April 23  2015, Thursday
Heart disease starts in youth
Dr KK AggarwalAutopsy studies of young people who died in accidents have shown that by the late teens, the heart blockages, the kind of lesions that cause heart attacks and strokes are in the process of developing.

The best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early. More than a third of children and adolescents are overweight or obese.

The first signs that men are at higher risk of heart disease than women appear during the adolescent years despite the fact that boys lose fat and gain muscle in adolescence, while girls add body fat.

Between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increases in the boys and drops in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, go down in boys but rise in girls.

Blood pressure increases in both, but significantly more in boys. Insulin resistance, a marker of cardiovascular risk, which is lower in boys at age 11, rises until the age of 19 years.

Any protection that the young women have for cardiovascular protection can be wiped out by obesity; hence, obesity in girls at any cost should be handled on priority.
Heart Care Foundation of India, a leading national non-profit organization jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India today celebrated World Earth Day
  • Of the more than 2.5 million emergency department visits related to drug abuse in the United States in 2011, more than half resulted from illicit drug use. Approximately 40% of these visits were related to cocaine use, which indicates that cocaine is perhaps one of the most commonly used illicit drugs in the U.S. In 2012, 2.2% of the U.S. population aged 12 years and older used cocaine.
  • The US Food and Drug Administration (FDA) has approved the first short-distance vision implant for certain patients with presbyopia who have had no cataract surgery. Besides this, the implant is intended for use in patients 45 to 60 years old who are unable to focus clearly on near objects or small print and need reading glasses with +1.00 to +2.50 diopters of power but do not need glasses or contacts for clear distance vision.
  • The siblings of patients with Crohn's disease have similar mucosal microbial dysbiosis that may contribute to the disease, suggests new research published online in Gut.
  • Patients with Duchenne muscular dystrophy (DMD) who took the oral drug idebenone for 12 months showed significantly lesser decline in standard respiratory function measures including peak expiratory flow (PEF) in a placebo-controlled trial published online in The Lancet.
  • New research published in Diabetes Care has suggested that the prevalence of prediabetes and diabetes differs among Asian Indians depending on where they live, with those residing in the United States having a 20% higher prevalence of prediabetes vs those living in India. However, Asian Indians living in India have a 50% higher prevalence of type 2 diabetes than those living in the United States.
Dr KK Spiritual Blog
The Vedic meaning of Mahamritunjaya Mantra and the Gayatri Mantra

Any activity should always engage the 3 H model of Heart, the Head, and the Hand. The same has been advocated by the western scholars of today. The concept is that while doing any work one should ask the head for choices and then refer these choices to the heart to choose one and finally order the hands to carry out that action.

In his book ‘The Seven Spiritual Laws of Success’, Deepak Chopra writes that conscious–based decisions are the best decisions. Before taking any decision he recommends asking the body for signals of comfort or discomfort and if the signals of discomfort are perceived, then one should not carry out that action.

All the above concepts come from our ancient Vedic knowledge. The two main mantras of our times are the Mahamritunjaya Mantra and the Gayatri Mantra.

The Mahamritunjaya Mantra is from the Rig Veda and needs initiation for attaining any Siddhi. This is the greatest reliever from all evils and reads as under: Aum Trayambakam Yajamahe, Sugandhim Pushtivardhanam; Uruva Rukamiva Bandhanan, Mrityor Mokshiye Mamritat. It means we worship Shiva, the Three–Eyed Lord; who is fragrant and nourishes all beings; May he protect us (bandhanana) from all big (urva) diseases (aarookam). May he liberate us (mokshiye) from death (mrityor), For the sake of immortality (mamritat, amrit); as the cucumber is automatically liberated, from its bondage from the creeper when it fully ripens.

The meaning of the mantra is the importance of the third eye and the benefits of its opening. The two eyes are at the level of the physical body. The third eye means the eyes of the mind and the eyes of the soul. It also indicates that in difficulty one should look inward from the eyes of the mind and ask for the choices. Like the cucumber, one should chose the good ones and drop the bad choices (Jo achcha lage use apna lo, jo bura lage use jane do).

The mantra for the conscious–based decision comes from Gayatri mantra: Om Bhur Bhuvasvaha Thath Savithur Varenyam Bhargo Devasya Dheemahi Dhiyo Yonaha Prachodayath. It means we meditate on the glory of the Creator; who has created the Universe; who is worthy of Worship; who is the embodiment of Knowledge and Light; who is the remover of all Sin and Ignorance; may He enlighten our Intellect.

It talks about the importance of conscious–based decisions and its directions to the intellect to choose the right and not the convenient actions.

The Gayatri is the Vedic prayer to illuminate the intellect. Gayatri is considered as Vedasara –– "the essence of the Vedas." Veda means knowledge, and this prayer fosters and sharpens the knowledge–yielding faculty. As a matter of fact, the four mahavakyas or ‘core–declarations’ enshrined in the four Vedas are implied in this Gayatri mantra.

Choosing the right decision from the consciousness was later defined by Buddha. He taught that before any action ask yourself the following four questions and if the answer to any of the question is no, not to indulge in that actions. These four questions are: is it the truth, is it necessary, will the actions bring happiness to you and to the others.
Cardiology eMedinewS
  • Ivabradine has been approved by US FDA for reducing the risk for hospitalization from worsening heart failure. The drug is indicated for stable patients with heart failure and a heart rate of >70 per minute on maximally tolerated beta-blockers
  • In patients with atrial fibrillation (Afib) and sleep apnea, continuous positive airway pressure (CPAP) treatment was associated with a 42% relative risk reduction of Afib recurrence, and the reduction was independent of other treatments as reported in JACC: Clinical Electrophysiology. The meta-analysis establishes CPAP as an important treatment option for Afib.
Quote of the Day
Success usually comes to those who are too busy to be looking for it. Henry David Thoreau
Pediatrics eMedinewS
  • A new retrospective review of children with genetically identified long-QT syndrome (LQTS) compliant with medical therapy suggests that complete avoidance of physical activity and sports might be unnecessary. The review is published in the March/April issue of JACC: Clinical Electrophysiology.
  • Receipt of the measles, mumps, and rubella (MMR) vaccine was not linked to an increased risk for autism spectrum disorder (ASD), even when older siblings had ASD, suggests a new study published in the April 21 issue of JAMA.
Make Sure
Situation: A patient died after receiving penicillin injection.

Reaction: Oh my God! Why was anaphylaxis not suspected?

Lesson: Make sure that each time a patient is given penicillin injection, anti-anaphylaxis measures are available.
Dr Good Dr Bad
Situation: A patient with Chikungunya was found to have high ESR.
Dr. Bad: It may not be Chikungunya.
Dr. Good: It is Chikungunya.

Lesson: High ESR is seen in Chikungunya.

(Copyright IJCP)
eMedi Quiz
During rapid sequence induction of anesthesia:

1. Slick’s maneuver is not required.
2. Pre-oxygenation is mandatory.
3. Suxamethonium is contraindicated.
4. Patient is mechanically ventilated before end tracheal incubation.

Yesterday’s Mind Teaser: Over a 4-day period, five men, four women, and six children are admitted to Philadelphia metropolitan hospitals with fever, prostration, hypotension, and various degrees of mucosal bleeding. All patients have thrombocytopenia, leukopenia, and elevated liver and renal function tests. None of the patients have travelled outside the mid-Atlantic area in the past 3 months. A viral hemorrhagic fever is suspected. Which one of the following epidemiological clues most strongly suggests that the outbreak is the result of a deliberate epidemic?

A. Multiple simultaneous epidemics of different diseases
B. Unusual age distribution of a common disease
C. Unusual antibiotic resistance pattern
D. Unusual geographic clustering of disease
E. Unusual route of exposure

Answer for yesterday’s Mind Teaser: D. Unusual geographic clustering of disease

Correct Answers received from: Daivadheenam Jella, Dr Shangarpawar, Dr Pandit Hantodkar, Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G

Answer for 21st April Mind Teaser: Tamoxifen may be associated with an increased risk of ischemic cerebrovascular complications.

Correct Answers received: Dr KV Sarma, Dr K Raju, Dr Avtar Krishan.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA News
Conference Update - Diabetes India 2015
Primary prevention of type 2 diabetes in India

Dr A Ramachandran, Chennai
  • There have been several pioneering prevention programs in the world like the DPP in the US, IDPP in India. The first prevention program was in China.
  • IDPP screened populations to recruit subjects at risk of developing diabetes with outcome to prevent or postpone onset of type 2 diabetes.
  • IDPP-1 (Diabetologia 2006;49:289-297) formed the background to do further studies on prevention of diabetes in subjects with IGT among Indians (Diabetologia May 2009; The Lancet Diabetes Sept 2013).
  • IDPP-1 randomized study subjects into 4 groups: No intervention, lifestyle modification, metformin and lifestyle modification + metformin. We had 95% participation adherence after 3 years. The trial concluded that lifestyle modification significantly reduced conversion to diabetes by 28.5%, metformin by 26.4% and lifestyle modification + metformin by 28.2%.
  • Difference between Indian study and western studies
    • Indians develop IGT at least one decade earlier
    • BMI is much lower
    • We use metformin at a much lower dose
    • Moderate lifestyle modification advocated
    • Weight loss was not significant
  • The primary prevention trials so far, have proved that lifestyle intervention can reduce incidence of diabetes in high risk subjects. But, such programs are labour intensive, costly and have not been widely implemented, even in high-income countries.
  • The pilot study in J Assoc Physicians India 2011 Nov;59:711-4 by Shetty AS et al showed that frequent communication via SMS was acceptable to diabetic patients and it helped to improve the health outcomes.
  • A new study evaluated whether tailored SMSs encouraging lifestyle changes could reduce incidence type 2 diabetes in Indian men with IGT (Lancet Diabetes Endocrinol. 2013 Nov;1(3):191-8). In the study, controls were given standard care advice; intervention group received standard care + motivational text messages, which were tailored according to stage of TTM. There was 36% relative risk reduction in T2DM and 9% absolute risk reduction. HDL-C improved, dietary adherence improved, no sign of improvement in physical activity.
  • A study published in Nov 2014 issue of Diabetes Care showed that early improvement was associated with a 75% lower incidence of diabetes in 2 years when compared with the remaining dysglycemic persons.
  • Increased triglycerides and increased waist circumference strongly associated with IR (Diabetes Medicine 2014 Jun 9): hypertriglyceridemic waist phenotype (HTWP): WC =90 cm; serum TG = 1.7 mmol/l. It can be used as a simple proxy for IR.
  • The oral disposition index is a strong predictor of incident diabetes in Asian Indian prediabetic men (Acta Diabetol. 2015 Feb 12).
Key messages from the SMS study
  • Mobile messaging could be a practical and affordable strategy to deliver lifestyle advice to delay or prevent onset of T2DM.
  • The ancillary studies have provided insight into the prediction and pathogenesis of diabetes in the Indian population.
  • This study is one of the 1st examples of clinical outcome using mobile technology or m-Health.
Sonal Namaste
Diarrhea Prevention

Recommendations to reduce subsequent episodes of diarrhea, malnutrition, and delays in physical and mental development.
  • Exclusive breastfeeding until age 6 months
  • Continued breastfeeding with complementary foods until 2 years of age.
  • Complementary feeding may be considered in younger infants if growth is inadequate.
  • Consumption of safe food and water.
  • Water brought to a rolling boil for at least 5 min is optimal for preparing food and drinks for young children.
  • Handwashing after defecating, disposing of a child's stool, and before preparing meals.
  • Latrines should be located more than 10 meters and downhill from drinking water sources.
Malaria Keypoints
Treatment of P. falciparum should be with Artemisinin combination therapy (ACT) and Primaquine. ACT recommended is Artesunate + Sulphadoxine-Pyrimethamine. In North-eastern states, it is Artemether + Lumefantin.
Inspirational Story
A Message by a Woman

Someone asked me "Are you a working woman or a housewife?

I said: Yes I am a full time working Housewife. I work 24 hours a day I am a Mom, a Wife, Daughter and a Daughter–in–Law.

I am an alarm clock, Cook, Maid, Teacher, Waiter, Nanny, Nurse, Handyman, Security officer, Counselor and a Comforter. I don’t get Holidays, sick leave or days off; I work through Day and Night.

I am on call all hours and get paid with a sentence "What you do all day at home"
Wellness Blog
Choose to become a father before you are 40

Men should think about becoming fathers much before 40 years in order to minimize the effects of age on fertility and outcomes of pregnancy. The ideal age to become a father is between 25–35 years.

The age of sperm donors as per recommendations should be less than 40 years of age. Beyond this age, the sperm quality is reduced considerably and this may adversely affect fertility and pregnancy outcomes.

Researchers from the French National Institute for Medical Research has reported that miscarriages rates were higher in women whose partners were older than 40 years when compared to women whose partners are young men. This risk doubled when their partners were 45 years of age.

Older fathers are more likely to have a child with schizophrenia, heart defects, cleft lip, Down syndrome or a child being born autistic.

In women, pregnancy after 35 years of age is generally regarded as high risk with greater chances of birth defects and miscarriages. But, according to the researchers, the age of the male should also be taken into consideration by gynecologists.
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Reader Response
Dear Sir, emedinews is very informative newspaper. Regards: Dr Kirat
IMA Videos
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IMA Humor
Slow Mom, Fast Mom!

Little Freddie's mother was in the hospital, and he was paying a visit to see his new brother. He wandered into an adjoining room which was occupied by a woman with a broken leg.

"Hello," he said. "How long have you been here?"

"Oh, about a month."

"Let me see your baby," he then asked.

"Why, I haven't a baby," the woman replied.

"Gee, you're slow," said Freddie. "My mama's been here just two days and she's got one."
Heart Care Foundation of India celebrates World Earth Day 2015
Hosts inter-school activities for over 400 students jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India and H.M.DAV Sr. Sec. School Daryaganj

Heart Care Foundation of India, a leading national non-profit organization jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India today celebrated World Earth Day. On the occasion, various inter school activities were organised at H.M.DAV Sr. Secondary School, Daryaganj, the co-host school. The theme for this year’s celebrations was “Clean Earth – Green Earth” and students from 15 to 20 schools were seen participating in competitions including placard designing, painting and model display. The underlying message of the event was the importance of Swachchtha and its close link with living a healthy life.

Speaking at the event, Dr K K Aggarwal, President, Heart Care Foundation of India and Hon. Secretary General, Indian Medical Association said, “We at Heart Care Foundation of India have been celebrating World Earth Day since almost three decades. This year we have dedicated ourselves to raising awareness about how just keeping one’s environment clean over 50 percent of the common health diseases can be prevented. I am grateful to our Prime Minister Honorable Narender Modi Ji for initating a campaign as noble as the ‘Swachh Bharat Abhiyan and urge every person to join and support it”.

“I will also like to highlight here that in the 21st century we are facing various environmental emergencies such as global warming, increase in the occurance of natural disasters, changing weather patterns that can have disastrous consequences in the future. It is the duty of every person to live an environment friendly life by saving water and electricity, using solar options where possible and reducing noise pollution. We need to promote good practices such as walking and cycling instead of using cars to move around when possible, using public modes of transport and reducing pollution which is the leading cause of lifestyle diseases in today’s date and age. We are thankful to Ministry of Earth Sciences for their relentless support throughout these years and hope that we can together continue to make a difference.”

Different competitions for students belonging to primary (1st to 5th standard), middle (6th to 8th) and senior classes (9th to 12th standard) were held. Junior section students participated in placard making wherein they framed messages on ‘global warming’. The little ones took everyone aback with the depth of their messages. Students from middle participated in a painting competition the topic of which was ‘Use of natural resources’. The young artists displayed imagination at its best and their painitngs will be displayed around the school for others to see and learn. Senior school students designed models on the theme ‘Green House effect’. Through varied glass models, students showcased their own interpretations of the phenomenon. Winners from each category were awarded and participation certificates were handed over to each and every participant.

Being the co-host of the event Shri R K Tiwari, Principal, H.M.DAV School, Daryaganj, said, “We are glad to be associated with Heart Care Foundation of India for the event. Children are the future of our country. Considering the serious environmental concerns that the world is facing, it is important to create awareness among them about ways to protect our surrounding. We always believe in propagating futuristic thinking for our students. Today’s activities would make the students think about the various environmental problems and come up with means to tackle them.”

Dr. Anil Sabarwal, CMD, Sabarwal Hospital, Daryaganj, who was the Chief Guest for the event said, “I would like to congratulate Heart Care Foundation of India for taking such a noble initiative. Besides damaging the environment; hazards such as global warming and increase in pollution are also causing various health problems. In the past few years we have seen a massive rise in fatal diseases like cancer. We cannot rule out the role of environmental pollution for this increase. Thus, it is important that every citizen should be aware of the necessity to keep our environment clean, green and disease free.”
Rabies News (Dr A K Gupta)
What does humanizing your dog means?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.