July 21  2015, Tuesday
eMedinewS
editorial
Food poisoning with rice dishes
Dr KK AggarwalStaphylococcus aureus and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit.
  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic–type food poisoning associated with B. cereus.
  • The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin-mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B. cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one–third of individuals. Symptom onset is usually within 1 to 5 hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.
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In cardiac arrest call 102 or 100
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Oncology / Obstetrics and Gynecology
Doubling the amount of weekly moderate to vigorous aerobic exercise, to 300 minutes instead of 150 minutes a week, seems to have a better effect on body fat that has been associated with increased risk of postmenopausal breast cancer, reported a trial of 400 inactive postmenopausal women published in JAMA Oncology.

Ear, Nose and Throat The delivery of electromagnetic pulses can improve the symptom's severity in patients with tinnitus, reported a new study published in JAMA Otolaryngology-Head & Neck Surgery. Researchers noted that patients receiving active repetitive transcranial magnetic stimulation (rTMS) experienced a 31% reduction in their tinnitus, compared with a 7% reduction in those receiving placebo rTMS.

Rheumatology
All-cause mortality was not increased among patients with gout treated with allopurinol, reported a large U.K. study published online in Rheumatology.

Neurology
A combination of well-studied biomarkers for Alzheimer's disease prediction showed good sensitivity and specificity for predicting later onset of cognitive impairment in healthy middle-aged people, suggested a long-running prospective study presented at the Alzheimer's Association International Conference.

Endocrinology
Less than 1% of obese people will attain normal weight, suggests a new study published online July 16 in the American Journal of Public Health. The findings suggested that current nonsurgical obesity treatment strategies are failing to achieve sustained weight loss for the majority of obese patients.
Top News from ADA 2015
Low Vitamin D Levels Common in Painful Diabetic Neuropathy

Diabetic peripheral neuropathy is associated with significantly reduced vitamin D levels, independent of sunlight exposure, a new study finds. This suggests a possible role of vitamin D in the pathogenesis of painful diabetic peripheral neuropathy and therefore a potential role of supplementation in its treatment, pending the results of randomized clinical trials, said study author Dinesh Selvarajah, MD, of the University of Sheffield, United Kingdom. This is the first study to carefully control for seasonal differences in vitamin D and for activity variations that affect vitamin D exposure. "We've certainly got a smoking gun. We've got a proof of concept. Now we need to do an intervention study to show whether this is a significant finding, because if it is, it's a simple enough treatment," he said. (Source: Medscape)
Cardiology eMedinewS
  • Australian physicians are taking advantage of 3D printing to create an exact replica of the patient's cardiac anatomy when planning left atrial appendage (LAA) closure procedures with the Watchman (Boston Scientific) device. According to the researchers, 3D printing is useful when closing the LAA with the Watchman, particularly in patients where "the anatomy is complex and the interaction between the device and the appendage is difficult to quantify, even using advanced imaging methods."
  • Exposure to the smoke from wildfires that hit the southeast region of Australia in December 2006 and January 2007, specifically to particulate matter at high PM2.5 concentrations, was associated with an upswing in out-of-hospital cardiac arrests in men and ischemic heart disease (IHD) events in women as per a study published July 15, 2015 in the Journal of the American Heart Association.
Pediatrics eMedinewS
Pediatrics
Psychiatry
A new study suggests that first-borns have higher IQs and consistently different personality traits than those born later in the family chronology. The analysis is reported in the Journal of Research in Personality.

Pediatrics
Allergy

Adding peanuts to the list of complementary foods introduced early in infancy can prevent peanut allergy in most high-risk infants, experts say in a consensus statement. Dr. Fleischer, representing the American Academy of Allergy, Asthma & Immunology, and colleagues from 10 other national and international organizations highlight the benefits of early, rather than delayed, peanut introduction in their consensus communication published online June 30 in the Journal of Allergy and Clinical Immunology.
Dr KK Spiritual Blog
The lips of truth shall be recognized forever, a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is ever lasting and always ends up in internal happiness and self-realization. And, in the long run, it always gives you happiness and an all-win situation. A lying tongue, on the contrary, will only give you a momentary pleasure but will lead to or create some difficulty later in life.

Spoken words cannot come back just as in the case of a released arrow from the bow. Once lost, one cannot get back his youth, virginity, or respect. Similarly, spoken bad words cannot be taken back and once spoken will create negative waves in the other persons (on whom they were spoken) mind which will persist as repressed thoughts or memory in the people’s mind for ever. Such bad memories will keep on coming back in the person’s mind causing damage to the personal relationships.

A spoken word is a karmic expression. For every karmic action there is an opposite and equal reaction. For every negative karmic action, one has to pay the debt either now or in future. The law of karma says that every debt has to be paid.

It is always better to avoid negative language both in spoken words as well as in the mind. The yoga sutras of Patanjali describe thinking, speaking or doing anything wrong as having the same karmic significance. We should not only purify ourselves in actions and spoken words but also in the mind. If a person keeps negative thoughts in the mind, sooner or later the same will be reflected to the outside world.

The momentary pleasure which one gets by “lying” has no spiritual significance as it only satisfies your ego sense or makes you attached to any of the five senses. The transient pleasure experienced by the body stimulates a chain of reactions, consisting of action, memory and desire leading to action again, which will only intensify the greed & attachments.

In the Mahabharata, Lord Krishna has given only two examples, which work as an exception to such a situation. Any truth, which harms others, may not be spoken and any lie which does not harm anyone but benefits a few may be spoken.

Truth is the opposite of doubt and it is always better to clear all the doubts from the mind as any repressed doubts can end up into causation of heart attack, paralysis and cancer.

Truth also means taking conscious-based decisions as the consciousness will never lie. While taking any decision one should always ask oneself— Is it the truth? Is it necessary? And will it bring happiness to me and the people around?

Lord Krishna is also described as “SATCHITANAND”, which only indicates qualities like truthfulness, conscious-based decisions and internal happiness. Truthfulness has to be practiced for over a period of time and made a part and parcel of your daily life. To start with a person may have bad experiences but in the long run truthfulness will always win.
Make Sure
Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year
Events
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Dr Good Dr Bad
Situation: A patient had a strong family history of cancer.
Dr Bad: Just get regular check ups.
Dr Good: Take low dose aspirin.
Lesson: A new observational analysis published online in the Lancet reports that long–term daily aspirin may prevent cancer deaths.

(Copyright IJCP)
Tip of the day
Rabies News (Dr A K Gupta)
What does humanizing your dog means?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.
IJCP Book of Medical Records
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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
HIMSS Asia Pacific India to host its 1st India mega-event on 5th & 6th August 2015 at The Leela Ambience, Gurgaon, India
This Inaugural event will focus on improving the Healthcare delivery using effective and efficient Healthcare Information Technology and Management Systems.

This is the first event for HIMSS in India which will be attended by the who’s who of the Healthcare industry from the Government to the Industry. This is a rare Healthcare event in India that has attracted high profile speakers from the Government and the industry to set the agenda for Healthcare IT in India. The event will be inaugurated by Shri. J.P.Nadda, Hon’ble Union Minister of Health & Family Welfare, Government of India. Besides, key policy makers would be participating in the conference from across ministries.

The event is happening at the right time, given our Honb’le Prime Minister’s push for Digital India with a focus on health, education and governance. We at HIMSS India, believe, that the Industry and the Government interaction is key in implementing the vision of our Hon’ble Prime Minister on Digital India, and this conference will be the defining point for the way forward. The report of the proceedings will be sent to all the key policy makers and made available free of charge to ensure the maximum reach and effectiveness. Also, our goal is to showcase the capabilities the private sector has in transforming of Healthcare in India through information technology, and we also wish to update the private sector on Government’s plans and policies said Rajendra Pratap Gupta, Chairman, HIMSS Asia Pacific India board. Delegates will have the opportunity to learn about and evaluate the latest innovations in healthcare and how health IT is at the forefront in transforming the healthcare experience and building a healthier India. The summit will also connect the private sector with various policy makers through sessions and keynotes. There will be multiple networking opportunities for startups and large organizations to have one to one discussions with potential entrants into this space who will be attending the conference as delegates and speakers.

The HIMSS India conference will have discussion with the key healthcare leaders on: Future of Healthcare IT in India; Cloud & Big data; Universal Health Coverage; mHealth & predictive analytics in healthcare; Rural Health; Smart Cities & HCIT; Chronic disease management; Clinicians and small hospitals; Medical education , skills development & training ; Pharmaceuticals amongst other topics

The conference promises the best of speakers on healthcare which includes Shri JP Nadda, Hon’ble Union Minister for Health & Family Welfare; Dr Devi Shetty, Chairman, Narayan Hrudalaya; Mr Phaneesh Murthy (Former CEO , iGate), Shri Nikunja Dhall, Joint Secretary, MOHFW; Dr Neena Pahuja, Director General , ERNET, Ministry of Comm & IT , Government of India; Dr KK Aggarwal, Secretary General, IMA; Dr Sanjeev Kumar, Executive Director, National Health Systems Resource Centre; Mr Rajendra Pratap Gupta, leading public policy expert and author of the BJP’s Election Manifesto amongst others.
Women Doctor's’ Wing of IMA Kancheepuram Branch organized CME Program for the month of July as below:
Date: 14.07.2015, Tuesday
Time: 02.00 pm – 04.00 pm
CME Topic: “Ovarian Preservation in Cancer Cervix”
16 members of WDW, IMA, Kancheepuram attended the program. The Meeting was followed by scientific discussion.
NEWS
Prostate cancer is the second most commonly diagnosed cancer in American men and the second-leading cause of cancer death. Sometimes the side effects of treatment, which include erectile dysfunction and incontinence, are worse than the disease.
Media
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Inspirational Story
A Most Important Lesson

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely, this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark–haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank. Just before class ended, one student asked if the last question would count toward our quiz grade.

"Absolutely," said the professor. "In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say ‘hello’." "I’ve never forgotten that lesson. I also learned her name was Dorothy.

Moral: Every person no matter who it is should be considered equal… something that we all forget so easily. To value a person regardless of their status is the highest noble work.
Wellness Blog
Fits or Epilepsy
  • Seizure is a sudden change in behavior that is the consequence of brain dysfunction.
  • Approximately 0.5–1% of population has epilepsy.
  • Some seizures are provoked i.e. that occur in metabolic derangements, drug or alcohol withdrawal and in situations like acute paralysis or acute encephalitis. Such patients are not considered to have epilepsy because these seizures would not recur in the absence of the provocation.
  • Less than 50% of epilepsy cases will have an identifiable cause such as head trauma, brain tumor, paralysis, infection, brain malformation etc.
  • Having one seizure does not always mean that the patient would always get a seizure.
  • One episode of seizure may not require treatment.
  • Hospitalization is required in the first seizure only if it is associated with prolonged post seizure altered level of consciousness.
  • Patients with unprovoked seizure may not be allowed to drive for some time.
  • In children, seizure can occur with high grade fever.
  • In adults, the first episode of seizure may be due to worms in the brain. In such a situation, it may be necessary to do an MRI test.
  • A patient with seizure can get married, live a normal life and produce children.
  • It is a misnomer that during a fit that the person should be made to smell a shoe.
  • During epilepsy, never put the fingers inside the mouth of the patient as they may get injured. Use a spoon instead to prevent tongue bite.
  • A patient with epilepsy fall will have stiffness in the body; on the contrary, patient with cardiac loss of consciousness will fall loose.
  • A seizure that lasts for more than 5–10 minutes requires specialized attention.
Quote of the Day
Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader. Paul J. Meyer
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Reader Response
Heart Care Foundation is doing a good job. I lost my son Dr. Abhik simply because there was no emergency CPR team outside hospital, and unfortunately l was not present in Malda on 11.6.2015: Dr A Maitra.
Digital IMA
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eMedi Quiz
A middle-aged male comes to the outer patient department (OPD) with the only complaint of hoarseness of voice for the past 2 years. He has been a chronic smoker for 30 years. On examination, a reddish area of mucosal irregularity overlying a portion both cords was seen. Management would include all except:

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

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4. Gentamicin.

Correct Answers received from: Dr G Madhusudhan, Arvind Diwaker, Dr K Raju, Dr K V Sarma, Dr Poonam Chablani.

Answer for 19th July Mind Teaser: 4. Calcaneum

Correct Answers received: Dr K Raju, Dr K V Sarma.
IMA Humor
Never be rude to anyone

An American tourist asked a boat guy in Zanzibar, "Do you know Biology, Psychology, Geography, Geology or Criminology?"

The boat guy said, "No. I don’t know any of these."

The tourist then said, "What the hell do you know on the face of this Earth? You will die of illiteracy!"

The boat guy said nothing. After a while the boat developed a fault and started sinking. The boatman then asked the tourist, "Do you know Swimology and Escapology from Crocodiology?"
The tourist said, "No!"

The boat guy replied, "Well, today you will Drownology and Crocodiology will eat you. I will not Helpology and you will Dieology because of your Badmouthology."
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Press Release
In cardiac arrest call 102 or 100

Most people who experience cardiac arrest at home, in their work place or in a public location die because they do not receive immediate cardiopulmonary resuscitation (CPR) from someone on the scene. About 90 percent of people who suffer out-of-hospital cardiac arrests die.

As a bystander, do not be afraid. Your actions will only help to revive the person, who is already clinically dead.

Addressing a gathering of 270 policemen at the Indian Medical Association (IMA) today Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA said that if you see a teen or adult suddenly collapse, immediately call helpline numbers 100 (police) or 102 (ambulance) and start pushing hard and fast in the center of the chest.

CPR, if done immediately, can more than double a person's chances of survival, added Padma Shri Awardee Dr A Marthanda Pillai National President IMA.

If you are called on to give CPR in an emergency, you will most likely be trying to save the life of someone you care about either a spouse, parent, child, friend or coworker.

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.

You can learn the two simple steps of hands-only CPR 10 in just one minute.

In cardiac arrest, call 102 or 100 and compress the center of the chest with a speed of 100 per minute.