May 21  2015, Thursday
editorial
Working hard when tired not good for the health
Dr KK Aggarwal Doing mental or physical work while exhausted may harm your health, according to a study from University of Alabama at Birmingham and published in International Journal of Psychophysiology.

In the study, fatigued people had bigger spikes in blood pressure compared to well–rested people while doing a memorization test.

When fatigued people regard a task as worthwhile and achievable, they increase their effort to compensate for their diminished capability. As a result, the blood pressure of a tired person increases and remains elevated until the task is completed or the person gives up.

In this study, Wright and colleagues told 80 volunteers they could win a modest prize by memorizing 2 to 6 nonsense trigrams (meaningless, three–letter sequences) within two minutes. Compared to volunteers with low levels of fatigue, those with moderate fatigue had stronger blood pressure while doing the two–trigram memorization task.
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Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • The use of statins or fibrates to lower cholesterol seems to be associated with a one third lower risk for stroke, but no reduction in coronary events, in older adults without previous vascular disease, suggested a new observational study published May 19 in the BMJ.
  • The monoclonal antibody dupilumab improves lung function and reduces severe exacerbations in patients with asthma, suggests a new study presented at the American Thoracic Society 2015 International Conference.
  • A novel sporicidal ethanol formulation applied to gloves before they are donned might prevent the contamination of hands with Clostridium difficile when the gloves are removed, suggests new research presented at the Society for Healthcare Epidemiology of America Spring 2015 Conference.
  • Measuring free testosterone along with total testosterone may provide a more accurate picture than measuring total testosterone levels alone for diagnosing deficiency of this male hormone, suggests a new study presented at the European Congress of Endocrinology (ECE) 2015.
  • Results of the phase 2 TOUCHSTONE study in patients with moderate to severe ulcerative colitis show that ozanimod (a novel sphingosine 1-phosphate receptor modulator) 1 mg induced clinical remission at week 8, the primary end point, and met all three secondary end points (reduction in Mayo score of at least 3 and at least 30%, decrease in the rectal bleeding score of at least 1 or a rectal bleeding score of 1 or lower, mucosal improvement, defined as an endoscopy subscore of 1 or lower).
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Dr KK Spiritual Blog
How long can one fast?

As per Allopathy, one cannot live without air or oxygen for more than 3 minutes, without water for more than three days and without food for more than 3 weeks.

As per Chandogya Upanishad, food is responsible for the making of motor organs (Karmendriyas), sensory organs, manas (mind, intellect, memory and ego) and prana. The fiery foods are responsible for making the motor indriyas, earthy foods for sensory indriyas and manas and water for making Prana Vayu. Therefore, it is possible for a person to live on water for up to few weeks because he will keep making Prana and keep breathing but absence of food on 14th day onward will start affecting his Gnanaindriyas and Manas. The person will start losing power of hearing, touching and sensing and will start showing impairment in mental status, memory, intellect functions and egoistic behavior.
Cardiology eMedinewS
  • Compared with healthy sleep patterns, long and short sleep durations appear to almost double the likelihood of stroke in middle-aged individuals with hypertension, suggests new research presented at the American Society of Hypertension (ASH) 2015 Annual Scientific Meeting.
  • A small pilot trial of carotid baroreflex activation therapy (BAT) that uses a tiny electrode surgically placed on the carotid sinus has demonstrated striking benefits in patients with NYHA class 3 reduced-ejection-fraction (EF) heart failure who could not be treated with biventricular pacing. The findings were presented at the Heart Rhythm Society 2015 Scientific Sessions.
Pediatrics eMedinewS
  • A placebo-controlled trial in adolescents presented at the American Psychiatric Association (APA) 2015 Annual Meeting has revealed that the selective serotonin reuptake inhibitor (SSRI) fluoxetine, a first-line treatment for adults with body dysmorphic disorder (BDD), may also help in pediatric BDD.
  • A promising screening tool that elicits responses from parents about potential communication delays accurately distinguishes infants with autism spectrum disorder (ASD) from those with developmental delay and from typically developing children, suggests new research presented at the International Meeting for Autism Research (IMFAR) 2015.
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, mouth, tongue or airway develops (Br J Clin Pharmacol 1999;48(6):861–5).
Dr Good Dr Bad
Situation: An elderly type 2 diabetic patient with cancer lung came with A1c of 7.5%.
Dr Bad: This is high. You need insulin therapy.
Dr Good: This result is ok.
Lesson: As per the 2007 American College of Physicians (ACP) guidelines, A1c goal may be higher than 7% for type 2 diabetic patients who are elderly or frail, who are at higher risk for adverse events from tight control, or have a limited lifespan due to comorbid conditions (Ann Intern Med. 2007 Sep 18;147(6):417-2).

(Copyright IJCP)
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Quote of the Day
Education is the best friend. An educated person is respected everywhere. Education beats the beauty and the youth. Chanakya
Wellness Blog
Treatment of Summer Diarrhea

One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. No antibiotic is needed. The only treatment is oral rehydration solution.

One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.
eMedi Quiz
When should you have your first colonoscopy to screen for colon cancer?

A. At age 35.
B. At age 40.
C. At age 45.
D. At age 50.
E. At age 55.

Yesterday’s Mind Teaser: What is the number one cancer killer of women?

A. Colon cancer.
B. Breast cancer.
C. Lung cancer.
D. Cervical cancer.
E. Esophageal cancer.

Answer for yesterday’s Mind Teaser: C. Lung cancer.

Correct Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr K Raju, Tukaram Pagad.

Answer for 19th May Mind Teaser: B. Their eggs have begun to degenerate.

Correct Answers received: Dr N K Mohanty, Dr Avtar Krishan, Dr G Madhusudhan, Tukaram Pagad, Dr Poonam Chablani, Dr K Raju.
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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
eIMA News
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Cleanliness drive to fight hospital infection
May 20, 2015 : Age Correspondent

Concerned over rising cases of infection due to unhygienic conditions in health institutions, doctors in the national capital will be launching a cleanliness drive at two city hospitals on Saturday. The drive will part of the Indian Medical Association’s (IMA) nationwide cleanliness drive in support to PM Narendra Modi’s Swachchh Bharat Abhiyan. According to the IMA, in last decade, the number of cases related to hospital-acquired infection (an infection acquired by a patient or others during a hospital visit or by staff during work) have doubled in the country due to unhygienic conditions the hospitals. “From earlier five per cent prevalence of hospital-acquired infection a decade ago, figures have touched 12 per cent now,” said secretary-general, IMA, Dr K.K. Aggarwal.

The cleanliness drive will be initiated at two hospitals, Bhagwan Mahavir and Guru Teg Bahadur Hospital. As per the plan, on May 23, doctors in national capital and other parts of country will clean the medical establishments and the surroundings for one hour.

“Rising number of hospital-acquired infections is a concern not only for patients but also for their relatives, doctors and other hospital staff. There are several reasons and places for spread of these infections from dirty toilets to poor sanitation conditions in wards and places frequented by the staff and public,” said senior cardiologist at Sir Ganga Ram Hospital, Dr S.C. Manchanda.

Supporting Mr Modi’s Swachchh Bharat Abhiyan for a healthier country, senior consultant at Fortis Hospital, Dr Pankaj Aneja, said that through proper cleanliness, the country will be able to control one-third of the deaths caused due to various infections.

Apart from cleaning the hospital premises, the doctors will make people aware of, especially children, hygienic practices to adopt in daily life. “A recent research by the public health association said only 53 per cent of the population wash hands with soap after defecation, 38 per cent before eating and 30 per cent before preparing food, said a diabetologist.
IMA, Kent RO partner for mass awareness on water borne diseases
20 May 2015: New Delhi: DNA: From the print edition

DNA Correspondent

The Indian Medical Association (IMA) and healthcare products maker Kent RO group have joined hands to increase awareness about prevention of water borne diseases. The duo recently launched a campaign christened 'IMA Swachh Bharat Swasth Bharat' to this effect with a focus on safe water consumption.

According to A Marthanda Pillai, national president and KK Aggarwal, honorary secretary general, IMA, the Indian Constitution (under Article 47) makes it one of the primary duties of the State to provide clean and safe drinking water to its citizens. "Yet three lakh children in India die due to diarrheal diseases every year before the age of three, a condition that is completely preventable by the elimination of unsafe drinking water. "Through this association, we aim to reduce the number of deaths caused by water borne diseases through mass awareness drives and educational initiatives," the duo said.

Kick-starting this initiative, the IMA will be adopting a model slum area in Delhi NCR where a community reverse osmosis (RO) plant will be placed for a period of six months to study its impact in the reduction of water borne diseases.

Elaborating on the importance of this initiative, IMA and Kent RO executives highlighted the fact that approximately 70% of the Indian population has no access to safe drinking water. Citing the World Health Organization (WHO) statistics, the executives said, that water-borne diseases account for around 4.1% of the total global disease burden causing over 1.8 million deaths annually. In fact, approximately 88% of this is attributed to unsafe water supply, sanitation and hygiene.

Mahesh Gupta, CMD, Kent RO Systems Ltd, said, the program is aimed at ensuring availability of clean and healthy drinking water across the country. "We understand the intrinsic relationship between access to clean and safe drinking water and a healthy India. We hope this partnership will be able to raise awareness about the issue and make a difference in the society," said Gupta.
Medical negligence kills class IX student in West Bengal
Headlines Today | May 19, 2: Suhana Yasmin Mondal, who was rushed to the prestigious SSKM Hospital in Kolkata on November 26, 2014, left unattended and she died due to blood loss the very next day.
R12.9m damages for medical negligence
PUBLISHED: 19 MAY 2015: The parents of a 5-year-old boy – who is physically, mentally and emotionally impaired – were awarded R12.9m in damages yesterday by the KZN High Court (Pietermaritzburg) in a medical negligence case against KZN Health.

The Witness reports that during labour, the mother was negligently managed – a C-Section was not performed when required and there was no back-up for labour emergencies. As a result, the baby was oxygen deficient during delivery and, or, immediately after delivery, which caused brain damage.

The child suffered from cerebral palsy with poor muscle tone, involuntary movement, an inability to sit, crawl or walk, an inability to speak and stiffness of the lower and upper limb muscles. The claim added that the child would require future hospital and medical treatment and devices that were reasonably necessary for a person with this condition. (Medical Brief)
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Inspirational Story
Knowing Yourself

Control, fear, doubt and anger; these are the real deadly killers of the human race. We hurt ourselves by feeling these emotions and we hurt others by directing these emotions at them.

But what if we could direct unconditional love to whomever we meet? What then? Could we help the world be a better place? Maybe, maybe not but we'd certainly help ourselves. Why do we let other people hurt us? Because we put expectations on them, expectations that we ourselves have failed to live up to with others.

If you love someone you feel it and that feeling is yours. Look at children. We still love our children when they disappoint us why not our workmates, teachers, friends and most of all partners? It’s because we put conditions on what we give out. Who hasn’t bought a present or done a job around the house expecting something in return – why? If you want to help someone or give something you choose to do it because you want to, not for "Brownie Points". No other reason than just because you want to – that is showing love.

You can help an old lady with her groceries and it feels good so why not with everything else. When you learn that giving love without expectation is the purest of all faith, then and only then, will you be on the road to really knowing yourself.
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Reader Response
Respected Sir Grand salute to IMA HQ and all the dedicated doctors and staff for there services at Nepal. LONG LIVE IMA. Dr. Sofiya Ansari
IMA Humor
A Modern Panchatantra story

Once upon a time, there was a software engineer who used to develop programs on his Pentium machine, sitting under a tree on the banks of a river. He used to earn his bread by selling those programs in the Sunday market. One day, while he was working, his machine tumbled off the table and fell in the river. Encouraged by the Panchatantra story of his childhood (the woodcutter and the axe), he started praying to the River Goddess. The River Goddess wanted to test him and so appeared only after one month of rigorous prayers. The engineer told her that he had lost his computer in the river.

As usual, the Goddess wanted to test his honesty. She showed him a match box and asked, "Is this your computer?" Disappointed by the Goddess’s lack of computer awareness, the engineer replied, "No."

She next showed him a pocket–sized calculator and asked if that was his.

Annoyed, the engineer said "No, not at all!!"

Finally, she came up with his own Pentium machine and asked if it was his.

The engineer, left with no option, sighed and said "Yes."

The River Goddess was happy with his honesty. She was about to give him all three items, but before she could make the offer, the engineer asked her, "Don’t you know that you're supposed to show me some better computers before bringing up my own?"

The River Goddess, angered at this, replied, "I know that, you stupid donkey! The first two things I showed you were the Trillennium and the Billennium, the latest computers from IBM!" So saying, she disappeared with the Pentium!!

Moral: If you’re not up–to–date with technology trends, it’s better to keep your mouth shut and let people think you’re a fool than to open your mouth and remove all doubt.
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How Long One Can Fast

A high-salt diet may increase the risk of developing gastric and duodenal ulcers. High concentrations of salt in the stomach can induce gene activity in the ulcer-causing Helicobacter pylori bacterium that causes it to become more virulent. Bacterial cells exposed to increased salt exhibit striking morphological changes. Cells become elongated and form long chains.

Salt restriction also reduces the diastolic blood pressure by 2-8 mmHg, said Padma Shri Awardee Dr. (Prof.) A. Marthanda Pillai, National President, IMA and Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

According to a WHO report, reducing salt intake would be a cost-effective way to reduce the risk of developing high blood pressure directly and reducing the risk of heart attack and stroke indirectly. The report recommends people to reduce consumption of sodium to less than 2 gm per day for each person. Common salt is chemically called sodium chloride (NaCl). About 2.5 gm of table salt contains one gm of sodium.

According to a report published from the All India Institute of Medical Sciences in the year 2000, the average intake of salt in India is 10 gm per day for each person. This would amount to about 4 gm of sodium. The current recommendations suggest reducing this consumption by half.

A research study conducted by researchers at Harvard Medical School and published in the British Medical Journal, found that reducing salt intake by 25% reduced the risk of developing heart disease by 25% and reduced the chance of death from heart disease by 20%.

In 2002, WHO estimated that about 62% of strokes and about 50% of heart attacks globally were attributable to high blood pressure.

Adding a pinch of salt to milk will keep it fresh longer is a common Internet tip for the population but traditional Ayurveda teaching goes against it. As per Charaka Samhita, too much of pipalli, alkali and salt are bad for the health. Ayurveda totally prohibits taking salt with the milk.
Rabies News (Dr A K Gupta)
Can rabies be transmitted to a dog that has eaten the flesh of a dead rabid cow or buffalo?

Yes, the rabies virus after multiplying in the brain spreads to other organs of the body like the heart, muscles, skin, etc. So the dog can definitely get infected because the virus can spread through oral mucous membrane.