December 23   2015, Wednesday
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EDITORIAL
Dr KK AggarwalDr KK Aggarwal US lifts lifetime ban on blood donations by gay men

The United States has formally lifted its lifetime ban on blood donations by gay men, replacing the rule with a 12-month waiting period after last sexual contact. The new rule overturns a ban that dates to 1983 and brings US policy in line with several other developed nations, including France, Japan and Australia, which all recently moved to allow men who have sex with men (MSM) to donate blood, as long as they have not had intimate relations in the past year. The 12-month deferral window is supported by the best available scientific evidence, at this point in time.

The ban remains in place for commercial sex workers and people who use injection drugs.

People with hemophilia or related clotting disorders are also still barred from donating blood for their own protection due to potential harm from large needles used during the donation process.
Breaking News

Warfarin + sulfonylurea increase risk of severe hypoglycemia

A retrospective Medicare database analysis of adults aged 65 and older has shown that warfarin and sulfonylureas (glipizide and glimepiride) used simultaneously significantly increase risk for severe hypoglycemia in this population group. The results published in BMJ by John A Romley, PhD, associate professor at the Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, and colleagues suggest a ” substantial positive association“ between concurrent use of warfarin and glipizide or glimepiride and emergency-department visits and hospital admission for hypoglycemia and for fall-related fractures, particularly around the time that patients who are already on the sulfonylurea initiate warfarin. What’s more, the data actually point to the possibility of a significant drug interaction between the medications… (Medscape)

Sudden cardiac arrest may be preceded by warning signs

Findings are from the ongoing Oregon Sudden Unexpected Death prospective study (Oregon SUDS) of sudden cardiac arrest (SCA) suggest that there may be a potential 'window of opportunity' to prevent fatal outcomes where warning symptoms occur in the days and even weeks preceding the event. In the study, about 50% of patients who experienced out-of-hospital cardiac arrest reported symptoms such as chest pain and shortness of breath to family members, friends, or healthcare providers hours or weeks before. Only one in five patients sought medical attention when these symptoms occurred. The study by Sumeet Chugh, MD, of Cedars-Sinai Medical Center in Los Angeles, and coauthors is published in the Annals of Internal Medicine… (Medpage Today)
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Specialty Updates
• Many people living with irritable bowel syndrome (IBS) are vitamin D deficient, suggests a new study published in the BMJ Open Gastroenterology. Researchers noted that amongst 51 patients with IBS, 82% exhibited insufficient vitamin D levels.

• A large, 8-year retrospective study with a median 6.4-year follow-up, published in the American Journal of Cardiology, linked long–term statin use with an increased risk of kidney disease. Statin users, compared with case-matched controls who didn't use statins, showed a 30% to 36% greater prevalence of kidney disease during follow–up.

• Postmenopausal women with periodontal disease are more likely to develop breast cancer, suggested new research published in Cancer Epidemiology, Biomarkers & Prevention. Those with a history of smoking are particularly affected.

• A new analysis from the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) has again highlighted the importance of time in treating patients with ischemic stroke. The paper, published online December 21 in JAMA Neurology, has shown that intra-arterial treatment (IAT) has better outcomes the earlier it's done.

• Several social and lifestyle factors appear to play a role in women's risk for metabolic syndrome as they experience menopause, suggested a Korean cohort study published online in Menopause. A lower education or income level and a sedentary lifestyle conferred the greatest increased risk for metabolic syndrome.

• Proton pump inhibitors (PPI) used to reduce stomach acid and treat acid reflux change the populations of microbes living in the intestines, which may help explain why they increase the risk of certain infections, reported a new study published online in the journal Gut Chronic inflammation in the bloodstream can 'fan the flames' of depression, suggested a new paper published in a recent edition of the American Journal of Psychiatry. Researchers noted that among patients suffering from clinical depression, concentrations of two inflammatory markers, CRP and IL-6, were elevated by up to 50%.

• A prophylaxis treatment can prevent new-onset hepatitis B in children who receive liver transplants from donors who were previously infected with hepatitis B virus (HBV) but had successfully cleared the virus. The findings are published in Liver Transplantation. The regimen consisted of HBV vaccine intramuscular injections and Hepatitis B immunoglobulin.

• Vitamin D supplements were of no use for treating anemia in patients with end-stage renal disease (ESRD) on dialysis, suggested a randomized, double-blind, placebo-controlled trial published in the Journal of the American Society of Nephrology. Six months of vitamin D supplementation did not reduce patients' need for epoetin compared with placebo.
eSPIRITUAL
What is the importance of silence?

True silence is the silence between the thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. Meditation is the process of achieving silence. Observing silence is another way of deriving benefits of meditation. Many yogis in the past have recommended and observed silence now and then. Mahatma Gandhi spent one day in silence every week. He believed that abstaining from speaking brought him inner peace and happiness. On all such days he communicated with others only by writing on paper.

Hindu principles also talk about a correlation between mauna (silence) and shanti (harmony). Mauna Ekadashi is a ritual followed traditionally in our country. On this day the person is not supposed to speak at all and observes complete silence all through the day and night. It gives immense peace to the mind and strength to the body. In Jainism, this ritual has a lot of importance. Nimith was a great saint in Jainism who long ago asked all Jains to observe this vrata. Some people recommend that on every ekadashi one should observe silence for few hours, if not the whole day.

In his book, The Seven Spiritual Laws of Success, Deepak Chopra talks in great detail about the importance of observing silence in day to day life. He recommends that everyone should observe silence for 20 minutes every day. Silence helps to redirect our imagination towards self. Even Swami Sivananda in his teachings recommends observation of mauna daily for 2 hours. For ekadashi, take milk and fruits every day, study one chapter of Bhagwad Gita daily, do regular charity and donate one-tenth of your income in the welfare of the society. Ekadashi is the 11th day of Hindu lunar fortnight. It is the day of celebration, occurring twice a month, meant for meditation and increasing soul consciousness.

Vinoba Bhave was a great sage of our country known for his Bhoodaan movement. He was a great advocator and practical preacher of mauna vrata. Mauna means silence and vrata means vow; hence, mauna vrata means a vow of silence. Mauna was practiced by saints to end enmity and recoup their enmity. Prolonged silence as the form of silence is observed by the rishi munis involved for prolonged periods of silence. Silence is a source of all that exists. Silence is where consciousness dwells. There is no religious tradition that does not talk about silence. It breaks the outward communication and forces a dialogue towards inner communication. This is one reason why all prayers, meditation and worship or any other practice whether we attune our mind to the spiritual consciousness within are done in silence. After the death of a person it is a practice to observe silence for two minutes. The immediate benefit is that it saves a tremendous amount of energy.

Silence is cessation of both sensory and mental activity. It is like having a still mind and listening to the inner mind. Behind this screen of our internal dialogue is the silence of spirit. Meditation is the combination of observing silence and the art of observation.
Legal Quote
Bolam v. Friern Hospital Management Committee (1957) 2 All ER 118

”A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.”
The switch from trivalent to bivalent oral polio vaccine

18th December, 2015

Objective 2: Three distinct stages

Withdraw
• bopv & routine Opv use

Switch
• topv to bopv(156 countries & territories)

Introduce
• at least one dose of IPV into routine immunization(126 countries )
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The Year in Medicine 2015: News That Made a Difference
Thousands Join ongoing Heart research study via smartphone app

In March, more than 40,000 people signed up for an ongoing global research study via ‘ MyHeart Counts ’, a free smartphone app in a matter of just two weeks. The app has been designed by researchers from Stanford University and the American Heart Association (AHA). The study aims to measure how activity affects health of the heart. Anyone aged 18 years or older with an iPhone 5s, 6, or 6 Plus can download the app, give consent to be included in the study, answer survey questions about risk factors, and then let sensors record their movements for 7 days… (Medscape)
Mandrola's Top 10 Cardiology Stories 2015
The basics make a comeback in managing AF

There were three findings related to atrial fibrillation (AF) this year. In a surprising result, the STAR–AF 2 trial found that additional ablation beyond pulmonary–vein isolation in patients with advanced forms of AF did not improve outcomes. Then, the LEGACY trial and CARDIO–FIT trials showed that weight loss and gains in fitness delivered potent antiarrhythmic effects. Finally, the ARREST–AF Substrate study showed that risk-factor modification worked by improving electrical and structural properties of human atria. This study won a Young Investigators Award at the AHA meeting. Now thought leaders say that modification of risk factors is central to the care of patients with AF (Source: Medscape)
AIIMS to expand its trauma services

AIIMS has decided to expand its trauma services in phase II of Jai Prakash Narayan Apex Trauma Center. This second phase of JPN trauma facility will have 2,250 beds. The new center will extend treatment facilities for other specialties too such as digestive diseases, head and neck surgery, spine treatment, organ transplant. Besides a control room for effective coordination and communication, the facility will have networking linkages with other hospitals and agencies…(Times of India)
Over 71 million people suffer from goiter

More than 71 million people in the country are suffering from goitre and other iodine- deficiency disorders. In a written reply to a question in Lok Sabha, Health Minister JP Nadda said that by the year 2017 the government plans to bring down the prevalence of IDD to below 5% and also ensure 100% consumption of adequately iodized salt at the household level… PTI
IPC Code to know

Section 482 in The Code Of Criminal Procedure, 1973

482. Saving of inherent powers of High Court. Nothing in this Code shall be deemed to limit or affect the inherent powers of the High Court to make such orders as may be necessary to give effect to any order under this Code, or to prevent abuse of the process of any Court or otherwise to secure the ends of justice.… (PIB)
The clampdown on diesel vehicles, and other measures ordered by the Supreme Court to tackle air pollution in the capital, will now extend to the entire NCR as well.
In the first inter-state heart transplant conducted in Mumbai, Kandivli (East) resident R Desai got an organ that was flown across 296km from Surat to a hospital in Mulund within 92 minutes, on Friday night.
A toll-free ‘Eyeway National Helpdesk‘ for the visually impaired

An ‘‘Eyeway National Helpdesk‘ for the blind and visually impaired was formally launched by Shri Lov Verma, Secretary, Dept. of Empowerment of Persons with Disabilities. Now the visually impaired citizens of India will be able to call the Eyeway Helpdesk on a toll free number, 1800-300-20469, and get answers to their queries. Trained counsellors will share information, guide and connect the caller with relevant professional solutions. The Eyeway National Helpdesk is an initiative of Score Foundation with support from the Dept. and other organizations like the Hans Foundation, Tech Mahindra Foundation and Essel Foundation … PIB
10 more new AIIMS to come

Laying the foundation stone for an All India Institute of Medical Sciences (AIIMS) at Mangalagiri near Guntur in Andhra Pradesh, Shri JP Nadda, Union health Minister said that 10 new AIIMS will come up in the country in one-and-half years. They would help fill the gap by adding 16,300 additional beds. The AIIMS will have all super specialties. The 960-bed facility is coming up on 200 acres at a cost of Rs.1,620 crore and will be completed in 2-3 years. The institute will have 100 medical seats… (The Pioneer)
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
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Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

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

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse– a doctor– as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/

Responses received

• Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar

•As regards Bioethical issues as deliberated above, may I suggest to keep discussion anonymous, important material for discussion are clinical facts and not the identification of the patient. This way perhaps we may not breach the confidentiality issues. Dr VJ Mahhadik
eWELLNESS
Seven Common Causes of Forgetfulness

• Lack of sleep is the most common cause. Too little restful sleep can also lead to mood changes and anxiety, which in turn can contribute to memory impairment.

• Many drugs can affect memory, which includes tranquilizers, antidepressants, blood pressure drugs and anti–allergic drugs.

• Low functioning thyroid can affect memory.

• Drinking too much alcohol can interfere with short–term memory.

• Stress and anxiety can lead to memory impairment. Both can interfere with attention and block the formation of new memory or retrieval of old memories.

• Forgetfulness can be a sign of depression or a consequence of it.

• If you are vegetarian, vitamin B12 deficiency can loss memory impairment.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Inspirational Story
Do not be jealous

We all have experienced how jealousy can disturb our peace of mind. You know that you work harder than your colleagues in the office, but sometimes they get promotions, you do not. You started a business several years ago, but you are not as successful as your neighbor whose business is only one year old. There are several examples like these in everyday life.
Should you be jealous? No. Remember everybody’s life is shaped by his/her destiny, which has now become his/her reality. If you are destined to be rich, nothing in the world can stop you.

If you are not so destined, no one can help you either. Nothing will be gained by blaming others for your misfortune.

Jealousy will not get you anywhere; it will only take away your peace of mind.
eMEDI QUIZ
Counseling and health and occupational screening require which of the following teledermatology tools?

a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. Online discussion group


Yesterday’s Mind Teaser: Appropriate teledermatology tool to screen [ACTIVE SURVEY] a dermatology case of public health importance like leprosy is

a. Mobile teledermatology
b. Videoconference
c. Store and forward teledermatology
d. Online discussion group

Answer for Yesterday’s Mind Teaser: a. Mobile teledermatology

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr Jayashree Sen & Dr Prakash Sen

Answer for 21st December Mind Teaser: b.2-12 weeks

Answers received from: Dr Jaya,  Dr K Raju, Dr Kailash Chandra Sharma, Dr Avtar Krishan.
Readers column
Dear sir, Very informative  news. Regards: Dr Kanak
Humor
Medical terms

• Artery – Study of painting

• Bacteria – Back door of cafeteria

• Bowel – Letter like A.E.I.O.U.

• Caesarean section – District in Rome

• Cat scan – Searching for kitty
Press Release
Take a pledge to reduce or give up alcohol consumption
Here are 15 ways to help you achieve this goal

New Delhi, Dec 22, 2015: If you are dependent on alcohol, or have other medical or mental health problems you should stop drinking completely. Reduction of heavy drinking may be a more acceptable goal for some patients who lack readiness to quit drinking.

The frequency of heavy drinking (>5 drinks/day for men and 4 for women) has the highest correlation with negative life consequences such as impaired driving, interpersonal problems and injuries.

You need to cut down if in the past one year you have taken one or more times, >5 drinks in a day (4 drinks for women). This positive response to a single question “How many times in the past year have you had X or more drinks in a day?” where X is five for men and 4 for women, is recommended for use by the National Institute on Alcohol Abuse and Alcoholism.

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said. “During the festive months there is a tendency for people to over-indulge without realizing the implications excessive alcohol consumption has on their health. Alcohol can cause hypertension, obesity, aggravate diabetes and also trigger heart attacks. It has a negative effect on ones neurological functioning. Given these health hazards associated with it, we would like to urge people to start the New Year by reducing or eliminating alcohol consumption from their day to day lives for a healthy and disease free life.”

National Institute on Alcohol Abuse and Alcoholism suggests the following for stopping or reducing alcohol:
1. Put it in writing why you want to reduce or stop: Write what you want to achieve, for example, will feel healthier; will sleep better, will improve my relationships.

2. Write confessions: Learn and practice various confession exercises. This will help you take care of inner guilt, which may be the precipitating factor.

3. Set a drinking limit: Those who are cutting back should set a limit as per their health. Most healthy people should limit to <40 ml in one hour, 80 ml in one day and <240 ml in a week. Women should take less than half of this amount

4. Keep a diary of your drinking: For initial 3-4 weeks, keep track of every drink. Note the situations you are most likely to drink. Give each situation a rating out of 10. Try avoiding those situations for the next few weeks.

5. Don’t keep alcohol within your reach: Remove alcohol from your living place. This can help limit drinking.

6. Eat your drink: Drinking slowly can help. Sip and do not gulp. Sip soda, water or juice after each drink. This is called Mindful drinking. If you are aware of your drinking, you will cut back on it. Otherwise, you will drink more.

7. Never drink on an empty stomach.

8. Keep weekly one or two spiritual fast/s. This will allow alcohol-free days. Decide not to drink a day or two each week.

9. Observe spiritual retreats: Observing spiritual retreats (Navratri by Hindus, Ramzan by Muslims and Easter by Christians) with no drinking can help. Or try abstaining for a week or a month to see your commitment to not drinking.

10. Become a tortoise: Learn to withdraw yourself from all stimuli, which can force you to drink.

11. Watch for peer pressure: Learn to say no. Do not drink just because others are, and you shouldn’t feel obligated to accept every drink you’re offered. Stay away from people who encourage you to drink.

12. Keep busy: Take a walk, play sports, go out to eat or catch a movie. When you’re at home, pick up a new hobby or revisit an old one. Painting, board games, playing a musical instrument, woodworking - these and other activities are great alternatives to drinking.

13. Ask for support: Let friends and family members know that you need their support.

14. Guard against triggers: Stay away from people and places that make you want to drink. In Yoga it is called Pratahyara and means staying away from the external stimuli. Lust cannot be removed by staying in a lustful atmosphere.

15. Be persistent: Most people who successfully cut down or stop drinking altogether do so only after several attempts.
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