March 23 2015, Monday
editorial
Cough Hygiene
Dr KK Aggarwal
  1. When you cough or sneeze, you tend to expel out respiratory waste, which can be droplets (larger than 5 microns) or airborne droplet less than 5 microns; both have different implications.
  2. Droplets remain suspended in the air only for a limited period and exposure of less than 3 feet is usually required for human to human transmission of droplet–borne respiratory organisms. In flu this can be upto 6 feet. The examples of droplet infections are patients with meningitis, influenza, rubella (German measles) etc.
  3. No precautions need to be taken by a person, who is 6–10 feet away from the patient but if a person is sitting or working even at a distance of 3–6 feet, the non–coughing person should wear simple mask.
  4. In contrast, airborne droplet nuclei, which carry respiratory secretions smaller than 5 microns can remain suspended in the air for extended period and can cause infections to people who are standing even more than 10 feet away. The example of airborne droplet nuclei infections are TB, measles, chickenpox and SARS.
  5. Patients with these diseases require to be placed in an isolation room and all those people who are looking after these patients must use a safe N95 mask.
  6. In normal house with open windows, there is a constant exchange of air, which prevents spread of infections but in rooms with air conditioners (ACs) with no air exchange, the infections can spread from one person to another.
  7. When sitting in an air conditioned atmosphere, the setting of the AC should be such that the same air is not circulated and fresh air is allowed to exchange. Split ACs, therefore, are more dangerous than the window ACs.
  8. In an office with split AC, if one of the employees is suffering from any of the droplet nuclei disease, he/she can transmit infection to others. Therefore, patients with confirmed TB, measles, chickenpox and SARS should not be allowed to work in offices with split ACs.
eMedipics IMA,IJCP,HCFI
An Inter Medical College Slogan contest was organized by Indian Medical Association
News
  • High levels of total and long-term physical activity, as well as specific types of physical activity, may decrease the risk for age-related cataract later in life, suggests an article published in Ophthalmology.
  • Current guidelines on giving thrombolysis 3 to 4.5 hours after stroke onset is based on uncertain evidence, and there needs to be urgent reconsideration of the available data to guide policy decisions, suggests a new review published March 17 in the British Medical Journal.
  • People aged above 65 who drink diet soda daily tend to expand their waistlines by much more than peers who prefer other beverages, possibly contributing to chronic illnesses, suggests a new study published online March 17 in the Journal of the American Geriatrics Society.
  • A new drug, named brentuximab vedotin (BV), seems effective in halting disease progression in adults with hard-to-treat Hodgkin lymphoma following stem cell transplantation, suggest the results of a phase 3 trial published in The Lancet.
  • Older adults who had spine imaging within 6 weeks of a new primary care visit for back pain had pain and disability over the following year that was not different from similar patients who did not undergo early imaging, suggested a study published in JAMA. Therefore, early imaging in these patients may not be associated with better outcomes.
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Dr KK Spiritual Blog
On 3rd Navratri control your fire and negative energies

Chadraghanta is worshipped on the third day of Navratri. SHE is shown with golden skin and riding a tiger. She is depicted with ten hands and 3 eyes with a crescent moon on the head.

Eight of HER hands display weapons. The rest two are in the mudras or gestures of boon giving and stopping harm (Varada and abhay mudra) indicating protection.

Out of eight hands five contains

1&2. Bow and arrow (to bend, focus, one point determination, The bow and arrows also represent energy. Holding both the bow and arrows in one hand indicates control over both potential and kinetic energies)

3. Trishul (balance)
4. Sword (sharp intelligence)
5. Cace (power to destroy the evil). Rest three hands contains

6. Rosary (tapas)
7. Lotus (detached attachment)
8. Kamandalu (acceptance).

In Ayurveda SHE represents the control over the fire element. In Yogashstra SHE represents the solar or Manipura Chakra with the Bija sound RAM.

Sound of her bell terrifies demons as well as all enemies. SHE represents protector and bravery.

Spiritual mantra on the 3rd Navratri

One should continuously (beaded rosary) control the fire (solar plexus) within by using our sharp intelligence (sword) and balancing the mind (Trishul) by focusing on one point (arrow and bow), practicing detached attachment (lotus), accepting things as they are (Kamandalu) and killing the negative energies by using gada (power) when needed.
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Cardiology eMedinewS
  • Routine thrombectomy with PCI for acute ST-elevation MI (STEMI) does not confer an advantage in CV death, recurrent MI, shock, or severe heart failure over 6 months compared with primary PCI alone, suggests a randomized trial called TOTAL, presented at the American College of Cardiology 2015 Scientific Sessions.
  • An antithrombotic regimen consisting of bivalirudin in ACS patients undergoing invasive management does not significantly reduce the 30-day risk of major adverse cardiac events (MACE) or net adverse clinical events, a co–primary end point including MACE and major bleeding, when compared with patients who receive unfractionated heparin, suggests the MATRIX study, presented at the American College of Cardiology (ACC) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Restricting the quantity of fructose children eat, but not the calories, may reduce their liver fat and the conversion of sugar to fat in the liver, suggests a new study presented at ENDO 2015, the annual meeting of the Endocrine Society.
  • Children's growth disorders can be detected earlier and more efficiently with the help of new growth monitoring tools, reports research from the University of Eastern Finland. These tools include up-to-date growth reference curves, evidence-based screening cut-off values for abnormal growth and automated growth monitoring based on electronic health records.
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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 trial suggest that this intervention is much better than thrombolytic therapy in such patients.
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Events
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Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

World Medical Association Declaration Principle VIII–Continuing Medical Education
  • All Physicians are committed to lifelong learning.
  • These educational experiences are essential if the physician is to keep updates of developments in medicine and if the physician is to maintain the knowledge and skills necessary to provide high quality care; scientific advances are essential to an adequate health care of the people.
  • Medical schools, hospitals and professional societies share the responsibility for developing and making available to all physicians opportunities for continuing medical education.
  • The demand to provide medical care, prevent disease and give advice in health matters calls for the highest standards of undergraduate post graduate and continuing medical education.
  • Internationally standardize methods of assessing professional competence and performance should be developed and applied in medical care
Dr Good Dr Bad
Situation: A patient with mediclaim policy required hospitalization for dental treatment.

Dr. Bad: It will not be covered.

Dr. Good: It will be covered.

Lesson: Clause 4.7 excludes dental treatment/surgery unless requiring hospitalization.

(Copyright IJCP)
IJCP Book of Medical Records
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eMedi Quiz
An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde-3-phosphate Dehydrogenase.
2.Phosphoglucomutase.
3.Lactate-dehydrogenase.
4.Glucokinase.

Yesterday’s Mind Teaser: All of the following conditions may predispose to pulmonary embolism except:

1. protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy

Answer for yesterday’s Mind Teaser: 4. Progesterone therapy

Correct Answers received from: Dr B R Bhatnagar, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr KV Sarma.

Answer for 21st March Mind Teaser: 1. Propamidine.

Correct Answers receives: Dr Prabodh K Gupta, Prateek, Daivadheenam Jella, Dr Avtar Krishan, Dr KV Sarma.
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Rabies News (Dr A K Gupta)
If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
Sonal Namaste
What should you do if you don’t have soap and clean, running water?

Bottle of hand sanitizer

Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.
Facts about Tuberculosis (TB)
What treatment is available for TB?
  • TB is treated through a combination of following drugs:
  • Isoniazid (INH)
  • Rifampicin
  • Pyrazinamide
  • Ethambutol
  • Streptomycin
  • Combination of drugs is administered to kill all the bacteria and prevent them from becoming resistant to one or more drugs.
  • The treatment is given for 6-9 months
OTHER APPRECIABLE SLOGANS RECEIVED BY IMA HQs. FROM MEDICAL STUDENTS RELATED TO CURE OF TUBERCULOSIS
SLOGAN
Name of Student
College
Gali gali mey DOTS hoga, Ghar ghar se TB Hatega
Shubham Sethy
Medical College & Hospital, Bhubaneswar, Odisha
Ghar ghar mey DOTS ho, har log TB mukt ho
Shubham Sethy
Medical College & Hospital, Bhubaneswar, Odisha
Gaon gaon mey DOTS hoga
Shubham Sethy
Medical College & Hospital, Bhubaneswar, Odisha
Har jagah DOTS pahunchiye, Desh bhar se TB hatega.
Shubham Sethy
Shubham Sethy
Bharat ko TB mukt kariye''
Shubham Sethy
Medical College & Hospital, Bhubaneswar, Odisha
DOTS ko hum apnayenge, TB mukt susth Bharat Banayenge
Shubham Sethy
Medical College & Hospital, Bhubaneswar, Odisha
Cover your cough; get the BCG vaccine.
Tanvi Agarwal
Santosh Medical College, Ghaziabad
Be TB free by maintaining good hygiene
Tanvi Agarwal
Santosh Medical College, Ghaziabad
BCG vaccine, on birth, is the main face
Aishwarya Pundir
Santosh Medical College, Ghaziabad
Covering your cough& sputum test after 21 days.
Aishwarya Pundir
Santosh Medical College, Ghaziabad
Regular medication won't let it spread more.
Aishwarya Pundir
Santosh Medical College, Ghaziabad
One Hand - Keerchief - Prevents TB mischief
K.Lakshmi Madhuri
Santosh Medical College, Ghaziabad
Be TB free and let healthy life soar.
Aishwarya Pundir
Santosh Medical College, Ghaziabad
Awareness is the key to ' TB FREE INDIA ' making !
Aishwarya Pundir
Santosh Medical College, Ghaziabad
Fighting cough doesnt make you tough-
Twesha
Santosh Medical College, Ghaziabad
The kiss of affection, the germ of infection
Sehyr
Santosh Medical College, Ghaziabad
Get ur partner tested for TB
Sehyr
Santosh Medical College, Ghaziabad
Hum sabka ek he hai nara, Tb sey mukt ho sheher humara
Sehyr
Santosh Medical College, Ghaziabad
Cough, Sneeze, Spit and kisses of affection do it sensibly to prevent and eradicate Tuberculosis
- Annanya Mitra
Santosh Medical College, Ghaziabad
Give BCG to children and to adults give tissues; And voilà! TB will cease to be an issue!
Neha Saini
Santosh Medical College, Ghaziabad
Help all your coughing neighbours get to the DOTS unit, Because treatment for the ill is prevention for the fit!
Neha Saini
Santosh Medical College, Ghaziabad
Diagnosis is simple, treatment accessible and cure unambiguous; Not the bacteria, it's ignorance that's killing us!
Neha Saini
Santosh Medical College, Ghaziabad
"Get Vaccine Shorts of DOTS and see the Lungs FIGHT against TB"
Prachi Aggarwal
 
Stand United and Thrash the Deadly Disease
Prachi Aggarwal
 
Swatchta Ko Milkar Apnana Hai
Yasir Mehtab
 
TB Ko Door Bhagana Hai, Desh Ko Swasth Bnana Hai
Yasir Mehtab
 
When Bacteria Can Work So Well Together- Why Can't We???
Yasir Mehtab
 
Chalo Bharat ka bhaar ghatayen milkar kar TB ko desh se bhagayen
Swagat Kumar Khamari
 
TB KI BIMARI SE HAI BACHNA, DOTS APNAO DOTS HAI APNA
Anjum Fatima
HIMSR, Jamia Hamdard, New Delhi
TB KE SUN LO LAKSHAN KHASI HO DO HAFTO SE, BUKHAAR HO CHADTA UTARTA , BHOOK BHI NA LAGTI HO, BALGUM MEI KHOON AATA HO, WAZAN BHI HO JAE AADHA.
Anjum Fatima
HIMSR, Jamia Hamdard, New Delhi
DOTS KA PUCCA WADA 6-8 MAHINE ILAAJ KAR LO PURA, DOTS CENTRE MEI JANA DAWAAI WAHI KHANA NAAGA NA ISME TUM KARNA TB KI BIMARI SE HAI BACHNA DOTS APNAO DOTS HAI APNA
Anjum Fatima
HIMSR, Jamia Hamdard, New Delhi
TB will take away a good fare until you are consciously aware
P. Ramanath Reddy
Kurnool Medical College
Dare it is ur life with TB, Rare it is with vaccine for TB
P. Ramanath Reddy
Kurnool Medical College
TB cannot make any fear because vaccine for it has made it clear
B. Saikrishna Reddy
Kurnool Medical College
TB is not really rare, it may turn out to be your nightmare so the best is to make aware
S. Amar Kishore Kumar Reddy
Kurnool Medical College
TB is not our final fate stop it from spreading to yourmate
V. Rahuldev
Kurnool Medical College
RNTCP a weapon to fight TB making India a happy place to be
M. Shruthi
Kurnool Medical College
Tuberculosis, a big cause of worry?
B. Sindhija
Hi-Tech Medical College & Hosp. Utkal University, Bhubaneswar, Orissa
"Kick TB out of INDIA, be a part of healthy INDIA"
Manish Panigrahi
Kurnool Medical College
Practice ‘DOTS’ to eradicate TB and make merry.
 
 
When a virus (HIV) and bacteria (TB) can together, why can’t we?
G. Akhila
Kurnool Medical College
Ensure cleanliness everywhere, hence, infectious diseases like TB can fine a place nowhere
Suguna Sophia G
Kurnool Medical College
Tuberculosis- ur kiss of affection maybe germ of infection
K. Poojith
Kurnool Medical College
If a backerium spreads as fast as a whatsapp message its eradication should be faster than a facebook post
R. Jayanth
Kurnool Medical College
TB is gonna eat our day so wipe it off from your way
G.S.M.S. Sainadh
Kurnool Medical College
TB get off my way, I still have long like to stay
M.A. Jeevan Sai
Kurnool Medical College
Don’t sit like an idle cow go know about the TYB now
P.Anantha Nag
Kurnool Medical College
What makes TB laugh at… is the ignorance we don’t care …..
M. Ravi Teja
Kurnool Medical College
Bane saphayi se swatch Bharath Binaa TB se swasth Bharath
K. Jyothi
Kurnool Medical College
TB rahith Hindustan duniya mein hoga pahala sthan
K. Jyothi
Kurnool Medical College
TB is not fair - fight for the cure, if u care
C. Niveditha
Kurnool Medical College
Hum subka hein, ek hi nara TB mukt hoo, sgahar hamaraa
C. Niveditha
Kurnool Medical College
If TB goes drug resistant, they why cant we be TB resistant
C. Akshitha
Kurnool Medical College
6 mahine ke DOTS ke course se, TB nikalo force se
Almas Agwani
 
Inspirational Story
Did you know…?

That Joan of Arc was only 17 when she was riding at the head of the army that liberated France from the English? That John Calvin was 26 when he published his "Institutes"?

That John Keats died when he was 26? That Shelley was 30 when he was drowned, but not before he left English literature his classic "Odes"?

That Sir Isaac Newton had largely discovered the working of the law of gravitation when he was 23? That Henry Clay, the "great compromiser," was sent to the United States Senate at 29 and was Speaker of the House of Representatives at 34?

That Raphael painted his most important pictures between 25 and 30? That Mozart only lived 35 years?

Of course, most of us will never achieve the prominence of these extraordinary individuals. Nor should we –– we are each cut from a unique pattern. But many people feel as if they should be leaving more of a mark on the world. When I was a young man I wanted to make things happen. After a few years I realized I would have to content myself with watching most things happen. (Now I often find that I have no idea at all what is happening!)

It helps to remember that there is a time for everything – and everybody. Our time to bear good fruit may be yet to come. In fact, we may do our best work, or find our unique place, later in life.

Colorado aspen trees grow vigorously. After the devastation of a forest fire, frequent occurrences in the Rockies, aspens are sometimes the first trees to return. They re-forest an area quickly, providing shade for slower–growing spruce and pine saplings. These evergreens grow slower, but may live many years longer than the aspens. Each tree grows in its own time.

So does each person. Some people come to fruition quickly; others contribute more significantly in later years.

If you’ve not yet come into your own, don’t worry. Tend to your work and aspirations with care. Don’t give up; but rather be patient, for growth can be slow. Remember, storms and disease are devastating, but they can also prune you and make you stronger. With proper nurture, you will in time enjoy a full harvest.

There is a time for everything and everybody. And the time to begin is now.
Wellness Blog
Warning signs of worsening heart failure

If you have heart failure, call your doctor if you notice any of these signs:
  • Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up feeling short of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental confusion
  • Loss of appetite
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The International Food Shortage

Recently, a worldwide survey was conducted and the only question asked was: "Would you please give your honest opinion about the solution to the food shortage in the rest of the world?"

The survey was, not surprisingly, a huge failure. Because:

In Africa they didn’t know what "food" meant.

In Eastern Europe they didn’t know what "honest" meant.

In Western Europe they didn’t know what "shortage" meant.

In China they didn’t know what "opinion" meant.

In the Middle East they didn’t know what "solution" meant.

In South America they didn’t know what "please" meant.

And, in the USA they didn’t know what "the rest of the world" meant.
Quote of the Day
If we wait until our lives are free from sorrow or difficulty, then we wait forever. And miss the entire point. Dirk Benedict.
Reader Response
  1. It would be interesting for these so called up holders of justice to ponder what punishment is meted for those with malpractice amongst the judiciary, police and politicians while they target weaker section of professionals! Sad Dr Binoy John
  2. Kudos to Dr KK Aggarwal for his excellent edits and vedantic gyan! It is the icing on the cake! Dr Hemang D Koppikar
IMA Inter Medical College Slogan contest on Tuberculosis
An Inter Medical College Slogan contest was organized by Indian Medical Association.

The Slogan by Mr. Swagat Kumar Khamari “TB KO DESH SE HATANA HE TOH DOTS KO HAME APNANA HAI” won the best Slogan Award.

The Slogan by Mr. Sameer Singh “AAO MILKAR DOTS APNAYE, AUR TB KO GHAR SE BHAGAYE” from Hi-Tech Medical College & Hospital, Bhubaneshwar won the Second Prize.

The Slogan by Mr. Amir Hussain “TB KE NIYANTRAN KA CHHOTA SA HAIN RAAZ, JALDI KARO JAANCH, PURA KARO ILAAJ and Slogan by Mr. Khalid Zafar “EK HI LAKSHYA EK HI NAARA TB UPCHAR MEIN DOTS SAHARA” both from HIMSR (Jamia Hamdard) won the Third Prize jointly.

Over 300 Slogans were received by Indian Medical Association. The jury included Dr K K Aggarwal, Dr R N Tandon, Dr N V Kamath, Dr V K Monga, Dr A C Dhariwal, Dr Neena Valecha, Dr Saurabh, Dr Nagpal, Dr Dinesh Negi and Dr Anil Goyal.

Releasing the results, Padma Shri Awardee Dr A Marthanda Pillai, National President, IMA and Padma Shri Awardee Dr K K Aggarwal, President, Heart Care Foundation of India and Hony. Secretary General, IMA said that a catchy slogan becomes an important part of any campaign. As TB is curable by regular treatment by Directly Observed Treatment; therefore the message of DOTS is necessary to reach every house hold.

The word DOTS is an abbreviated form of "Directly Observed Treatment – Short Course" and it means that every TB case is given treatment under direct supervision to the TB Case.

As TB resistance is dangerous, DOTS becomes important so that direct complete treatment is given.

The aim of IMA TB Initiative is to register all cases online and fight TB in Coherent manner to prevent development of drug resistance against TB.