April 24  2015, Friday
editorial
Seven Common Causes of Forgetfulness
Dr KK Aggarwal
  1. Lack of sleep is the most common cause. Two little restful sleep can also lead to mood changes and anxiety which in turn can contribute to memory impairment.
  2. Many drugs can affect memory, which includes tranquilizers, antidepressants, blood pressure drugs and anti–allergic drugs.
  3. Low functioning thyroid can affect memory.
  4. Drinking too much alcohol can interfere with short–term memory.
  5. Stress and anxiety can lead to memory impairment. Both can interfere with attention and block the formation of new memory or retrieval of old memories.
  6. Forgetfulness can be a sign of depression or a consequence of it.
  7. If you are vegetarian, vitamin B12 deficiency can loss memory impairment
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Call to Action for TB free India, in New Delhi on April 23, 2015, Ministry of Health & Family Welfare-Government of India.
News
  • In a new safety alert, the US FDA has advised that healthcare providers should caution patients who use topical pain medications containing the nonsteroidal anti-inflammatory drug (NSAID) flurbiprofen to be careful about interacting with their pets or other animals. Pets are at risk of becoming sick or dying when exposed to flurbiprofen, and people using these medications should use care when applying them in a household with pets, as even "very small amounts could be dangerous to these animals," the agency said. After secondhand exposure, two cats in one household developed kidney failure and recovered with veterinary care. Two cats in a second household developed signs that included reluctance to eat, lethargy, vomiting, melena, anemia, and dilute urine and died despite veterinary care. A third cat in the second household also died after the owner had stopped using the medication. At necropsy, the three cats had evidence consistent with NSAID toxicity. (Medscape)
  • Patients with osteoporosis appear to have a significantly higher risk of sudden sensorineural hearing loss than those without osteoporosis, suggested the first and largest Asian population-based study. The findings are published online in the Journal of Clinical Endocrinology & Metabolism.
  • Human papillomavirus (HPV) screening used on its own may miss cervical cancer, reports a study published online in Cancer Cytopathology. Researchers noted that more cases were detected when it was used in combination with cytology.
  • Adhesive strips do not improve overall scar formation when added to dermal sutures for wound closure, suggests new research published online in JAMA Dermatology.
  • For patients with acute cholecystitis, CT is not yet accurate enough to go straight from a scan to a treatment plan, points new research presented at the American Roentgen Ray Society 2015 Annual Meeting.
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Dr KK Spiritual Blog
Why is Ganesha worshipped in every pooja?

Every Hindu ritual traditionally begins with a prayer to Lord Ganesh. The wedding ceremony too begins with a pooja of Lord Ganesha invoking him to bless the couple and to ensure that the ceremony goes off well.

Ganesha, the son of Shiva and Parvati, is the harmonious Aacharan or characteristic disposition of man. Remembered and ritually worshipped before starting a new venture, the entity of Ganesha has in store the facets of a complete man.

The elephant head of Ganesha represents wisdom, intelligence and a healthy mind capable of making sound decisions. Think before you speak, implies Ganesha’s head.

The big ears of this elephant deity signify the lending of a patient ear to the echo produced by others’ deeds and speech. It is said that half the dispute is resolved by patiently lending an ear to the words of the other. It also denotes that one must patiently listen to all sides before reaching a decision.

Ganesha’s extremely small mouth characteristically represents the need for a limited dialogue and the vanity of talking too much.

Overexpression through words results in unsought–for problems, which could have been avoided.

Ganesha’s small eyes highlight the need for a focused outlook in life. Such an outlook not only re-defines and foresees the right goals, but also relieves one from the stress–manifested episodes in life.

The long trunk identifies with the power of discrimination. Ganesha’s long nose has the strength to uproot a tree and the competency of picking up a pin from the ground. Such should be the approach of an individual who should be capable of perceiving the good and bad for one’s own self, and then have the strength to overcome these against all odds.

The tusks and the small teeth of Ganesha tell us to maintain a balance between loss (broken tooth) and gains (whole tooth) in the life. Man ought to maintain his mental state so that ups and downs do not deter him from his honest endeavors.

The ample stomach of Ganesha advocates the need for retaining information. Acquiring knowledge, utilizing it and retaining it for years to come, is the crux of ‘big–belly commandment’.

The Char–Bhuja Dhari Ganesha, further represents strength by virtue of his four hands in which the Lord entraps his attachments, desires and greed. Two arms of Ganesha, which hold a rope, represent control over the attachments. The laddoo or sweet in one symbolizes command over desires and earthly delusions.

The mouse sitting near the feet of Ganesha represents greed and gluttony upon which the Almighty rides, exhibiting control over evils.

Ganesha’s physical traits are an assembly of the characteristics most desired in an individual of substance.
Cardiology eMedinewS
  • A new scientific statement issued by the American Heart Association (AHA) puts forward recommendations for healthcare providers treating adults over age 40 who have congenital heart disease. The statement was published online in Circulation.
  • A study evaluating the effects of thyrotropin levels on the upper end of normal noted that differences in thyroid function within the population reference range did not appear to be associated with coronary risk. The findings are published online in JAMA Internal Medicine.
Pediatrics eMedinewS
  • The primary technique for detecting fetal anemia should be middle cerebral artery peak systolic velocity (MCA-PSV) measured by Doppler interrogation, suggests a new Clinical Guideline from the Society for Maternal-Fetal Medicine (SMFM). The new guideline appears online in the American Journal of Obstetrics & Gynecology.
  • Obese children experienced the greatest improvements in body mass index (BMI) when pediatricians used computerized clinical decision support and families were offered an intervention for self-guided behavior change, suggested the results from a randomized controlled trial published online April 20 in JAMA Pediatrics.
Quote of the Day
If you’re not using your smile, you’re like a man with a million dollars in the bank and no checkbook. Les Giblin
Make Sure
Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.
Dr Good Dr Bad
Situation: A diabetic patient with stroke came for evaluation.
Dr Bad: Get routine tests done.
Dr Good: Also get blood sugar and A1c done.
Lesson: Increased rate of heart failure can contribute to higher mortality in stroke patients with hyperglycemia. On multivariate analysis, fasting glucose was significantly associated with risk of in–hospital heart failure (Eur J Neurol 2009;16(2):251–6)

(Copyright IJCP)
eMedi Quiz
A 5-year-old boy suffering from Duchenne muscular dystrophy has to undergo tendon-lengthening procedure. The most appropriate anaesthetic would be:

1. Induction with intravenous thiopentone and N2O; and halothane for maintenance.
2. Induction with intravenous protocol and N2O; and oxygen for maintenance.
3. Induction with intravenous suxamethonium and N2O; and halothane for maintenance.
4. Inhalation induction with inhalation halothane and N2O; oxygen for maintenance.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 2. Pre-oxygenation is mandatory.
Correct Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr K Raju, Dr G. Madhusudhan, Dr Avtar Krishan.
Answer for 22nd April Mind Teaser: D. Unusual geographic clustering of disease
Correct Answers received: Daivadheenam Jella, Dr Shangarpawar, Dr Pandit Hantodkar, Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G.
eMedinewS Humor
An English professor

As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned.

"Mr. McDonald," he said, "I can’t make out this comment you wrote on my paper."

My father took the paper and, after studying it, sheepishly replied, "It says that you should write more legibly."
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Rabies News (Dr A K Gupta)
An unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog. What should be done?

If an unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog, wounds should be thoroughly washed with water and povidone iodine should be applied. If the stray dog is suspected to be rabid, then the pet dog should be put to sleep (euthanasia). But if the owner is not ready or the rabid status of the stray dog is not known, post–exposure vaccination of the pet with cell culture vaccine and simultaneous careful observation of the pet are recommended for up to 2 months (up to six months is desirable) for possible signs of rabies in the pet. During this period for any sickness in dog, the owner should take the dog to the veterinarian to get rabies ruled out at the first instance. It should be noted that post–exposure vaccination is not very successful in dogs. Simultaneously, pre–exposure vaccination of all household members is necessary.
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
EIMA News
IMA to promote ‘Save girl child’ campaign
The Hindu: Karimnagar, March 20, 2015: Indian Medical Association (IMA) Telangana State president elect K Shyam Sunder has said that he would strive to remove the role of ‘middlemen’ in medical profession and bring reputation to the medical fraternity.

Talking to newsmen here on Thursday, he said that the IMA would support medical professionals who follow principles, moral and ethical values and maintain integrity and added that they would not support professionals, who resort to unethical practices and cheat gullible patients.

Stating that they would ensure that all the medical professionals follow the model code of conduct, he said that they would conduct a State-level conference on the importance of following ethical values in medical profession.

Explaining about the future activities of the IMA in Telangana State, he said that they had decided to go with the slogan of ‘Save girl child’ and reduce MMR (mother mortality rate) and IMR (infant mortality rate) in the State. He also said that they would also launch special awareness programmes to check quacks and sorcery in the State.

He also said that they would launch awareness programmes on various diseases and take up special drives in the rural areas for the family planning and immunisation programmes.

He said that they would continue their health awareness programme in coordination with the state and central governments.

Earlier, the IMA Karimnagar chapter leaders V Bhoom Reddy, KS Sagar Rao, BN Rao, Y Narendra, Rajeshwar Rao, P Pavan Kumar, Tirupathi Reddy, Rajender and others had felicitated Dr Shyam Sunder on his election as the TS IMA president.

They also recollected the services of Shyam Sunder as the IMA district secretary, president and IMA state secretary.
Inspirational Story
A box of kisses

Some time ago, a man punished his 3–year–old daughter for wasting a roll of gold wrapping paper. Money was tight and he became infuriated when the child tried to decorate a box to put under the Christmas tree. Nevertheless, the little girl brought the gift to her father the next morning and said, "This is for you, Daddy." He was embarrassed by his earlier overreaction, but his anger flared again when he found the box was empty.

He yelled at her, "Don’t you know that when you give someone a present, there’s supposed to be something inside it?" The little girl looked up at him with tears in her eyes and said, "Oh, Daddy, it is not empty. I blew kisses into the box. All for you, Daddy."

The father was crushed. He put his arms around his little girl, and he begged for her forgiveness.

It is told that the man kept that gold box by his bed for years and whenever he was discouraged, he would take out an imaginary kiss and remember the love of the child who had put it there.

In a very real sense, each of us as humans have been given a gold container filled with unconditional love and kisses from our children, friends, family and God. There is no more precious possession anyone could hold.
Wellness Blog
Do Not Ignore Breakfast

Taking a good breakfast made of carbohydrates and lean protein, can help lessen cravings and hunger during the rest of the day, which can lead to significant weight loss.

A research by Dr. Daniela Jakubowicz, a clinical professor at Virginia Commonwealth University and an endocrinologist at the Hospital de Clinicas Caracas in Venezuela has shown that sedentary, obese women lost almost five times as much weight on the "big breakfast" diet as did women following a traditional, restrictive low–carbohydrate diet. While treating obese people we need to treat carb cravings and hunger.

On waking up in the morning, the body is primed to look for food. The metabolism is revived up, and levels of cortisol and adrenaline are at their highest. The brain needs energy right away, and if one doesn’t eat or eats too little, the brain needs to find another fuel source. To do this, it activates an emergency system that pulls energy from muscle, destroying muscle tissue in the process. Then when you eat later, the body and brain are still in high–alert mode, so the body saves energy from the food as fat.

Also the levels of the brain chemical serotonin are highest in the morning and the craving levels are at the lowest and you may not feel like eating. As the day wears on, serotonin levels dip, and you get cravings for chocolate or cookies, and such similar foods. If you eat these foods, your serotonin levels rise, and your body begins to associate good feelings with them, creating an addictive cycle.

The high protein, carbohydrate mix in breakfast gives the body the initial energy boost it needs in the morning. Throughout the rest of the day, the meals are made up of protein and complex carbohydrates, like vegetables. Because protein is digested slowly, you won’t feel hungry.

If you have to eat chocolate or candy, eat them in the morning because if you eat them when serotonin levels are high, they won’t taste as good, and the brain won’t feel the same serotonin boost. This will eventually help cut down on cravings.

Eating breakfast with high glycemic foods may be harmful. After eating cereal or a doughnut, the blood sugar and insulin levels spike. Once that blood sugar is used up, you’ll still have excess insulin circulating, which makes you hungry and makes you crave carbohydrates.
IMA News
Dr. K.K. Aggarwal,
Hony. Secretary General, Indian Medical Association,
lndraprastha Estate, I.T.O., New Delhi-110 002

Dear Dr. Aggarwal,

I take this opportunity to convey my sincere greetings to you and I am pleased to inform you that the Ministry of Public Health of the Republic of Ecuador has planned a special programme to invite specialist surgeons and doctors from all over the world to visit Ecuador with the aim to partake in governmental endeavour to upheaval public health sector in Ecuador and assist Ecuadorian Surgeons and Doctors in treating patients while residing in Ecuador on a short/long stay.

With this brief account, I would like to request you kindly furnish and share with the Embassy of Ecuador, at your earliest convenience, the list of the best and renowned Indian surgeons and doctors in the following fields:
  1. Neurosurgeon:
    • Arteriovenous malformations
    • Meningiomas
    • Hamartoma
    • Residual lesion relapsing from Hypophyseal macroadenoma.
    • Lump in auditory canal
    • Extra-axial Cerebellopontine angle tumor
    • Squamous cell cancer poorly differentiated in base of skull/ lower cranial.
    • Retinoblastoma
  2. Cardiologist:
    • Congenital heart defect
  3. Oncology:
    • Leukaemia
    • Mesothelioma peritoneal
    • Ependymoma in lumbar spine
    • Neuroendocrine tumor
  4. Other pathologies:
    • Esophageal fistula
    • Laryngotracheal stenosis
    • Pregnancy with myelomeningocele
    • An inborn error of metabolism
    • Severe meningitis syndrome
I thank you in advance for the kind attention that you may give to this request and I take this opportunity to send you my warm regards.

Yours Sincerely
Mentor Villagomez
Ambassador
Sonal Namaste
The SAVE LIVES: Clean Your Hands annual initiative is part of a major global effort led by the World Health Organization (WHO). It includes the "My Five Moments for Hand Hygiene", which define the key moments when healthcare workers should perform hand hygiene.

This evidence-based, field-tested approach is applicable in a wide range of settings. The WHO approach recommends that healthcare workers should clean their hands:
  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings
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Reader Response
  • Congratulations to National President and Hony Secretary General for organizing a very effective and informative CWC Meeting. It was well managed and smooth. We hope that follow up action will also be very effective. Thanks: Dr RD Dubey
  • Dear Dr Pillai & KK, Congratulations for the effective & decisive CWC at Delhi. Well-structured organized & conducted meeting. Pillai's leadership & KK's executive skills are explicitly experienced by leaders & members of IMA. Agendas & Resolutions were well thought of and concluded. The two-day meeting has honored our Constitution. Let us lead IMA in a new progressive direction & support our members’ rights and the health of the Public of our Nation. Venue & care of participants will be evergreen in the minds of our members. Wishing continued progress & success for Team IMA: Dr Arul
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News on Maps
Suspect malaria in any febrile illness: IMA
Treating uncomplicated malaria with single oral anti-malarial drug may be negligence

On the occasion or World Malaria day to be observed on 25th April, IMA has come out with guidelines for public and physicians.

Giving the details Padma Shri Awardee, Dr A Marthanda Pillai National President Indian Medical Association and Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association., said that malaria should be suspected in patients with any febrile illness. The initial symptoms and signs of malaria are nonspecific and may also include high pulse rate, high respiratory rate, chills, rigors, malaise, fatigue, sweating, headache, cough, loss of appetite, nausea, vomiting, abdominal pain, diarrhea, joint pains and muscular pains.

Groups at high risk for severe malaria and its consequences include young children (6 to 36 months) and pregnant women. Older children and adults develop partial immunity after repeated infection and are at relatively low risk for severe disease.

Travelers to areas where malaria is endemic generally have no previous exposure to malaria parasites and are at very high risk for severe disease if infected with Plasmodium falciparum.

The incubation period for P. falciparum infection is usually 12 to 14 days, while that of dengue is 4-10 days. Longer incubation periods are more likely in semi-immune individuals and individuals taking inadequate malaria prophylaxis at the time of infection. The relapsing malarias (P. vivax) can cause clinical illness several weeks or months after the initial infection.

Rapid diagnostic tests for detection of malaria antigens are accurate and easy to use. They require no electricity or lab infrastructure and give results within 15 to 20 minutes. However, these tests provide a qualitative result and cannot provide quantitative information regarding parasite density.

Uncomplicated malaria consists of symptomatic malaria without evidence of vital organ dysfunction and parasite count of less than 5% with the ability to take oral therapy.

Giving monotherapy of oral anti malarial drug in uncomplicated malaria may amount to negligence

Artemisinin derivatives are the only rapidly acting anti-malarial drugs as of date and if used alone, can lead to the development of artemisinin resistance.

Hence, they should not be administered as monotherapy for uncomplicated malaria except for specific studies on artemisinin resistance as injectables for severe malaria.

Injectable artemisinin derivatives should be used only in severe malaria.

Using these drugs in uncomplicated malaria may amount to negligence said Padma Shri Awardees, Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical association.

The Drugs Controller General of India (DCGI) banned oral single drug formulations of artemisinin and its derivatives in July 2009. WHO recommends access to quality-assured artemisinin-based combination therapies (ACTs) only.

For oral artemisinin-based monotherapies to be effective in eliminating malaria parasites, they need to be taken as a full 7-day treatment course. However, due to the rapid clinical response i.e. clearance of signs and symptoms within 2-3 days, most patients do not complete the full regimen leading to resistance.

Artemisinin-based therapies are the mainstay of recommended malaria treatments today, and their efficacy must be preserved, as no new class of antimalarial medicines is expected to enter the market within the next few years.

The anti-malaria drug artemisinin and its derivatives are artesunate and artemether.