Doctors should ask patients to avoid visiting crowded enclosed spaces.

Some other facts

1. Rationalisation of investigations
2. Rationalisation of admissions
3. Rationalisation of treatment
4. Government should give subsidy on investigation cost
5. Investigation cost should be fixed with no variables
6. When not to investigate and when not to admit should be propagated

ALLOPATHY DOCS SEEK EXCLUSIVE EMBLEM

By Jyoti Shelar, Mumbai Mirror | Feb 19, 2015, 12.00 AM IST
Some of the various designs for the emblem, provided by doctors from across the country

While the abbreviation 'Dr' is commonly used by all doctors, including homoeopathy and ayurveda practitioners, modern medicine doctors are looking for a unique emblem that will be exclusively associated with them.

With all types of medical practitioners using the prefix 'Dr', modern medicine (allopathy) doctors now want a unique emblem that will exclusively signify their practice. 

Accordingly, the Indian Medical Association – an umbrella body of doctors practicing modern medicine - has called for suggestions from their various State branches across the country. Once finalised, IMA plans to send the emblem for approval to the Medical Council of India and the health ministry. 

"The plan is to have an emblem that will resemble the modern medicine doctors. Today, the abbreviation 'Dr' is used by homoeopathy and ayurveda practitioners too. There is no sign to differentiate the MBBS doctors," said Dr K K Aggarwal, who heads the IMA which counts over 2.5 lakh doctors as its members all over the country. 

"We want something simple and easily recognisable. If a layman spots the emblem from a distance, he should automatically know that there is a modern medicine practitioner at that spot," said Aggarwal. He added, "So far, as modern medicine doctors have no exclusive emblem, it is time for them to get one." 

While most people associate doctors with the red cross, the sign is actually a protection symbol of the 1864 Geneva Convention. A green cross has been designated for pharmacies. The field of medicine is also associated with a symbol of Asclepius, the ancient Greek god of medicine. The symbol comprises a rod with a snake curled around it. 

Meanwhile, the IMA's branches in various States are working on several designs as well as colour combinations. At an IMA meeting in Ahmedabad last week, members discussed having a multicoloured cross that will signify sickness to wellness through colours. "Red signifies danger, green signifies wellness and blue signifies healing. We want something multi–coloured to depict the work we do," said Aggarwal, adding that doctors are also debating on suggestions to use the stethoscope or letters Rx (which signifies medicial prescriptions) as part of the emblem. 

Want to send in your designs?
Mail IMA at drkkaggarwalima@gmail.com
Medscape Family Physician Lifestyle Report 2015
Where Do Family Physicians Lean on the Political Spectrum?

Instead of asking Medscape family physicians whether they are Democrat, Republican, or Independent, the survey focused on whether members considered themselves liberal or conservative in fiscal and social areas. Without clear definitions of these terms, the responses are very subjective; the aim was to get a sense of political biases rather than voting habits. Half of family physicians claim to be socially liberal and about two thirds are fiscally conservative, regardless of burnout status. Political views have not changed in the 2 years since the previous report. Of interest, a 2007 study of medical students found them much more likely to be liberal than conservative and also more liberal than other young American adults.
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Inspirational Story
Brotherhood

Ram received an automobile from his brother as Birthday present. One day when Ram came out of his office, he saw a street urchin was walking around the shiny new car, admiring it.

"Is this your car?" He asked. Ram nodded, "My brother presented me on my birthday." The boy was astounded. "You mean your brother gave it to you and it didn’t cost you nothing? Boy, I wish…" He hesitated.

Of course Ram knew what he was going to wish for. He was going to wish he had a brother like his brother but what the lad said jarred Ram all the way down to his heels.

"I wish," the boy went on, "that I could be a brother like that." Ram looked at the boy in astonishment, and then impulsively he added, "Would you like to take a ride in my automobile?"

"Oh yes, I’d love that." After a short ride, the boy turned and with his eyes aglow, said, "Would you mind driving in front of my house?" Ram smiled a little. He thought he knew what the lad wanted. He wanted to show his neighbors that he could ride home in a big automobile. But Ram was wrong again.

"Will you stop where those two steps are?" The boy asked. He ran up the steps. Then in a little while Ram heard him coming back, but he was not coming fast. He was carrying his little crippled brother. He sat him down on the bottom step, then sort of squeezed up against him and pointed to the car.

"There he is, brother. Like I told you upstairs, his brother gave it to him and it didn’t cost him a penny. Some day I’m going to give you one just like it then you can see for yourself all the pretty things in the shop windows that I’ve been trying to tell you about."

Ram got out and lifted the crippled boy to the front seat of his car. The shining–eyed older brother climbed in beside him and the three of them began a memorable ride.
Quote of the Day
Nothing ever comes to one that is worth having, except as a result of hard work. Booker T. Washington
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Reader Response
  1. Good information sir. Mangesh Gulwade
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Listening

The teacher, during an English lesson, asked her students: "Now tell me, what do you call a person who keeps on talking when people are no longer interested?"
Little Johnny, in the back row, raised his hand. "Yes, Johnny," said the teacher

"A teacher!"
eMedi Quiz
A couple, with a family history of beta thalassemia major in a distant relative. has come for counseling. The husband had HbA2 of 4.8% and the wife has HbA2 of 2.3%. The risk of having a child with beta thalassemia major is.

1. 50%
2. 25%
3. 5%
4. 0%

Yesterday’s Mind Teaser::  A middle aged male comes to the outer patient department (OPD) with the only complaint of hoarseness of voice for the past 2 years. he has been a chronic smoker for 30 years. On examination, a reddish area of mucosal irregularity overlying a portion both cords was seen. Management would include all except:

1. Cessation of smoking.
2. Bilateral cordectomy.
3. Microlaryngeal surgery for biopsy.
4. Regular follow–up.

Answer for yesterday’s Mind Teaser:2. Bilateral cordectomy.
Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy
Answer for 17th Feb Mind Teaser:4. Gentamicin.
Correct Answers receives: Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan, Dr. Bharat Bhushan Aggarwal
Press Release of the Day
IMA wants a Single window registration for medical establishment

At present, there are over 72 various Registration and Acts applicable to the medical profession and the same is not health friendly.

IMA has proposed the Govt to come out with Indian Health Act 2015 where a single window registration should be done for medical establishments.

In the current proposed budget, IMA has written to the Finance Minister to consider the same and has requested to made a special budget for uniform registration under s single window.

Giving details,  Padmashri Awardee , Prof  (Dr.) A. Marthanda Pillai,  National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA said that the main aim of the IMA is to provide affordable and accessible healthcare to all  which is only possible if the medical professionals are not harassed and get clearance under one roof without any hassles.

IMA also wants health to be declared as infrastructure status and medical profession as a service industry.

There should be uniform laws for medical doctors and medical establishments, e.g. advertising is not allowed to doctors but there is no prohibition for it for the medical establishments.  Similarly, doctors cannot hire agents but there is no such prohibition for the medical establishments.

Doctor is a professional service provider. Subsidy in their medical fee needs to be compensated through rebates in various taxes applicable to them.  For this a separate provision should be made in the coming budget.

In view of the current outbreak of flu, IMA also wants that a separate budget should be allocated every year for such outbreaks. In the last two decades, India has seen various outbreaks of new diseases in every one or two years.