September 21   2015, Monday
eMedinewS
All about Calcium Carbide
Dr KK Aggarwal
  • Under PFA Section 44AA, the use of calcium carbide for artificial ripening of mangoes, apple, plum, banana is prohibited and can attract both imprisonment and fine.
  • Calcium carbide powder is usually kept wrapped in paper between the fruits (unripe mangoes) in a basket or box.
  • Once the basket of mango is closed from the top, calcium carbide absorbs moisture and produces acetylene gas, which accelerates the ripening process of fruits.
  • The health hazards are related to the gastrointestinal tract, kidney, heart, liver and brain and in long run cancer.
  • Calcium carbide 1kg is sufficient to ripen 10 tons of fruit.
  • How do we know that the fruit has been artificially ripened with calcium carbide?
    • It will be less tasty.
    • The aroma will be different
    • It is uniform in color.
    • The color of the mango changes from green to dark yellow.
    • It will have a less shelf life.
    • It will be overtly soft.
    • There may be black patches on the mango skin.
    • There may be multi color patches on the skin of the mango (Red, yellow, green patches)
  • How should artificially ripened fruits be handled?
    • Never eat off–season fruits, especially before time
    • Rinse all fruits in running tap water for few minutes before use.
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Diabetes
Hyperglycemia after eating may interfere with work productivity for some people with diabetes, suggests new research presented at the European Association for the Study of Diabetes (EASD) 2015 Meeting.

Oncology
For women with low-risk ductal carcinoma in situ (DCIS) who opt for surgical excision without radiation, the risk of local recurrence of DCIS or invasive cancer increases steadily over the ensuing 12 years without reaching a plateau, suggests a new study published online in the Journal of Clinical Oncology.

Ophthalmology
Visual acuity remains stable or continues to improve over 5 years in most patients treated with ranibizumab for neovascular age-related macular degeneration under "real-life" conditions, suggested a new study presented at the 15th EURETINA Congress.

Infectious Diseases
Antibiotic resistance rates across the globe are alarming, and the only sustainable solutions are to limit overuse and misuse of antibiotics, according to the Center for Disease Dynamics, Economics & Policy (CDDEP) report.

Pulmonary Medicine
Beta blocker use seems to be associated with a reduced risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD), suggests an observational study published online in Thorax.
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Cardiology eMedinewS
  • New data from participants from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) showed that those who had high baseline resting heart rates (between 71 and 117 beats/minute) had significantly higher risk than those with slower heart rates for decline in both basic activities of daily living (such as grooming, feeding, and urinary continence) and instrumental activities (such as housework, using technology, and taking medication as prescribed). The findings were published online in CMAJ.
  • Injection drug users who undergo surgery for infective endocarditis (IE) have a significantly higher risk of reoperation or death between 3 and 6 months after surgery compared with patients who develop endocarditis who are not IV drug abusers, suggested an article published in the September issue of the Annals of Thoracic Surgery.
Pediatrics eMedinewS
Pediatrics
Dental Health

A new study suggests that children of mothers who had chronic stress in pregnancy may be at an increased risk for dental caries. The findings are published in the American Journal of Public Health.

Pediatrics
Obesity

Children were 14% more likely to be overweight or obese if they lived in an area where access to green space was limited and were 35% more likely if they grew up without a garden to frolic in, according to an oral presentation by Giel Nijpels, MD, PhD, professor of general practice medicine, VU Medical Center, Amsterdam at the annual meeting of the European Association for the Study of Diabetes.
Pulmonary Embolism
Bedside echocardiography may be used for patients who remain unstable despite resuscitation, in order to obtain a presumptive diagnosis of PE to justify the administration of potentially life-saving therapies, including thrombolysis.
Dr KK Spiritual Blog
What is the importance of life force?

A physical body becomes useless once the life force is gone. The same body, which was lovable to everyone, becomes a liability after death. Everyone wants to dispose it as early as possible as keeping a dead body at home is considered a bad omen.

During the transfer of dead body from one place to another, nobody wants to keep the body in a vehicle other than a hearse van, meant to transport dead bodies. No family would be willing to carry the dead body of a person in a car in which the deceased person had been traveling or driving for years.

Once you touch a dead body you are required to take a bath, for any reason, health or ritual, before you commence your daily routine.

Within a matter of hours in absence of life force, the physical body starts disintegrating and in a matter of days, it shows signs of self-destruction and putrefaction.

This vital force is nothing but the soul, atma, brahma, spirit or consciousness described in different Vedic texts.

Adi Shankaracharya in his book Bhaja Govindam shloka 6 says:

Yávat-pavano nivasati dehe
Távat-pøcchati kuùalam gehe,
Gatavati váyau dehápáye
Bháryá bibhyati tasmin káye.(6)

“Till the life force remains in the body, people come and enquire about your welfare. But, the moment the life force goes out, even your wife is afraid of coming anywhere near your body”.

Life force can be equated to the network of information in computer, radio, television or mobile phone. All these gadgets without data are useless and are thrown away. This silent data retrievable by operational and application software represent the life force or soul of these electronic gadgets.

Just as one does not give importance to a computer without data, one should not give importance to the physical body. It is the life force within the body which is respected and cared for and that is what real “I” or “We” are. All glories of the body are only until the life force remains in it. In Bhagavad-Gita, Lord Krishna in Chapter 2 (2.23) says about this life force or ataman “fire cannot burn it, weapon cannot cut it, water cannot wet it, air cannot dry it, it is immortal”.

The life force has no dimensions: height, weight, color or image. It is immortal, omnipotent, omniscient and omnipresent. The weight of a live and a dead body immediately after the death is the same.

It is the same life force, which dwells in everybody and during life is modified by actions, memory and desire cycle. If one gets attached to any of the three, then one starts getting detached from the soul or the life force. People who are in touch with their life force all the time attain peace and happiness and die young in old age.

Most Vedic mahavakyas talk about, that it is the same spirit, which dwells in everybody and hence every person in the society should be welcomed and treated with equal importance. Aham brahmasami, tatwam asi, vasudeva kutumbakam, etc. are a few of the examples.

According to Adi Shankaracharya, one can achieve non-duality only by seeing God in everyone. Athithi-devo-bhava is also based on the same principle.
Wellness Blog
Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published in the journal Gastroenterology. This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or UC. Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation. The diagnosis of ulcerative colitis (UC) was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation. Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.

A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH) D level was 27.6 ng/mL. Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years. The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.

For every 1 ng/mL increase in predicted 25(OH) D level, the risk for CD was reduced by 6%. For UC, there was also a reduction in risk, but it was non–significant at 4%. Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD. Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk. For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD. Intakes of 800 IU/day or higher led to greater reductions in the risks for UC and CD. Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P Co. Ed. Model, Sr. Sec School, Ansari Nagar-18-9-15
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Make Sure
Situation: A patient on binasal oxygen developed nasal mucosal damage.
Reaction: Oh my God! Why was the oxygen given at the rate of 4 liters per minute?
Lesson: Make sure that oxygen via nasal catheter, is not given at a rate of >3 liters per minute.
Dr Good Dr Bad
Situation: A mosquito was caught after he had bitten an individual.
Dr. Bad: This mosquito has become non-infected.
Dr. Good: Once infected, the mosquito remains infected for life.
Lesson: Once infected, a dengue mosquito carries the virus for its life span and continues to transmit the virus to humans.
eMedinewS Humor
A Friendly Honest Neighbor

A man received the following text from his neighbor:

I am so sorry Bob. I’ve been riddled with guilt and I have to confess.

I have been tapping your wife, day and night when you’re not around. In fact, more than you.

I’m not getting it at home, but that’s no excuse.

I can no longer live with the guilt and I hope you will accept my sincerest apology with my promise that it won’t happen again.

Bob, anguished and betrayed, went into his bedroom, grabbed his gun, and without a word, shot his wife and killed her.

A few moments later, a second text came in: Damn autocorrect. I meant "wifi", not "wife".
Reader Response
Dear Dr. Aggarwal, I am very happy with your eMedinewS. It is very informative. Dr G G Mansharamani
HCFI Videos
Rabies News (Dr A K Gupta)
A previously immunized person is bitten again. What is the re–exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to over treat than under treat.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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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
News
  • Researchers from UK and Netherlands have identified a variety of signs and symptoms that can help diagnose detrusor underactivity (DU). Patients with DU group were found to a higher occurrence of decreased and/or interrupted urinary stream, hesitancy, and feeling of incomplete bladder emptying. Men with DU had a significantly lower occurrence of decreased urinary stream, hesitancy, and urgency vs those with bladder outlet obstruction. They also showed more urinary tract infections and greater use of antibiotics, and had a significantly higher occurrence of both decreased sensation and straining vs patients with normal pressure flow studies or bladder outlet obstruction.
  • "A disabling syndrome of chronic neuropathic pain, vexing fatigue, and profound autonomic dysfunction may appear after HPV vaccination," say authors, headed by Manuel Martínez-Lavín, MD, from the Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, in Mexico City in a report published online September 10 in Clinical Rheumatology.
  • In a study of mildly obese East Asian patients with type 2 diabetes, 64% of patients who had bariatric surgery attained complete or partial diabetes remission that lasted 5 years, and they maintained a mean weight loss of 21%. In contrast, fewer than 3% of patients in a comparison medical-care group had diabetes remission, and their mean body mass index (BMI) was virtually unchanged. (September 16 in JAMA Surgery)
  • A group of technology and science experts hopes to recruit at least one million individuals to the Precision Medicine Initiative (PMI), designed to enhance innovation in biomedical research and ultimately move the United States into an era where medical treatment is tailored to each patient. The authors define precision medicine as an approach to disease treatment and prevention that attempts to maximize effectiveness by considering individual variability in genes, environment, and lifestyle.
  • Personalized medicine will be a key theme here at the European Respiratory Society (ERS) International Congress 2015, especially for complicated diseases like asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung fibrosis.
  • An asthma flare-up diary may help assess the severity of asthma exacerbation in young children, according to a Canadian study. The Asthma Flare-up Diary for Young Children (ADYC) consists of a 17-item questionnaire scored from 1 (best) to 7 (worst). Parents of children between 1 and 6 years old fill out the diary from the onset of an upper respiratory tract infection (URTI) through resolution of asthma symptoms. (September 2 in the Journal of Allergy and Clinical Immunology) Results of a Canadian multicenter study suggest that patients with rheumatoid arthritis who achieve remission after 6 months of treatment with etanercept (Enbrel) plus methotrexate may be able to discontinue the methotrexate.
  • In patients with bacteremia caused by methicillin-susceptible Staphylococcus aureus (MSSA), nafcillin was less cost-effective than cefazolin, a first-generation cephalosporin, according to results of a retrospective analysis (Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
  • The immediate availability of on-site cytopathology evaluation during fine needle aspiration (FNA) of pancreatic masses does not increase the diagnostic accuracy of the biopsy, according to a multicenter study reported in the American Journal of Gastroenterology.
214th Central Working Committe of IMA on 20.09.2015 Speech
IMA established in 1928 has actively participated in the freedom struggle and building nations health.

It has 1700 branches spread over the entire country with 2.5lakh members. 214th Central Working Committee meeting is being held at Kerala. National leaders and, office bearers from all states will deliberate on national health policy matters and come out with concrete suggestions for better public health and medical practice.

Welcome to Kerala, God's own country.
State Govt is working closely with IMA in many projects and policies.

In the recent outbreak of Diphtheria IMAs guidance and strong involvement is highly appreciated.

Vaccine advocacy by IMA is being highly appreciated by the community. Government has also endorsed IMAs food policy. The patient care fund of IMA is a great humanitarian venture where Drs are doing charity activities and also compiling a fund to help poor patients. The school and village adoption prog is also exemplary.

Govt is seeking IMAs opinion in all scientific matters and is working closely with IMA and modern medical community to address various public health issues.

Kerala has excellent health parameters and tops the country in various indices. Yet we're looking forward to make health care more scientific and affordable. IMA reccomendations are hence very important for the Govt. IMA SPEECH
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Bioethical issues in medical practice
A patient’s right to information

Dr Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

A doctor’s healthy father suddenly started complaining of weakness, dyspnea and loss of appetite. A chronic smoker for many years, he was diagnosed with pulmonary cancer with few weeks to live. Keeping in mind his father’s happy go lucky nature, total ignorance of health issues and his own sadness for his father, the doctor did not disclose the diagnosis to his father. He asked the treating doctor not to tell his father either. One day the father came for consultation alone and asked the treating doctor point blank- what is wrong with me?

What should the treating doctor do?

a. Tell the entire truth and betray his friend’s trust?
b. Tell a white lie to his patient?
c. Any other choice?

Which is the way you would prefer and why? Can you suggest some other solution and why?

Do write in with views and your suggestions!
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
The cockroach theory for self development

At a restaurant, a cockroach suddenly flew from somewhere and sat on a lady. She started screaming out of fear. With a panic stricken face and trembling voice, she started jumping, with both her hands desperately trying to get rid of the cockroach. Her reaction was contagious, as everyone in her group also got panicky. The lady finally managed to push the cockroach away but ...it landed on another lady in the group. Now, it was the turn of the other lady in the group to continue the drama.

The waiter rushed forward to their rescue. In the relay of throwing, the cockroach next fell upon the waiter.

The waiter stood firm, composed himself and observed the behavior of the cockroach on his shirt. When he was confident enough, he grabbed it with his fingers and threw it out of the restaurant.

Sipping my coffee and watching the amusement, the antenna of my mind picked up a few thoughts and started wondering, was the cockroach responsible for their histrionic behavior? If so, then why was the waiter not disturbed?
He handled it near to perfection, without any chaos.

It is not the cockroach, but the inability of the ladies to handle the disturbance caused by the cockroach that disturbed the ladies. I realized that, it is not the shouting of my father or my boss or my wife that disturbs me, but it's MY inability to handle the disturbances caused by their shouting that disturbs me. It's not the traffic jams on the road that disturbs me, but MY inability to handle the disturbance caused by the traffic jam that disturbs me.
More than the problem, it's MY reaction to the problem that creates chaos in my life.

Lessons learnt from the story

I understood, I should not react in life.

I should always respond.

The women reacted, whereas the waiter responded.

Reactions are always instinctive whereas responses are always well thought of, just and right to save a situation from going out of hands, to avoid cracks in relationship, to avoid taking decisions in anger, anxiety, stress or hurry.

A beautiful way to understand............LIFE
eIMA Quiz
What lifestyle changes may reduce a woman’s risk of breast cancer?

A. Staying trim as an adult.
B. Drinking a glass of red wine each day.
C. Getting moderate to vigorous physical exercise regularly.
D. A and C.
E. There is little you can do to lower your chances of developing breast cancer.

Yesterday’s Mind Teaser: You’ve had yeast infections before, but in the past year they haven’t really gone away. This could be a sign of:

A. Diabetes
B. Emphysema
C. Stomach ulcers
D. Depression
E. Food allergies

Answer for Yesterday’s Mind Teaser: A. Diabetes

Correct answers received from:Dr Shangarpawar. Dr B R bhatnagar. drpoonamchablani. Dr K Raju

Answer for 19th September Mind Teaser: 30 minutes three or four days a week.

Correct Answers received from: Dr B R bhatnagar. drpoonamchablani. Dr K Raju
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By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest. Confucius
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IMA Calls for Scientific and Humane approach in Health care

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