July 22  2015, Wednesday
eMedinewS
editorial
Donating blood reduces chances of heart attack
Dr KK AggarwalOne should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.
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In cardiac arrest call 102 or 100
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News
Allergy and Immunology
People with moderate to severe asthma who add aerobic exercise to their treatment regimen may have an easier time controlling common symptoms than people who rely on drugs alone, suggested a small study published in Thorax.

Infectious diseases
For asymptomatic HIV-infected patients with CD4 counts above 500 cells/mm3, starting antiretroviral therapy immediately after diagnosis cuts the risk of developing AIDS or other serious illnesses in half, reported The Strategic Timing of Antiretroviral Treatment, or START, trial, one of the largest trials of HIV infection ever conducted. The findings are published online in the New England Journal of Medicine.

Ophthalmology
A study presented at the American Society of Retina Specialists (ASRS) 2015 Annual Meeting suggested that adding topical squalamine to ranibizumab improves visual acuity significantly more than ranibizumab alone in patients with retinal vein occlusion.

Neurology
A new study suggests that metabolites in salivary samples may be able to discriminate normal aging from mild cognitive impairment and Alzheimer's disease and can predict neurocognitive performance. The findings were presented at a press briefing during the Alzheimer's Association International Conference (AAIC) 2015.

Oncology / Endocrinology
A study of long-term thyroid cancer outcomes shows, among other findings, that moderate suppression of thyroid-stimulating hormone (TSH), which drives the disease, may be as beneficial as more extreme hormone suppression. Results are published online in the journal Thyroid.
Cardiology eMedinewS
  • PCI performed in hospitals that did not have on-site cardiothoracic support in place to deal with rare catastrophic adverse outcomes was not associated with an increased risk of mortality in the short- or long-term, reported data from a large UK registry. The results, published July 20 in the Journal of the American College of Cardiology, suggest that PCI can be safely performed in clinical centers without surgical backup.
  • A coronary artery calcium (CAC) score of zero confers at least a 15-year warranty during which mortality risk from coronary artery disease (CAD) remains under 1% in both men and women, reported a long-term prospective follow-up study published online in the Journal of the American College of Cardiology: Cardiovascular Imaging.
Pediatrics eMedinewS
  • Children who get good grades in school and eventually work in complex jobs involving data and numbers may be protected from getting dementia later in life, suggests new research presented at the Alzheimer's Association International Conference (AAIC) 2015.
  • Blood lipid profiles are associated with childhood asthma, airway obstruction, bronchial responsiveness, and aeroallergen sensitization, suggests a new report published in the Journal of Allergy and Clinical Immunology.
Dr KK Spiritual Blog
Direct all your energy towards the soul and nor the ego

The epic Mahabharata can also be understood as a science of inner Mahabharata happening in everybody’s mind.

Lord Krishna symbolizes the consciousness and the five Pandavas, the five positive qualities of a person namely, righteousness (Yudhishthir), focused (Arjuna), power to fight injustice (Bheem), helping others (Sahdev) and learning to be neutral in difficult situations (Nakul). Panchali indicates the five senses, which can only be controlled when these five forces are together.

Dhritrashtra symbolizes ignorance, Duhshasan negative ruling quality (dusht while ruling) and Duryodhana (dusht in yudh) one who is not balanced in war.

Conscious-based decisions need to be taken to kill the negativity in the mind. Every action, if directed towards the consciousness or the soul, is the right action. To kill all the 100 Kauravas (the 100 negative tendencies a person can have) controlled by Duryodhan and Duhshasan along with Shakuni (the negative power of cunningness), positive qualities have to be redirected towards consciousness and take right decisions.

The five Pandavas (positive qualities) made soul (Lord Krishna) as their point of reference (Sarthi) and won over the evils (Kauravas).

Bhishma Pitamah, Karna and Dronacharya, individually all had winning powers; but, they all supported negative thoughts and made Duryodhana as their point of reference and ultimately had to die.

The message is very clear – if one directs his or her positive powers towards ego as the reference point in long run, they will be of no use and, in fact, will be responsible for one’s destruction.

Ravana too was a great scholar but he directed all his energies and powers towards his ego and ended up in misery.

Therefore, one should cultivate a positive mental attitude, positive thoughts instead of directing them towards desire, attachment or ego and should direct them to soul/consciousness for a positive outcome.
Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored; it is an impending sign that the patient is going into shock.
Events
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Dr Good Dr Bad
Situation: A prediabetic male wanted to know if he could eat fish
Dr Bad: Do not take it.
Dr Good: You can have it.
Lesson: According to a study published online July 20 in the American Journal of Clinical Nutrition eating fish can help men reduce their risk for type 2 diabetes by 27% (Am J Clin Nutr. 2011 Sep;94(3):884-91).

(Copyright IJCP)
eMedi Quiz
A couple, with a family history of beta thalassemia major in a distant relative has come for counselling. The husband had HbA2 of 4.8% and the wife has HbA2 of 2.3%. The risk of having a child with beta thalassemia major is.

1. 50%
2. 25%
3. 5%
4. 0%

Yesterday’s Mind Teaser: A middle-aged male comes to the outpatient 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.

Answer for yesterday’s Mind Teaser: 2. Bilateral cordectomy
Correct Answers received from: Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Dr B R Bhatnagar, Dr G Madhusudhan, Dr Pandit Hantodkar.
Answer for 20th July Mind Teaser: 4. Gentamicin
Correct Answers received: Dr G Madhusudhan, Arvind Diwaker, Dr K Raju, Dr K V Sarma, Dr Poonam Chablani.
eMedinewS Humor
Everything happens for a Reason, the hard part is finding the Reason.
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Rabies News (Dr A K Gupta)
Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No, antibodies from vaccination do not cross an intact blood–brain barrier.
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
eIMA News
Dr B C Roy National Awards to be announced soon
Dr B C Roy National Award Committee will be announcing Dr B C Roy National Awards. Last Dr B C Roy Awards were given in the year 2008.

The Chairman of the award committee is appointed by Hon’ble Prime Minister. The new award committee has been constituted and is likely to announce the awards soon.
Awards for the years 2009-2014 are pending and are likely to be announced together. All the pending applications received by MCI for the past years are likely to be considered for the award.
IMA in the recent past has persuaded the PM office, MCI office, Health Ministry to reinstitute the awards as early as possible.
I PLEDGE MY ORGANS (IMA- IPMO Initiative)
IMA proposes to start a new project “I PLEDGE MY ORGANS (IPMO)” In this Project IMA members will be invited to pledge their Organs on the IMA website.

We cannot run any campaign unless we support it and are a part of it.

The concept will be launched in the Meeting of State Presidents and Secretaries to be held in August, 2015 at Mumbai.

You are requested to kindly give your suggestion for the same.
Ivabradine for heart failure with reduced EF
Patients with chronic stable heart failure with LVEF =35 percent, in sinus rhythm with a resting heart rate =70 per minute and who are either on a maximum tolerated dose of a beta blocker or who have a contraindication to beta blocker, should be started on ivabradine. The drug slows the sinus rate through inhibition of the f-channels. Ivabradine in such patients reduces the risk of hospitalization for worsening heart failure. (http://www.accessdata.fda.gov/drugsatfda_
docs/label/2015/206143Orig1s000lbl.pdf
(Accessed on June 25, 2015).
Understanding medical ethics
Medical Ethics is not a set of rules to practice medicine. It contains broad guidelines, which are to be practiced while providing medical care to patients. The developments in society keep on changing the interpretation of these guidelines.

Principles of ethical guidelines: A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook Principles of biomedical ethics. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. The four principles are:
  1. Respect for autonomy: The patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
  2. Beneficence: A practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
  3. Non-maleficence: "First, do no harm" (primum non nocere).
  4. Justice: Concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
Other values include
  • Respect for persons: The patient (and the person treating the patient) has the right to be treated with dignity.
  • Truthfulness and honesty: The concept of informed consent has become important in the recent past.
(By Dr Sanjay Jain)
Error of judgment is not medical negligence’
Mohammed Iqbal: The Hindu

In a significant ruling, the National Consumer Disputes Redressal Commission has made a distinction between medical negligence and “error of judgment” while rejecting a complaint against a private hospital of Delhi, which was accused of failing to make a correct diagnosis of cancer in a patient. The patient later died during treatment in another hospital.

Complainant Kamani Sharma had charged a doctor in Pamposh Medical Care Centre at Pamposh Enclave here with diagnosing her husband with tuberculosis Rajinder Sharma in December 1999, while he was actually suffering from cancer. The patient later approached LNJP Hospital, Rajiv Gandhi Cancer Hospital and Sir Ganga Ram Hospital, where he was diagnosed as an advanced case of lung cancer and metastasis.

The patient underwent biopsy at Maulana Azad Medical College and took treatment at Sir Ganga Ram Hospital. In spite of best efforts, he died on November 19, 2000.

Ms. Sharma alleged that it was the wrong diagnosis of tuberculosis initially made at Pamposh Medical Care Centre that led to the critical condition of her husband and his death within a short span of 11 months. She sought a compensation of Rs.65 lakh for medical negligence and deficiency in service.

A Bench of the Commission, comprising Justice J.M. Malik and S.M. Kantikar, dismissed the complaint last week, while holding that it was a case of “error of judgment” rather than medical negligence. The Bench said Rajinder did not turn up at the hospital for eight months and its doctor never treated him.

The Commission noted that the patient was a heavy smoker and drug addict and had earlier received anti-tubercular therapy (ATT) for testicular TB. There was a possibility of healed TB focus or sarcoidosis. “We are of the considered view that it was an error of judgment that the doctor failed to diagnose cancer at the initial examination of the patient.”

Applying the principle of “loss of chance” to the instant case, the Bench held that the failure to diagnose would not matter so much as the patient was suffering from frank metastasis in brain and liver. There were less than 50 per cent chances of survival, it said and absolved the doctor of the charge of negligence.

The Commission rejected the complaint and said the advice given at Pamposh Medical Care Centre for investigations and biopsy of the lesion for proper diagnosis was not followed. “After the lapse of eight months, the patient went to LNJP Hospital, which became fatal for him...It was negligence of the patient, for which the doctor is not liable.”
News
  • Carrying a gene variant that affects the release of a specific brain protein may put one at greater risk of developing an alcohol use disorder, according to the results of a recent animal study. The study was led by Professor Dorit Ron, PhD, Endowed Chair of Cell Biology of Addiction, Department of Neurology, University of California, San Francisco, and was funded by the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.
  • Parents with Medicaid insurance were more likely to overuse antibiotics than parents with commercial insurance, according to a small survey of Massachusetts families.
  • “Doctors should be responsible. They should not portray themselves as master of a particular subject by obtaining such degrees. Because, they cannot get any knowledge or experience through such degrees,” said Dr Jayesh Lele, president elect, Indian Medical Association (Maharashtra). (Source: DNA)
  • In a case decided by the National Consumer Disputes Redressal Commission (NCDRC) – awarding a sum of Rs 5 lakhs rendering a finding of medical negligence against the State, its Govt. Hospital and two Govt. Doctors. Appeal was filed by the claimant-appellant for enhancement of compensation. In the Judgement of the case – V. Krishnakumar v. State of Tamil Nadu & Others, delivered by Justice Jagdish Singh Khehar and Justice Sharad Bobde, on July 1, 2015, it has been specifically ruled that State would be vicariously liable for damages and the hospital is also vicariously liable for acts of its doctors. (The Hitvada)
Inspirational Story
Never leave the mind vacant

An empty mind is the devil’s workshop. All evil actions start in a vacant mind. Keep your mind occupied in something positive, something worthwhile. Actively follow a hobby. Do something that holds your interest. You must decide what you value more: money or peace of mind. Your hobby, like social work or religious work, may not always earn you more money, but you will have a sense of fulfillment and achievement.

Even when you are resting physically, occupy yourself in healthy reading or chanting of God’s name.
Media
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Wellness Blog
Treatment of Fatty Liver
  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried.
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.
Quote of the Day
Yesterday is not ours to recover, but tomorrow is ours to win or lose. Lyndon B. Johnson
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Reader Response
Dear Sir, very informative news. Regards: Dr Karuna
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Press Release
Women have the same right as men to revival through the life-saving technique of Hands only CPR in the case of a sudden cardiac arrest emergency

Heart Care Foundation of India, IMA, Delhi Police and Delhi Red Cross society dispel socio-cultural myths about administering hands-only CPR to women

Most people who experience a 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. Majority of such people are women since there exist socio-cultural barriers in the minds of the bystanders to administer Hands only-CPR to women. The mere idea of putting their hand on an unknown woman’s chest is enough to make bystanders shy away from the whole process and instead wait for paramedics to arrive. What they do not understand is that each minute wasted, leads to a 10% lesser chance of the person’s revival.

“While men and women are equally at risk of a sudden cardiac arrest (SCA), women are less likely to be resuscitated given socio-cultural myths that exist in our society. What people do not realize is that each person irrespective of their caste, gender and religion has the right to receive emergency care and the right to live. Hands-only CPR 10 is a simple to learn and effective life-saving technique that does not violate Indian social or religious norms”, said Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA while conducting a CPR workshop for the Delhi Police PCR van staff.

The technique of Hands Only CPR-10 does not require a person to touch a woman’s breasts but merely press the center of their chest at a speed of 10x 10 – 100 compressions per minute till the ambulance arrives. Mouth-to-mouth breathing is no longer required in this technique barring the case of a victim who has collapsed due to drowning.

Adding to this, Padma Shri Awardee Dr A Marthanda Pillai National President IMA said, “CPR, is a technique that involves chest compressions without artificial respiration to help save the life of a victim who has collapsed due to a sudden cardiac arrest. It must only be performed on a person who has no pulse rate and is not breathing. Chest compressions must be stopped only when the person starts breathing again or an ambulance arrives. If administered immediately, Hands-only CPR can double a person's chances of survival”.

Heart Care Foundation of India jointly with the Indian Medical Association, Delhi Red Cross Society and Delhi Police has taken up the challenge of training 100% of the Delhi Police PCR van staff on the life-saving technique of hands only CPR 10 by Independence Day 2015.

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heart beats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after, the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.
header header

State

Name

Mobile

Venue

ANDHRA PRADESH

Dr. VENKATESWARLU PONNURU

9848032246

EB Section 1st Floor, TE Madhapur, Hyderabad

ASSAM

Dr. MANABENDRA GOSWAMI

9435193724

CTO building, Ground Floor, PAN Bazaar, Guwahati.

BIHAR

Dr. SAHAJANAND PD. SINGH (ACTING PRESIDENT)

9334118698,9431009091

Room adjacent to media centre room, ground floor,O/o CGM, BSNL Bihar Telecom Circle, Sanchar sadan, CTO building, Near GPO, Patna – 800001

CHHATTISGARH

Dr. AJAY GOVERDHAN

9424107891

Room no.F-207, 1st Flr, Telephone Bhavan, Fafadih, Raipur

CHANDIGARH

Dr. GAJINDER DEWAN

9876027113

Grnd Flr, Adjoining CSC, Sector -17, Chandigarh

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Grnd Flr, Central Repair Shop, Navrangpura, TE, Navrangpura, Ahmedabad

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Grnd Flr, Karimabad, Admin Building, Ghod Road, Surat

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Alkapuri TE Building, Grnd Flr, BB Helpdesk room, Near Race Course Circle, Vadodara

GUJARAT

Dr. CHETAN N. PATEL

9426378078

TE Building, Sector-11, 1st Flr, CRS room, Gandhinagar

HARYANA

Dr. ANIL GOYAL

9810053999

1st Floor Room, Sector 44, Plot No.42, CSC BSNL Gurgaon

KARNATAKA

Dr. HONNE GOWDA

9448118299

CTO Building, Ground floor, Adjacent to CSC, Bangalore

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

Grnd Flr, CSC, TE Building, Model Colony, Pune

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

Room no. 64 SFMS, Ground Floor, CTO Bldg, Civil Lines, Nagpur

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

SDELC, 1st Floor, Canada Corner, BSNL Nasik, Nashik

MADHYA PRADESH

Dr. AMARJIT SINGH BHALLA

9826266385

BSNL Bldg No.3, 1st Floor, Nehru Park, Indore

MADHYA PRADESH

Dr. AMARJIT SINGH BHALLA

9826266385

CTO BSNL Building, New market, TT Nagar, Bhopal

ORISSA

Dr. SAROJ KUMAR SAHU

9437002424

1st Floor, CTO building, CSC, PMG Square, Bhubaneshwar

ORISSA

Dr. SAROJ KUMAR SAHU

9437002424

CTO Building BSNL Cuttack

PUNJAB

Dr. SURINDER PAUL SINGH SOOCH

9814064426

1st Floor, Dugri Urban Estate, BSNL Ludhiana, Ludhiana

RAJASTHAN

Dr. R.K. AGARWAL

9314475929

1st floor, CTO Building, MI road, BSNL, Jaipur

RAJASTHAN

Dr. R.K. AGARWAL

9314475929

Grnd flr, E-10B, BSNL Bldg, Road no.2, Indraprastha Area, Kota

TELANGANA

Dr. SHYAM SUNDER KASAPA

9849797013

EB Section 1st Floor, TE Madhapur, Hyderabad

UTTAR PRADESH

Dr. SHARAD KUMAR AGARWAL

9717111942

TE Kaiser Bagh, Lucknow

UTTAR PRADESH

Dr. SHARAD KUMAR AGARWAL

9717111942

108, 1st floor, BSNL Admin building, Sanjay Place, Agra