July 24  2015, Friday
eMedinewS
editorial
Predicting sudden cardiac death
Dr KK Aggarwal
  • Normally people can walk a distance of 400–700 meters in 6 minutes.
  • A 6-minute walking distance of less than 300 meter is simple and useful predictor of sudden cardiac death in patient with mild to moderate heart failure.
  • Patient with ILD who can cover less than 200 meters during 6 minute walk test are 4 times more likely to die than those who can walk greater distance.
  • People who can cover a distance of 200–300 meters need further evaluation.
  • A fall of SpO2 of more than 4% ending below 93% suggests significant desaturation.
  • An improvement of more than 70 meters or 10% in distance walk can make all the difference.
  • An improvement of 30 meters in any distance walked is the minimally important difference in any treatment.
  • Sudden cardiac death is linked to 15% of total urban mortality
  • Risk factors for sudden cardiac death include abnormal lipid level, high blood pressure, cigarette smoking physical inactivity, diabetic, obesity and family history of pre–mature heart disease or heart attack.
  • Binge alcoholism can cause sudden cardiac death (6 or more drinks per day or five drinks in one session)
  • Risk of sudden cardiac arrest is transiently increased during for up to 30 minutes after strenuous exercise (1/1.5 million of episode of exercise)
  • If you are at low risk for having a heart problem, you do not need a regular treadmill test.
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eMedipics
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In cardiac arrest call 102 or 100
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News
Oncology
Regional nodal irradiation can reduce breast cancer recurrence in patients with node-positive or high-risk node-negative disease, but offers no survival benefit, reported two large clinical trials published in the July 23 issue of the New England Journal of Medicine.

Neurology
Knowing the amyloid status of patients could help direct anti-Alzheimer's disease drugs to those most likely to benefit from them and prevent prescribing these agents unnecessarily, suggests new research presented at the Alzheimer's Association International Conference (AAIC) 2015.

Infectious diseases
Final 10-year results from the HIV Prevention Trials Network (HPTN) 052 study — in which the HIV-positive partner in a serodiscordant couple received antiretroviral therapy to protect the negative partner from HIV transmission — revealed that antiretroviral therapy, when taken until viral suppression is achieved and sustained, is a highly effective, durable intervention for HIV prevention. The findings were presented at the 8th International AIDS Society Conference.

Ophthalmology
Eye surgeons in developing countries can use fibrin glue on the scleral rim to increase the number of donor corneas they can use for transplant, suggests new research published online in the British Journal of Ophthalmology.

Diabetes
Two new studies published in The BMJ suggest that regular sugary drink consumption and a combination of low birth weight and an unhealthy lifestyle in adulthood are associated with increased risk of type 2 diabetes.
Cardiology eMedinewS
  • A large proportion of middle-aged men and women who had a similarly aged sibling with recent MI showed no CV symptoms themselves despite significant coronary lesions by coronary CT angiography (CCTA), reported a prospective cohort study presented at the Society of Cardiovascular Computed Tomography (SCCT) 2015 Annual Scientific Meeting.
  • Low-dose radiation from cardiovascular computed-tomography (CT) angiography results in DNA and cellular damage, as well as increased expression of cells involved in the regulation of cell repair and apoptosis, suggested a new study published online July 22 in the Journal of the American College of Cardiology: Cardiovascular Interventions. Researchers noted that most of the cells damaged by the CT angiogram were repaired, but a small percentage of cells died.
Pediatrics eMedinewS
Pediatrics/Neurology
Blood levels of arginine vasopressin (AVP) were significantly and positively correlated with scores on the Developmental Neuropsychological Assessment (NEPSY)–II Theory of Mind subscale among children with autism spectrum disorder (ASD) but not in neurotypical children, reported a study published online July 22 in PLos One.

Pediatric/Cardiology
In children, vitamin D levels, as measured by serum 25-hydroxyvitamin D (25[OH]D) concentrations, are inversely associated with non-HDL cholesterol levels, fasting triglycerides, and total cholesterol levels, suggests a new study published in PLos One.
Dr KK Spiritual Blog
Astik Vs Nastik

Traditionally, people believe that Nastik are people who do not go to temples or related places of worship. They also do not believe in God.

To differentiate between Astik and Nastik, we need to first understand the concept of Sanatan Dharma and Arya Samaj Dharma. People who believe in Sanatan Dharma consider God as separate from the self and worship him in the form of an idol. They believe in Dualism theory.

Arya Samaj followers do not do idol worship and believe in non–dualism and treat God and self as one.

Arya Samajis, therefore, will not go to a temple where the idols of Gods are placed. Being an Arya Samaji does not mean that the person is Nastik.

The word Nastik means someone who does not believe in God at all, therefore, he or she also does not believe in self as God is nothing but self. In medical sciences, these are the people who have no insight and will usually be suffering from depression and loss of self–esteem.
Make Sure
Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Dr Good Dr Bad
Situation: A patient with sepsis developed thrombocytopenia.
Dr Bad: It is due to drugs.
Dr Good: It is due to sepsis.
Lesson: More than 50% of patients with sepsis show thrombocytopenia in their peripheral smear.

(Copyright IJCP)
eMedi Quiz
Thirty-eight children consumed eatables procured from a single source at a picnic party. Twenty children developed abdominal cramps followed by vomiting and watery diarrhea 6-10 hours after the party. The most likely etiology for the outbreak is:

1. Rotavirus infection.
2. Enterotoxigenic E. coli infection
3. Staphylococcal toxin.
4. Clostridium perfringens infection.

Yesterday’s Mind Teaser: A 5-year-old boy passed 18 loose stools in last 24 hours and vomited twice in last 4 hour. He is irritable but drinking fluids. The optimal therapy for this child is:

1. Intravenous fluids.
2. Oral rehydration therapy.
3. Intravenous fluid initially for 4 hours followed by oral fluids.
4. Plain water ad libitum.

Answer for yesterday’s Mind Teaser: 2. Oral rehydration therapy.

Correct Answers received from: Dr K V Sarma, Dr Kailash Sharma, Dr G Madhusudhan., Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 22nd July Mind Teaser: 4. 0%

Correct Answers received: Dr Poonam Chablani, Viswanatha Sarma, Dr B R Bhatnagar, Dr A C Dhariwal, Dr B B Aggarwal, Daivadheenam Jella, Dr Avtar Krishan.
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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
Dear Doctor,

The verdict of the Kerala and Tripura High Courts regarding private practice of government doctors are contradictory.

While the Kerala high court gave a judgment not limiting government doctors to charge fees, even more than stipulated by the government, the Agartala High Court has brought in many restriction of the practice of government doctors.

The direction of the court that a doctor cannot practice more than 3 hours on a week day has to be contested. Court could have opined a government doctor can practice after the working hours in government hospital and without hindrance to his duty as a government doctor.

Fixing of fees by the court is also against trade practices. A professional is entitled to fix his fees and it is the choice of the patient/ service seeker to avail his service at the fees fixed by the doctor. This is the right of the professional

The court verdict also did not give any weightage for the specialty or seniority of the doctor. A receipt need to be given only on demand by the patient and there is no need to make it a routine with each consultation.

It is noteworthy that Kerala high court held that ‘excess fee charged by government doctors cannot be branded as illegal gratification and that such a doctor cannot be prosecuted under prevention of corruption act’. When a doctor is authorized under the law, to accept consultation fees or to accept medical certificate fee, and if the doctor demands or accepts something over the stipulated fees, the doctor cannot be prosecuted under the PC Act.

Quoting this verdict, and other justifications mentioned above, the IMA Tripura state branch should file an appeal against the Agartala High Court verdict. National IMA is ready to offer all legal and logistical support on this issue

Prof.Dr.A.Marthanda Pillai
National President,
Indian Medical Association.
News
  • Whether you are slim or obese, if you drink lots of sugary soda or other sweetened drinks you are more likely to develop type 2 diabetes, as per a new analysis reported July 22 in online edition of the BMJ
  • "We found that both low birth weight and unhealthy lifestyle were associated with a significantly higher risk of type 2 diabetes," study leader Dr. Lu Qi, associate professor of nutrition and epidemiology at Harvard School of Public Health in Boston, and colleagues said in a news release from the journal BMJ, which published the findings July 21.
Inspirational Story
Sometimes your biggest weakness can become your biggest strength

Take, for example, the story of one 10–year–old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move.

"Sensei," the boy finally asked, "Shouldn’t I be learning more moves? This is the only move I know"

"But this is the only move you’ll ever need to know," the sensei replied.

Not quite understanding, but believing in his teacher, the boy kept training. Several months later, the sensei took the boy to his first tournament.

Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time–out. He was about to stop the match when the sensei intervened.

"No," the sensei insisted, "Let him continue." Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion. On the way home, the boy and sensei reviewed every move in each and every match.

Then the boy summoned the courage to ask what was really on his mind. "Sensei, how did I win the tournament with only one move?" "You won for two reasons," the sensei answered.

"First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm."

The boy’s biggest weakness had become his biggest strength.
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Quote of the Day
Perfection is not attainable, but if we chase perfection we can catch excellence. Vince Lombardi
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Reader Response
Sir, Congrats...a very nice initiative to connect all of us. Nice to see a vibrant, progressive and dynamic team IMA. Long live IMA. With lots of respect: Dr Shekhar R Mane
Wellness Blog
First Aid in Burns
  • Patients with severe thermal burns are at significant risk of death and major morbidity.
  • Look for evidence of respiratory distress and smoke inhalation injury, a common cause of death in the acute burn victim.
  • Laryngeal edema can develop suddenly and unexpectedly.
  • Burn depth and size determine fluid resuscitation and the need for transfer.
  • Vascular collapse from burn shock is a critical component.
  • Rapid, aggressive fluid resuscitation to reconstitute intravascular volume and maintain end–organ perfusion is crucial.
  • The fluid requirement during the initial 24 hours of treatment is 4 mL/kg of body weight for each percent of total body surface area burned, given IV. Superficial burns are excluded from this calculation. One-half of the calculated fluid need is given in the first 8 hours; the remaining half is given over the subsequent 16 hours.
  • It is important to monitor urine output. Hourly urine output should be maintained at 0.5 mL/kg in adults.
  • Burn patients may be exposed to carbon monoxide and require immediate treatment with high–flow oxygen.
  • Cool and clean wounds, but avoid inducing hypothermia.
  • Remove any jewelry and any hot or burned clothing and obvious debris not densely adherent to the skin.
  • Irrigation with cool water may be used.
  • Topical antibiotics are applied to all non superficial burns.
  • Give opioids (morphine) to treat pain and give tetanus prophylaxis.
IMA Humor
Priceless definitions

Wrinkles: Something other people have, similar to my character lines.
IMA Videos
News on Maps
Rabies News (Dr A K Gupta)
What is the role of monoclonal antibodies in Rabies?

Monoclonal antibodies against rabies virus have been widely used in the diagnosis and immunological analysis of rabies. Human monoclonal antibodies to rabies virus G protein are also expected to be used as a replacement for rabies immunoglobulin (RIG) in the post–exposure treatment of rabies. In 1978, Wiktor reported the preparation of rabies virus monoclonal antibodies. Since then, rabies virus monoclonal antibody (mAb) technology has been more and more widely used in basic research and diagnosis of rabies.
Press Release
First of its kind e-meet on Tuberculosis held between 1000 IMA doctors from across 28 of its State branches and the Association leadership

The interactive webcast was an initiative under IMA Digital, a program in line with the Prime Minister’s Digital India initiative

Bridging the vast geographical gap that exists in our country, the Indian Medical Association has launched several digital initiatives aimed at more efficient implementation of its programs. As a part of this, a first of its kind e-meet was held between 3-4 pm today which connected over 100 doctor members of IMA from across States with the leadership on the subject, “Why notifying tuberculosis cases was important”. The overall aim of the Indian Medical Association is to use the digital medium to amplify important healthcare messages to both its 2.5-lakh doctor members and to the public at large.

Interacting with over 1000 IMA doctors from across the country, Padma Shri Awardee, Dr A Marthanda Pillai, National President, IMA and Padma Shri Awardee, Dr KK Aggarwal, Honorary Secretary General, IMA in a joint statement said, “In May, 2012 the Ministry of Health & Family Welfare declared Tuberculosis as a notifiable disease. Most Municipal Corporation Acts also include Tuberculosis under the section of dangerous diseases, which mandate reporting. The Medical Council of India in its ethics for doctors clearly states under regulations 5.2 and 7.14 that it is mandatory for all practicing doctors of modern medicine to notify communicable diseases, which includes Tuberculosis. It further states that once Tuberculosis is notifiable disease as per the IMA guidelines, there is no question of confidentiality or privacy.”

According to Section 269-270 of the Indian Penal Code, if the spread of Tuberculosis is allowed to continue in the society by means of not taking the necessary treatment or not advising treatment, it can account to negligence.

The IMA further said that each person who gets exposed to a patient suffering from Tuberculosis must be traced and treated. One undetected Tuberculosis patient can spread the disease to 20 additional people on an average and can continue to do so for up to 2-3 years. 10-14% of the total cases where the patient receives only half the treatment can take more serious forms and develop into MDR TB. MDR Tuberculosis is highly contagious and can cause the infection to spread to healthy people at a rapid speed.

In addition to the e-meet, IMA has already created a digital group called Team IMA, which will make daily communication between over over 2000 Central Council Members possible. Since the beginning of this year, over 2 lakh doctor members of the IMA are being sent daily updates on the organization and key health matters through the medium of text messages and emails.

IMA will also be launching a first of its kind Tele Medicine Rural Health Consultation service on 16thAugust, 2015 where the IMA Dhule Branch will connect with the IMA headquarters through videoconferencing.
header

State

Name

Mobile

Venue

ANDHRA PRADESH

Dr. VENKATESWARLU PONNURU

9848032246

EB Section 1st Floor, TE Madhapur, Hyderabad

ASSAM

Dr. MANABENDRA GOSWAMI

9435193724

CTO building, Ground Floor, PAN Bazaar, Guwahati.

BIHAR

Dr. SAHAJANAND PD. SINGH (ACTING PRESIDENT)

9334118698,9431009091

Room adjacent to media centre room, ground floor,O/o CGM, BSNL Bihar Telecom Circle, Sanchar sadan, CTO building, Near GPO, Patna – 800001

CHHATTISGARH

Dr. AJAY GOVERDHAN

9424107891

Room no.F-207, 1st Flr, Telephone Bhavan, Fafadih, Raipur

CHANDIGARH

Dr. GAJINDER DEWAN

9876027113

Grnd Flr, Adjoining CSC, Sector -17, Chandigarh

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Grnd Flr, Central Repair Shop, Navrangpura, TE, Navrangpura, Ahmedabad

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Grnd Flr, Karimabad, Admin Building, Ghod Road, Surat

GUJARAT

Dr. CHETAN N. PATEL

9426378078

Alkapuri TE Building, Grnd Flr, BB Helpdesk room, Near Race Course Circle, Vadodara

GUJARAT

Dr. CHETAN N. PATEL

9426378078

TE Building, Sector-11, 1st Flr, CRS room, Gandhinagar

HARYANA

Dr. ANIL GOYAL

9810053999

1st Floor Room, Sector 44, Plot No.42, CSC BSNL Gurgaon

KARNATAKA

Dr. HONNE GOWDA

9448118299

CTO Building, Ground floor, Adjacent to CSC, Bangalore

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

Grnd Flr, CSC, TE Building, Model Colony, Pune

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

Room no. 64 SFMS, Ground Floor, CTO Bldg, Civil Lines, Nagpur

MAHARASHTRA

Dr. T.C. RATHOD

9422168300

SDELC, 1st Floor, Canada Corner, BSNL Nasik, Nashik

MADHYA PRADESH

Dr. AMARJIT SINGH BHALLA

9826266385

BSNL Bldg No.3, 1st Floor, Nehru Park, Indore

MADHYA PRADESH

Dr. AMARJIT SINGH BHALLA

9826266385

CTO BSNL Building, New market, TT Nagar, Bhopal

ORISSA

Dr. SAROJ KUMAR SAHU

9437002424

1st Floor, CTO building, CSC, PMG Square, Bhubaneshwar

ORISSA

Dr. SAROJ KUMAR SAHU

9437002424

CTO Building BSNL Cuttack

PUNJAB

Dr. SURINDER PAUL SINGH SOOCH

9814064426

1st Floor, Dugri Urban Estate, BSNL Ludhiana, Ludhiana

RAJASTHAN

Dr. R.K. AGARWAL

9314475929

1st floor, CTO Building, MI road, BSNL, Jaipur

RAJASTHAN

Dr. R.K. AGARWAL

9314475929

Grnd flr, E-10B, BSNL Bldg, Road no.2, Indraprastha Area, Kota

TELANGANA

Dr. SHYAM SUNDER KASAPA

9849797013

EB Section 1st Floor, TE Madhapur, Hyderabad

UTTAR PRADESH

Dr. SHARAD KUMAR AGARWAL

9717111942

TE Kaiser Bagh, Lucknow

UTTAR PRADESH

Dr. SHARAD KUMAR AGARWAL

9717111942

108, 1st floor, BSNL Admin building, Sanjay Place, Agra