July 20  2015, Monday
eMedinewS
editorial
How to keep your memory sharp?
Dr KK Aggarwal
  • Manage your stress especially deadline pressure and petty arguments.
  • The biggest stress is ongoing sense of extreme anxiety. This can be managed by deep breathing, meditation, yoga and by mindful approach to living.
  • Get a goodnight sleep. The most common reason for poor sleep is difficulty in falling asleep and staying asleep. Many drugs used to treat insomnia which can also impair memory.
  • If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time.
  • Get up at the same time in the morning.
  • If you smoke, quit.
  • If you do not drink, do not start.
  • Alcohol makes it difficult to perform short term memory tasks such as memorizing list.
  • Alcohol induces vitamin B1 deficiency, which can cause dementia.
  • Protect your brain from injury as repeated minor head traumas can cause brain damage.
  • Wear seat belt when riding in a motor vehicle.
  • Wear helmet while driving or riding motorcycle.
IMA,IJCP,HCFI
eMedipics
IMA,IJCP,HCFI
Heart Care Foundation of India, IMA, Delhi Police and Delhi Red Cross society have taken up the initiative to train 100% of the Delhi Police PCR van staff in the life-saving technique of Hands Only CPR 10
IMA,IJCP,HCFI
News
Nutrition
Obesity
A meal in a restaurant might seem to be healthier than one eaten in a fast-food outlet, but a new study suggests that eating out at either location leads to a much greater consumption of calories than eating a meal prepared at home. The findings are published in the European Journal of Clinical Nutrition.

Infectious diseases
Diabetes

Rosuvastatin worsens insulin resistance in nondiabetic, HIV-infected adults who are receiving antiretroviral therapy, suggests new research published online in Clinical Infectious Diseases.

Obstetrics and Gynecology
Psychiatry Postmenopausal vaginal changes, like dryness, itching and pain during sex, may be more disruptive for those who are also suffering from depression or urinary incontinence, suggests a new study published online in the journal Menopause.

Oncology
Patients who undergo treatment with anthracycline-based chemotherapy for breast cancer are at risk of developing diastolic dysfunction, suggested a new study published in The Oncologist.
Top News from ADA 2015
GLP-1 agonist alters brain response to seeing, eating food

Glucagonlike peptide-1 (GLP-1) may play a role in the brain regarding anticipation of tasty food and may reduce food cravings. Individuals who received injections of the GLP-1 receptor agonist exenatide (Bydureon) had dampened responses in the brain's reward system at the sight of chocolate milk and enhanced responses after drinking the chocolate milk, in a small functional-MRI study. The GLP-1 agonist also increased activation in the brain's reward system after consuming food, which may prevent overeating, Liselotte van Bloemendaal, MD, from VU University Medical Center, Amsterdam, The Netherlands, reported. (Source: Medscape)
Cardiology eMedinewS
Cardiology
Obstetrics and Gynecology
A combination of smoking and giving birth preterm can more than triple the risk of cardiovascular disease faced by mothers, suggests a new study published in the European Journal of Preventive Cardiology.

Cardiology
New research suggests that sudden death caused by cardiac arrhythmia can be triggered by changes in body temperature. The study is published in the Journal of Physiology.
Pediatrics eMedinewS
Pediatrics
Cardiology A study published July 15 in the journal PLOS ONE found a statistically significant association between higher vitamin D levels and lower non-HDL cholesterol in children, even after taking into account body mass index, consumption of cow's milk and levels of physical activity.

Pediatrics
Nutrition
New research suggests that the way children related to food and eating was crucial in weight gain. Physical activity and TV viewing, on the other hand, did not explain why the BMI of some children increased more as compared to others. The findings are published in the Journal of Pediatric Psychology.
Dr KK Spiritual Blog
Leverage your strengths
  • Know your strengths
  • According to a British study, only about one–third of people have a useful understanding of their strengths.
  • If something comes easily, you may take it for granted and not identify it as a strength.
  • If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  • Strengths which most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
  • Strengths are so important that they’re worth cultivating and applying in your daily life, even if they don’t come naturally to you.
Make Sure
Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.
IMA,IJCP,HCFI
Inspirational Story
Sometimes ignorance is bliss

My classmate, Susan, and I are in the middle of our thesis rewrites for Johns Hopkins University. We only have two weeks left and we are both quite razzled at the prospect of doing more research in the remaining time.

Today Susan called me to say that she desperately needed more history about a small tribe of Native Americans that lives in the Grand Canyon But there’s only one telephone on the reservation and no one ever answers it.

As a matter of fact, the three times she visited the tribe’s Visitor Center while she was on vacation, she said no one ever opened up the building.

Being a computer geek, I said, "Have you checked the Internet?"

She said, "No, what a great idea! Thanks." I did a quick check using Excite while she used Yahoo and she was astounded at the information available about this little-known tribe.

She thanked me profusely for the tip and hung up.

Two hours later, she called me back sounding absolutely miserable. "Susan," I said, "What’s the matter?"

"Well," she said, "You’re not going to believe it but they have their own Web page with all the information I could ever want about the tribe."

"That’s great," I said. "What more could you ask for?" "You don’t understand," she said. "My article is about how isolated the tribe is and how their only path to the outside world is a little dirt trail up the side of the canyon!

On their Web page, they even have a scanned photo of the helicopter that brought the donated PC into the canyon."

Moral of the story: Sometimes ignorance is bliss ––especially when you’re trying to finish a thesis on time.
Wellness Blog
Kidney stone of less than 5mm size needs no treatment

A stone in the kidney passage of less than 5mm should not be treated as it will invariably pass in the next four weeks. A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone of more than 10mm invariably require a non–medical intervention.

New avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are Nifedipine (calcium channel blocker), alpha-blockers and steroids.

Until now it was thought that the best investigation for renal stone is intravenous pyelography. But now it has been prove beyond doubt that when a patient presents with kidney pain and a renal stone is suspected the undisputed investigation of choice is unenhanced CT scan of the abdomen. As per the guidelines, open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.

North India is considered a stone belt, with most cases of kidney stones in India being from this area.
Events
IMA,IJCP,HCFI
Dr Good Dr Bad
Situation: A patient came with right heart failure.
Dr Bad: Continue with your normal fluid intake.
Dr Good: Restrict your fluid intake.
Lesson: In right heart failure, fluids should be restricted.

(Copyright IJCP)
eMedinewS Humor
Carpenter's distance

A carpenter was giving evidence about an accident he had witnessed. The lawyer for the defendant was trying to discredit him and asked him how far away he was from the accident.

The carpenter replied, "Twenty-seven feet, six and one-half inches."

"What? How come you are so sure of that distance?" asked the lawyer.

"Well, I knew sooner or later some idiot would ask me. So I measured it!" replied the carpenter.
eMedi Quiz
A 31-year-old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows Type As curve and acoustic reflexes are absent. All constitute part of treatment, except:

1. Hearing aid.
2. Stapedectomy.
3. Sodium fluoride.
4. Gentamicin.

Yesterday’s Mind Teaser: Avascular necrosis can be a possible sequelae of fracture of all the following bones, except:

1. Femur neck
2. Scaphoid.
3. Talus.
4. Calcaneum.

Answer for yesterday’s Mind Teaser: 4. Calcaneum.
Correct Answers received from: Dr Jainendra Upadhyay, Dr K Raju, Dr G Madhusudhan, Daivadheenam Jella.
Answer for 17th July Mind Teaser: 3. Hemophilia.
Correct Answers received: Dr Poonam Chablani, Dr K Raju, Dr K V Sarma, Dr Avtar Krishan.
IMA,IJCP,HCFI
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
In every public place and public function people should know compression only CPR

If a sole lay rescuer is present or multiple lay rescuers are reluctant to perform mouth-to-mouth breathing, Heart are Foundation of India encourage the performance of CPR -10 using excellent chest compressions alone.

Lay rescuers should not interrupt excellent chest compressions to palpate for pulses or check for the return of spontaneous circulation, and should continue CPR-10 until an electric shock machine is ready to defibrillate, medical help arrives or the patient wakes up.

Addressing the gathering of 2745 police men at the IMA today Padma Shri Awardee Dr K K Aggarwal - President of Heart Care Foundation of India and Honorary Secretary General of IMA said that, untrained youngsters should perform compression-only CPR. From 11 years of age, they can effectively perform dispatcher-directed CPR by compressing the chest at an appropriate rate and depth. However, the technique benefits from formal training.

Chief Guest of the function Gajender Solanki Noted Kavi said that " in every public function there should be people who know compression only CPR.

Heart Care Foundation of India, Indian Medical Association Delhi Red Cross Society and Delhi police jointly are training all PCR van staff in this life saving technique.

Police were told to remember two number. Firstly 100: in emergency call 100 and start compressing the chest with a speed of 100 per minute AND the number 10, within ten minutes of death and for the next ten minutes compress the chest of the individual. CPR 10 is not given if a person is breathing.

Dr V K Monga former chairman health committee MCD also spoke on the occasion.'
eIMA News
Posting of AYUSH doctors in PHCs after crash training programs in modern medicine on the pretext of non-availability of modern medical doctors
Sri Narendra Modi ji
Honorable Prime Minister of India

Subject: Posting of AYUSH doctors in PHCs after crash training programs in modern medicine on the pretext of non-availability of modern medical doctors

Respected Sir,

Indian medical association strongly object to the posting of AYUSH doctors in PHCs after crash training programs in modern medicine on the pretext of non-availability of modern medical doctors

The non-availability of modern medical doctors in rural areas in sufficient numbers is due to multiple reasons
  1. There is less number of medical colleges in states where there is shortage of doctors
  2. The syllabi and curriculum of MBBS do not give exposure to a medical student regarding rural heath scenario
  3. The entrance examination system for MBBS itself promotes city-based candidates to get admission
  4. The doctor population ratio is not the only criteria for better health parameters, e.g. Sri Lanka. It is the doctor, nurse, midwife, health worker population ratio which is more important. India has better doctor population ratio, the nurse, midwife, health worker population ratio is worse
  5. The responsibility of heath manpower in the PHCs is mainly preventive rather than curative alone. Empowering AYUSH doctors just to prescribe modern medicine in PHCs will be addressing only part of the responsibility of the modern medicine doctor in the PHC
  6. The government instead of all the issues related to public health, is trying to solve it by a single intervention of empowering AYUSH Doctors, which is going to have a deleterious effect on public health
  7. The backbone of health care in any country is the family doctor system. By posting AYUSH practitioners in PHC, government is destroying the family doctor system. Family doctors are the first link in health care delivery for the population. They play a pivotal role in preventive health, early diagnosis and timely referral, up keeping of health details of family members. Instead of destroying the family doctor system, the service of the family doctors in the respective PHC area particularly where government doctors are not available, can be used on a retainership basis.
Global comparison

Based on cumulative data from comparative time periods (2001-2005), in 2005 India had a doctor: population ratio of 0.5 per 1,000 persons in comparison to 0.3 in Thailand, 0.4 in Sri Lanka. The ratio of 2.19 nurses and midwives per doctor ranks India lower than Sri Lanka (3.94) and Thailand (5.07)

This makes it necessary for India to simultaneously augment the number of doctors. More importantly when a comparison is made between Sri Lanka and India, Sri Lanka has better health parameters even though India has more Doctor per population. This has been achieved because their nurse/midwife ratio to doctor is higher than India. So what we really require is more of nurses and midwives and health workers than Doctors.

India finds itself ranked 52 of the 57 countries facing an HRH crisis. In 2006, only 26% of doctors resided in rural areas, serving 72% of India’s population. Density of nurses is three times higher in urban areas than rural areas

What India requires is a reversal of the distribution of doctors and para-medics. A special program to achieve this goal has to be envisaged by the government by
  1. Starting new medical colleges only in rural areas by upgrading district hospitals into medical colleges and preference to be given to local candidates
  2. Measures to attract young doctors to rural areas by offering attractive salaries, accommodation, facilities for education of children and transport.
  3. Rural service by young doctors should be given weightage in PG admissions
  4. The MBBS entrance exam presently is city centred more of graduates in big cities getting admission by virtue of being able to afford entrance coaching classes. The criteria for medical admission have to be restructured giving more weightage for performance upto plus two.
  5. The staff pattern of many of the states where there is non-availability of doctors in rural areas, has not been revised at least for the past 15 years. This is one reason for non- availability of doctors in rural areas. There is urgent need to revise the staff pattern as per the population growth.
National Commission on Macroeconomics and Health. Report of National Commission on Macroeconomics and Health. New Delhi: Ministry of Health and Family Welfare, Government of India; 2005

World Health Organisation (WHO). Global Atlas of the Health Workforce. Geneva: WHO; 2010

Rao K, Bhatnagar A, Berman P. India’s health workforce: size, composition and distribution. In La Forgia J, Rao K, Editors. India Health Beat. New Delhi: World Bank/Public Health Foundation of India; 2009

Historial perspectives
Physical infrastructure and HRH norms based on population were envisaged as early as 1946 by the Bhore Committee. Since then, various expert committees have set targets for HRH, many of which are yet to be achieved. These include the norm of one nurse per 500 population, one pharmacist per 2000 population (Bhore Committee 1946); one laboratory technician per 30,000 population and one health inspector per20,000 population (Chadha Committee 1963); one male and female health worker each for 3,000 - 3,500 population at the grassroots, i.e. within a distance of less than 5 kilometres (Kartar Committee 1974).

As of late, we have the Indian Public Health standards (IPHS) (2010) norms; One SHC for a population of 5,000, one PHC for a population of 30,000, and one CHC for a population of 1,20,000. This includes one SHC per 3,000 population, one PHC per 20,000 population and one CHC per 80,000 population for hilly / tribal and remote areas.

The weak knowledge base on HRH in Government and private sectors has been a matter of grave concern. We require a scientific HR Development Policy and information mangement system to have a rationalised HRH planning

Medical seats
The admission capacity in year 2013-2014 was about 50,078 students, at Undergraduate level and about 24,239 students, at Postgraduate level in India. (MCI Website, June 30, 2015)
According to the Medical Council of India (MCI), the total number of registered doctors in the country is 9,36,488 as on December 31, 2014 and that of auxiliary nurses midwives is 7,56,937 & registered nurses/midwives are 16,73,338 (Health Minister J P Nadda in Lok Sabha, March 13, 2015)

Six ‘high HRH production’ states (i.e. Andhra Pradesh, Karnataka, Kerala, Maharashtra, Pondicherry and Tamil Nadu) represent 31% of the Indian population, but have a disproportionately high share of MBBS seats (58%) and nursing colleges (63%) as compared to the eight ‘low HRH production’ states (i.e. Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh), which comprise 46% of India’s population, but have far fewer MBBS seats (21%) and nursing colleges (20%).

India has 19 health workers (doctors – 6, nurses & midwives – 13) per 10,000 people. WHO norms provide for 25 per 10,000 people (Steering Committee on Health for the 12th Five Year Plan of the Planning Commission)
IMA,IJCP,HCFISource: MCI annual report, 2014

Projected availability (Planning commission high level expert group on Universal Health Coverage, 2011 November)
IMA,IJCP,HCFISource: Planning commission HLEG report

As per planning commission report recommendations, following is the additional requirements for medical institutions
IMA,IJCP,HCFISource: Planning commission HLEG report

To achieve required doctors, nurses and midwives per 1000 population, our requirement of medical colleges, nursing colleges & schools are as above. The fact that this statistics have been worked out taking into consideration that one doctor sees 25 patients per day where as in India, when a doctor sees 200 and above patients per day, this theoretical number is not immediately necessary.
What we need in more of nurses and midwives rather than medical doctors
So there is no need for a short term plan of training AYUSH Doctors for prescribing modern medicine drugs and posting them in PHCs.

Thanks and regards

Prof Dr A Marthanda Pillai       Dr KK Aggarwal
National President                     Honorary Secretary General
Beware! Your Doctor Might Be On The Verge Of Sexual Misconduct
5 ways to avoid sexual abuse at the hands of your doctor

Dailybhaskar.com | Jul 14, 2015, 16:59PM IST

Gone are the days when doctors were thought to be the saviors, now the task of saving lives has been reduced to a mundane business, and worse- the medical practitioners,

who were once considered kin of God have become notorious, thanks to the malpractices undertaken by some of them. But the worse thing to have happened to this profession of rescuers is the fact that some of them have turned into sexual predators, who are sitting in the comfort of their plush clinics, awaiting women who would fall prey to their bad intent. And much like our western counterparts, Indians too have started becoming victims of such unexpected crimes.

Though we are pretty sure that each one of you is capable of dealing with an abuser in the disguise of a doctor, we are listing a few ways to ensure you don't have to face any sexual misconduct at a medical facility.
  1. Choose a female gynecologist: No, we are not trying to stop you from visiting a male gynecologist, but just asking you to opt for a female gynecologist because sexual abuse at the hand of male gynecologists tops the list of sexual abuse cases involving medical practitioners. This way at least you'll be ensuring that that a man doesn't touch you at places you would not want him to.
  2. Always speak logic: You are visiting a doctor doesn't mean you don't have the right to question the course of treatment being meted out to you. If your doctor insists on undergoing a pelvic/breast examination, always question the intent and ask for the logic. Most of the women become victims of abuse because they are too shy to question their doctor.
  3. Do not undress: Not every test requires the patient to undress or wear the medical gown, be aware of what's right and wrong.
  4. If there's a need to administer you anesthesia, make sure you have a family member around during the process.
  5. Don't be a mute spectator: If ever you meet a doctor, whose intentions don't seem right to you, speak up or else you'll only encourage him to continue misdeeds.
(Note: all state and city branches to find out editions this has published and we need to write to the editor)
Weekly webcast Thursday
Dear ALL

Digital IMA

Starts weekly webcast Thursday 3-4 PM

Topic for this week: Why and how to notify TB

Dr A Marthanda Pillai

Dr K K Aggarwal

TB Experts

watch at: http://tinyurl.com/oz4gfjy
http://www.emedinews.in/ima-webcast.html
Media
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Quote of the Day
A crust eaten in peace is better than a banquet partaken in anxiety. Aesop
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Reader Response
Dear Sir, Thanks for upgrading our knowledge. Regards: Dr SJ Sharma
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IMA Videos
News on Maps
Rabies News (Dr A K Gupta)
Can rabies vaccine be given to a child with chicken pox or measles?

As rabies is 100% fatal, there is no contraindication for antirabies vaccination. Rabies vaccine can be given to a child with chicken pox or measles and it is effective. If possible administration of measles vaccine should be postponed by a fortnight after the completion of antirabies immunization.