May 24  2015, Sunday
IMA congratulates Union Health Minister Shri JP Nadda on taking over as President of 68th World Health Assembly
Dr PillaiDr KK AggarwalThe Indian Medical Association (IMA) congratulates Union Health and Family Welfare Minister Shri JP Nadda on taking over as the President of the 68th Session of the World Health Assembly being held from May 18 to May 26 at Geneva.

IMA believes that it is a matter of great honour for our country, and IMA in particular, to assume presidency of this prestigious global health event that plays a decisive role in context of global health initiatives to prevent and cure various diseases. The health minister’s projection of India’s position on various global health issues has drawn positive response globally which is a matter of great pride.

The Presidential Address articulated India’s stand aptly by highlighting the importance of Yoga and emphasising the need to adopt a healthy lifestyle to improve health globally.

The contribution of 2.1 million US dollars to the World Health Organization (WHO) reflects India’s commitment to WHO and has helped to establish the role of India as a global leader in health.

India has assumed presidency of the prestigious World Health Assembly, the decision making body of the WHO, after a gap of 19 years.

A special photo exhibition on Yoga - “Yoga for All, Yoga for Health” was also organised at Geneva on the initiative of the Union health Ministry. Such an event on Yoga, an ancient Indian tradition, has happened for the first time at a prestigious global platform creating history.

Last year in December, the UN General Assembly adopted a resolution led by India, with co-sponsorship from 177 countries, to observe 21st June as the International day of Yoga.

Prof. Dr. A. Marthanda Pillai                                                                                           Prof. Dr. K. K. Aggarwal
National President, IMA.                                                                                                Honorary Secretary General, IMA.
IMA Swachh Bharat Campaign
Dr KK Spiritual Blog
You look at people the same way as you are

Honest people look everybody as honest and dishonest people look everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with your personal experience. I recall a doctor saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he had not taken into consideration the doctors who did not approach him.
Cardiology eMedinewS
  • Too much or too little sleep may be a stroke risk factor in hypertension. Self-reported typical sleep duration less than 5 hours was associated with a 1.83-fold elevated adjusted risk compared with the recommended 7 to 8 hours per night (95% 1.56-2.14), Oluwaseun Akinseye, MD, of the Icahn School of Medicine at Mount Sinai in New York City. People who usually slept more than 9 hours per night had a 74% elevated stroke risk (American Society of Hypertension meeting)
  • The use of statins or fibrates was associated with a 30% decrease in the incidence of stroke in healthy older people with no known history of vascular events, according to a population-based study. (BMJ)
Pediatrics eMedinewS
  • Evidence remains inconclusive on whether giving premature infants glycerin enemas or suppositories helps to promote meconium evacuation and transition to enteral feeding, suggests new research published online in Pediatrics.
  • Preliminary findings from ongoing research presented at the American Thoracic Society 2015 International Conference suggest that many children who have asthma also have peanut allergies but do not know it. Among the children with asthma tested for IgE, about 22% tested positively for peanut sensitivity.
Make Sure
Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to evaluate the patient thoroughly and only moderately tap the ascitic fluid as overenthusiastic tapping can be life–threatening.
Dr Good Dr Bad
Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it.
Dr. Good: Continue it.
Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.
(Copyright IJCP)
Wellness Blog

Fever does not mean presence of infection. There are many situations where there is fever without infection and hence needs no antibiotics.
  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36oC to 38.3oC. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5oC, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.
eMedinewS Humor
The Absent–Minded Professor

An absent-minded professor was moving to a new house further along the same street. His wife knew that he was prone to forgetting things and so she wrote down the new address on a piece of paper he went off to college. She handed him the paper and the key to the new house and reminded him not to go back the old address.

That morning, one of his student asked him a complex question and the professor wrote the answer down on the back of the slip of paper. This student asked whether he could keep the paper.

Forgetting what was on the other side, the professor said, "Certainly."

In the evening, he returned out of habit to the old house, tried the key and could not get in. Realizing his mistake, he search in his pockets for the slip of paper with the new address, but off course there was no sign of it. So he wandered along the street and the stop the first personable–looking lad whom he saw.

"Excuse me, I’m professor Galbraith. You would not happen to know where I live, would you."
eMedi Quiz
Since sunscreen-awareness campaigns began, have skin-cancer rates decreased?

A. Yes, fewer people are getting skin cancer.
B. No, skin-cancer rates and deaths from the disease are on the upswing.
C. No, skin cancer is on the rise, but fatalities are down.
D. Skin-cancer rates have been stable over the past decade.
E. Yes, but only among older women.

Yesterday’s Mind Teaser: How much exercise do you really need?

A. 45 minutes twice a week.
B. 30 minutes three or four days a week.
C. 60 minutes at least three or four days a week.
D. 30 minutes at least four or five days a week.
E. It depends on your age and overall physical-fitness level.

Answer for yesterday’s Mind Teaser: D. 30 minutes of exercise at least four times a week.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Dr G Madhusudhan, Dr Prabodh K Gupta, Dr Avtar Krishan.
Answer for 22nd May Mind Teaser: C. About 30 percent of your total calories should be from fat.
Correct Answers received: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr G Madhusudhan.
Rabies News (Dr A K Gupta)
What are the common side effects of intra–dermal rabies vaccination?

Cell culture vaccines have proved to be remarkably safe and free of significant adverse events. However, mild symptoms of pain, erythema, irritation or swelling at the intradermal injection sites occur in 3–92% of patients. The most frequent symptom is local irritation in 7–64% of vaccines. Generalized symptoms reported by 3–14% of recipients include headache, fever and influenza–like illness. Transient macular, papular and urticarial rashes are occasionally seen. All these adverse effects are mild, transient and self limiting and rarely call for the use of antihistamines and analgesics.

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
  • Antibiotic therapies are used for approximately 56 percent of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses (Dr. Greg Filice, Society for Healthcare Epidemiology of America).
  • Exercise activates brain centers associated with pain modulation in patients with fibromyalgia and may prove an effective treatment, suggests new research presented at the American Pain Society (APS) 34th Annual Scientific Meeting.
  • A higher number of lymph nodes removed during resection for gastric adenocarcinoma confers a survival advantage in all patients except those with advanced stage disease, suggests new research published online in the Journal of the American College of Surgeons.
  • Repeating postpartum depression (PPD) screening at 6 and 12 months after childbirth revealed that 13.5% of women were newly at high risk for depression compared with their status when screened immediately after giving birth, reported a new study published in the May/June issue of the Annals of Family Medicine.
  • A higher number of lymph nodes removed during resection for gastric adenocarcinoma confers a survival advantage in all patients except those with advanced stage disease, suggests new research published online in the Journal of the American College of Surgeons.
  • Screening for vitamin D deficiency: During most seasons, 10 to 15 minutes of sun exposure near midday is sufficient for adequate vitamin D synthesis in light-skinned individuals. However, darker skin pigmentation, winter season, or northern latitudes can markedly reduce skin synthesis of vitamin D and increase the need for dietary sources. Screening is recommended in populations at risk for vitamin D deficiency, but not for the population at large. The best test for assessing vitamin D status is to measure 25(OH)D levels. Screen
    1. Infants and young children with nonspecific symptoms such as poor growth, gross motor delays, and unusual irritability
    2. Dark-skinned infants and children
    3. Infants with a history of prematurity
    4. Children on anticonvulsants or chronic steroids
    5. Children with malabsorption
    6. Inflammatory bowel disease
    7. Children with low dietary intake of vitamin D, who are not taking supplements
    8. Children with elevated levels of serum alkaline phosphatase (ALP) (e.g., >500 int. units/L in neonates or >1000 int. units/L in children up to 9 years of age; ALP levels tend to decrease after puberty
    9. Patients at risk for low bone density, such as those with amenorrhea, immobilization, chronic kidney or liver disease, and for those who are pregnant or lactating
Warning about use of non-prescription asthma treatments
US FDA: Some non-prescription therapies, such as racemic epinephrine inhaler (sold as Asthmanefrin) and systemic ephedrine (sold as Bronkaid and Primatene tablets), are less effective than standard therapies for asthma and have a higher rate of side effects.
Safety of inhaled long-acting beta agonist/glucocorticoid for asthma during pregnancy
In a study of 1302 pregnant women with asthma, the risk for a major congenital malformation was not increased when a LABA plus low dose inhaled glucocorticoid was compared with a medium dose inhaled glucocorticoid, or when a LABA plus medium-dose inhaled glucocorticoid was compared with a high-dose inhaled glucocorticoid (J Allergy Clin Immunol 2015; 135:123).
Transfusion threshold for patients who have undergone cardiac surgery
In the TITRe2 trial, 2007 patients who underwent cardiac surgery were randomly assigned to a restrictive transfusion threshold (hemoglobin <7.5 g/dL) or a liberal threshold (<9 g/dL).There was no difference in the rate of the primary combined outcome of serious infection or an ischemic event. We suggest a transfusion threshold of 7.5 to 8 g/dL for these patients. (N Engl J Med 2015; 372:997).
No effect of blood storage duration on transfusion outcomes (April 2015)
The Age of BLood Evaluation (ABLE) trial evaluated critically ill adults requiring an RBC transfusion, and the REd CEll Storage duration Study (RECESS) evaluated patients undergoing complex cardiac surgery. Neither trial found a difference in primary outcome (90-day mortality or change in multi-organ dysfunction score) or in a variety of secondary outcomes or adverse events. The data supports current transfusio3333333333333333339n practice that does not take into account RBC storage duration (N Engl J Med 2015).
World No Tobacco Day
Inspirational Story
The Three Races

In old times, a fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.

One day, the boy was preparing for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.

The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power... he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy however felt proud and important.

A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.

"Another race, another race!" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?" quizzed the little boy. "This is no race" he exclaimed. "Race!" said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy."What has happened? Why not do the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "…this time, finish together, all three of you, finish together" continued the wise man. The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.

"Old man, I understand not! Who is the crowd cheering for? Which one of us three?" asked the little boy. The wise old man looked into the little boy’s eyes, placing his hands on the boy’s shoulders, and replied softly, "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"
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Quote of the Day
Happy is the man who can do only one thing; in doing it, he fulfills his destiny. Joseph Joubert
Reader Response
Dear Sir, very informative news. Regards: Dr Shorya
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Press Release
Doctors across 135 cities participate in the biggest ever Clean India National Movement by Indian Doctors

Alkem Chronic, an SBU of Alkem Laboratories Ltd with support from the Indian Medical Association organizes a mass cleanliness drive with the message ‘A clean India will deliver a healthy India’

Yesterday India witnessed one of the biggest cleanliness rallies by the medical fraternity, which occurred simultaneously in 135 cities across the nation. In line with the Hon’ble Prime Minister’s Swachh Bharat Abhiyan, Alkem Laboratories, India’s 5th largest pharmaceutical company with support from the Indian Medical Association & the medical fraternity took up the mission of raising awareness about how a “Clean India will deliver healthy India”.

The message of the drive was short and simple, ‘More than 50% of diseases can be eliminated and health budget saved if one's surroundings are kept clean’. As a part of the campaign, the Indian Medical Association educated over 2.5 lakh of its doctor members about the importance of imparting basic health and hygiene awareness to their patients for a healthier India. In Delhi a large number of participants were seen cleaning the twin premises of Swami Dayanand Hospital and Bhagwan Mahavir Hospital showcasing their support towards the cause.

Commenting on the initiative the Alkem Laboratories Ltd Chronic Team said that “It is indeed a proud moment for everyone at Alkem for having successfully rolled out a clean India campaign at such a large scale. We are overwhelmed with the number of people who came out on the streets today across 135 cities to clean their surroundings and spread the message that only a “Clean India will deliver a healthy India”.

Adding to this, Padma Shri Awardees and the National President & Honorary Secretary General of the Indian Medical Association, Dr. Marthanda Pillai and Dr K K Aggarwal & Dr Ajay Lekhi – President Delhi Medical Association in a joint statement said, “We at Indian Medical Association believe that awareness is the first step to disease prevention and are proud to be associated with this movement. It is the duty of every doctor to educate their patients about basic hygiene measures such as the proper technique of washing one’s hands. Let us together take a pledge to make our city a cleaner and healthier one”.

Dr. R.M. Chhabra, Bhagwan Mahavir Hospital, Dr. Anil Gomber , MD, Saroj Hospital, Dr Vimal Nakra, Max Hospital, Patparganj, and Dr. Ashok Sharma, Indraprastha Apollo Hospital who participated in the cleanliness drive in a joint statement said, “Delhi is the most polluted city in the world having, one of the country's highest volumes of particulate matter pollution. Also known as PM 2.5, it is recognized to be the most harmful to human health. Recent studies show that every third child in Delhi suffers from reduced lung function due to air pollution. Steps can be taken by each and every individual to reduce this environmental disease burden. Small measures like conserving energy, recycling, safe household water storage, better hygienic measures, more judicious management and use of toxic substances at home and at the workplace, can help us go a long way in keeping India clean and thus in turn avert a host of diseases. The government alone cannot achieve this. We would like to use the platform provided by Alkem & IMA to call out to all our citizens to take up a personal mission of keeping the country clean.”.

A recent report by the United Nations mentions that over 1 lakh people in India die of water-borne diseases annually. One of the major reasons for this is that about 70 per cent of water supply here is majorly polluted with sewage effluents. In light of this, it becomes very important to cultivate clean habits amongst people. Cleanliness drives of such scale help in making people understand the importance and need for sanitation, hygiene and water resource management.