June 20  2015, Saturday
In Paralysis, Act Fast
Dr KK Aggarwal Brain attack should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack. All patients with paralysis should be investigated for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery, which can cause future paralysis.

  • One should rule out brain hemorrhage as soon as possible.
  • Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
  • Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL start insulin.
  • Maintain normothermia for at least the first several days after an acute stroke.
  • For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre–eclampsia/eclampsia).
  • For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is =185 mmHg and diastolic blood pressure is =110 mmHg.
  • Antithrombotic therapy should be initiated within 48 hours of stroke onset.
  • For patients receiving statin therapy prior to stroke onset it should be continued.
Dr KK Aggarwal, Honorary Secretary General, IMA HQs with IMA Goa Branch leaders
Cardiology eMedinewS
  • The US Food and Drug Administration has approved the third-generation Sapien transcatheter heart valve for the treatment of patients with aortic stenosis. The Sapien 3 includes a design change over previous iterations in that it includes a polyethylene terephthalate outer skirt designed to minimize paravalvular leak.
  • An international study of 19,000 adults suggested that those who used a pedometer and smartphone-based blood-pressure monitor, walking an additional 1000 steps a month was associated with significant improvements in systolic blood pressure. The findings were presented at the European Society of Hypertension (ESH) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Older teenagers, Asians, females, and those with existing mental disorders had the highest risk among adolescents of incurring a self-inflicted injury (SII), reported a population-based longitudinal study published in Pediatrics.
  • Preschoolers with oppositional defiant behavior are more likely to have shorter telomeres, a hallmark of cellular aging, which is associated with increased risk for chronic diseases and conditions like diabetes, obesity and cancer in adults. The findings were published in the journal Translational Psychiatry.
Dr KK Spiritual Blog
You Cannot Hate Strangers

You can only hate somebody whom you have loved. Hatred, therefore, is withdrawal of love.

Love is the opposite of fear and not hate. Most of us assume that love and hatred are opposite to each other but hatred is withdrawal of love and manifestation of fear; it’s not opposite.

In spirituality, you cannot have love and fear together. Love means being in touch with your consciousness. Love is total absence of fear.

As per mythology, there are only two emotions and they are emotions of love and emotions of fear. All other emotions are their sub-categories. For example, love can be categorized into joy, peacefulness, happiness, forgiveness. Fear, on the other hand, can give rise to hatred, depression, guilt, inadequacy, discontentment, prejudice, anger etc.

In Ayurveda, fear is linked with Vata disorder, Pitta with anger and Kapha with attachment and possessiveness.

Again, as per As per Ayurveda, fear is linked with large intestine, pitta with small intestine and kapha with stomach and upper GI systems.

Fear in Vedic sciences is linked with Mooldhara Chakra, the first chakra with the sound LUM and love is linked to the Heart, the fourth Heart Anhata Chakra with its sound Yum. In terms of Vedic sciences, in Chakra meditation, Mooldhara chakra has the opposite characteristics of Anhata or Heart Chakra. Therefore, the sounds LUM and YUM are often chanted together.

Fear or love have different chemistry. Fear is based on adrenaline and love is based on endorphins. Fear is related to adrenaline based fight and flight.

The most important fear in body is fear of death. If that fear goes, one attains spirituality.

In the Sikh prayer “Ik Onkaar Sat Naam Kartaa Purakh Nirbh-a-o Nirvair Akaal Moorat Ajoonee Saibhn Gur Parsaad Jap………...”

‘Nirbhay’ means free of fear. Once one is in touch with consciousness the fear goes away.

When there is fear, there is no love and when there is no love, there is fear. Fear and love cannot be experienced at the same time.
Make Sure
Situation: A patient with blood in sputum came back with massive bleeding.
Reaction: Oh my God! Why was the first bleeding ignored?
Lesson: Make sure to properly investigate even minor bleeding in sputum.
Dr Good Dr Bad
Situation: A patient with painful diabetic neuropathy came with postural hypotension.
Dr Bad: The two are unrelated conditions.
Dr Good: It is due to autonomic dysfunction.
Lesson: Painful diabetic neuropathy is associated with significantly greater autonomic dysfunction than painless diabetic neuropathy. The greater autonomic dysfunction seen in painful diabetic peripheral neuropathy may reflect more predominant small fiber involvement and also adds to the growing evidence of its role in the pathophysiology of painful diabetic polyneuropathy.

(Copyright IJCP)
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
Press Release
B12 deficiency can present with recent memory loss

If you are forgetting things, get your vitamin B 12 levels done instead of worrying that you are going towards dementia, said 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 IMA.

Animal products (meat and dairy products) provide the only dietary source of B12 (cobalamin - Cbl) for humans. Strict vegans avoid all animal products, and are at risk of developing nutritional Cbl deficiency. The usual western diet contains 5 to 7 micrograms of cobalamin per day, while the minimum daily requirement is 6 to 9 micrograms per day. Total body stores of Cbl are 2 to 5 mg and one-half of this is in the liver. It takes years to develop vitamin B12 deficiency after absorption of dietary B12 ceases.

There is a link between infection with Helicobacter pylori (as seen in peptic ulcer) and low serum B12 levels. Mild and usually subclinical cobalamin deficiency can also occur in 24% of the elderly. People taking metformin, such as obese, those with diabetes, polycystic ovarian disease, may be at risk of developing B12 deficiency, which can be reversed with oral calcium supplementation.

Prolonged use of omeprazole (given for acidity) can result in Cbl deficiency. Women who are only moderate vegetarians may become Cbl deficient during pregnancy and lactation; their infants may also be Cbl deficient.
eIMA News
IMA Bardez Branch
  • 3/5/15: Medical camp held in association with Satya Sai Charitable Trust at Betim. Dr Chetan Kerekar examined patients for various elements along with Dr Taruna; 152 patients attended the camp.
  • 9/5/15: Dr PV Rataboli of IMA Bardez gave a talk on 'Rational use of antibiotics, pharmacist perspective' for pharmacists all over Goa at the Goa Medical College auditorium.
  • 10/5/15: Netradeep camp was held in Aldona in association with IMA Goa state and Mukta Opticians. There were 154 registrations; 120 spectacles were distributed, 7 cataracts were detected.
  • 16/5/15: IMA Bardez organised a CME program at Hotel Green Park. Dr PV Rataboli spoke on 'Prescription errors in Medical Practice', a discussion on kinetics, composition of drugs, various combinations available.
  • 22/5/15: Dr Pandarinath Audi IMA Bardez was called as an expert in a live phone-in program on breast cancer on Goa Doordarshan, where aim was to create awareness about the rapidly rising incidence of breast cancer in Goa and to stress upon the need of self examination.
  • 31/5/15: Dr Rataboli was invited as speaker by IMA Bicholim to speak on ' Rational use of antimicrobials' at Lion hall Bicholim.
  • 31/5/15: IMA Bardez in collaboration with Shree Shantadurga Sports Club, Varkhand, Pernem, observed and conducted awareness camp on ‘World No Tobacco Day'. Dr Dattaprasad Nagvenkar gave a talk on 'Adverse effects of tobacco '. A total of 30 people attended the camp.
  • Antibiotic treatment of patients with computed tomography (CT)-proven, uncomplicated appendicitis may be as effective as appendectomy, suggests a new study published in the June 16 issue of JAMA. Most patients assigned to receive antibiotic treatment did not require an appendectomy during 1 year of follow-up, and those who did receive an appendectomy did not have significant complications.
  • Daily baricitinib, an oral Janus kinase (JAK)1/2 inhibitor, yields rapid clinical improvement in the signs and symptoms of rheumatoid arthritis in patients with active disease who have failed at least one tumor necrosis factor (TNF) inhibitor, suggests the RA-BEACON trial presented at the European League Against Rheumatism Congress 2015.
  • The latest criteria for diagnosing gestational diabetes, issued by the UK National Institute for Health Care Excellence (NICE), will miss some cases, and these women are at particularly high risk of having large-for-gestational-age infants, claims a new study published online in Diabetologia.
  • The presence in serum of three antibodies to human papillomavirus type 16 (HPV16) seems to predict better progression-free and overall survival in patients with oropharyngeal cancers, suggests new research published online June 15 in Clinical Cancer Research.
  • Transcranial magnetic stimulation (TMS) significantly reduces major depressive symptoms during pregnancy and appears to be a safe and effective alternative to antidepressants for women who do not wish to take medication while pregnant, suggested new research presented at the 12th World Congress of Biological Psychiatry.
IMA opposes MBBS exit exam
Rema Nagarajan,TNN | Jun 19, 2015, 01.25 AM IST

The Indian Medical Association (IMA) has written to the ministry expressing reservation regarding an exit exam for MBBS graduates, even if it is voluntary. Instead, IMA is mulling over proposing that the health ministry and the MCI adopt a single exit exam for all medical students which could replace the final year MBBS exam conducted by various colleges and universities.

Senior doctors and officials pointed out that proposing something that was not doable often led to the proposal being scuttled such as the proposal to combine a licensing exam with the final year MBBS exam. Many countries including the US, the UK, Australia, China and Thailand have licensing exams which are separate from the final exams for a medical student to become a graduate.

To address concerns regarding the quality of doctors being produced, the ministry had proposed a common exit exam for students of private and government medical colleges, at a meeting with representatives from the IMA as well as the Medical Council of India, the regulatory body for medical education.

IMA general secretary Dr KK Aggarwal said that the IMA supported a common entrance exam, the National Eligibility cum Entrance Test (NEET) as a way to ensure quality. "This was proposed by the health ministry, favoured by the MCI and also has the support of the society at large. So the government should work to make this happen," said Dr Aggarwal.
Inspirational Story

A young lady named Sally relates an experience she had in a Seminary Class, given by her teacher, Dr. Smith. She says Dr. Smith was known for his elaborate object lessons.

One particular day, Sally walked into the seminary and knew they were in for a fun day. On the wall was a big target and on a nearby table were many darts. Dr. Smith told the students to draw a picture of someone that they disliked or someone who had made them angry, and he would allow them to throw darts at the person’s picture.

Sally's girlfriend drew a picture of a girl who had stolen her boyfriend. Another friend drew a picture of his little brother. Sally drew a picture of a former friend, putting a great deal of detail into her drawing, even drawing pimples on the face. Sally was pleased at the overall effect she had achieved.

The class lined up and began throwing darts, with much laughter and hilarity. Some of the students threw their darts with such force that their targets were ripping apart. Sally looked forward to her turn, and was filled with disappointment when Dr. Smith, because of time limits, asked the students to return to their seats. As Sally sat thinking about how angry she was because she didn't have a chance to throw any darts at her target.

Dr. Smith began removing the target from the wall. Underneath the target was a picture of Jesus……

A complete hush fell over the as each student viewed the mangled picture of Jesus; holes and jagged marks covered His face and His eyes were pierced. Dr. Smith said only these words…… "In as much as ye have done it unto the least of these my brethren, ye have done it unto me." Matthew 25:40

No other words were necessary; the tear–filled eyes of each student focused only on the picture of Christ.
Wellness Blog
Fluctuating blood pressure more harmful

In the elderly persons with high blood pressure, further fluctuations and spikes in blood pressure readings can affect their ability to think clearly and other cognitive function.

As per a North Carolina State University study, in people whose systolic blood pressure is 130 mm Hg or higher, the cognitive functions get impaired on days when their blood pressure spikes and fluctuates. On the other hand, in people with normal blood pressure, the cognitive functions do not get impaired if their blood pressure spikes or fluctuates.

Several studies in the past have found a link between high blood pressure and dementia, which is marked by a loss of memory and other cognitive abilities, including the ability to speak, identify objects or think abstractly. In another study it was found that treating high blood pressure in the very elderly may help reduce their risk of developing dementia.

The carry home message is that if you have blood pressure that wildly fluctuates and you also have underlying high blood pressure, you might be in double trouble for poorer cognitive functioning.
Quote of the Day
Excellence is a better teacher than mediocrity. The lessons of the ordinary are everywhere. Truly profound and original insights are to be found only in studying the exemplary. Warren Bennis
IMA in Social Media
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https://www.facebook.com/imayoungdoctorswing 1542 likes
Twitter @IndianMedAssn 1002 followers
http://imahq.blogspot.com/ www.ima-ams.org
IMA Humor
Wonderful confession by a girl in church and amazing reply she got.

She: I’m in love with a boy who is far away from me.
I’m in India and he lives in UK.
We met on marriage website.
Became friends on FaceBook.
Had long chats on WhatsApp.
Proposed each other on Skype.
N now 2 months of relationship through Viber.
I need your blessings and good wish, Oh God.

Guy besides her said: Now get married on Twitter.
Have fun on Tango.
Buy your kids from eBay.
Send them through Gmail.
And if you are fed up with your husband or kids then, unko OLX pe bech de
eMedi Quiz
Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5' Capping.
3. 3' polyadenylation.
4. Glycosylation.

Yesterday’s Mind Teaser: Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Answer for yesterday’s Mind Teaser: 2. Corticosteroid.

Correct Answers received from: Dr Pandit Hantodkar, Dr Shangarpawar, Manoj Bhatt, Dr Nagesh, Dr K P Chandra, Dr Poonam Chablani, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 18th June Mind Teaser: 2. pKa

Correct Answers received: Daivadheenam Jella.
Reader Response
Dear Sir, very informative news. Regards: Dr Kanan
Rabies News (Dr A K Gupta)
Can a person receiving/completed antirabies immunization, either pre–exposure or post–exposure, donate blood?

A person receiving/completed antirabies immunization can donate blood. However, the recipient does not benefit from the transfer of rabies-neutralizing antibodies due to hemodilution.
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