August 24   2015, Monday
eMedinewS
editorial
Stress may increase smoking habits
Dr KK AggarwalStress increases the risk of heart attack by pushing people toward bad habits.

A British study published in the Journal of the American College of Cardiology suggests that people with psychological stress had a 50 percent increased risk of a cardiovascular disease event over the follow–up period. The reasons were higher smoking rates and low exercise levels of individuals who were stressed.

In the study over a seven year follow–up period, incidence of cardiovascular events –– heart attacks, stroke, bypass surgery and the like –– was 50 percent higher among the people with a high level of depression and anxiety when compared to happier people. Smoking and lack of physical activity explained about 63 percent of the increase, with smoking alone responsible for 41 percent.

Alcohol intake explained less than 2 percent of the increase, with high blood pressure assigned 13 percent of the blame.

All such patients should be treated with combined physiological approaches with intensive lifestyle changes to reduce modifiable risk.
An Apple a day or a statin a day
  • The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12,500).
  • The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10?800).
  • Data on the effect on vascular mortality (any stroke, cardiac death, or other vascular death) of the UK population of a statin a day came from the Cholesterol Treatment Trialists’ meta-analysis, which found that reducing cholesterol with a statin reduces the relative risk of vascular mortality by 12% per 1.0 mmol/L reduction in low density lipoprotein cholesterol and that on average this is reduced by 1.08 mmol/L over a year of treatment.
  • Cholesterol Treatment Trialists’ reports: Statins leading to an excess incidence of myopathy of 0.5/1000 patients over five years, of rhabdomyolysis of 0.1/1000 over five years, and of diabetes mellitus of 0.1% a year
  • Prescribing statins to everyone over the age of 50 years is predicted to lead to 1200 excess cases of myopathy, 200 cases of rhabdomyolysis, and 12,300 diagnoses of diabetes mellitus.
  • Prescribing either apples or statins to everybody over 30 years old is estimated to reduce the annual number of vascular deaths by 8800 (6500 to 11?100) or 9600 (7200 to 12?900) respectively, 3% more than prescribing to everybody over 50 years. The number of adverse events is predicted to double to 2400 cases of myopathy, 400 of rhabdomyolysis, and 24?400 excess diabetes diagnoses.
  • If compliance with apple prescriptions was 90%, the number of vascular deaths averted would increase to 11?000 (8100 to 13?900); this is 29% more than with 70% compliance
  • Finally, if the apple prescription has no effect on any aspect of the average diet except amount of fruit consumed, annual vascular deaths would reduce by 7100 (5000 to 9400), 20% fewer than if dietary compensation occurs
  • Choosing apples rather than statins may avoid more than a thousand excess cases of myopathy and more than 12?000 excess diabetes diagnoses.
(Source: BMJ 2013;347:f7267)
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eMedipics
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Heart Care Foundation of India’s (HCFI) trains over 200 school children on the importance of healthy eating, hygiene and sanitation
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News
Oncology
A new study published in JAMA Oncology has questioned whether surgery and radiotherapy are appropriate for women in the earliest stages of breast cancer. Researchers suggested that such treatment may be unnecessary for many women with ductal carcinoma in situ (DCIS), after finding it is unlikely to reduce risk of death from the cancer.

Psychiatry
Dissociative thinking and the related concept of inferential confusion appear to be key predictors of obsessive-compulsive disorder (OCD), showing strong associations after controlling for negative mood states, suggests new research published in the Journal of Clinical Psychology.

Rheumatology
Patients with rheumatoid arthritis (RA) have alterations in their oral and gut microbiomes that partially normalize with treatment, suggests a metagenome-wide association study published online in Nature Medicine.

Neurology
Cardiology
Diabetes

Nine potentially modifiable risk factors may contribute to up to two thirds of Alzheimer's disease cases worldwide, suggests an analysis of the available evidence, published online in the Journal of Neurology Neurosurgery & Psychiatry. The factors associated with a heightened risk included frailty, carotid artery narrowing, high and low blood pressure, and type 2 diabetes (in the Asian population).

Dentistry
The first-ever three-dimensional (3D) printer system to manufacture denture bases has been cleared for marketing by the US Food and Drug Administration. The Dentca Denture Base may soon allow dentists to make dentures in their offices.
Cardiology eMedinewS
Cardiology
Neurology
Complementary Medicine

A new study, published in the journal Medical Acupuncture, suggests that a form of acupuncture, called electroacupuncture, may benefit patients with high blood pressure and lower their risk of stroke and heart disease.

Cardiology
Diabetes

Compared to other kinds of fat, extra virgin olive oil may have healthier effects on levels of blood sugar and cholesterol after meals, suggested an Italian study, thus explaining why a traditional Mediterranean diet rich in olive oil is linked to lower risk of cardiovascular disease. The findings are published in the journal Nutrition and Diabetes.
Pediatrics eMedinewS
Pediatrics
Pulmonary Medicine

A new, single use DispozABLE™ Spacer2 (a valve-less holding chamber to help with the optimal delivery of salbutamol sulphate) has been developed by the technical team at UK-based medical device manufacturers, Clement Clarke International for the safe and prompt treatment of school age children suffering acute asthma. A study showing the efficacy of DispozABLE™ Spacer2 was presented at the International Society for Aerosols in Medicine (ISAM) conference.

Pediatrics
Neurology
Ophthalmology

Temporary visual deprivation shortly after birth induces permanent auditory responses in the visual area of the brain, highlighting a crossmodal competition for brain territories during the early sensitive period of brain development, suggests new research published in Current Biology.
Dr KK Spiritual Blog
Should doctors be detached?

In dealing with patients, the traditional Doctor-Patient relationship model has been that doctor should remain cool, calm and collected at all times.

Doctor’s approach needs to be strictly scientific, logical, objective, methodical precise and dispassionate. This model has been since the era of William Osler, the father of modern medicine. The term used is imperturbability which means coolness and presence of mind under all circumstances.

Osler said a rare and precious gift to doctor is right of detachment. The right of detachment insulates the doctors and protects them from the powerful emotions that patients display in their presence like anger, frustration, grief, rage and bewilderment. It also insulates patients from the rolling emotions that doctors may at times feel towards them.

However, a detached attitude also insulates doctors from empathizing with patients. A detached doctor may talk in a language that is over patient’s head.

Detachment is not like a light switch that you can turn on and off to suit the situation. Detachment as a practice cannot be in isolation if it becomes your personal style of distracting from the world, it may not be just for the patients but also from your colleague, family friends and even yourself.

I recall when I joined by hospital the first lesson given to me by my boss was not to get unduly attached with patients. As etiquette, we were taught not to socialize with patients. Even today the new American Guidelines talk that doctors should not socialize with their patients on social media including Facebook. Even doctors are human beings and their personal lives should not be known to patients. As far as lawsuits are concerned, it is equally true that known close patients file a law suit much more than unknown people because over a period of time they know your weakness. One should learn to empathize with the patients and yet be detached from its results. Doctors who follow Bhagwad Gita understand this concept very well.
Scientific awareness on personal hygiene and prevention from obesity among school going children, SULABH Public School
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Make Sure
Situation: A rape victim became pregnant.
Reaction: Oh my God! Why was emergency contraceptive not given to her?
Lesson: Make sure that all victims of rape are given an emergency contraceptive.
Dr Good Dr Bad
Situation: An infant was found to have high blood sugar.
Dr Bad: Such a young child cannot have diabetes.
Dr Good: It can be diabetes.
Lesson: Diabetes can occur in infants as well as in older children.

(Copyright IJCP)
eIMA Quiz
Which is not true regarding portocaval shunts?

a) Used for intractable ascites
b) It can be made selective by using 8 mm interposition graft
c) It is a partial shunt
d) Distal splenorenal shunt does not involves splenectomy

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: c) It is associated with APC mutation

Answers received from: Amit Desai, Dr Ridu Kumar Sharma, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr.B.R.Bhatnagar, Daivadheenam Jella, Dr Avtar Krishan,

Answer for 22nd August Mind Teaser: c) Astrocytomas

Correct Answers received from: Dr.B.R.Bhatnagar, Daivadheenam Jella, Dr Avtar Krishan,
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule for rabies vaccine?

The vaccine on Day 0 (first injection) must be doubled and given at two sites (deltoids or thigh in young children). In category II exposures, it is recommended to administer even RIGs along with vaccine. Rest of the schedule is same as for any other patient.
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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
2nd CSI Cardiac Prevent
It gives us immense pleasure to cordially invite you to the 2nd CSI Cardiac Prevent, being held at Hotel Taj Palace, New Delhi from 25th to 27th September 2015. The motto of the conference is ‘Innovations in Heart Disease Prevention – 2015’.

India is rapidly racing towards earning the unpropitious title of the ‘CVD capital of the world.’ The economic costs and the loss from this disease to the enviable demographic advantage of the country are likely to be immense. This is especially worrying since the disease strikes early and portends far worse outcomes among Indians. Moreover, the disease now is known to affect all classes of people, sparing none. Thus the time for action is NOW!

We expect 800 delegates, mainly from India and neighbouring countries and more than 100 experts from all over the world to attend Cardiac prevent 2015, making it one of the largest meetings in the discipline of preventive cardiology. The first day of the meeting, 25th September, will be used for public lectures, awareness camps and other public activities. The scientific program will feature interactive educative sessions and workshops apart from conventional plenary sessions, featured symposia, breakout sessions and oral presentation sessions for abstracts. We have invited renowned international and national faculty who are the leaders in the field of preventive cardiology. We sincerely hope that the blend of pleasant weather, warm hospitality and revitalizing social evenings will make the scientific environment richer.

Looking forward to welcoming you
With warm Regards
H K Chopra       Ashok Seth                 S Ramakrishnan
President          Organizing Chairman     Organizing Secretary

CSI Cardiac Prevent 2015 Cardiac Prevent 2015
NewS
1. The new study, from an analysis of more than 150,000 healthcare professionals in the United States, found that overall, light to moderate drinking (alcohol intake of < 15 g/day for women and < 30 g/day for men) was associated with a small but nonsignificant increase in cancer risk in both women and men (BMJ)

2. If you are a coffee drinker and are being treated for colon cancer, don't stop," said senior author Charles Fuchs, MD, MPH, from the of Dana-Farber Cancer Institute in Boston.

3. For 2014, the provisional crude death rate for influenza and pneumonia was 17.3 deaths per 100,000 population, down from 18.0 deaths per 100,000 in 2013. The age-adjusted death rate for the two diseases fell by 5% from 2013 to 2014 (15.9 vs 15.1 deaths per 100,000 standard population).

4. The provisional crude death rate from HIV disease fell from 2.2 deaths per 100,000 population in 2013 to 2.1 deaths per 100,000 population in 2014.

5. The provisional crude death rate from falls among persons aged 65 and older increased from 57.0 deaths per 100,000 population in 2013 to 58.2 deaths per 100,000 population in 2014. After adjustment for age, the death rate rose by 3% from 2013 to 2014 (56.7 vs 58.4 per 100,000 standard population).

6. The provisional crude death rate from heart disease fell from 193.3 per 100,000 population in 2013 to 192.7 deaths per 100,000 population in 2014. After adjustment for age, the death rate decreased by 2% from 2013 to 2014 (169.8 vs 166.6 per 100,000 standard population).

7. The provisional crude death rate from stroke increased from 40.8 deaths per 100,000 population in 2013 to 41.7 deaths per 100,000 population in 2014. After adjustment for age, the 2014 death rate was similar to the 2013 death rate (36.3 vs 36.2 per 100,000 standard population).

8. For 2014, the provisional crude death rate from Alzheimer's disease increased to 29.4 deaths per 100,000 population, from the death rate of 26.8 in 2013. After adjustment for age, the death rate rose by 8%, from 23.5 deaths per 100,000 standard population in 2013 to 25.4 deaths per 100,000 standard population in 2014.

9. For 2014, the provisional crude death rate from diabetes was similar to the death rate in 2013 (24.0 deaths per 100,000 population vs 23.9). After adjustment for age, the death rate fell slightly by 1% from 2013 to 2014 (21.2 vs 20.9 deaths per standard population).

10. As onion prices go through the roof in Monsoon season, food processing minister Harsimrat Singh Badal has got an idea — process this key kitchen staple into powder and paste forms when prices are low and save it for a rainy day.

11. LUDHIANA: A Sarabha Nagar-based hospital was accused of medical negligence after the death of a 42-year-old patient here on Saturday morning. The family of the deceased alleged that Sukhbir Singh died because the hospital staff had given him the wrong injection.

12. PANAJI: Unidentified doctors at the Goa Medical College have been booked for medical negligence after they reportedly left a piece of gauze in the patient’s stomach while conducting surgery.
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
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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
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Inspirational Story
The Touchstone

When the great library of Alexandria burned, the story goes, one book was saved. But it was not a valuable book; and so a poor man, who could read a little, bought it for a few coppers.

The book wasn't very interesting, but between its pages there was something very interesting indeed. It was a thin strip of vellum on which was written the secret of the "Touchstone"!

The touchstone was a small pebble that could turn any common metal into pure gold. The writing explained that it was lying among thousands and thousands of other pebbles that looked exactly like it. But the secret was this: The real stone would feel warm, while ordinary pebbles are cold.

So the man sold his few belongings, bought some simple supplies, camped on the seashore, and began testing pebbles.

He knew that if he picked up ordinary pebbles and threw them down again because they were cold, he might pick up the same pebble hundreds of times. So, when he felt one that was cold, he threw it into the sea. He spent a whole day doing this but none of them was the touchstone. Yet he went on and on this way. Pick up a pebble. Cold - throw it into the sea. Pick up another. Throw it into the sea.

The days stretched into weeks and the weeks into months. One day, however, about mid-afternoon, he picked up a pebble and it was warm. He threw it into the sea before he realized what he had done. He had formed such a strong habit of throwing each pebble into the sea that when the one he wanted came along, he still threw it away. So it is with opportunity. Unless we are vigilant, it's easy to fail to recognize an opportunity when it is in hand and it's just as easy to throw it away.
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Dear Sir, Very informative news. Regards: Dr Karuna
Wellness Blog
Honey excellent for Cough

A spoonful of honey can quieten children’s’ night time cough and help them — and their parents — sleep better.

When compared to the cough syrup ingredient dextromethorphan or no treatment, honey came out on top. As per a study from Archives of Paediatrics and Adolescent Medicine, the results are so strong that one is able to say that honey is better than no treatment and dextromethorphan was not. There is currently no proven effective treatment for cough due to an upper respiratory infection like the common cold. While dextromethorphan is widely used, there is no evidence that it works, and it carries risks.

Honey is used around the world as a home remedy for cough, and might provide a safe, effective alternative to cough medicine. To investigate, the researchers compared buckwheat honey, a honey–flavoured dextromethorphan preparation, and no treatment in 105 children who had sought treatment for night time coughs due to colds. Among the three groups, children given honey had the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality may be soothing to the throat, while its high antioxidant content could also be a factor. Honey also has antimicrobial effects. Honey is not recommended for infants younger below one year of age because of the risk of botulism spores.
IMA Humor
A waiter suddenly became ill and was rushed to the hospital emergency room. He was lying on the operation table in great pain when he saw an intern walk by.

“Doctor, you have to help me,” the waiter pleaded.

“Sorry,” the intern said. “This is not my table.”
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Press Release
Obesity – a growing epidemic in India

Over 30% of the Indian population including children are found to be suffering from potbelly or abdominal obesity. The incidence of metabolic syndrome, characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high blood sugar is at an all-time high in the country and continues to rise. The reason for this is the unhealthy lifestyle choices made by majority of the population including consumption of a diet, which predominantly has high trans fats, sugar and cholesterol, long hours spent working in closed spaces with minimal physical exercise and dependence on evils such as alcohol and cigarettes.

Normally once a person's height stops increasing, most of his/her organs will also stop growing. The weight of the heart, liver of kidney cannot increase after that. Only muscles can build up to some extent. The only thing, after that stage, which can increase the weight of the body, is deposition of fat. Therefore, any weight gain after puberty is invariably due to fat. Though the overall weight can be in the normally acceptable range but any weight gain within that range will be abnormal for that person. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. After the age of 50, the weight should reduce and not increase.

Speaking about the incidence of obesity in India, Padma Shri Awardee Dr KK Aggarwal, President HCFI & Honorary Secretary General IMA said, “An abdominal girth of more than 90 cm in men and 80 cm in women indicates that the person is vulnerable to future heart attacks. Normal weight obesity is the new epidemic in our country. A person can be obese even if his body weight is within the normal range. Even an extra inch of fat around the abdomen can increase the chances of heart disease by 1.5 times. Losing weight can reduce snoring, arthritis pain, blood pressure and also check uncontrolled diabetes. The time has come to raise mass awareness about the need to make smarter lifestyle choices to keep diseases such as diabetes, heart attacks and hypertension at bay. We are at more risk than ever before."

Potbelly obesity is linked to eating refined carbohydrates and not animal fats. General obesity is linked to eating animal fats. Refined carbohydrates include white rice, white maida, and white sugar. Brown sugar is better than white sugar. Refined carbohydrates are called bad carbohydrates, and animal fat is called bad fat. Trans fat or vanaspati is bad for health. It increases the levels of bad cholesterol and reduces good cholesterol in the body.

Some tips to keep obesity under check
  • Skip carbohydrates once in a week.
  • Combine a sweet food with bitter food (for instance choose to cook aloo methi over aloo matar).
  • Consume bitter green items in foods such as karela, methi, palak, bhindi, etc.
  • Do not eat trans fats (vanaspati).
  • Do not consume more than 80 ml of soft drink in a day.
  • Do not consume sweets with more than 30% sugar.
  • Avoid maida, rice, and white sugar.
  • Walk, walk and walk…