April 20  2015, Monday
World Medical Association Council Decisions
Dr KK Aggarwal The 200th WMA Council meeting was held in Oslo, Norway (April 16-18) and attended by delegates from more than 35 national medical associations.

The meeting discussed a number of issues, including the following:
A draft Declaration on Alcohol was proposed by the Australian Medical Association aimed at reducing excessive alcohol consumption and supporting WMA members in producing harm-reduction policies. The document, which covers legal and regulatory measures as well as social policy interventions, was approved by the Council for forwarding to the General Assembly in October for adoption.

Mobile Health
A proposed Statement on the opportunities and risks associated with mobile health, was debated and approved by the meeting. The paper calls for regulation to protect patient safety and user data following the enormous growth of mobile health devices such as mobile phones, patient monitoring devices, personal digital assistants and applications. This growth had been largely unregulated, and as a result could have potential patient safety implications. The paper will now be discussed by the General Assembly in Moscow (Oct 14-17).

Social Determinants of Health
President elect Sir Michael Marmot reported on plans for following up the successful conference on the Social Determinants of Health held in London last month. The first aim would be to strengthen global networks, the second would be to build on the evidence base by publishing a supplementary book and the third aim would be to develop educational tools for physicians through online courses and training workshops to learn what they can do to tackle the Social Determinants of Health.

Street Children
Proposed new guidelines for physicians on providing health support to street children were approved by the Council. Delegates agreed that child maltreatment was a world health problem and that physicians had an important role to play in prevention, early identification and comprehensive treatment of child abuse victims. The guidelines will now be considered by the WMA Assembly in October.

Nuclear Weapons
The Council approved a proposed Statement for discussion at the General Assembly requesting all national medical associations to join the WMA in urging their respective governments to work to ban and eliminate nuclear weapons.

Riot Control Agents
The Turkish Medical Association presented a paper on the appropriate use of riot control agents. Following a debate, the Council supported the Statement and this will now be considered by the WMA General Assembly.

Dr. Ardis Hoven, Immediate Past President of the American Medical Association, was elected Chair of Council.

Prof. Dr. Frank Ulrich Montgomery, President of the German Medical Association, was elected Vice-Chair, and Dr. Masami Ishii, from the Japan Medical Association, was elected Treasurer.

In the committee elections, Dr. Dongchun Shin (Korean Medical Association) was elected Chair of the Finance and Planning Committee, Dr. Miguel Jorge (Brazilian Medical Association) was elected Chair of the Socio-Medical Committee and Dr. Heikki Pälve (Finland Medical Association) was re-elected Chair of the Medical Ethics Committee.

General Assembly
The WMA's next Council meeting and annual General Assembly will be held in Moscow from Oct 14-17.
Even children can have acidity
Children who have continuing recurrence of cough and croup could be suffering from stomach acid reflux problems.

Croup or ‘Kali Khansi’, as it is called in local parlance, is recognized by a loud cough that often sounds like the barking of a seal. It can cause rapid or difficult breathing, and sometimes wheezing. Croup is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger.

In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can further trigger swelling with any kind of viral or respiratory infection.

Identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated.

The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.
213th Meeting of the Central Working Committee of Indian Medical Association at Hotel Radisson Blu, New Delhi.
  • Older patients taking proton pump inhibitors for heartburn and acid reflux are twice more likely to be hospitalized with kidney failure than peers who do not take the pills, reports a study published online April 16 in CMAJ Open.
  • Patients with enterovirus D68 (EV-D68) infection may develop acute flaccid myelitis, suggests new research published online in The Lancet Infectious Diseases.
  • The US Food and Drug Administration (FDA) has approved a new intraocular lens (IOL) for patients having cataract surgery who choose to correct their vision problems at the same time.
  • QT intervals may be prolonged after hematopoietic stem cell transplantation (HSCT), suggests new research published online in Bone Marrow Transplantation.
  • A new study suggests that a Western lifestyle may have a negative impact on the diversity of the crucial gut bacteria. The findings are published in the journal Cell.
Dr KK Spiritual Blog
Understanding the concept of Shiva and Shakti

After the life force leaves the body even the wife does not like to come near the body (Bhaja Govindam). This life force has no weight, water cannot wet it, air cannot dry it, and weapons cannot cut it (Bhagwad Gita Chapter 2).

The scientific description of this life force comes from the first Maha Vakya, from Aitareya Upanishad in Rig Veda, which describes that "Consciousness or Intelligence is the Brahman (Pragnanam Brahma).

This life force or the intelligence represents the conscious energy, energized consciousness or energized information.

In computer language this intelligence is both the data that has been fed and the software to operate this data. The software is driven by the power of intention and by the process of attention.

In Vedic language, the data is the "Purusha or Shiva" and the software the "Shakti" (Sakti). While the data or the Shiva is inactive and idle, without Shakti or energy, the data has no value and it makes" Shiva" a "SAVA". When Shakti moves toward Shiva it becomes awareness or consciousness. In Vedanta language, it is called as soul or Brahman.

For comparison, the relationship that Matter and Energy have in Physics; Purusha and Prakruti in Samkya Philosophy; Infinite and Zero in Mathematics; Potential and Kinetic Energy in Energetics; Meaning and Word in Linguistics; Father and Mother in sociology; so is the relationship between Shiva and Sakti in understanding the mystery of Vedanta.

Shiva and Sakti are thus two inseparable entities in Indian mysticism. Just as moonlight cannot be separated from the moon, Shakti cannot be separated from Shiva. Kashmir Shaivism says that "Shiva without Shakti is lifeless (Sava) because wisdom cannot move without power".

Shiva and Shakti are different from the masculine and feminine aspects of the human body. In tantric spiritual path, one seeks to develop a perfect harmony and balance between masculine aspects (example mental focus, will, intellect) and feminine aspects (example sensitivity, emotion).

Shiva or the data is classified in the body in three subgroups: creation, protection and destruction. These in Hindu mythology are called "Brahma, Vishnu and Mahesh". Some add another two more dimensions in them making them five and these are "revelation and concealment". One can find these qualities in anything that’s alive.

The Shakti or the forces (power) are also subclassified into five subtypes.
  1. Chitta Shakti: Pure consciousness or the awareness of God.
  2. Ananda Shakti or pure bliss.
  3. Gnana Shakti or the ‘knowledge of God’. It is pure knowledge, which organizes and orchestrates the infinite correlative activity of the universe.
  4. Kriya Shakti or ‘pure action’, which is the action directed toward God (action which does not have the bondage of karma. Action which has the bondage of karma comes from the ego. It is based on beliefs and expectations and interpretations and fears and judgments and past memories, whereas non–binding action, which is non–Karmic, is called Kriya—action rooted in pure awareness and creativity)
  5. Desire (Ichcha Shakti: the desire or intention to unite with God)
Deepak Chopra in his Book ‘Path of Love’ describes Shakti as under:

If the voice of God spoke to you, Her powers would be conveyed in simple, universal phrases:
  • Chitta Shakti: "I am."
  • Ananda Shakti: "I am blissful."
  • Gnana (Gyana) Shakti: "I know."
  • Kriya Shakti: "I act."
  • Ichcha Shakti: "I will" or "I intend."
These powers, if used towards acquiring spiritual wellbeing, any action (pure kriya) directed by the desire (pure ichcha) leads to pure knowledge (pure gnana) and ends with internal bliss (ananda).

On the other hand, in routine life if these powers are governed by the ego, then the Action (Kriya) leads to Memory (Gnana) and memory leads to desire (Ichcha) and then action again.

According to Tantra, Satchidananda is called Shiva–Sakti, the hyphenated word suggesting that Shiva or the Absolute and Sakti or its creative power, are eternally conjoined like a word and its meaning; the one cannot be thought of without the other.
Cardiology eMedinewS
  • Men with moderate-to-severe lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) may be at increased risk for cardiovascular disease (CVD), reported a new Italian study published online in BJU International.
  • A retrospective cohort study of patients between the ages of 50 and 69 years who underwent primary, isolated mitral-valve replacement (MVR) showed no difference 15 years later in survival rates between bioprosthetic vs. mechanical valves. Patients who received mechanical mitral valves had significantly higher incidence of both stroke and bleeding events, while those who received bioprosthetic valves had higher incidents of reoperation. The findings are published in the Journal of the American Medical Association.
Pediatrics eMedinewS
  • Most children referred to a specialist feeding clinic did better following cessation of high-energy oral nutritional supplements, reported Scottish research published online in Archives of Disease in Childhood.
  • A study of 15-year-olds in the UK revealed that those who had been most exposed to alcohol use in films were also most likely to have tried alcohol, and about twice as likely as the least exposed to have been binge drinking. The findings were published online in Pediatrics.
Make Sure
Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Dr Good Dr Bad
Situation: A patient with mediclaim of Rs. 2 lakhs has used a cumulative bonus of Rs. 40000 after 8 years. How much can he claim take next year?
Dr. Bad: Same as 2.4 lakhs.
Dr. Good: It will be 10% less.
Lesson: In case of claim under the policy in respect of insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of claim of sum insured on the next renewal. However, basic sum insured will be maintained and will not be reduced.

(Copyright IJCP)
Inspirational Story
Power of Thought: Hitting Unseen Target

Yogi Raman was a true master of the art of archery. One morning, he invited his favorite disciple to watch a display of his skill. The disciple had seen this more than a hundred times before, but he nevertheless obeyed his teacher.

They went into the wood beside the monastery and when they reached a magnificent oak tree, Raman took a flower, which he had tucked in his collar and placed it on one of the branches.

He then opened his bag and took out three objects: his splendid bow made of precious wood, an arrow and a white handkerchief embroidered with lilacs.

The yogi positioned himself one hundred paces from the spot where he had placed the flower. Facing his target, he asked his disciple to blindfold him with the embroidered handkerchief.

The disciple did as his teacher requested.

‘How often have you seen me practice the noble and ancient sport of archery?’ Raman asked him.

‘Every day,’ replied his disciple. ‘And you have always managed to hit the rose from three hundred paces away.’

With his eyes covered by the handkerchief, Yogi Raman placed his feet firmly on the ground, drew back the bowstring with all his might – aiming at the rose placed on one of the branches of the oak tree – and then released the arrow.

The arrow whistled through the air, but it did not even hit the tree, missing the target by an embarrassingly wide margin.

‘Did I hit it?’ said Raman, removing the handkerchief from his eyes.

‘No, you missed completely,’ replied the disciple. ‘I thought you were going to demonstrate to me the power of thought and your ability to perform magic.’

‘I have just taught you the most important lesson about the power of thought,’ replied Raman. ‘When you want something, concentrate only on that: no one will ever hit a target they cannot see.’
eMedi Quiz
Which of the following statements regarding tamoxifen is correct?

1. Compared with AIs, tamoxifen has been associated with a decreased risk of venous thromboembolic events.

2. Similar to AIs in post menopausal women, tamoxifen increases the risk of bone loss and osteoporosis.

3. In post menopausal women, tamoxifen has shown better efficacy than inhibitors.

4. Tamoxifen may be associated with an increased risk of ischemic cereborvascular complications.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.

Correct Answers received from: DR JAINENDRA UPADHYAY, Dr. G. Madhusudhan, Dr Avtar Krishan, Daivadheenam Jella

Answer for 16th April Mind Teaser: A. Hypertension and aging.

Correct Answers received: Daivadheenam Jella
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
IMA News
Conference Update - Diabetes India 2015
HbA1c alone is sufficient as a marker of good diabetes control

Dr Ashish S Dengra, Jabalpur
  • Chronic hyperglycemia is captured by A1c but not by FPG (even when repeated twice).
  • Microangiopathic complications (retinopathy) are associated with A1c as strongly as with FPG.
  • A1c is better related to cardiovascular disease than FPG.
  • Fasting is not needed for A1c assessment.
  • No acute perturbations (e.g., stress, diet, exercise, smoking) affect A1c.
  • A1c has a greater pre-analytical stability than blood glucose.
  • A1c has an analytical variability not inferior to blood glucose.
  • Standardization of A1c assay is not inferior to blood glucose assay.
  • Biological variability of A1C is lower than FPG and 2-h OGTT PG.
  • Individual susceptibility to protein glycation might be caught by A1c.
  • A1c can be used concomitantly for diagnosing and initiating diabetes monitoring
Natural history of T2DM in Asia

Dr Nam Han Cho,
  • Diabetes is a global epidemic which is out of control, but worse in Asian countries.
  • It is a huge and growing problem and costs to the society are high and escalating.
  • Five countries from Asia figure in the top 10 and account for most cases of diabetes globally.
  • Asian countries share similar risk factors.
  • There is an association between economic growth and diabetes.
  • Rapid urbanization and modernization obesogenic environment i.e. physical inactivity, psychosocial stress and abundance of food
  • Asians are prone to developing diabetes at a lower level of obesity.
  • Diabetes has the potential to negatively impact economy and may bankrupt healthcare systems.
  • Cost effective interventions in healthy living and diet decrease the burden of diabetes and save on healthcare costs and lost productivity.
  • There has been a dramatic rise in the number of diabetic population in Korea: economic growth, greater exposure to risk factors (lifestyle and diet), demographic changes (childhood obesity, aging population).
Hypertriglyceridemia: The most difficult lipid disorder to evaluate and treat

Dr Robert H Eckel, USA
  • Hypertriglyceridemia is the most difficult lipid disorder to evaluate and treat. Hypertriglyceridemic disorder in adults is not a single gene. We do not know if TGs by themselves are an atherogenic risk or is it because of the company they keep.
  • The intra-individual biological variability (diurnal and monthly) of lipids make it more difficult to define hypertriglyceridemia.
  • TGs are inversely associated with HDL-C, if high HDL-C levels, almost always TGs are low.
  • Dietary treatment of severe hypertriglyceridemia: <5%, no alcohol, discontinue all TG-lowering drugs, monitor TG q 3 days until levels are below 1000, then restart treatment.
  • Fibrates do not reduce the CHD events in high risk patient groups. What impact hypertriglyceridemia has on CHD outcomes is not yet clear.
  • Lower fasting TG to less than 500 mg/dL; this will reduce the risk of pancreatitis.
  • Follow the current guideline recommendations to lower LDL-C.
  • The real value of Apo-B is in patients who do not have raised LDL-C (<100 mg/dL). In such patients it can be very informative and should be taken as an indicator of CVD risk.
  • Plasma apoB and the other cholesterol indexes are complementary rather than competitive indexes of atherosclerotic risk (Am J Cardiol. 2003 May 15;91(10):1173).
  • Baseline TGs are determinants of the response to bezafibrate (BIP trial).
  • Omega-3 fatty acids are beneficial in reducing CV risk (JELIS; Lancet 2007), especially in patients with high TG and low HDL-C (Atherosclerosis. 2008).
  • If fasting TG is >200 mg/dL and HDL-C <35 mg/dL, consider a fibrate or omega-3 fatty acid.
Sonal Namaste
How should you wash your hands?
  • Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them.
Antriksh Indian Medical Golf Towers: IMA joins hands with Antriksh Group
IMA has entered into a MoU with Antriksh Group. The group is developing a residential society exclusively for the member doctors of the IMA called ‘Antriksh Indian Medical Golf Towers’, situated at Sector 150, Noida-Greater Noida Expressway, Noida. This residential society and the colony will comply with all health parameters as defined by the IMA making it an environmentally healthy society.

IMA has been able to negotiate the following key items with Antriksh Group for its members:
  • IMA members who wish to book apartment(s) in this society will get a discount of 20% on the basic sales price.
  • Few additional charges such as Lease Rent, Fire Fighting Charges, Club Membership Charges have been completely waived off for the IMA members.
  • In case any member wants to sell off their unit in the open market at any time during the construction, the first transfer fees, which is typically around 2-5% of the cost of the apartment has been completely waived off for the members.
  • If at the end of 1 year, any member feels that the project is not worth investing, they can apply for cancellation and will get 100% refund, without any deduction.
  • Many financial schemes have been created to enable the IMA members to choose the best suitable payment mode for them. One of them is EMI subvention scheme in which the buyer member will be required to pay only 10% of the total cost of the apartment. For next three years, until possession of apartments is offered, the developer will pay pre-EMIs to the financing bank. And after one year of booking, if the IMA member is not satisfied with the value of the investment, they can apply for cancellation and get their money back.
  • Developers will also help the buyer member with loan arrangement.
  • The society once in frame will co-own the management of the Club House called “IMA House” and the Golf Club.
  • Relatives of IMA members will also be entitled to book flats in this scheme.
It is expected that once 200 member doctors buy apartments in this project, the market cost of the apartments will increase by minimum around Rs 1000 per sq ft in one year and by a minimum Rs 2000 per sq ft in 2 years’ time frame. This will yield to a buyer who books under the subvention scheme, a profit of 200% and 400% over a period of 1 years and 2 years respectively. Buyers can keep that parameter as a benchmark of gauging the return on their investment.

The apartment buying agreement of the IMA member will be directly with the developer and IMA will not be party to it. IMA has only negotiated special terms for the members.

Members who wish to enquire about the project, visit project site or book may contact the special helpdesk created by Antriksh.

Contact details

Phone helpline: 92124 11999
Email helpline: antriksh.ima@gmail.com
Project website: www.antrikshimagolftowers.in
Antriksh Group website: www.antrikshgroup.com
IMA website: www.ima-india.org

Snapshot of key features of the project (as per project Brochure)
  • Lowest density sector in Delhi NCR leading to limited number of units and wide open areas
  • Project in the centre of a 9 Hole signature Golf Course
  • 3BHK and 4 BHK apartments with super area – 2025 sq ft, 2425 sq ft, 2900 sq ft and 3475 sq ft
  • Sector located at the junction of 3 major expressways
  • Certified Green Building Concept
  • Ultramodern club house with Swimming Pool
  • Maximum sports facility including Cricket Academy
  • Sr Sec School, Nursing Home, temple, Local market all within the township boundaries
  • 24x7 electricity and potable water supply
  • 3 tier security system with CCTV monitoring in centralized Hi-tech control room.
Some of the key features of ‘Health Friendly Homes’ concept created by IMA are as follows:
  • Air and Noise Pollution Control
  • Water Softening Plant
  • Mobile Tower Radiation Free Zone
  • Rain Water Harvesting
  • Eco friendly Garbage Disposal
  • Nursing Home/Healthcare Centre
  • First Aid Kits and First Aid Centres
  • 24×7 Ambulance Facility
  • Potable Water Supply
Malaria Keypoints
Fever is the main symptom, periodic or continuous, with or without chills and rigors.
Complaint against Doctors
Dear IMA

I have the utmost respect for the medical profession and I have been raised to believe doctors are noble. This attitude, however, has been challenged time and again by many who I have gone to for treatment over the course of my life.

I have come across doctors who do not think it unethical to discuss my medical history with complete strangers who in turn have used the information for their own profit. I have actually had dentists carry out unnecessary procedures at my expense, again for another's benefit. Doctors have prescribed medicines even though I've had no problems and some of them have deemed that I am unfit without me being present. Even my father fell victim to a doctor's bad judgment and after his demise our grieving family was dealt with rudely.

Needless to say, I have developed serious doubts about doctors and will think twice before going to any expert for medical advice. It seems like no one comes to this field with a completely genuine desire to help. I hope the council does something to make this profession more ethical. Also, please suggest a few ways to ensure that a particular doctor is good at his work and above corruption.

Pearl D'Mello
Wellness Blog
Turmeric can prevent heart failure

Traditional Indian turmeric prevents heart failure, lowers cholesterol, prevents cancers and gall stones and augments scar formation in a wound.

Studies from the University of Toronto’s Cardiology Division and published in the Journal of Clinical Investigation have shown that curcumin, an ingredient in the curry spice turmeric, when given orally to a variety of mouse models with enlarged hearts (hypertrophy), could prevent and reverse hypertrophy, prevent heart failure, restore heart function and reduce scar formation.

In the studies, curcumin was given to rats, who then underwent surgery or received drugs designed to put them at risk of heart failure. The rats that received curcumin showed more resistance to heart failure and inflammation than comparison groups of rats that did not get curcumin.

Curcumin treatment also reversed heart enlargement. Curcumin short–circuited the heart enlargement process, though itis not clear how it did that.

The healing properties of turmeric have been well–known. The herb has been used in traditional Indian medicine to reduce scar formation. For example, when there is a cut or a bruise, the home remedy is to reach for turmeric powder because it can help to heal without leaving a bad scar.

Curcumin has come under the scientific spotlight in recent years, with studies investigating its potential benefits for reducing cholesterol levels, improving cardiovascular health and fighting cancer.

As an herb, turmeric should to be taken 300 mg thrice–daily with meals. It has useful actions like antioxidant, anti–inflammatory, anti-rheumatic, cholesterol–lowering, anti-cancer and prevention of gall stones. It is also found to be useful in situations like dysmenorrhea, dyspepsia, HIV, muscle soreness, peptic ulcer disease, scabies and uveitis.

Curcuminoids act as free radical scavengers. They also inhibit leukotrienes and synthesis of prostaglandins. The anti–inflammatory activity has been claimed to be comparable to NSAIDs (such as indomethacin).

Curcuminoids lower blood lipid peroxides, decrease total cholesterol and LDL cholesterol, and increase HDL cholesterol. Turmeric has also been claimed to inhibit platelet aggregation.
Quote of the Day
It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward
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Reader Response
Dear Sir, emedinews provides very educational information. Regards: Dr vijay
IMA Videos
News on Maps
Taking proper precautions can prevent summer health risks
After the cold winters, the warmth of summer is always welcome. But, like the winters, the summer season too brings its own set of health problems. Some of the common health problems in summer include heat exhaustion, heatstroke, dehydration, food poisoning. But, these problems are preventable if proper precautions are taken, said Padma Shri Awardee Dr A Marthanda Pillai National President Indian Medical Association and Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

Heat exhaustion is a milder form of heat-related illness in which the body temperature is between 37°C and 40°C. The symptoms include dizziness, thirst, weakness, headache and malaise. Treatment is by prompt cooling and hydration with water or rehydration drinks.

Without prompt treatment, heat exhaustion can lead to heatstroke, a life-threatening condition. The body temperature is above 40°C, which can damage the functioning of the internal organs of the body. Patients of heat stroke have high body temperature, dry and hot skin, dehydration, confusion, rapid and weak pulse, short-rapid breathing; they may even be unconsciousness. To prevent heatstroke, limit outdoor activities especially during hottest part of day. Drink plenty of water and juices to keep the body well-hydrated. Wear loose fitting and light colored clothes.

Food poisoning is common during summer. During summers, food may be contaminated as they may be prepared under unhygienic kitchen conditions. Similarly drinking water too may be contaminated. Also high temperature favors rapid growth of bacteria in food resulting in food poisoning. Food and beverages sold on roadside are also important sources of food poisoning. To prevent food poisoning, always carry your own drinking water. Avoid eating cut open fruits that are sold on the roadside. Remember the formula for food and water hygiene: “Heat it, boil it, peel it, cook it or forget it.”

To prevent dehydration during summer, drink plenty of fluids to maintain adequate body fluid level, especially during outdoor activities like sports. Don't wait till you feel thirsty. Always keep homemade lemonade or ORS handy. Avoid alcohol or caffeinated drinks as they can further increase fluid loss.

Wearing sunglasses and a hat to protect the eyes from the strong UV radiation are other precautions that one can take during summer.
Rabies News (Dr A K Gupta)
If the skin test is positive to ERIG, what should be done?

If skin test is positive, it is better to switch over to HRIG.
eIMA Humor
Where’s the toast I asked for?

An elderly husband and wife visit their doctor when they begin forgetting little things. Their doctor tells them that many people find it useful to write themselves little notes.

When they get home, the wife says, "Dear, will you please go to the kitchen and get me a dish of ice cream? And maybe write that down so you won’t forget?"

"Nonsense," says the husband, "I can remember a dish of ice cream."

"Well," says the wife, "I’d also like some strawberries and whipped cream on it."

"My memory’s not all that bad," says the husband. "No problem – a dish of ice cream with strawberries and whipped cream. I don’t need to write it down."

He goes into the kitchen; his wife hears pots and pans banging around. The husband finally emerges from the kitchen and presents his wife with a plate of bacon and eggs.

She looks at the plate and asks, "Hey, where’s the toast I asked for?"