August 23   2015, Sunday
eMedinewS
editorial
How to keep your memory sharp?
Dr KK Aggarwal
  • Manage your stress especially pressures of deadlines and petty arguments.
  • The biggest stress is an ongoing sense of extreme anxiety. This can be managed by deep breathing, meditation, yoga and by mindful approach to living.
  • Get a good night’s sleep. The most common reason for poor sleep is difficulty in falling asleep and staying asleep. Many drugs are used to treat insomnia, which can also impair memory.
  • If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time.
  • Get up at the same time in the morning.
  • If you smoke, quit.
  • If you do not drink, do not start.
  • Alcohol makes it difficult to perform short term memory tasks such as memorizing list. Alcohol induces vitamin B1 deficiency, which can cause dementia.
  • Protect your brain from injury as repeated minor head trauma can cause brain damage. Wear seat belt when riding in motor vehicle. Wear helmet while driving or riding motorcycle.
IMA,IJCP,HCFI
eMedipics
IMA,IJCP,HCFI
Women IMA Leaders Summit (WIMALS) 2015, IMA Dhule
IMA,IJCP,HCFI
News
Oncology
A study has found that overall, light to moderate drinking (alcohol intake of <15 g/day for women and <30 g/day for men) is associated with a small but nonsignificant increase in cancer risk in both women and men. The findings are published online August 18 in the BMJ.

Ophthalmology
Most adult contact lens wearers in a Centers for Disease Control and Prevention (CDC) online survey reported at least one lens hygiene behavior that put them at risk for an eye infection. In addition, nearly one third of them reported at least one healthcare visit for a red or painful eye while wearing contact lenses, reported an article published in the August 21 issue of the Morbidity and Mortality Weekly Report.

Obesity
While it may be a convenient way to fit lunch into a hectic work schedule, new research published in the Journal of Health Psychology suggests that eating while "on the go" could lead to weight gain and obesity in people who are dieting.

Diabetes
A large study covering over 20 years of data has found that men with partners who have had gestational diabetes (GDM) may be at increased risk for developing diabetes themselves. The study will be published in the September issue of Diabetes Care.

Obstetrics and Gynecology
The American College of Obstetricians and Gynecologists (ACOG) published a Practice Bulletin concerning emergency contraception online August 19 and in the September issue of Obstetrics & Gynecology. The new recommendations include an expanded discussion and guidance on the use of ulipristal acetate and new data regarding the effect of body weight on emergency contraception efficacy.
Cardiology eMedinewS
  • Although the majority of women with peripartum cardiomyopathy make a full recovery within a year of giving birth and after receiving "conventional heart failure therapy," those with severe left ventricular (LV) dysfunction and significant remodeling at first visit are at risk for future cardiovascular events. Results from the prospective Investigations of Pregnancy Associated Cardiomyopathy (IPAC) study are published in the August 25 issue of the Journal of the American College of Cardiology.
  • Only 10.4% of patients who were hospitalized with heart failure from 2005 to 2014 and were part of a large national registry were referred for cardiac rehabilitation when they were discharged from the hospital, suggested new research published in the August 25 issue of the Journal of the American College of Cardiology. The study shows that there is a need for targeted quality-improvement programs to improve use of cardiac rehabilitation for eligible patients with heart failure.
Pediatrics eMedinewS
Pediatrics
Diabetes

Diabetic ketoacidosis (DKA) rates of 5% to 7% are occurring in non-newly diagnosed children with type 1 diabetes in the United States, United Kingdom, and Western Europe, suggests a new study published online August 17 in Diabetes Care.

Pediatrics
Nephrology

The US Food and Drug Administration (FDA) has approved the expanded use of cysteamine bitartrate delayed-release capsules for children as young as 2 years with nephropathic cystinosis.
Dr KK Spiritual Blog
Leverage your strengths
  • Know your strengths.
  • According to a British study, only about one–third of people have a useful understanding of their strengths.
  • If something comes easily, you may take it for granted and not identify it as a strength.
  • If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  • Strengths, which are most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
  • Strengths are so important that they are worth cultivating and applying in your daily life, even if they don’t come naturally to you.
Inspirational Story
Sometimes ignorance is bliss

My classmate, Susan, and I are in the middle of our thesis rewrites for Johns Hopkins University. We only have two weeks left and we are both quite frazzled at the prospect of doing more research in the remaining time.

Today Susan called me to say that she desperately needed more history about a small tribe of Native Americans that lives in the Grand Canyon But there’s only one telephone on the reservation and no one ever answers it.

As a matter of fact, the three times she visited the tribe’s Visitor Center while she was on vacation, she said no one ever opened up the building.

Being a computer geek, I said, "Have you checked the Internet?"

She said, "No, what a great idea! Thanks." I did a quick check using Excite while she used Yahoo and she was astounded at the information available about this little-known tribe.

She thanked me profusely for the tip and hung up.

Two hours later, she called me back sounding absolutely miserable. "Susan," I said, "What’s the matter?"

"Well," she said, "You’re not going to believe it but they have their own Web page with all the information I could ever want about the tribe."

"That’s great," I said. "What more could you ask for?" "You don’t understand," she said. "My article is about how isolated the tribe is and how their only path to the outside world is a little dirt trail up the side of the canyon!

On their Web page, they even have a scanned photo of the helicopter that brought the donated PC into the canyon."

Moral of the story: Sometimes ignorance is bliss ––especially when you’re trying to finish a thesis on time.
Scientific awareness on personal hygiene and prevention from obesity among school going children, DAV Public School-R K Puram
IMA,IJCP,HCFI
Make Sure
Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.
Dr Good Dr Bad
Situation: A diabetic patient since 20 years came for a routine checkup.
Dr Bad: Get blood sugar done.
Dr Good: Also, get your sugar, eye and kidney check up done.
Lesson: The risk of cataract increases with increasing diabetes duration and severity of hyperglycemia. Data from the Beaver Dam Eye Study, the Blue Mountains Eye Study, and the Visual Impairment Project, have documented associations between diabetes and cataract (Source: Diabetes Care 2008;31(9):1905–12).

(Copyright IJCP)
eIMA Quiz
What is not true for HNPCC?

a) It is the most common hereditary colorectal cancer syndrome in USA.
b) It is associated with MMR gene mutation.
c) It is associated with APC mutation.
d) It is associated with carcinoma colon and extraintestinal cancers.

Yesterday’s Mind Teaser: Which of the following is not true for malignancy of familial adenomatous polyposis?

a) Adrenals
b) Thyroid
c) Astrocytomas
d) Hepatoblastomas

Answer for Yesterday’s Mind Teaser: c) Astrocytomas

Answers received from: Dr Poonam Chablani, Dr B R Bhatnagar, Dr Ridu Kumar Sharma, Dr Avtar Krishan.

Answer for 21st August Mind Teaser: a) Complete proctocolectomy and Brook's ileostomy

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K V Sarma, Dr B R Bhatnagar, Dr G Madhusudhan, Dr Avtar Krishan.
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
What precautions should be taken while vaccinating by the ID route?
  • The ID injections must be administered by staff trained in this technique.
  • The vaccine vials must be stored at +2°C to + 8°C after reconstitution.
  • The total content should be used as soon as possible, but at least within 8 hours.
  • The 0.1 ml ID administration of cell–culture vaccine should create a wheal of at least 5 mm diameter with "peau de orange" appearance.
  • If ID dose is given subcutaneously then there is a possibility of poor immune response due to low antigen load. This may be life–threatening.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
eIMA News
News
  • In the article, published in the August 18 issue of the JAMA, Tracy Tylee, MD, and Irl B Hirsch, MD, both of the University of Washington School of Medicine, Seattle, argue that the old regular and neutral protamine Hagedorn insulins are just as effective as the more expensive analogs for most patients with type 2 diabetes who require insulin and can be used safely as long as steps are taken to avoid hypoglycemia. Medscape
  • RAIPUR: Acting tough on medicos for indulging in "unethical" practices, the Chhattisgarh Medical Council on Friday suspended the registration of three private doctors. While one doctor has been suspended for taking benefits of foreign jaunts from a pharmaceutical company, the other two face action for violating the self-advertising code of the Medical Council of India (MCI). TOI
HC slams centre’s stay-in-India policy for docs
By Jyoti Shelar, Mumbai Mirror | Aug 21, 2015, 12.00 AM IST

The Aurangabad bench of the Bombay High Court had a very pointed query for the Centre on Thursday - do you have enough jobs for doctors? The bench was hearing a petition filed by the Maharashtra Association of Resident Doctors (MARD) over the Centre's decision not to issue "No Obligation to Return to India" (NORI) certificate to doctors.

The NORI certificate is mandatory for doctors wishing to practise abroad and by not issuing the document, the government has effectively put a ban on doctors going abroad.

Coming down heavily on the government, the bench comprising justices R M Borde and P R Bora asked the Centre's counsel whether the government was in a position to provide a job to every doctor. It also gave the Centre and the Medical Council of India seven days to respond.

Hearing the petition on Thursday, the court criticised the government for taking such a huge decision without consulting the Medical Council of India and immediately made MCI a party to the petition. The court has now asked the MCI to submit its views on the serious matter.

The court also pointed out that doctors go abroad as they are provided with better facilities which they don't get in India. "Therefore such a ban should not be called for," said the bench.
How soon you should get back to work after common diseases
Malaria: With proper treatment, the symptoms of malaria usually go within 2 weeks. Malaria is not contagious so once the fever is manageable, one can join work.

Chicken pox: The infection fades away after 10 days. A person is contagious from 2 days before the rash appears until the crusting of all blisters (which is usually 5 days after the first blisters appear).

Oral (mouth) herpes: Symptoms appear 1 to 2 weeks after contact with the virus. Oral herpes gets easily transmitted by direct exposure to saliva or even from droplets in breath. It can also spread by skin contact with infected areas. Transmission can occur even from droplets of breath and skin contact so it is advisable to resume work only after complete healing of sores.

Genital herpes: Symptoms usually appear 1 to 2 weeks after the first exposure to the virus. Over the next 2-3 weeks, more blisters can appear and rupture into painful open sores. The lesions eventually dry out, develop a crust and heal rapidly without leaving a scar (usually 6 weeks). The lesions heal out in 6 weeks.

Dengue: The acute febrile phase lasts for about 2-7 days and is frequently accompanied by facial flushing, skin erythema (redness), generalized bodyache, myalgia (muscle pain), arthralgia (joint pain) and headache. It is followed by a period of clinically significant plasma leakage, causing shock usually lasts 24–48 hours. The final phase is a steady reabsorption of extravascular compartment fluid in the following 48–72 hours. Dengue is not contagious and hence one can resume work depending on fever and weakness limitation.

Hepatitis B: Hepatitis B spreads only via blood and body secretions. Rest is advised only in acute cases and on case to case basis, depending on the level of liver enzymes.

Swine flu: It is highly contagious. People with swine-flu illness should stay at home at least 24 hours after the fever is resolved (100° F [37.8°C]) without the use of fever-reducing medicines. Elevated temperature is associated with increased shedding of influenza virus and staying at home might reduce the number of infected individuals. This is applicable to camps, schools, businesses, mass gatherings and other community settings.

Cholera: Patients are presumably infectious till the stools are positive, which is usually only a few days after recovery. But, a carrier state might persist for several months. Transmission usually occurs by ingestion of water and food contaminated with the bacteria. However, infection can also occur through person-to-person transmission, especially in the crowded places. Adequate control measures for prevention of infection in the community include rapid and accurate microbiological diagnosis, prompt treatment, patient isolation and preventative education.

Viral conjunctivitis: It is mild and symptoms usually get resolved in 7-14 days without treatment and without any long-term effects.

Bacterial conjunctivitis: It may last as few as 2-3 days or up to 2-3 weeks. Many cases improve in 2-5 days without treatment.

Conjunctivitis can be spread by patients through simple social greeting with other people, i.e., shaking of hands. Patients often rub their eyes and contaminated hands will transfer the organism to the other healthy individuals.
SMS of the day: IMA Rise & Shine
Giving statin to all over 50 leads to 1200 excess cases of myopathy, 200 cases of rhabdomyolysis, 12?300 diagnoses of diabetes.

Dr Pillai Dr KK
New model of care (Pre-emptive care model)
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
IMA Digital TV – Webcast Done So far
23rd July 2015 – TB Notification

6th August 2015 - Breastfeeding and Neonatal Skin Care

13th August 2015 - All About Vitamin D - IMA USV Initiative
IMA,IJCP,HCFI IMA Digital TV IMA Digital TV
IMA Digital TV
IMA Digital TV
IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
Media
IMA,IJCP,HCFI
Wellness Blog
Fecal Microbiota Transplantation (FMT)

Fecal Microbiota Transplantation (FMT) has emerged as highly effective treatment of C. difficile, including recurrent C. difficile infections. The transplantation refers to the infusion of a suspension of fecal matter from a healthy individual into the GI tract of another person to cure a specific disease through a colonoscopy. It is based on the concept that stool is a biologically active, complex mixture of living organisms with great therapeutic potential for C. difficile infection. Most patients with C. difficile infection respond to metronidazole, vancomycin but 15–35% may have recurrence. Patients who have one recurrence have 45% chances of a second recurrence, and after a second recurrence, 65% will have a third recurrence. The current treatment of recurrence is additional course of metronidazole, oral vancomycin, or prolonged oral vancomycin. FMT is commonly performed by colonoscopy but doctors have used nasogastric tube or nasoenteric tube, gastroduodenoscopy and enema.
Quote of the Day
The happiest people in the world are not those who have no problems, but those who learn to live with things that are less than perfect.
IMA in Social Media
https://www.facebook.com/ima.national 28704 likes
https://www.facebook.com/imsaindia 46803 likes
https://www.facebook.com/imayoungdoctorswing 1784 likes
Twitter @IndianMedAssn 1116 followers
http://imahq.blogspot.com/
www.ima-ams.org
http://www.imacgpindia.com/
http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
Reader Response
It is indeed a great victory for IMA. Such proactive actions are the need of the hour. Dr Ravi Wankhedkar
IMA Humor
A traffic slogan: Don’t let your kids drive if they are not old enough – or else they never will be
IMA Videos
News on Maps
Press Release
Administer with caution – Risks of platelet transfusion

Unnecessary platelet transfusion may cause more harm than good in dengue patients, must be

Until and unless a patient’s platelet count is below 10,000, or there is spontaneous, active bleeding, no platelet transfusion is required.“It is a myth that all dengue patients require platelet transfusion. In fact unnecessary transfusion causes more harm and puts the patient at risk of complications such as sepsis, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), alloimmunization and allergic and anaphylactic transfusion reactions” said Padma Shri Awardee Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA.

Other risks of platelet transfusion include febrile non-hemolytic transfusion reactions (FNHTR), transfusion-associated graft-versus-host disease (ta-GVHD), andpost-transfusion purpura (PTP). The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell.

Dr. KK Aggarwal added, “While treating dengue patients, physicians should remember the ‘Formula of 20' i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention”.

Platelet transfusion is risky because of the following reasons:
  1. Donor screening does not eliminate the risk of bacterial and other bloodborne infections
  2. Platelets are stored at room temperature, where bacteria can proliferate rapidly
  3. The incidence of bacterial contamination is higher for platelets than for red blood cells (RBC) (1 in 2000 for platelets versus 1 in 30,000 for RBC)
  4. Transfusion of any blood product, including platelets, can lead to transfusion-related acute lung injury
  5. Transfusion of any blood product may be associated with circulatory overload. Platelet transfusion introduces approximately 200 mL of intravascular volume per transfusion. The incidence of TACO is in the range of one to three per 100,000 transfusions and is higher in patients predisposed to volume overload (eg, with comorbidities such as congestive heart failure, renal failure, respiratory failure, and positive fluid balance).
  6. Platelets express Class I human leukocyte antigen (HLA) antigens, which can be recognized by the recipient's immune system as foreign. Production of anti-HLA antibodies can adversely affect the response to future platelet transfusions.
  7. Allergic reactions to platelet transfusion are relatively common. They are usually due to IgE directed against proteins in the donor plasma. Common symptoms include urticaria and pruritus in mild cases, and wheezing, shortness of breath and hypotension in more severe cases.
  8. Anaphylactic reactions (severe allergic reactions) are a very rare complication of platelet transfusion. These are associated with rapid onset of shock, angioedema, and respiratory distress. Many cases occur due to the production of anti-IgA antibodies in recipients who are IgA deficient.
  9. Febrile non-hemolytic transfusion reactions are mediated by various inflammatory mediators and leukocytes and may manifest as fevers, chills, and rigors.
  10. Transfusion-associated graft-versus-host disease (ta-GVHD) can occur with any transfusion that contains lymphocytes, given the correct immunologic setting.
The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season.