February 23  2015, Monday
Avoid Drunk or Drugged Driving
Dr KK Aggarwal The dangers of drinking alcohol and driving are well known to all. But, it is also important to recognize that taking drugs and driving too can be as dangerous, Drugged driving or driving under the influence of any drug that acts on the brain can adversely affect your, vision, reaction time and judgment and driving skills. This not only endangers your life but also of your co–passengers as well as others on the road.

Tips for safe driving
  • All through the year, especially during the holiday season, take steps to make sure that you and everyone you celebrate with avoids driving under the influence of alcohol or other drugs.
  • Always designate a non–drinking driver before any holiday party or celebration begins.
  • Arrange for someone to pick you up
  • Do not let a friend drive if you think that they are impaired. Take the car keys.
  • Stay overnight at your friend’s place, if possible and drive back home in the morning.
CPR cum Health Check up Camp at Punjab Kesari Varisht Nagrik 16th December 2013
Acute STEMI: Current management strategy 2015 Dr Ashok Seth, New Delhi
  • It is important to understand the pathophysiology so that the Clinician and the Cardiologist are on the same path.
  • The main aim of management of acute MI is to restore blood supply to the infarcted myocardium at the earliest and efficiently via thrombolysis, or primary PCI.
  • As we progress in time, more muscle is infarcted; the survival of patient falls drastically as LVEF goes down, that is why ‘time is muscle’.
  • Thrombolysis: 1st hour is golden hour and gives best of results; within 3 hours is still acceptable but after 3 hours, prognosis unfavourable.
  • Primary PCI is preferred reperfusion strategy if done within 90 min of first medical contact at an experienced facility. Fibrinolysis, if primary PCI cannot be done within 90 min of first medical contact.
  • Patients who present late, tenecteplase or alteplase is preferred. Single bolus of tenecteplase is far more satisfying than streptokinase. Tenecteplase: Administration simple, greater TIMI3 flows, but cost 4 times high.
  • Pre hospital lysis even with streptokinase saves far more lives and improves survival than in-hospital lysis.
  • Within 3 hours of symptom onset, thrombolysis is equal to PCI. If patient presents > 3 hours, angioplasty is a superior tool to revascularize; there is no incremental loss in its efficacy as time goes by.
  • We cannot say that thrombolysis is better or that primary PCI is the ideal strategy. It is important to combine the two approaches: Facilitated PCI, rescue PCI or pharmacoinvasive therapy.
  • Recommendations for STEMI triage and transfer for PCI:
    • STEMI: It is reasonable to transfer high-risk patients who receive fibrinolytic therapy as primary reperfusion therapy at a non PCI-capable facility to a PCI–capable facility as soon as possible where PCI can be performed either when needed or as a pharmacoinvasive strategy
    • Patients who are not high risk who receive fibrinolytic therapy as primary reperfusion therapy at non PCI capable facility may be transfereed to PCI capable facility for PCI (as when needed or as pharmacoinvasive strategy)
    • STEMI patients best suited for fibrinolysis: Present early after symptom onset with low bleeding risk. After fibrinolysis, if not high risk, transfer to a PCI capable, if sypmtosm persist and failure to reperfuse
CKD: A Clinician’s approach

Dr Mohan Biyani, Ottawa, Canada
  • CKD: Evidence of kidney structure or function or eGFR <60 ml/min/1.73 m2 plus persistence of abnormalities for ≥3 months.
  • Acute vs chronic kidney disease: In acute disease, size normal, no anemia/renal osteodystrophy
  • CKD patients are at high risk of CVD, infections and ADRs.
  • Early identification of CKD and interventions will improve CV outcomes and delay progression.
  • High risk patients: DM, HT, ASCVD, PVD, f/h of ESRD; such patients should be screened for CKD.
  • Methods to assess GFR: Serum creatinine, calculated GFR based on serum creatinine (Cockcroft Gault and MDRD formulae), timed urine clearance, serum cystatin C, nuclear scans, inulin clearance (gold standard, but expensive, used in research)
  • KDIGO 2012: Subdivided Stage 3 CKD into two on the basis of albuminuria: G3a, G3b; divided into three: A1 <3, A2 3-30, A3 >30
  • For CKD, not only GFR, but there is also a need to have albuminuria to understand health implications.
  • Proteinuria is the strongest risk factor for ESRD; indicative of CKD progression
  • Microalbuminuria (30-299 mg/day albumin), macroalbuminuria (≥300 mg/day), overt proteinuria (≥300 mg protein), nephrotic range proteinuria (>3gm/day protein)
  • Management of proteinuria: Non pharmacological (protein and salt restriction, weight loss), pharmacological (lower BP)
Meet the Expert session

Dyslipidemia Management: Moderator: Dr Upendra Kaul, Panelists: Dr S Narsinghan, Dr Amal Banerjee, Dr AH Zargar, Dr U Jadhav
  • There is increase in prevalence of CHD in India. The number of patients is incrementally rising. The CHD burden in India has increased from 2.7 to 6.1 crores in 2015.
  • Dyslipidemia is one of the 9 risk factors for CHD.
  • Atherosclerosis is a reversible disease, LDL–C has an important role in its progression and development.
  • Statins are primary drugs for dyslipidemia. Residual risk beyond statins is still a concern.
  • The new ACC/AHA guidelines focus on comprehensive atherosclerotic CV risk reduction and not on comprehensive lipid management. It has identified four statin benefit groups: Secondary prevention (high dose statins), primary prevention LDL–C > 190 mg/dL (high dose statins), diabetics 40–75 years age, no clinical ASCVD (moderate dose statins) and intermediate levels of LDL–C 70–189, no CVD/DM; but no mention of non-statins.
  • Insulin resistance develops much before diabetes sets in. You already have progressive lipid abnormalities hence, this subset of population is very important.
  • Non HDL–C has emerged as a strong CV risk predictor; encompasses all atherogenic lipid particles; strength of association with CVD is greater for Non HDLC vs LDL–C and ApoB. It should be measured in patients with TG 300-500 mg/dL
  • Non–HDL goals can be achieved with TG lowering after desired LDL–C levels are achieved (AACE 2013).
  • Statins have to be given. We have to find an answer as what (non–statin) can be added: Fibrates, niacin, salaglitazar.
  • 90% of CKD patients are eligible for statins except for those on dialysis.
  • Diabetics no CAD (moderate dose statin), overt CAD (High dose statin), no CAD but risk factor (moderate dose statin) (ADA 2015)
Multi Vessel CAD: CABG Vs PTCA
Dr OP Yadava, New Delhi

Percutaneous interventions do not provide any survival benefits which bypass surgery does.
  • PCI provides incomplete revascularization which translates into increased events and readmission during follow up.
  • Stents do not perform as well as CABG in presence of co–morbidities like diabetes mellitus, chronic kidney disease and LV dysfunction.
  • Technology is not yet ready.  Even BVS platform have lot of unanswered questions & issues like thick struts, radial strength, deliverability, visibility on imaging etc.
  • Safety profile of stents is subjudice and repeat revascularization rates are much higher than CABG translating into escalating costs for the patient.  It’s therefore important that all decisions should be taken by the ‘Heart Team’.
Cardiology eMedinewS
  • For men with atrial fibrillation (AF) who tick at least one box on the CHA2DS2-VASc risk-factor score sheet, the risk of ischemic stroke ranges from 1.96% per year to as high as 3.50%, depending on the specific risk factor composing the score, according to the results of a new analysis is published in the February 24, 2015 issue of the Journal of the American College of Cardiology. For women with AF and at least one additional risk factor, the risk of stroke ranges from 1.91% to 3.34% per year.
  • Four out of five cardiovascular risk-prediction algorithms, including the new American College of Cardiology (ACC)/American Heart Association (AHA) risk calculator, overestimate the risk of cardiovascular events, according to the results of a new study. The latest analysis published in the February 17, 2015 issue of the Annals of Internal Medicine, which included patients from the Multi-Ethnic Study of Atherosclerosis (MESA), showed that the 2013 ACC/AHA risk calculator, which is designed to assess the 10-year risk of cardiovascular disease and stroke, overestimated the risk of cardiovascular end points by 86% in men and 67% in women. Overall, the ACC/AHA risk score overestimated risk by a net of 78%.
Pediatrics eMedinewS
  • Children with low serum vitamin-D levels in childhood appear to have an increased likelihood of developing subclinical atherosclerosis in adulthood independent of conventional cardiovascular risk factors, the results of a Finnish study indicate. The results show that low 25-hydroxy (25-OH) vitamin-D levels in childhood are associated with increased carotid intima-media thickness (IMT) almost 30 years later, particularly in females. The findings are published online February 10 in the Journal of Clinical Endocrinology and Metabolism.
  • While babies frequently nap during the daytime, a study suggests that it may be best for napping to cease within the first couple of years of life. Researchers have found that daytime napping is associated with poorer sleep quality in young children over the age of 2. The study, published in Archives of Disease in Childhood, investigated the impact of napping on night-time sleep quality, behavior, cognition and physical health for young children up to the age of 5 years.
Make Sure
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 suggest that this intervention is much better than thrombolytic therapy in such patients.
(Contributed by Dr MC Gupta, Advocate)

Q. My hospital sometimes advertises in the newspapers inviting philanthropists to help poor patients who do not have money to pay for costly surgery etc. When the donors, including MLAs, come to the hospital for the charity, they bring with them local press and media people for publicity. This sometimes affects the normal functioning of the hospital. Are any hospital ethics being violated? What are your comments?

A. My comments are as follows:


  • Your hospital is doing a good service. No hospital ethics are being violated.
  • The media and press coverage might cause some disturbance in the hospital but that is for a good cause. Moreover, the hospital gets free publicity. This may be good for the hospital.
Dr Good Dr Bad
Situation: A patient with Mediclaim of Rs. 2 lakhs has used a cumulative bonus of Rs. 40000 after 8 years. How much can he claim in the next year.
Dr. Bad: Same as 2.4 lakhs.
Dr. Good: It will be 10% less.

Lesson: Incase of claim under the policy in respect of insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of claim of sum insured on the next renewal. However, basic sum insured will be maintained and will not be reduced.
IJCP Book of Medical Records
IJCP’s ejournals
Twitter of the Day
Dr KK Aggarwal: High BP in Pregnancy Increases Risk for Future Atherosclerosis http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra:No matter what happened in the past, we all have the right and the capacity to be happy and lovedhttp://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.
Video of the Day
eMedi Quiz
A 7 year old girl from Bihar presented with three epidodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver and mild ascites. Portal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy reveled esophageal varices. The most likely diagnosis is:

1. Kala azar with portal hypertension.
2. Portal hypertension of unknown etiology.
3. Chronic liver disease with portal hypertension.
4. Portal hypertension due to extrahepatic obstruction.

Yesterday’s Mind Teaser:: Thirty-eight children consumed eatables procured from a single source at a picnic party. Twenty children developed abdominal cramps followed by vomiting and watery diarrhea 6-10 hours after the party. The most likely etiology for the outbreak is:
1. Rotavirus infection.
2. Entero-toxigenic E.Coli infection
3. Staphylococcol toxin.
4. Claustridium perfringens infection.

Answer for yesterday’s Mind Teaser:: 4. Claustridium perfringens infection.
Correct Answers received from: : Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan,
Answer for 22nd Feb Mind Teaser:2. Oral rehydration therapy.
Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
Meeting of the Central Working Committee of Indian Medical Association
  1. All members of the Central Working Committee, IMA
  2. All Office bearers of IMA who are not members of the Central Working Committee are invited as per Rule No.27 (B) of the Memorandum, Rules & Byelaws.

In continuation of our earlier notification regarding 213th meeting of the Central Working Committee of Indian Medical Association scheduled to be held at New Delhi on Saturday& Sunday, April 11 & 12, 2015, the Programme of the CWC shall be as follow:-

11th April 2015 (Saturday)
1.00 pm to 2.00 pm
Lunch & Registration
2.00 pm to 8.00 pm
Meeting of the CWC

12th April 2015 (Sunday)
7.00 am to 8.00 am
8.00 am to 1.00 pm
1.00 pm to 2.00 pm
Meeting continues
2.00 pm to 4.00 pm
CWC meeting continues
4.00 pm
High Tea

The of the meeting shall be informed to you shortly.
Please intimate your travel itinerary ether on the following Email IDs:
np@ima–india.org and hsg@ima-india.org
TA will be reimbursed as per IMA Rules.
For any further queries, please contact the following Office bearers:

Hony.Finance Secretary, IMA HQs
312, Sangam Apartment, West Enclave
Pitampura, Delhi-110 034

9810089490 Dr. Hans Raj Satija
Hony. Asst. Secretary, IMAHQs
A–5/7, Paschim Vihar
New Delhi–110 063

Dr K K Aggarwal
Padma Shri,
National Science Communication &
Dr B C Roy National Awardee
Honorary Secretary General
President, Heart Care Foundation of India
Declare swine flu natural calamity, IMA secy gen asks govt Rajeev Dikshit,TNN | Feb 22, 2015, 01.30 AM IST
Secretary general of the Indian Medical Association (IMA) Dr K K Aggarwal on Saturday asked the Central government to declare swine flu a natural calamity. He also asked the medical fraternity and institutions not to create panic as only swine flu with pneumonia is lethal.

"The Central government should take an epidemic like swine flu as natural calamity as is done during natural disasters like tsunami when huge funds are released for relief operations and rehabilitation. Epidemics including swine flue are not a man-made problem and innocent people suffer in case of its outbreak. Hence it becomes responsibility of the government to tackle it promptly," said Dr Aggarwal.

Dr Aggarwal, who was in Varanasi on Saturday to attend a programme at the local unit of IMA, said, "In case of swine flue with pneumonia, the progressive breathlessness will cause total unrest for affected person. Except this symptom there is no need to worry especially when the blood pressure and breathing is normal."

"Immunization is advisable only for the doctors handling the cases of swine flue. Only affected people should wear thin layer masks, which is available in market at very low cost. Precautions are a must for affected people as well as doctors and hospital staff. The rising temperature is a good sign as it will start subsiding this disease with more rise in mercury," he added.

He said when IMA and other bodies increased pressure on government it fixed the rate of pathology test of suspected swine flue cases in private centers as Rs 4500 in Delhi. "But, we are demanding the government to bring it to Rs 1,000 as this is enough for required tests and private pathologies and diagnostic centers should also realize that monetary interests should be kept aside in case of epidemics in order to make the cost of treatment affordable for all, said Dr Aggarwal asking all units of IMA to start efforts for convincing the state governments for fixing lowest price for diagnostic tests for private centers during epidemics.

He praised the stand of the local unit of IMA for not extending any support to the radiologists and doctors contributing in female foeticide and causing imbalance in male-female ratio. He said that association is in full favour of Medical Council of India's Act which says that in the case of conviction of a medical practitioner under PCPNDT Act, his/her registration will be cancelled and association with IMA would also end.

He said that IMA is initiating a pharmacy to make medicines available to people on up to 80% less cost. If Varanasi unit of IMA will show interest, he said, such pharmacy can also be started here.
Sonal Namaste
There are three isolation categories that reflect the major modes of microorganism transmission in nosocomial settings: contact, droplet, and airborne spread
Medscape Family Physician Lifestyle Report 2015
Does Living with a Partner Reduce Family Physicians Burnout?

Slightly less than half (49%) of family physicians who are living with partners are burned out, while 59% of those without partners experience burnout. When looking at specific living status, the highest rates of burnout were among those who are separated (64%) or divorced (60%) and living alone. Those who were widowed or in a first marriage had the lowest burnout rates (48%).
Inspirational Story
Begin with a Blank Page

If you could start your life all over what would be different? What would you change now if you were able to wave a magic wand and start from scratch? Just imagine you have no ties, no burdens, no limits, no memories, and no past.

What would your life look like? If the answer that comes to your mind is different than what you are doing, why is that? Is it because of someone else's opinion? A spouse, a parent or maybe your children?

The ultimate test of your life is to close your eyes and think of yourself on your deathbed. Lying there, preparing yourself to leave, look back at your life as you are currently living it.

How do you feel? Are you satisfied you lived completely? Or do you wish you had done differently? Very few of our senior citizens look back on their life and say, "I sure wish I had spent more time at the office!" Nobody says, "I wish I had watched more TV!"

This is what they say. "I wish I had been bolder. I wish I had given more. I wish I had tried harder to see more, do more and feel more." People wish that they had lived more. I, for one, have to admit to a certain amount of holding back on dreams and goals because of our two boys. As my life progresses I realize there is no reason to hold back.

We have not been exactly standing still either. We have done our best to live our dreams. We built a sailboat and sailed for 7 years traveling on the open ocean. We lived in the snow in Aspen Colorado, and on the beach in South Carolina. An old brick mill was our home in Long Island, versus a boat dock in Palm Beach Florida. We are writers of books and music, actors in the theater, and we home– school the boys. We have built a horse farm, and businesses! Yet, there is so much more we want to do! It is a balancing act. We all must have sufficient finances to support a comfortable lifestyle, (although most of us tend to spend way too much on that!) Part of this balancing act is to understand what we are passionate about doing so that work becomes a joy instead of a job.

Is this not a major reason of lost dreams and goals? Many people find work, call it a job and make a living at it. But they begrudge every minute of it, going as far as using the job as a reason for playing the martyr. Find something else!

There are many, many teachers of the attraction philosophies of "making a life". With as many opportunities today in every field imaginable, somewhere, something is calling to you.

Another part of the balancing act is to include those around you in frank and open discussions in what it is you want. I find some of my coaching clients have kept their wants and needs bottled up inside them forever! They had already decided for the other person in their lives there was no interest in whatever it was they themselves wanted to do! How absurd! How can we possibly know what someone else wants!

Would it not be tragic to spend your life in a big city for 40 years, working at a job you despise because you thought your spouse liked it, even though you wanted to live in the country and be a farmer? Then one day you overhear your spouse tell her best friend all she ever wanted to do was live in the country? 40 years! Sure this is a bit far fetched – but you would be amazed at what I hear!

Make an attempt today to start with a brand new page of your life. Create your life story how you want it. If there are others in your life to be involved, have them do the same exercise. Then compare what your notes. If this matches your current life, congratulations! You are one of the few. Now make it better.

However, if your written life stories sound like someone completely different, then you are living a life of conflict. Here is the good news. Your life is your life. No one can take that away from you. You are not indentured. You are not a slave. You are free to go, do, and be whomever you wish.

It might not be easy, but it sure might be worth it. I coach people daily who are changing their lives. There are so many things to be grateful for, and so many things open to us. We owe it to all the ones before us who gave us this opportunity to take advantage of it.
Quote of the Day
Only those who dare to fail greatly can ever achieve greatly. Robert F. Kennedy
Reader Response
  1. Dear National Pres Dr AMP, & HSG Dr KKA, Vanakkam, Well analysed and written conveying correct message on the outbreak of any disease, especially now about the swine flu. We will follow the guidelines issued. Regards: Dr L V K Moorthy
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Dr KK Spiritual Blog
The vast power of the Spirit

Om Poornamadah
Om Poornamadah Poornamidam
Poornaat Poornamudachyate
Poornasya Poornamaadaaya
Poornameva Avasihyate"

‘The whole is whole; if you take away the whole away from the whole the whole will still remain.’ (That is infinite, this is infinite, from the infinite, the infinite has come. Having taken the infinite out of the infinite, the infinite alone remains). (In Vedanta, "That" represents superconsciousness, God or the Brahman and "This" the visible universe)

Atman, which makes up our body, is 99.99 per cent space or void and if we look at the rest, it is also nothing but space or void. This void or ‘akasha’ is what is called Brahman, God or consciousness and is a web of energized information.

This web of information of inner space called inner consciousness is the Atman or the Soul. This is connected with the outer space in the universe having a similar web of energized information called the Spirit or Brahmand.

The Spirit has been given many names by different religions: Allah, Buddha, Brahman, Christ or Wahe Guru. They all signify the same. This spirit, the energized field of information, is a powerful expression of live energy which can move faster than the speed of light. Soul is nothing but an individualized expression of the spirit.

This energy containing information in the spirit cannot be seen, felt, touched, tasted or smelt. It is beyond the perception of the five senses. One cannot destroy it with a weapon, fire, water or air. This consciousness is embedded in the space of each and every cell of the body. It is like sugar added to the milk. Once added, you cannot find it as it gets embedded with each and every drop of the milk.

Soul originates from the spirit. Each soul differs from the other by way of the subtle layer of consciousness called the ‘Sukshma Sharir’, which is controlled by the triad of actions, memories and desires.

Spirit is like the light, which is always positive and removes darkness. The basic nature of consciousness is "truth and bliss". The soul and the spirit are devoid of hatred, anger or jealousy and are full of unconditional love. They are nothing but a treasury of information about everything. This infinite information is capable of doing anything, including miracles.

It is like the flame of a candle, which can light an infinite number of candles, while still retaining its illumination to the same degree.

Deepak Chopra once said that the soul is like the voice of Lata Mangeshkar coming through a radio, and if you break the radio, you will not find Lata Mangeshkar in it. Similarly, if you cut the body into pieces, you cannot find the physical presence of the spirit. Spirit is omnipresent and any amount of Spirit taken out from it will not make any difference to it.

In religious terms, the infinite or the vastness is equated and described by the blue color, and that is one reason why most gods are represented in blue color, or are shown in the background of blue sky. This only represents the vastness and infinite character of the consciousness.

A guru explained the Spirit to his disciples by the following equation: 1 × 1 = 1, 1/1=1 or, in other words everything is One. One can also explain it by the equation that infinity when added, subtracted, multiplied or divided by infinity will result only in infinity.

This infinite potential in our minds is present in between the thoughts and can be experienced by enabling oneself to go in between the thoughts by a process called meditation. One can experience the silent gap between the thoughts either with the use of primordial sound mantra as a vehicle or by way of yoga. People who have learnt meditation and have achieved the ability to go into the silent gaps can accomplish everything in their life using the principles of intention and attention. After any intention is introduced in the silent gap, a new reality can be created.

"That which is born of the flash is a flash; that which is born of the spirit is spirit" (John)
Wellness Blog
Elderly Beware of Commonly Prescribed Group of Drugs

Transient ischemic attack or TIA or mini paralysis is a brief episode of neurologic dysfunction caused by lack of blood supply in the focal brain or eye, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction or brain attack

It is a neurological emergency and early recognition can identify patients who may benefit from preventive therapy or from surgery of large vessels such as the carotid artery.

The initial evaluation of suspected TIA and minor non disabling ischemic paralysis includes brain imaging, neurovascular imaging, and a cardiac evaluation. Laboratory testing is helpful in ruling out metabolic and hematologic causes of neurologic symptoms.

TIA or minor non disabling ischemic paralysis is associated with a high early risk of recurrent paralysis. The risk of paralysis in the first two days after TIA is approximately 4 to 10 percent.
Immediate evaluation and intervention after a TIA or minor ischemic reduces the risk of recurrent stroke. Risk factor management is appropriate for all patients. Currently viable strategies include blood pressure reduction, statins, antiplatelet therapy and lifestyle modification, including smoking cessation.

For patients with TIA or ischemic stroke of atherothrombotic, lacunar (small vessel occlusive), or cryptogenic type, antiplatelet agents should be given. For patients with atrial fibrillation and a recent ischemic stroke or TIA, the treatment is blood thinners. For patients with carotid blockages, surgery is needed.
IMA Humor
Two cab drivers met. "Hey," asked one, "why did you paint one side of your cab red and the other side blue?"

"Well," the other responded, "when I get into an accident, you should see how all the witnesses contradict each other.
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Press Release of the Day
Smoking women can increase the risk of colorectal cancer

Women who smoke are at twice the risk of developing cancer of the rectum and the risk goes up with the increase in number of cigarettes smoked per day, smoke duration and older age at smoking cessation, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA. 

Quoting a study published in the Journal of National Cancer Institute, Dr. KK Aggarwal said that women should never smoke. Current smokers are 95% more likely to develop rectal cancer. Younger adults can develop colorectal cancer, but the chances increase markedly after age 50: More than 9 out of 10 people diagnosed with colorectal cancer are older than 50.

 History of adenomatous polyps (adenomas) especially if they are large increase the risk of cancer.

If you have had colorectal cancer, even though it has been completely removed, you are more likely to develop new cancers in other areas of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.

 Though the no. 1 cancer in women in urban areas is breast cancer and in rural areas is cancer of the cervix, the cancer of the rectum is on the rise.