September 22   2015, Tuesday
eMedinewS
Non obstructive heart blockages not benign
Dr KK Aggarwal In a retrospective study of patients undergoing elective coronary angiography, non-obstructive coronary artery disease (heart blockages), compared with no apparent coronary artery disease (no blockages), was associated with a significantly greater 1-year risk of heart attack and all-cause mortality.

After risk adjustment, there was no significant association between 1- or 2-vessel non-obstructive coronary artery disease (blockages in one or two arteries) and mortality, but there were significant associations with mortality for 3-vessel non-obstructive coronary artery disease (blockages in all three arteries).

Veterans with evidence of non-obstructive CAD on elective coronary angiography had a 2- to 4.5-fold greater risk for heart attack compared with those with no evidence of blockages and 1-year heart attack risk was found to increase progressively by the extent of blockages, rather than increasing abruptly when blockages became obstructive. The results of this study are published in Nov. 5 issue of JAMA.

Never tell your patients “that your coronaries are fine and they have nothing to worry about." Instead, one should say “There is evidence of atherosclerosis and while there is no need to panic, we need to address it.”

Remember there is nothing like “mild coronary artery disease." Up to 1 in 4 angiograms show minimal plaque or blockages.

Non-obstructive blockages mean presence of atherosclerotic plaque revealed during coronary angioplasty or angiography that does not appear to obstruct blood flow or result in angina symptoms.

These non-obstructive lesions occur in between 10% and 25% of patients undergoing elective angiography, and their presence has historically been characterized as "insignificant" or "no significant blockages in the medical literature even though multiple studies have shown plaque ruptures leading to heart attack commonly come from non-obstructive plaques.
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eMedipics
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Nephrology
High dietary intake of sodium and potassium may speed the progression of kidney disease, suggests a study published in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Rheumatology
Infectious Diseases

Staphylococcus lugdunensis is underestimated as a cause of hospital-acquired osteoarticular infection, and should be treated aggressively, suggested new research presented at the Interscience Conference of Antimicrobial Agents and Chemotherapy 2015.

Ophthalmology
In patients with neovascular age-related macular degeneration, pigment epithelial detachment and intraretinal cysts are more important biomarkers of vision loss than subretinal fluid, suggests new research presented at the European Society of Retina Specialists 15th EURETINA Congress.

Oncology
A new research has demonstrated that brief exposure to a targeted therapy can tell doctors which HER2-negative breast cancer patients will respond, and which should switch to another kind of treatment. The discovery would provide physicians with invaluable information regarding the effectiveness of bevacizumab. The findings are published in the International Journal of Cancer.

ENT
A sizeable number of US adults have trouble hearing, and they are not getting help for it, according to a new data brief from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). According to Carla E. Zelaya, PhD, and colleagues, in the 2014 National Health Interview Survey, 1 in 6 adults aged 18 years and older, nearly 17%, reported trouble hearing without a hearing aid.
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Cardiology eMedinewS
  • In patients with chronic kidney disease (CKD) undergoing coronary revascularization, those who received an everolimus-eluting stent (EES) had a significantly lower risk of death, stroke, and need for repeat revascularization at 30 days compared with patients who underwent CABG surgery, suggested a new observational study published in the Journal of the American College of Cardiology.
  • Muscle power improves in patients with heart failure when they adopt a diet high in nitrates, found in abundance in beetroot juice, suggests a new study published in the journal Circulation: Heart Failure.
Pediatrics eMedinewS
  • Teenagers are much more likely to smoke and be dependent on nicotine if a parent is dependent on nicotine, especially daughters if their mother is dependent on nicotine, suggests a new study published online in the American Journal of Public Health.
  • A new study suggests that emotional relationships and educational style are key to reducing problems with children and the strain on foster families. The findings are published in the Journal of Child and Family Studies.
Pulmonary Embolism
A definitive diagnosis of PE is made radiographically on CTPA, contrast-enhanced CT pulmonary angiography, or MRPA (Magnetic resonance pulmonary angiography)by the demonstration of a filling defect in any branch of the pulmonary artery. With V/Q scanning, a high-probability scan is sufficient to confirm PE.
Dr KK Spiritual Blog
The Buddhist Description of a Disease: Desire, Hatred and Ignorance

According to the Buddhism, three negative emotions cause a disease and they are “ignorance, hatred and desire”. According to the Buddhism philosophy, physical sicknesses are classified into three main types.
  • Disorders of the desire (Ayurvedic equivalent Vata Imbalance): These are due todisharmony of the wind or energy. The seed of these disorders are located in the lower part of the body. It has cold preferences and are affected by mental desires. A person suffers from the disorders of movement functions.
  • Disorders of the hatred (Ayurveda equivalent Pitta imbalance): It is due to disharmony of the bile. The seed of these disorders is centered in the middle and upper part of the body and is caused by the mental emotion hatred. In Ayurveda text, it is equivalent to “Pitta” disorder. The person suffers from metabolic and digestive abnormalities.
  • Disorders of the ignorance (Ayurveda equivalent Kapha imbalance): It is due to the disharmony of phlegm, which is generally centered in the chest or in the head and is cold in nature. It is caused by the mental emotion ignorance.
Desire, hatred and ignorance are the main negativities mentioned in Buddha philosophy. They are all produced in the mind. Once produced, they behave like a slow poison. The Udanavarga once said, “From iron appears rust, and rust eats the iron”, “Likewise, the careless actions (karma) that we perform, lead us to hellish lives.

According to the other scriptures, six afflictions are most troublesome, ignorance, hatred, desire, miserliness, jealousy and arrogance. Patience is the most potent virtue a person can acquire. According to the Shanti Deva, “There is no evil like hatred, and there is no marriage like patience. Therefore, dedicate your life to the practice of patience.”

Bhagvad Gita mentions the enemies as Kama, Krodha, Lobh, Moh and Ahankar and out of these, Kama Lobh and Ahankar as the three gateways to hell.
Wellness Blog
How to answer and make calls on mobile phones
  • Say ‘hello’ and not “yes” when calling or answering calls. It’s hard and rude.
  • Always put the phone gently if you need to put the telephone down during the conversation. Also hang up gently. Never slam the phone. The person at the other end may still be on the phone and sudden bang can be hurtful as well as rude.
  • Make sure the number is correct so as not to risk disturbing strangers.
  • Make your call as brief as possible, especially with busy people.
  • When calling people who do not recognize your voice, introduce yourself.
  • Time your calls. Do not interfere with the work schedule of others
  • Make business calls well before the close of the office hours.
  • After dialing a wrong number, apologize.
  • When the number you are calling is not answered quickly, wait long enough for someone to put aside what he or she is doing. It is very annoying to have been disturbed just to pick up the telephone and find the caller has hung up.
  • Never take a personal mobile call during a business meeting.
  • Never talk in public places
  • Don't talk emotionally in public.
  • Don't use loud and annoying ring tones
  • Never make calls while shopping, banking or waiting in line.
  • Keep all talks brief and to the point.
  • Use an earpiece in high-traffic or noisy locations.
  • Demand "quiet zones" and "phone-free areas" at work and in public venues.
  • Never call people at odd hours. If you sleep at 2am does not mean, others also follow the same.
  • When calling on mobile, always ask if the other person is free to talk.
  • Learn to text if it is not an emergency.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Modern ERA Convent Sr. Sec. School
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Make Sure
Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression (CPR) can be given if the heart stops on the way.
Dr Good Dr Bad
Situation: A female smoker wanted to know her risk of diabetes.
Dr. Bad: There is no risk.
Dr. Good: You are at high risk.
Lesson: A study published in the journal ‘Diabetes Care’ has shown that women who smoke more than 20 cigarettes daily have higher chances of developing type 2 diabetes.
eMedinewS Humor
Tick Tock, Tick Tock

Imagine there is a bank that credits your account with morning with Rs 86400. It carries over no balance from day to day. Every evening deletes whatever part of the balance you failed to use during the day. What would you do?

Draw out every rupee, of course!

Each of us has such a bank, its name is TIME.

Every morning, it credits you with 86400 seconds. Every night it writes off, as lost, whatever of this you have failed to invest to good purpose. It carries over no balance. It allows no over draft. Each day it opens a new account for you. Each night it burns the remains of the day. If you fail to use the day's deposits, the loss is yours. There is no going back. There is no drawing against "tomorrow".

You must live in the present on today's deposits. Invest it so as to get from it the utmost in health, happiness, and success!

The clock is ticking, make the most of today.
HCFI Videos
Rabies News (Dr A K Gupta)
What precautions should be taken while vaccinating by the ID route?
  • The ID injections must be administered by staff trained in this technique.
  • The vaccine vials must be stored at +2°C to + 8°C after reconstitution.
  • The total content should be used as soon as possible, but at least within 8 hours.
  • The 0.1 ml. ID administration of cell–culture vaccine should create a wheal of at least 5 mm diameter with "peau de orange" appearance.
  • If ID dose is given subcutaneously then there is a possibility of poor immune response due to low antigen load. This may be life–threatening.
IJCP Book of Medical Records
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Monday 16th November IMA National Protest Day
News
  • New research shows that adults who reported receiving sodium-related medical advice were more likely to take steps to limit their intake. Ultimately, the circle of influence on children's sodium intake begins with their healthcare team educating parents and caregivers, who then make decisions that directly impact the food the family eats.
  • A Small pilot study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) reports that a device that detects a pattern of chemicals in the breath was both sensitive and specific for TB. The device was able to detect both pulmonary and extrapulmonary forms of the disease.
  • According to the WAVES (Women AntiretroViral Efficacy and Safety) study, HIV infected women would do better with a widely used single-pill treatment regimen than with an often-recommended multi-pill schedule. The findings of the first randomized double-blind trial of HIV drugs conducted only among women were presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
  • An expert panel has developed 10 evidence-based recommendations for exercise among patients with ankylosing spondylitis (AS), published in the journal Rheumatology. These recommendations cover assessment, monitoring, safety, disease management, AS-specific exercise, physical activity, dosage, adherence and exercise setting.
  • The number of mobile health apps has soared in the past 2 years, with more than 165,000 mHealth apps now available in the Apple iTunes and Android app stores, according to a new study by the IMS Institute for Healthcare Informatics.
  • More than a third of children develop diabetes and nearly half develop neurobehavioral problems after surgery for congenital hyperinsulinism, according to a cross-sectional study reported online September 1 in The Journal of Clinical Endocrinology & Metabolism.
  • "Low adherence to guidelines for the treatment of uncomplicated cystitis in primary care can lead to overuse of fluoroquinolones and excessive duration of treatment, both of which can cause higher antibiotic resistance," said Larissa Grigoryan, MD, from the Baylor College of Medicine in Houston at the Interscience Conference of Antimicrobial Agents and Chemotherapy 2015.
  • An international consortium of laboratories from around the world, all of which are studying various differences between dengue viruses, has emphasized that the understanding of dengue virus is too simplistic.Previously, scientists believed there were just four strains of dengue viruses and that each strain is genetically different than the others. Now, researchers have found that there are many more differences in the viruses’ antigenic properties, which are the outer surfaces of the virus that the immune system recognizes.
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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!
IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
Media
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Inspirational Story
Steps to Happiness

Everybody Knows: You can't be all things to all people. You can't do all things at once. You can't do all things equally well. You can't do all things better than everyone else. Your humanity is showing just like everyone else's.

So: You have to find out who you are, and be that. You have to decide what comes first, and do that. You have to discover your strengths, and use them. You have to learn not to compete with others, because no one else is in the contest of *being you*.

Then: You will have learned to accept your own uniqueness. You will have learned to set priorities and make decisions. You will have learned to live with your limitations. You will have learned to give yourself the respect that is due. And you'll be a most vital mortal.

Dare To Believe: That you are a wonderful, unique person. That you are a once-in-all-history event. That it's more than a right, it's your duty, to be who you are. That life is not a problem to solve, but a gift to cherish. And you'll be able to stay one up on what used to get you down.
eIMA Quiz
What is the main reason women have trouble becoming pregnant after age 30?

A. Their ovaries release fewer eggs.
B. Their eggs have begun to degenerate.
C. They have sex less frequently.
D. The uterine lining thins.
E. It is a high-stress period in their lives.

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: D. A and C.

Correct answers received from: Dr K V Sarma, Dr K Raju, Dr Poonam Chablani, Dr Rajesh S Joshi, Daivadheenam Jella, Dr B R Bhatnagar, Dr Avtar Krishan.

Answer for 20th September Mind Teaser: A. Diabetes

Correct Answers received from: Dr B R Bhatnagar, Dr Avtar Krishan.
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Quote of the Day
Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence. Helen Keller
Reader Response
Dear Dr. A. Marthanda Pillai, President Indian Medical Association and Dr KK Aggarwal, HSG, Indian Medical Association, Congratulations for a Quality & Decisive CWC at Trivandrum, God's own Country.

Well prepared Agendas targeting the burning issues of the profession. Discussions were to the point & conclusions are appreciable. Kindly perpetuate this culture in the coming meetings & we will achieve our Goals.We start after a heavy sumptuous lunch & most of the team is half asleep.We may start at 11 am & close at 2 pm next day.

Reporting items can go to back; discussion agendas can still move forward. Kudos to Kerala Team for their excellent choice of venue, food & above all the Hospitality of Kerala colleagues were highly enjoyable & memorable.All the Leaders & members are back home with green memories. Best wishes towards continued performance & Progress. Prof Dr S Arulrhaj, MD., FRCP(Glasg)
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Press Release
IMA calls for Scientific and humane approach in healthcare

The central working committee meeting of IMA has stressed the need for scientific and humane attitudes in healthcare delivery. Dr A Marthanda Pillai, National President, Indian Medical Association (IMA) Dr KK Aggarwal, Honorary Secretary General (IMA), Dr SS Aggarwal, President-elect, National leaders, Presidents, Secretaries and leaders from all States branches of IMA attended the two-day conference, which concluded on Sunday in Thiruvananthapuram.

Speaking on the occasion, Padma Shri Awardee Dr A Marthanda Pillai – National President, IMA & Padma Shri Awardee Dr KK Aggarwal – Honorary Secretary General, IMA in a joint statement said, "The need of the hour is for the government to address the issues that the medical fraternity is facing. Violence against doctors and hospitals is at an all time high, and immediate action must be taken in this regard".

The National sample survey has revealed that people of the country have opted for modern medicine for 99 percent of in-patient & 91 percent of outpatient care. The cost of treatment is escalating and out of pocket expenditure is nearly 80 percent. As a result, small and medium hospitals, which are the backbone of the healthcare delivery system, are facing serious threats and violence incidents.

In addition to this, the penetration of unfair means into modern medicine and false propaganda by unscientific systems is hampering health care to a major extent. The recent outbreak of Diphtheria in Kerala is the direct result of such unscientific propaganda employed to mislead the public. To reinstate peace and requisite order, immediate action is required to save the medical industry as well as the health of the people.

IMA has put forward the following demands for urgent implementation:
  • Government should increase the allotment of funds for health to at least 4 percent of the GDP immediately
  • Government funding should be exclusively reserved for proven scientific methods. Their aim should be at prioritizing care for poor, marginalized sections of the society and rural community. IMA has agreed to provide assistance nationwide in this regard
  • BSc community health aimed at providing inferior care for rural citizens should not be implemented
  • Drugs, vaccines and medical equipment should be manufactured in the public sector on a priority basis. The vaccine and sera-manufacturing units under public sector, which were closed down a few years back should be urgently made functional again
  • Drug prices should be effectively controlled. Additionally, cost-based price control instead of the market-based control should be put in place
  • Small and medium-sized hospitals should be saved from closure by providing monetary aid, tax benefits and logistics. Additional launch programme for starting aided hospitals in modern medicine should be formulated
  • Violence in hospitals should be effectively contained by nationwide implementation of a Hospital Protection Act
  • Clinical establishment act will lead to the closure of small-scale hospitals and should be done away with. For the benefit of individuals, IMA along with NABH is working towards the standardisation of all medical institutions of the country. The project has already been implemented in Kerala and has gained wide acceptability already
  • The Consumer Protection Act is detrimental in medical care as it is a service sector rather than a business hub. The unscrupulous awards offered will increase the treatment costs further and lead to the practice of defensive medicine. Hence, the act should be done way with until such time capping of compensation amount is implemented
  • The detrimental clauses of the PCPNDT Act that involves hardships for property using ultrasound technology should be modified to suit better utilisation of this investigation
In addition to this, IMA will further strengthen its presence in patient care and community service. IMA members will put in efforts to extend their services to as many as possible by following anticipated measures like:
  • Effective Implementation of POCSO Act and extensive programmes aimed at preventing child sex abuse. All the IMA branches will implement ‘Save the girl child’ project
  • Strengthening medical services in rural areas through the Aao Gaon Chalen project
  • Grievance redressal forum will be implemented to address the grievances of patients nationwide in all districts
  • Tuberculosis control will be prioritized, and IMA will actively participate in the RNTCP programme
  • Telemedicine and medical education through electronic media will be extensively implemented to create awareness about medical hygiene
  • Social projects emphasizing on safe sound, hygienic food and safe pregnancy will be implemented
After concluding the discussion, the working committee expressed satisfaction over the ongoing active social projects of IMA. The Nepal disaster relief operation of IMA was appreciated for it proved to be successful in saving many lives.

IMA has decided to carry effective sensitization measures to achieve the demands. The organization has also chalked out plans for calming down the agitation if the urgent demands are not effectively addressed to. Also, IMA has decided to publish fact sheet on an unscientific system of practice and its hazards.