June 23  2015, Tuesday
Tips on family history of high cholesterol
Dr KK Aggarwal Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL("bad cholesterol") levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.
IMA Tinsukia Branch (Assam) observed World Environment Day by cleaning the premises of IMA House and also cleaning the surroundings of the existing plants and trees around the building;14 members were present.
  • NEW YORK: India created two world records on International Yoga Day with the yoga performance at Rajpath led by Prime Minister Narendra Modi: The record for largest yoga class, with 35,985 people, and the record for most nationalities participating in a single yoga event -- 84.
  • Ms Sushma Swaraj also attended the celebrations held at New York's Times Square, with hundreds of people joining a yoga session. A mass yoga session was held at the Visitor's Plaza in the UN Headquarters too -- a "first in UN history," tweeted MEA spokesperson Vikas Swarup.
  • At the commencement of what is possibly the largest congregation to practise Yoga, Prime Minister Narendra Modi declared Rajpath had become 'Yogpath' (the path of Yoga) on Sunday."Did anyone ever think that Rajpath can become 'Yogapath'?" Mr. Modi said.
  • Researchers suggest that along with vaccination programs, intense environmental surveillance is also important to achieve polio eradication. They demonstrated that there can be sustained chains of silent transmission in populations for more than 3 years, without a single person ever showing up as a reported polio case. The findings are published in PLoS Biology.
  • Researchers from Scotland bring to light their concern that a wrongly diagnosed zinc deficiency can lead to copper deficiency due to the treatment can lead to too much zinc. The findings are published in the Journal of Clinical Pathology.
  • Prior vaccination against herpes zoster (HZ) among some patients who later develop the virus reduces their risk for postherpetic neuralgia (PHN) compared with those who are not vaccinated, according to results from a new cohort study published online June 1 in the Journal of Infectious Diseases.
  • Individualized preventive topical corticosteroid (TCS) regimens are best for the long-term management of adult vulvar lichen sclerosus (VLS) as reported online in JAMA Dermatology. According to Dr. Andrew Lee, from the University of Sydney, New South Wales, Australia, daily use of TCS coincided with a decreased risk of cancer and also helped to preserve the vulval architecture, both of which are major concerns in the treatment of VLS.
Cardiology eMedinewS
  • Analysis of data from 96 participants in the Heart Attack Prevention Programme for You (HAPPY) London (HAPPYLondon) study found that in patients free of hypertension symptoms or left ventricular (LV) hypertrophy, those with a high systolic blood-pressure reading in a clinic measurement had a higher LV ejection fraction (LVEF) than those with a normal systolic blood-pressure reading (European Society of Hypertension (ESH) 2015 Scientific Sessions).
  • A novel method of quantifying the risks of major bleeding and stent thrombosis may guide decisions about the duration of dual-antiplatelet therapy in stent recipients. A two-pronged approach relying upon a CRUSADE bleeding risk score greater than 40 as a red flag cautions against 24 months of dual-antiplatelet therapy (DAPT) in favor of 6 months, while also taking into consideration the anatomic location of an individual’s coronary artery disease as a guide to ischemic risk, such as stent thrombosis (European Association of Percutaneous Cardiovascular Interventions Annual Congress).
Pediatrics eMedinewS
  • Allaying concerns about performing RCTs in the vulnerable extremely preterm infants, data from a retrospective analysis of more than 5000 extremely preterm infants showed that those enrolled in randomized clinical trials (RCTs) had outcomes no different from those of similar infants who were not participants in RCTs (June 16 JAMA).
  • Children whose parents smoked when they were toddlers are likely to have a wider waist and a higher BMI by time they reach 10 years of age in comparison to those who have not been exposed to second hand smoke.
Dr KK Spiritual Blog
The Science behind Training and Development

Training in any field requires gaining knowledge, skills and positive mental attitude towards the object of learning.

Knowledge is everything about what and why. In Yoga, it correlates with the Gyan (Gnana) Marg. Skill is all about how to do it and correlates with Karma Marg.

The positive mental attitude is linked to willingness to do any work or in other words one’s Astha in that action. In Yoga, it is synonymous with Bhakti Marg.

In Bhagwad Gita, Lord Krishna talks about all the principles of management including how to train and develop an individual.

The development teaches and increases one’s intelligence quotient (IQ), physical quotient (PQ), emotional quotient (EQ) and moral quotient (MQ).
Make Sure
Situation: A dengue patient with BP 100/90 developed shock.

Reaction: Oh my God! Why was rapid fluid challenge not given?

Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue
Dr Good Dr Bad
Situation: A patient on aspirin was to go for non vascular surgery.

Dr Good: Stop aspirin for seven days.

Dr Bad: Stop aspirin fir two days.

Lesson: Based on POISE-2, we recommend discontinuing aspirin about seven days before noncardiovascular surgery.
eMedi Quiz
A measure of location which divides the distribution in the ratio of 3:1 is:

1. Median.
2. First quartile.
3. Third quartile.
4. Mode.

Yesterday’s Mind Teaser: Elements of primary health care include all of the following except:

1. Adequate supply of safe water and basic sanitation.
2. Providing essential drugs.
3. Sound referral system.
4. Health Education.

Answer for yesterday’s Mind Teaser: 3. Sound referral system.

Correct Answers received from: Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella.

Answer for 21st June Mind Teaser: 1. Hydatidiform mole.

Correct Answers received: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Nikhil Mohanty, Dr G Madhusudhan.
Rabies News (Dr A K Gupta)
Can rabies vaccine be given to HIV or AIDS patient?

Rabies vaccine can be given to HIV or AIDS patient. RIGs are recommended even in category II exposures in such patients and double the dose of anti–rabies vaccine must be given on day 0 of vaccination.
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
Press Release
Nasal wash adopted from Jal Neti now is a standard treatment

Many people with asthma also have nasal and sinus secretions, which if present, can make asthma worse. A salt water nasal wash or nasal irrigation adopted from the traditional Indian Jal Neti now has become a standard treatment.

A nasal wash cleans nasal secretions so that nasal drugs can be more effective. It cleans allergens and irritants from the nose reducing their impact; cleans bacteria and viruses from the nose reducing infection and decreases swelling in the nose and increases air space, said Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, Indian Medical Association (IMA) and President, Heart Care Foundation of India

However, while doing a nasal irrigation, following precautions needs to be taken:
  • Wash your hands before the procedure.
  • Do not use well water.
  • Do not use Tap water.
  • One can use boiled, filtered, distilled, RO or sterilized water.
  • If Tap water is used, it should be roll boiled for 1 minute and then cooled.
  • If filtered water is used, filter should have pores the size of 1 micron or smaller.
  • Half teaspoon of non iodized salt should be added in an 8 oz. glass of water.
  • Iodized salt may be irritating to the nose
  • A pinch of baking soda is added to the solution before use.
  • For one single wash, 4 oz. are enough but if the nose is congested, 8 oz. can be used.
  • Prepare a new salt water solution each time.
  • After the nasal wash, left out water should be taken out from the nasal cavity by repeated blowing of the nose.
  • The pot should be thoroughly cleaned after each use.
  • Always do the nasal wash procedure while leaning over the sink or basin.
  • Nasal wash can also be done 1 hour before bed to help one breathe better and more deeply.
  • It can also be done before doing respiratory exercises.
  • In individuals who have nasal allergy, nasal wash will help to reduce the allergen load.
eIMA News
  • Indian Medical Association, Kancheepuram branch participated in International Day of Yoga event organized by Yoga & Naturopathy – Lifestyle Clinic, Government District Headquarters Hospital, Kancheepuram on Sunday 21st June 2015 from 08.00 am – 09.00 am at the Government District Head Quarters Hospital, Kancheepuram.
  • Tamil Nadu Sathyamangalam IMA members along with Vivekanatha Yuva Kendra students celebrated International yoga Day at P Puliampatti on 21st of June.
  • On Quackery: Deccan Herald: “But in most cases, they manage to secure a bail. There is a need to change the provision in which the punishment is extended beyond three years. It needs to be made a non-bailable offence,” says Dr K K Aggarwal, Honorary Secretary, Indian Medical Association (IMA).
  • If the doctor did something intentional to cause you harm, the reason why most medical malpractice attorneys in New York will not take your case is because there will not be any available insurance coverage. When harm is done intentionally, the doctor's professional liability insurance company is going to say that they do not cover anything that was done intentionally. The insurance company will state that they only cover situations that were accidental, that were negligent, or mistaken circumstances.
  • Union Health Minister Jagat Prakash Nadda on Sunday took part in the International Yoga Day celebrations at the Sanjeevaiah Park in Hyderabad, hailing what he dubbed a 'memorable' day for all participants.
  • Lifestyle diseases have become a major health challenge and yoga can help prevent these, said union Health Minister J.P. Nadda at International Yoga Day celebration here on Sunday.
IMA National Health Scheme
  1. Aims and Objectives of the Scheme
    To provide financial assistance to the members and his/her spouse, child (ren) and parent(s) on the event of hospitalization, diagnosis and management of the following diseases:-
    1. Heart Disease: - Angioplasty, Bypass Surgery and Valve replacement Surgery.
    2. Renal Failure, Haemodialysis, Renal Transplantation,
    3. All Malignant diseases
    4. Brain Tumours
    5. Hip and Knee replacement surgery.
    6. Spine and disc surgery
    7. Cerebrovascular accidents
    8. Road Traffic and other accidents
    9. Other major illness requiring hospitalization approved by the scrutinizing committee appointed by the IMA National President
  2. Beneficiaries
    1. Benefits of the scheme shall be available only to the member and his / her spouse, child (ren) and parent(s), if the member has paid the membership subscription of his and his/ her spouse child (ren) and Parent(s).
    2. In the event of death of a member, the spouse, child (ren) and parents can opt as a beneficiary member of the scheme.
    3. Such a beneficiary member shall not have any other right including the right to contest or to vote.
  3. Eligibility for Membership:-
    1. Life member of IMA.
    2. Member should be below the age of 80 years at the time of joining.
  4. Admission Fee. (A F) (One time pay)
    For members / Spouse / Parents
    1. Below age of 35 yrs                  Rs. 1000.00
    2. Below age of 45 Yrs
      but above 35 Yrs                       Rs. 1250.00
    3. Below age of 55 Yrs
      but above 45 Yrs                       Rs. 1750.00
    4. Below age of 60 Yrs
      but above 55Yrs                        Rs. 5000.00
    5. Below age of 65 Yrs
      but above 60 Yrs                       Rs. 7000.00
    6. Below age of 70 Yrs
      but above 65 Yrs                       Rs. 8000.00
    7. Below age of 80 Yrs
      but above 70 Yrs                       Rs. 10,000.00

      For child (ren) of members
      Child (ren) below the
      age of 25 Yrs                           Rs. 1000 .00
  5. Annual Membership
    Subscription(AMS)            (To Pay Every Year)

    Every member/ beneficiary member Rs 500.00

    Out of Rs 500/- annual membership fee Rs 300/- will go to National IMA account and Rs 200 to Scheme.
  6. Annual Financial Assistance Contribution (AFAC) (To Pay every Year)

    Every Member / beneficiary member / Child (ren) shall pay the following amount.
    1. Children below 25 yrs           Rs. 2500.00
    2. Below the age of 55 yrs        Rs. 3000.00
    3. Above 55 and below 60 yrs   Rs. 5000.00
    4. Above 60 and below 65 yrs   Rs. 7000.00
    5. Above 65 and below 70 yrs   Rs. 8000.00
    6. Above 70 and below 80 yrs   Rs. 10000.00
When a member / Spouse / Child(ren) / Parents first join the scheme they should pay the Admission fee, Annual membership subscription and Advance financial assistance contribution (AF + AMS + AFAC) at the rate mentioned above. Prescribed application form along with the admission fee, Annual membership subscription and Advance Financial Assistance Contribution drawn in favour of the scheme “IMA National Health Scheme” by A/C Payee draft payable at the secretary’s office has to be sending to the Hony. Secretary’s office. No cash or money order will be accepted. Admission fee (AF) is onetime payment.

Annual membership subscription and advance financial assistance contribution shall be paid every year (AMS +AFAC).

Founder Member:-

Members who join first time will get the status of founder member Irrespective of age group. There will be a concession of Rs 1500 to those who join above the age of 55 years since they are paying higher premium. This benefit will be only for six months only from March 1st to 30th September 2015. This benefit is to give opportunity for all below 80 years. After September this benefit will stop and have to pay as the prescribed tariff above.



Member/ spouse/ child (ren)/parents shall submit their application in the prescribed application form along with their admission fees, membership subscription and Advance Financial Assistance Contribution ((AF + AMS + AFAC) drawn in favour of the scheme “IMA National Health Scheme” by A/C Payee draft or local cheque payable at the head office - secretary’s office place at Thiruvananthapuram with endorsement by local branch secretary or Branch president of IMA with copy of life membership certificate and passport size photo of member. No cash or money order will be accepted. From 2nd Year onwards members need to pay only Annual Subscription and Advance Finance Assistance Contribution (AMS +AFAC).

All communications may send to secretary.
Dr. Alex Franklin, “Thudakkottil”, Dr. PNRA -34, Dr. Pai Road, Poojappura
Thiruvananthapuram -12, dralexfranklin@gmail.com
Letter to Editor
Dear Sir, I'm from Indirapuram Ghaziabad UP. There is illegal selling of sleeping tablets on all medical store. i.e., tablets are sold without doctor’s prescription. This may be dangerous. In that case, you will stop the illegal selling of sleeping tablets as soon as possible. I hope that you will take necessary action on this. Thanks: Anuj Mishra, Dainik Jagran, Noida UP -201301.

The Editor, eMedinewS

With reference to the editorial on Exit exam for doctors. I have the following suggestions:

1. Medical education, particularly the examinations, should be nationalized.

2. There should be a common entrance examination, and common semester examinations for all in the Nation.

3. The system of examinations should be similar to the National Board examinations: No internal examiners should be allowed. Examinations, both theory and practicals, should be conducted in centres away from the parent institutions of the candidates.

The above will go a long way in bringing about a uniform standard of education in the medical field in our country.

Yours sincerely

Dr. Prabhakar Korada, DNB (Psychiatry), GF 9, Ruby Block, Sree Vensai Projects, Kompally, Secunderabad - 500014
Inspirational Story
Daddy, how much do you make an hour?

With a timid voice and idolizing eyes, the little boy greeted his Father as he returned from work, "Daddy, how much do you make an hour?" Greatly surprised, but giving his boy a glaring look, the Father said: "Look, son, not even your mother knows that. Don’t bother me now, I’m tired."

"But Daddy, just tell me please!? How much do you make an hour," the boy insisted. The Father finally giving up replied: "Twenty dollars per hour." "Okay, Daddy? Could you loan me ten dollars?" the boy asked.

Showing restlessness and positively disturbed, the Father yelled: "So that was the reason you asked how much I earn, right?? Go to sleep and don’t bother me anymore!"

It was already dark and the Father was meditating on what he had said and was feeling guilty. He thought that his son wanted to buy something.

Finally, trying to ease his mind, the Father went to his son’s room. "Are you asleep son?" asked the Father.

"No, Daddy. Why?" replied the boy partially asleep. "Here’s the money you asked for earlier," the Father said.

"Thanks, Daddy!" rejoiced the son, while putting his hand under his pillow and removing some money.

"Now I have enough! I have twenty dollars!" the boy said to his Father.

The Father sat there, gazing at his son, confused at what his son just said. "Now Daddy could you sell me one hour of your time?"
Quote of the Day
A good head and a good heart are always a formidable combination. Nelson Mandela
IMA in Social Media
https://www.facebook.com/ima.national 28463 likes

https://www.facebook.com/imsaindia 46434 likes

https://www.facebook.com/imayoungdoctorswing 1543 likes

Twitter @IndianMedAssn 1006 followers

http://imahq.blogspot.com/ www.ima-ams.org




Reader Response
Excellent article on why drugs can cost more. Neeta
Wellness Blog
Why do commercial and foods cooked by ‘halwais’ taste better?

Hydrogenated oils containing trans fats are tastier than foods cooked in plant oils. Most hydrogenated oils involve hydrogenation of palm oils. Hydrogenation increases their shelf life, makes them easier to cook and spoil less easily. French fries, microwave popcorns and food cooked by traditional halwais are cooked in hydrogenated trans fats.

Most commercially catered food prepared from trans fats are tasty and often people overeat by at least 500 calories because of the taste provided by the hydrogenated oils.

Per serving, 5 grams of trans fatty acids is present in French fries, 6 gm in breaded fish burger, 5 gm in breaded chicken nuggets, 2 gm in biscuits, 2.7 gm in margarine, 2 gm in cakes, 1.6 gm in corn chips, 1.2 gm in microwave popcorn and 1.1 gm in pizza.

Four gm of trans fats are present in one parantha, 3.4 gm in one poori, 5.2 gm in one bhatura, 1.7 gm in one dosa, 6.1 gm in one tikki, 3 gm in one samosa, 2 gm in one serving of pakoda, 2.9 gm in one serving of vegetable pulao and 3.6 gm in one serving of halwa.

Just about 2.6 gm a day of trans fats, half as much contained in a packet of French fries can raise the risk of heart disease significantly.

Some trans fats occur naturally in foods, especially those of animal origin. The chemical configuration of trans fatty acids confers harmful effects, including adverse influences on blood LDL- and HDL-cholesterol concentrations. They raise LDL and lower HDL cholesterols. By comparison, consumption of saturated fats also raises the LDL cholesterol concentration, but does not lower HDL. Thus, while saturated fats adversely affect the lipid profile, they may not be as harmful as trans fatty acids.

Trans fatty acids may also interfere with the desaturation and elongation of n-3 (omega-3) fatty acids. These are important for the prevention of heart disease and complications of pregnancy. In an analysis from the Nurses’ Health Study, for each increase of 2 percent of energy from trans fat, the relative risk for incident coronary heart disease was 1.93. There are no known physiologic benefits related to the consumption of trans fatty acids; thus, reduction in their intake makes sense.

The words “partially hydrogenated” on the list of package ingredients are clues to their presence. Since 2006, the US Food and Drug Administration (FDA) has made it a requirement that Nutrition Facts labels portray trans fat content. FDA estimates that the average daily intake of trans fat in the U.S. population is about 5.8 grams or 2.6% of calories per day for individuals 20 years of age and older. On average, Americans consume approximately 4 to 5 times as much saturated fat as trans fat in their diet. FDA’s label requirement is that if a dietary supplement contains a reportable amount of trans fat, which is 0.5 gram or more, dietary supplement manufacturers must list the amounts on the Supplement Facts panel. The FDA final rule on trans fatty acids requires that the amount of trans fats in a serving be listed on a separate line under saturated fats on the Nutrition Facts panel.

However, trans fats do not have to be listed if the total fat in a food is less than 0.5 gram (or 1/2 gram) per serving.

All restaurants in New York have banned all food items, which contain more than 0.5 gm of trans fats in one serving.

  • Check the Nutrition Facts panel: Choose foods lower in saturated fats, trans fats and cholesterol.
  • Choose alternative fats. Replace saturated and trans fats in your diet with mono- and polyunsaturated fats. These fats do not raise LDL (or "bad") cholesterol levels and have health benefits when eaten in moderation. Sources of monounsaturated fats include olive and canola oils. Sources of polyunsaturated fats include soybean, corn, sunflower oils, and foods like nuts.
  • Choose vegetable oils (except coconut and palm kernel oils) and soft margarines (liquid, tub, or spray) more often because the combined amount of saturated and trans fats is lower than the amount in solid shortenings, hard margarines, and animal fats, including butter.
  • Consider fish. Most fish are lower in saturated fat than meat. Some fish, such as mackerel, sardines and salmon, contain omega-3 fatty acids that are being studied to determine if they offer protection against heart disease.
  • Limit foods high in cholesterol such as liver and other organ meats, egg yolks and full-fat dairy products, like whole milk.
  • Choose foods low in saturated fat such as fat free or 1% dairy products, lean meats, fish, skinless poultry, whole grain foods and fruit and vegetables.
IMA Humor
No Exit

A person checks into a hotel for the first time in his life, and goes up to his room. Five minutes later he calls the desk and say, "You've given me a room with no exit. How do I leave?"

The desk clerk says, "Sir, that's absurd. Have you looked for the door?"

The person says, “Well, there's one door that leads to the bathroom. There's a second door that goes into the closet. And there's a door I haven't tried, but it has a 'do not disturb' sign on it."
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