February 25  2015, Wednesday
editorial
Harvard’s Medical School’s 4 Exercising Tips For People With Diabetes
Dr KK Aggarwal
  1. Get a "preflight" check
    1. Talk with your doctor before you start or change a fitness routine.
    2. Especially if you are overweight or have a history of heart disease, peripheral vascular disease, or diabetic neuropathy.
    3. Go for a complete physical exam and an exercise stress test for people if you are 35 or older and who have had diabetes for more than 10 years. The results can help determine the safest way for you to increase physical activity.
  2. Spread your activity throughout the week
    1. Adults should aim for a weekly total of at least 160 minutes of moderate aerobic activity, or 80 minutes of vigorous activity, or an equivalent mix of the two.
    2. Be active at least 3 to 5 days a week.
  3. Time your exercise wisely
    1. The best time to exercise is 1 to 3 hours after eating, when your blood sugar level is likely to be higher.
    2. If you use insulin, it’s important to test your blood sugar before exercising. If it is below 100 mg/dL, eat a piece of fruit or have a small snack to boost it and help you avoid hypoglycemia. Test again 30 minutes later to see if your blood sugar level is stable.
    3. Check your blood sugar after any particularly grueling workout or activity.
    4. If you use insulin, your risk of developing hypoglycemia may be highest 6 to 12 hours after exercising.
    5. Do not exercise if your blood sugar is too high (over 250).
Be prepared

Should you experience a medical problem while exercising (or at any time) it is important that the people who care for you know that you have diabetes. Keep card handy or glucose tablets with you while exercising in case your blood sugar takes a sudden nosedive.
eMedipics
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CPR 10 Utsav 15th December 2013
News Around the Globe
  • A chronotherapeutic intervention combining sleep deprivation (wake therapy), bright-light therapy, and sleep scheduling may have long-term benefits for some patients with major depression, suggest follow-up data from a randomized, controlled trial. The study is published online in Acta Psychiatrica Scandinavica.
  • The US Food and Drug Administration (FDA) has granted accelerated approval to panobinostat for the treatment of patients with relapsed multiple myeloma.
  • Taking a couple of naps may counteract the impact of a sleep-restricted night on stress and immune markers, suggests a new study. This could potentially benefit night and shift workers or other chronically sleep-deprived populations. The study is published in the Journal of Clinical Endocrinology and Metabolism.
  • Vildagliptin lowers hepatic triglyceride levels but does not affect body weight or peripheral insulin sensitivity, suggests new research published in The Journal of Clinical Endocrinology & Metabolism.
  • Ultrasonography (US) should be preferred over magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) for diagnosing full-thickness rotator cuff tears, suggests a new meta-analysis published online in the British Journal of Sports Medicine.
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.

Ganesha’s head that of an elephant, 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 Ganapati Deva 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 of the arms of Ganesha, which hold a rope, symbolize control over the attachments. The laddoo or sweet in one shows 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.
Event
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Cardiology eMedinewS
  • Alirocumab shows significantly better LDL-C lowering than ezetimibe, with a comparable safety profile to ezetimibe, suggests a new phase III study published in Future Cardiology.
  • Nanometer-sized "drones" that deliver a special type of healing molecule to fat deposits in arteries represent a new way to prevent heart attacks caused by atherosclerosis, suggests a study in pre-clinical models by scientists at Brigham and Women's Hospital (BWH) and Columbia University Medical Center. The findings are published in the online issue of Science Translational Medicine.
Pediatrics eMedinewS
  • When infants at high risk of developing peanut allergy consume peanut on a regular basis, their risk can be dramatically reduced, according to LEAP — the Learning Early About Peanut study. The study was published online in the New England Journal of Medicine.
  • Children with egg allergy can safely receive intranasal doses of a live attenuated influenza vaccine (LAIV) made with egg protein, suggests new research published online in the Journal of Allergy and Clinical Immunology.
Make Sure
Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.
Medicolegal
(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Phenol poisoning is known as carbolism
  • Dettol is a chlorinated phenol and it is nontoxic to adults even in higher concentrations; some fatalities have occurred in children.
  • Poisoning by phenol or Dettol is known as carbolism because of the carbolic acid.
  • The acid in a concentrated form acts as a corrosive and remotely as a narcotic poison.
  • It coagulates proteins but does not form a firm chemical combination with them. Applied to the skin, it causes a burning sensation followed by tingling, numbness and anesthesia due to its effect on sensory nerve endings.
  • Dangerous symptoms may be caused by 0.3 to 0.42 g of carbolic acid; about 2g is the average fatal dose. A quarter of a teaspoon full dissolved in glycerin killed a six month old child.
  • Carbolic acid is largely used as an antiseptic, as a disinfectant and as a preservative. It is used in the preparation of many disinfecting powders.
  • Carbolic soaps should not be used for enemas. Being easily procurable several cases of accidental and suicidal poisoning by carbolic acid have occurred.
  • On account of its powerful odor and taste, it is rarely used for homicidal purposes though it has been sometimes used for murdering children and infants.
Dr Good Dr Bad
Situation: A child came with focal convulsions with onset of high–grade fever.
Dr Bad: These are simple febrile convulsion.
Dr Good: These are not simple febrile convulsions.
Lesson: Simple benign febrile convulsions are always generalized.
IJCP Book of Medical Records
IJCP’s ejournals
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Wellness Blog
Blood pressure measurement may detect proneness to heart attack

The ankle–brachial index (ABI), a simple, non–invasive 10–minute test should be incorporated into a routine physical exam for diagnosing peripheral arterial disease in the middle aged and the elderly, especially those with heart attack risk factors like smokers, diabetics and the ones with high BP or cholesterol levels.

With the patient in a supine position, the doctor takes blood pressure readings from both arms; he then takes blood pressure readings from both ankles with a sphygmomanometer and Doppler device. ABI value is calculated by dividing the higher systolic pressure in each leg by the higher systolic brachial pressure.

ABI scores should be interpreted as follows:
  • Greater than 0.90: Normal
  • 0.71 – 0.90: Mild obstruction
  • 0.41 – 0.70: Moderate obstruction
  • Less than 0.40: Severe obstruction
  • More than 1.30: Calcification of the vessels
Presence of peripheral arterial disease may indicate associated blockages in the heart and proneness to heart attack or paralysis.
eMedi Quiz
Strong correlation with colorectal cancer is seen in:

1. Peutz-Jegher's polyp.
2. Familial polyposis coli.
3. Juvenile polyposis.
4. Hyperplastic polyp.

Yesterday’s Mind Teaser: A 40 year old male had undergone splenectomy 20 years ago. Peripheral blood smear examination would show the presence of:

1. Dohle bodies
2. Hypersegmented neutrophils.
3. Spherocytes.
4. Howell-Jolly bodies.

Answer for yesterday’s Mind Teaser: 4. Howell-Jolly bodies.
Correct Answers received from: Dr Avtar Krishan, Dr Poonam Chablani, Dr M Mahesh, Dr G Sampath, Daivadheenam Jella.
Answer for 24th Feb Mind Teaser: 4. Portal hypertension due to extrahepatic obstruction.
Correct Answers receives: Dr KV Sarma, Dr Avtar Krishan, Daivadheenam Jella.
Press Release of the Day
Heart disease may present with asthma like symptoms

Heart disease may present with asthma like symptoms said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Dr. Aggarwal said that the commonest cause of breathlessness is not asthma. Both obesity and anemia can cause exertional breathlessness. Uncontrolled blood pressure, diastolic dysfunction of the heart and enlarged heart can also cause breathlessness.

The thumb rule is that any breathlessness appearing for the first time in life after the age of 40 is cardiac in nature unless proved otherwise.

Impaired relaxation functions of the heart are a new epidemic of the society where the heart arteries do not have any blockages but the heart cannot relax properly. Diastolic functions of the heart can be evaluated by tissue Doppler echocardiography examination. Ordinary echo exam will miss the diagnosis as it usually detects the contracting systolic functions of the heart.
eMedinewS Humor
Doctor, Doctor! I keep thinking I’m God!
Doc: When did this start?
Well first I created the sun, then the earth, then the…
Twitter of the Day
Dr KK Aggarwal: ECG not reliable marker for predicting heart disease http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra: Knowing that everyone is doing their best from their level of consciousness. http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
What are the initial (prodromal) symptoms of rabies?
  • Pain or paresthesia at the site of the bite is well–known as a diagnostically useful prodromal symptom occurring in one–third to two–thirds of cases. In Thailand, however, a specific type of paresthesia–itching–was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesia may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in 3 of the 4 patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
IMA NEWS
Suggestions for Medical Emblem Received So Far
IMA,IJCP,HCFI
 
Dear All,

Recently we were contacted by student representatives of DD Medical College, Tamilnadu regarding an issue faced by the students of there.

The college lost it's MCI affiliation in midway, leaving almost 200+ UG MBBS students in a very bad situation. Their life and career, tampered.

Though appeals have been give even up to Supreme Court, the verdicts were never in favour of the students.

State Gov, Central Gov, Health ministry and MCI has turned their backs on these students leaving their life and career at stake.

They were left with an only option of going for an indefinite strike.

They currently have some 50+ representatives at Delhi who tried to organise a peaceful protest in 'Nirman Bhawan', Health Ministry Office, Delhi, on 24 Feb 2015; But inspite approved permission from DCP, New Delhi, they were not allowed to protest and the entire students as well as the parents who accompanied them were arrested even before the media etc arrived on the spot. And is still in custody (as of 7:00 PM, 24 Feb).

Now their only hope is our support.

Kindly give your valued views and opinions regarding the above issue and how we can help them.

With Regards
Yathu Thulaseedharan Pillai
96 test positive for swine flu
BINDU SHAJAN PERAPPADAN: No new cases of swine flu death have been reported from the city in the past 24 hours keeping the total death toll at nine this season. Six hundred and sixty eight persons were tested for the flu on Monday and 96 cases were reported positive. The city currently has 2,337 cases of swine flu according to a senior health official.

Explaining how to keep the flu in check Dr. K. K. Aggarwal, honorary secretary general Indian Medical Association, said: “Prevention of swine flu mainly involve implementation of the respiratory hygiene, cough etiquette and hand hygiene.’’

Respiratory hygiene involves maintaining a distance of at least three feet from the person who is coughing and sneezing.

Cough etiquette involves covering the mouth and nose with a tissue when you cough and sneeze and put the used tissue in a waste basket. If one does not have a tissue, then one should cough and sneeze into the upper sleeves and not hands or handkerchief.

Frequent hand hygiene should be observed before and after every patient contact, contact with potential infectious material and before putting on and after taking of personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol-based hand rubs. If hands are visibly soiled, then they should be washed with soap and water, noted a release issued by the IMA.

“Flu is diagnosed when a person suffers from cough and cold. Only sore throat is not a sign of flu. Flu patients do not require antibiotics. Unless cough and cold is associated with breathlessness, it does not require admission,” he added.
IMA wants single window registration for medical establishment
Sunday, February 22, 2015 : IMT

New Delhi: Indian Medical Association (IMA) has proposed the union government to come out with Indian Health Act 2015 where a single window registration should be done for medical establishments.

At present, there are over 72 various Registration and Acts applicable to the medical profession and the same is not health friendly, according to a statement by IMA.

In the current proposed budget, IMA has written to the union finance minister regarding this and has requested the minister to make a special budget for uniform registration under s single window.

Giving details, Dr A Marthanda Pillai, national president and Dr K K Aggarwal, honorary secretary general, IMA said that the main aim of the IMA is to provide affordable and accessible healthcare to all which is only possible if the medical professionals are not harassed and get clearance under one roof without any hassles.

IMA also wants health to be declared as infrastructure status and medical profession as a service industry.

There should be uniform laws for medical doctors and medical establishments, e.g. advertising is not allowed to doctors but there is no prohibition for it for the medical establishments. Similarly, doctors cannot hire agents but there is no such prohibition for the medical establishments, the statement said.

Doctor is a professional service provider. Subsidy in their medical fee needs to be compensated through rebates in various taxes applicable to them. For this a separate provision should be made in the coming budget, it added.
Media
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Inspirational Story
The Story of the One Eyed Mother

My mom only had one eye. I hated her... she was such an embarrassment... She cooked for students & teachers...to support the family. There was this one day during elementary school and my mom came. I was so embarrassed. How could she do this to me? I threw her a hateful look and ran out.

The next day at school... "Your mom only has one eye?!?!"...eeeee said a friend. I wished my mom would just disappear from this world. So I said to my mom, "Mom... Why don't you have the other eye?! If you're only going to make me a laughing stock, why don't you just die?!!!"

My mom did not respond... I guess I felt a little bad, but at the same time, it felt good to think that I had said what I'd wanted to say all this time... Maybe it was because my mom hadn't punished me, but I didn't think that I had hurt her feelings very badly.

That night... I woke up, and went to the kitchen to get a glass of water. My mom was crying there, so quietly, as if she was afraid that she might wake me. I took a look at her, and then turned away. Because of the thing I had said to her earlier, there was something pinching at me in the corner of my heart. Even so, I hated my mother who was crying out of her one eye. So I told myself that I would grow up and become successful.

Then I studied real hard. I left my mother and went to Singapore to study. Then, I got married. I bought a house of my own. Then I had kids, too... Now I'm living happily as a successful man. I like it here because it's a place that doesn't remind me of my mom.

This happiness was getting bigger and bigger, when... What?! Who's this?! It was my mother...Still with her one eye. I felt as if the whole sky was falling apart on me. Even my children ran away, scared of my mom's eye.

And I asked her, "Who are you?!" "I don't know you!!!" as if trying to make that real. I screamed at her, "How dare you come to my house and scare my children! GET OUT OF HERE! NOW!!!"

And to this, my mother quietly answered, "Oh, I'm so sorry. I may have gotten the wrong address," and she disappeared out of sight. Thank goodness... She doesn't recognize me. I was quite relieved. I told myself that I wasn't going to care, or think about this for the rest of my life. Then a wave of relief came upon me...

One day, a letter regarding a school reunion came to my house in Singapore. So, lying to my wife that I was going on a business trip, I went. After the reunion, I went down to the old shack that I used to call a house... Just out of curiosity

There, I found my mother fallen on the cold ground. But I did not shed a single tear. She had a piece of paper in her hand....It was a letter to me. "My son... I think my life has been long enough now... And... I won’t visit Singapore anymore. .. But would it be too much to ask if I wanted you to come visit me once in a while? I miss you so much... And I was so glad when I heard you were coming for the reunion. But I decided not to go to the school. For you... And I'm sorry that I only have one eye, and I was an embarrassment for you.

You see, when you were very little, you got into an accident, and lost your eye. As a mom, I couldn't stand watching you having to grow up with only one eye... So I gave you mine... I was so proud of my son that was seeing a whole new world for me, in my place, with that eye. I was never upset at you for anything you did.. The couple times that you were angry with me... I thought to myself, 'It's because he loves me....’ My son... Oh, my son... “I was crying out loud..., if I could turn the time back...

This message has a very deep meaning and is passed to remind people of the goodness they have enjoy was because of others directly or indirectly. Pause a moment and consider your life! Be thankful of what you have today compared to many millions who do not live lives as you do!

Do spend some time in prayer for your mum out there!
Quote of the Day
Be always at war with your vices, at peace with your neighbors, and let each new year find you a better man. Benjamin Franklin
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Reader Response
  1. Dear Sir, Very informative news. Regards: Dr Kanchan
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