April 22  2015, Wednesday
editorial
Role of folate or folic acid in cancer prevention
Dr KK AggarwalThe role of folic acid in cancer prevention is uncertain. Large observational studies have suggested a decrease in risk of colorectal and other cancers with dietary folate but other randomized trials have raised the possibility of harm.

A largest meta–analysis of individual patient data from randomized trials of folic acid for the prevention of cardiovascular disease and colorectal adenoma during an average of 5.2 years of treatment found no significant difference in overall cancer incidence for patients assigned to folic acid or placebo.

Vollset SE, Clarke R, Lewington S, et al. Effects of folic acid supplementation on overall and site–specific cancer incidence during the randomised trials: meta–analyses of data on 50,000 individuals. Lancet 2013.
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213th Meeting of the Central Working Committee of Indian Medical Association at Hotel Radisson Blu, New Delhi.
News
  • The updated draft guidelines for breast cancer screening issued by the US Preventive Services Task Force (USPSTF) remain unchanged from the 2009 revision. The update restated that mammography screening is most beneficial for women 50 to 74 years of age and that women 40 to 49 years should make individual decisions about screening in association with their doctors.
  • Omega-3 fatty acid supplementation improves the signs and symptoms of meibomian gland dysfunction, suggests a new study presented at the World Cornea Congress (WCC) VII.
  • The American Academy of Neurology (AAN) and the American Epilepsy Society (AES) have released a new guideline on the prognosis and treatment of first unprovoked seizures. The guidelines are published online April 20 in Neurology.
  • Mechanical thrombectomy after thrombolysis is better than thrombolysis alone when initiated within 5 hours of stroke onset in patients with moderate to severe strokes due to large artery occlusion, suggest intermediate results of the THRACE study presented at the European Stroke Organisation Conference (ESOC) 2015 meeting.
  • New findings published online in the European Journal of Clinical Nutrition suggest that the body metabolizes glucose from foods with more slowly digestible starch (SDS) comparatively more slowly and steadily than from foods with less SDS.
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Dr KK Spiritual Blog
All about depression
  • Depression is a major public health problem as a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  • A non–psychiatrist physician misses the diagnosis of depression 50% of times.
  • All depressed patients must be specifically asked about suicidal ideations.
  • Suicidal ideation is a medical emergency.
  • Risk factors for suicide are psychiatric known disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide.
  • Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • World over about 1 million people commit suicide every year.
  • Seventy–nine percent of patients who commit suicide contact their primary care provider in the last one year before their death and only one–third contact their mental health service provider.
  • Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  • In the US, suicidal rate is 10.5 per 100,000 people.
  • In America, suicide is increasing in middle aged adults.
  • There are 10 to 40 non–fatal suicide attempts for every one completed suicide.
  • The majority of suicides completed in US are accomplished with fire arm (57%); the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  • Fifty percent of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by committing suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are successful three times more often.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children or married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicidal rate in male clinicians is 1.41 and that in female clinicians is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  • Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.
Cardiology eMedinewS
  • Prolonged time from first medical contact to reperfusion therapy, i.e. "system delay," may affect both short- and long-term mortality, but only in patients who had an anterior vs nonanterior ST-segment-elevation MI (STEMI), suggests new research published online in Open Heart.
  • A new study published in the April 28 issue of the Journal of the American College of Cardiology has revealed that patients with type 1 diabetes undergoing CABG surgery have a more than 2-fold increased risk of death at 6 years than the general population undergoing CABG.
Pediatrics eMedinewS
  • Children who have trouble swallowing pills can be taught to do so at a young age through several potential interventions, suggested an article published online April 20 in Pediatrics. The interventions include behavioral therapy, flavored throat spray, verbal instruction, specialized pill cups and head posture training.
  • Approximately 1% of infants experience perinatal hepatitis B virus (HBV) infection despite having received recommended immunoprophylaxis, suggests a new study. The greatest risk for infection was noted in infants whose mothers were younger, hepatitis B e-antigen–positive, or had a high viral load, and in infants who received fewer than three hepatitis B vaccine doses. The findings are published online April 20 in Pediatrics.
Make Sure
Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation.
Reaction: You should do cervical swabs and consider starting antibiotics.
Lesson: Make Sure to remember that a woman with such symptoms may have endometritis, which requires prompt diagnosis and may respond to doxycycline and metronidazole.
Dr Good Dr Bad
Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in ventricles or cisterns.

(Copyright IJCP)
Wellness Blog
Fever

Fever does not always mean presence of infection. There are many situations where fever may occur without any infection and hence needs no antibiotics.
  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.
eMedi Quiz
Over a 4-day period, five men, four women, and six children are admitted to Philadelphia metropolitan hospitals with fever, prostration, hypotension, and various degrees of mucosal bleeding. All patients have thrombocytopenia, leukopenia, and elevated liver and renal function tests. None of the patients have travelled outside the mid-Atlantic area in the past 3 months. A viral hemorrhagic fever is suspected. Which one of the following epidemiological clues most strongly suggests that the outbreak is the result of a deliberate epidemic?

A. Multiple simultaneous epidemics of different diseases
B. Unusual age distribution of a common disease
C. Unusual antibiotic resistance pattern
D. Unusual geographic clustering of disease
E. Unusual route of exposure

Yesterday’s Mind Teaser: Which of the following statements regarding tamoxifen is correct?

1. Compared with AIs, tamoxifen has been associated with a decreased risk of venous thromboembolic events.
2. Similar to AIs in post menopausal women, tamoxifen increases the risk of bone loss and osteoporosis.
3. In post menopausal women, tamoxifen has shown better efficacy than inhibitors.
4. Tamoxifen may be associated with an increased risk of ischemic cerebrovascular complications.

Answer for yesterday’s Mind Teaser: 4. Tamoxifen may be associated with an increased risk of ischemic cerebrovascular complications.

Correct Answers received from: Dr Poonam Chablani, Dr K Raju, Dr KV Sarma, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 18th April Mind Teaser: 1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.

Correct Answers received: Dr G Madhusudhan, Dr Avtar Krishan.
eMedinewS Humor
Tech support

Tech support: "Okay Colin, let’s press the control and escape keys at the same time. That brings up a task list in the middle of the screen. Now type the letter "P" to bring up the Program Manager."

Customer: I don’t have a P.

Tech support: On your keyboard, Colin.

Customer: What do you mean?

Tech support: "P" on your keyboard, Colin.

Customer: I’M NOT GOING TO DO THAT!!
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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
IMA News
WVA/WMA GLOBAL CONFERENCE ON ONE HEALTH
Thursday, 21st May – Friday, 22nd May 2015
Madrid, Spain
Drivers towards One Health
“Strengthening collaboration between Physicians and
Veterinarians”
The World Veterinary Association (WVA) and the World Medical Association (WMA) in collaboration with the Spanish Medical and Veterinary associations are inviting you to participate at the Global Conference on 'One Health' Concept to be held on 21st and 22nd of May in Madrid, Spain (Vía de los Poblados, 3, A.M.A Parque Empresarial Cristalia - Edificio 4).

The Global Conference aims to bring together Veterinarians, Physicians, Students, Public Health Officials, NGOs and others from the different world regions to learn, discuss and to address critical aspects of the 'One Health' Concept.

The main objectives of the conference are to strengthen the links and communications and to achieve closer collaboration between Physicians, Veterinarians and all appropriate stakeholders to improve the different aspects of health and welfare of humans, animals and the environment.

VENUE
  • Agrupación Mutual Aseguradora (A.M.A.) - La Mutua de los Profesionales Sanitarios
  • Address: Vía de los Poblados 3, Parque Empresarial Cristalia, Edificio 4, Madrid, Spain
  • Telephone: +34 913 43 47 00 / Fax: +34 913 43 47 62
    / Email: ama@amaseguros.com
REGISTRATION

The links below will lead you to the registration page. Please click the link according to your status. Students, young and retired Physicians and Veterinarians will benefit from reduced registration fees only through the designated link.
Conference Update - Diabetes India 2015
Lean Type 2 Diabetes mellitus: Is it a separate entity?

Dr Aloke Kumar Gupta, Gorakhpur, Uttar Pradesh
  • About 80% of Indian diabetic population is non-obese in contrast to western population.
  • Type 2 DM-Lean patients have distinct pathophysiological features like increased hepatic glucokinase activity, increased hepatic insulin extraction and increased hepatic microsomal enzymatic activity as compared to obese type 2 diabetes.
  • Because of increased hepatic insulin extraction, the serum insulin levels are low despite good C-peptide levels as compared to obese type 2 DM in whom C-peptide and serum insulin are directly correlated.
  • Type 2 DM-Lean patients do not have islet cell antibody, which distinguishes them from LADA.
  • Clinically they have good beta cell reserve for long duration and respond well to sulfonylurea drugs for pretty good duration.
  • They have more microvascular complications like neuropathy (70%), retinopathy (20-40%) and nephropathy.
  • Most cases initially present with infections.
  • Macrovascular complications like CAD and CVD, which are major cause of mortality in obese type 2 DM is not seen in type 2 DM-lean.
Diabetic Neuropathy: Differential diagnosis

Dr Mathew John,
Trivandrum
  • Diabetic neuropathy can have a variety of manifestations.
  • Not all neuropathy in diabetes is diabetes in etiology.
  • Look for red flag signs suggestive of non-diabetic etiology: predominant motor involvement, predominant autonomic involvement, bowel and bladder involvement, proximal muscle involvement, acute or subacute in onset and progression.
  • Do basic investigations and nerve conduction velocity when indicated.
Sonal Namaste
Over 200 diseases are caused by unsafe food containing harmful bacteria, parasites, viruses, chemical substances.
Malaria Keypoints
Cases of malaria due to P. vivax should be treated with chloroquine and primaquine in full doses according to age.
Health and Climate Change
The environment influences human health in many ways — through exposures to physical, chemical and biological risk factors, and through related changes in behavior in response to those factors. According to the WHO, 13 million deaths annually are due to preventable environmental causes. Mitigating environmental risk could save as many as four million lives a year in children alone, mostly in developing countries.

“Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air and water. The warming of the planet will be gradual, but the increasing frequency and severity of extreme weather events, such as intense storms, heat waves, droughts and floods, will be abrupt and the consequences will be acutely felt. The earliest and most severe threats are to developing countries, with negative implications for the achievement of the health-related Millennium Development Goals and for health equity. It is therefore essential to formulate a clear response in order to protect human health and ensure that it is placed at the centre of the climate debate.” WHO, report by the secretariat, January 2009

In May 2009, the World Health Assembly adopted a resolution on health protection from climate change, signaling a much higher level of engagement from the health sector. The resolution draws attention to the further strengthening of the evidence for human-induced climate change, and consequent risks to global health, the achievement of the Millennium Development Goals, and health equity.

At the global level, representatives of the world's government have been meeting several times over the last years to discuss climate change, in particular around the United Nations Climate Convention on climate change as well as the kyoto protocol.

WMA Policy & Action
The WMA is committed to ensuring that the health sector is fully integrated in the current global debates and actions on climate change and to engaging physicians further for the protection of health from climate change.

On 1 of September 2009, the WMA held a seminar “Climate Change and Health Care” in Copenhagen to bring together physician leaders, other health actors and high-level experts from around the world in order to exchange experiences on the impact of climate change on health and to develop a global strategy, in particular in the context of the coming 15th Conference of the Parties to the UN Framework Convention on Climate Change.

At its annual General Assembly in New Delhi, India (17 October), the WMA approved a Declaration setting out an action plan to bring health to the forefront of the climate change debate and to mitigate the serious health risks facing the world. WMA leaders insisted that physicians must be more involved in the development of policies to protect the health of all their patients.

The WMA follows the governmental talks in the context of the United Nations climate change negotiations. Physicians are concerned that the negotiations do not take fully into consideration the well-evidenced impact of climate change on health as well as the public health benefits of climate change mitigation activities. Based on the skills, experience and knowledge of their members, medical associations act to make health an inherent component of governmental talks in the context of the UN climate change process.

Together with environment & health NGOs, WMA endorsed the Cancun statement "The time to act is now" at the occasion of the UN Cancun Summit (December 2010).

The Durban Summit (COP17 on climate change, December 2011) brought together a strong global health coalition, in which WMA was represented, bringing forward physicians' concerns in this area. A Durban Climate and Health Declaration and Plan of Action were adopted in the parallel NGO Climate and Health Summit.

Building upon this successful climate and health summit, an informal alliance of health organizations around the world (that includes WMA) has adopted the Doha Declaration on Climate, Health and Wellbeing to accompany the Doha Climate Change Conference (COP18). The statement details why health experts are extremely worried about the slow progress at the international climate negotiations, and highlights why health co-benefits can be important argument for ambitious climate mitigation.

With two years now gone since the adoption of the Durban Declaration and the Health Sector Call to Action in Durban, the same health organisations organised a second Climate and Health Summit in parallel with the 19th COP negotiations in Warsaw, Poland next November (11-22/11/2013), with the support of WHO. It provided an opportunity for groups to collaborate and share progress in the development and implementation of strategies and projects to build resilience to the impacts of climate change on health.
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Inspirational Story
The Talking Bird

There is an old story about a fellow who lived alone and went to a pet store to buy a parrot. He thought the bird might fill some of his lonely hours. The very next day, however, he came back to complain, "That bird doesn’t talk."

The store owner asked if he had a mirror in its cage, and the man said he didn’t. "Oh, parrots love mirrors," he explained. "When he sees his reflection in the mirror, he'll just start talking away." So he sold him a birdcage mirror.

The bird owner was back the next day to gripe that his parrot still hadn’t said a word. "That’s very peculiar," allowed the pet expert. "How about a swing? Birds really love these little swings, and a happy parrot is a talkative parrot." So the man bought a swing, took it home, and installed it in the cage.

But he was back the next day with the same story. "Does he have a ladder to climb?" the salesman asked. "That just has to be the problem. Once he has a ladder, he'll probably talk your ear off!" So the fellow bought a ladder.

The man was back at the pet store when it opened the next day. From the look on his face, the owner knew something was wrong. "Didn’t your parrot like the ladder?" he asked. His repeat customer looked up and said, "The parrot died."

"I’m so sorry," the stunned businessman said. "Did he ever say anything?"

"Well, yes. He finally talked just before he died. In a weak little voice, he asked me, "Don’t they sell any bird seed at that pet store?’"

Some of us have mistakenly thought that happiness consists of lining our cages with toys, gadgets, and other stuff. Excessive consumption has become the hallmark of our life. "Whoever has the most toys wins" seems to be the likely candidate to be the bumper sticker for an entire culture. But is it so?

There is a spiritual hunger in the human heart that can’t be satisfied by seeing one’s own image reflected back in vanity mirrors, playing with our grown–up toys, or climbing the corporate ladder. Our hearts need real nourishment. The love of family and friends, relationships over the pursuit of more things, personal integrity, a secure connection to God –– these are the things that feed the soul.

Have you chosen a life course that leads to a destination that matters?
Quote of the Day
Laughter is the closest distance between two people. Victor Borge
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Reader Response
Dear Sir, Thanks for the useful information. Regards: Dr Kalpna
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IMA to sensitize 2.5 lacs doctors on Vector borne Diseases
In the summers, if the water coolers are not rub dried on a weekly basis, they can become a source for Vector breeding, leading to diseases like dengue, malaria and Chikungunya.

Addressing a Press Conference, Padmashri Awardee Dr. A. Marthanda Pillai, National President, Dr. Ashok Adhao, Past National President and Padmashri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA in a joint statement said that to ear mark the World Malaria Day on 25th April, IMA will be sensitizing 2.5 lacs on 10 Points which every doctor must know regarding Vector Borne Diseases:
  1. While dengue mosquito is a day biter, the malaria mosquito is a night biter. Therefore mosquito precautions should be taken 24 x 7.
  2. Even a small reservoir of water like a bottle cap, paper cups, paper plates, Chai Ka Kullarh etc. can be a breeding place for mosquitoes. Mosquitoes only require a micro environment to grow.
  3. Breeding of mosquito in medical establishments is a medical negligence. It can spread Vector Borne Diseases to patients with low immunity leading to high mortality.
  4. Treating Falciparum malaria with a single drug is a medical negligence. Such patients should be treated with Artemisinin combination therapy (ACT).
  5. While malaria mosquito bites one person in 3 days, dengue mosquito bites 3 persons in a day.
  6. Malaria can be diagnosed by using Rapid Diagnostic Test (RDT) and the test can remain positive upto 3 weeks, after treatment is completed and after the blood has become negative for malaria parasite.
  7. The mosquito which creates noise in the night is culex (Filaria mosquito) and not malaria and dengue mosquitoes.
  8. In Malaria, if fever persists after 72 hours, one should suspect drug resistance.
  9. In dengue unless there is bleeding, platelets transfusion is not required.
  10. In dengue, if we keep difference between upper and lower blood pressure more than 40 most deaths can be saved.
Rabies News (Dr A K Gupta)
If HRIG is not available, can human normal immunoglobulin (polyvalent) be given?

Human normal immunoglobulin cannot be a substitute for HRIG.