May 25  2015, Monday
The type of food you eat also matters
Dr KK Aggarwal Everyone needs a mix of proteins, carbohydrates, and fats, plus enough vitamins and minerals for optimal health. But some of the food choices within these categories are better than others.
  1. Added sugar: Whether it’s white granulated sugar, brown sugar, high– fructose corn syrup, corn sugar, or honey, sugar contains almost no nutrients and is pure carbohydrate and full of empty calories, causing blood sugar to rise and fall like a roller coaster. Soft drinks and other sugar–sweetened beverages are the primary source of added sugar in the diet and a major contributor to weight gain. One extra 12–ounce can of a typical sweetened beverage a day can add on 15 pounds in a year. Those liquid calories aren’t as satisfying as solid food.
  2. Dairy fat. Ice cream, whole milk, and cheese are full of saturated fat and some naturally occurring trans fat both bad for the heart. The healthiest milk and milk products are low–fat versions, such as skim milk, milk with 1% fat and reduced–fat cheeses.
  3. Baked sweets. Cookies, snack cakes, doughnuts, pastries etc are packed with processed carbohydrates, added sugar, unhealthy fats, and often salt.
  4. White carbohydrates. Bread, pasta, potatoes, rice, cookies, cake, or pancakes are bad. One should opt for whole–grain versions. One can choose homemade cookies or bars using grains such as oatmeal, and less sugar and unhealthy fats.
  5. Processed and high–fat meats. Meats like bacon, ham, pepperoni, hot dogs, and many lunch meats are less healthy than protein from fish, skinless chicken, nuts, beans, soy, and whole grains. Fresh red meat should be eaten sparingly and the leanest cuts selected.
  6. Salt. Current dietary guidelines recommend reducing sodium to 1,500 mg per day and not exceeding 2,300 mg per day. But most of us get 1½ teaspoons (or 8,500 mg) of salt daily; this translates to about 3,400 mg of daily sodium.
IMA Swachh Bharat Campaign
  • Statin use for primary prevention of cardiovascular disease among healthy adults has been linked to an increased risk for diabetes, diabetes complications, and overweight/obesity in a new retrospective cohort study in individuals followed for an average of 6.5 years. The findings are published in the Journal of General Internal Medicine.
  • A short course of oral prednisone slightly improves function but has no effect on acute radicular leg pain (sciatica) or subsequent need for surgery among patients with a herniated lumbar disk, suggested a study published in JAMA.
  • The study, which was funded by the National Institutes of Health, showed that low doses of D-cycloserine significantly reduce alcohol cravings for up to 3 weeks, leading to significant reductions in alcohol consumption.
  • Chronic treatment with the phosphodiesterase-5 (PDE-5) inhibitor vardenafil (Levitra, Bayer/GlaxoSmithKline) for 6 months in men with type 2 diabetes is safe, improves both endothelial function and measures of hemodynamic function, and reduces inflammatory markers. (ECE2015)
  • Only 3% of patients with stable angina received all the information necessary to make an informed decision about undergoing angiography and possible percutaneous coronary intervention (PCI), according to an analysis of cardiologist-patient conversations. (JAMA)
Dr KK Spiritual Blog
Why do we Ring the Bell in a Temple?

The vibrations of the ringing bell also produce the auspicious primordial sound ‘Om’, thus creating a connection between the deity and the mind. As we start the daily ritualistic worship (pooja), we ring the bell, chanting:

Aagamaarthamtu devaanaam
gamanaarthamtu rakshasaam
Kurve ghantaaravam tatra
devataahvaahna lakshanam

"I ring this bell indicating the invocation of divinity, So that virtuous and noble forces enter (my home and heart); And the demonic and evil forces from within and without, depart."
Cardiology eMedinewS
  • Middle-aged and older individuals with masked hypertension may be at risk for cognitive decline, or vice versa, suggests new research presented at the American Society of Hypertension (ASH) 2015 Annual Scientific Meeting.
  • The Denmark-based DANAMI-3 PRIMULTI trial has concluded in favor of complete revascularization in patients with ST-segment-elevation MI (STEMI) and multivessel disease, instead of a strategy of PCI limited to the infarct-related artery (IRA). The findings were presented at the Congress of the European Association of Percutaneous Cardiovascular Interventions (EuroPCR) 2015.
Pediatrics eMedinewS
Children who are stunted are more likely to be at risk of overweight and obesity than children of normal height, according to a new study among 2- to 5-year-olds in Indonesia, the world's fourth most populous nation. (2015 European Congress on Obesity)
Make Sure
Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Reaction: Oh my God! Why was aspirin given!
Lesson: Make sure to remember that aspirin is contraindicated in children.
Dr Good Dr Bad
Situation: Embolization occurs in how many patient of DVT? (JR to SR).
Dr Bad: Rare!
Dr Good: Common!
Lesson: Embolization occurs in about 50% of patients with proximal vein DVT.

(Copyright IJCP)
eMedi Quiz
The following separation technique depends on the molecular size of the protein:

1. Chromatography on a carboxymethyl (CM) cellulose column.
2. Iso-electric focusing.
3. Gelfiltration chromatography.
4. Chromatography on a diethylaminoethly (DEAE) cellulose column.

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: B. No, skin-cancer rates and skin-cancer deaths are on the upswing.

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr Avtar Krishan, Dr. G. Madhusudhan

Answer for 23rd May Mind Teaser: D. 30 minutes of exercise at least four times a week

Correct Answers received: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr G Madhusudhan.
Quote of the Day
A successful man is one who can lay a firm foundation with the bricks others have thrown at him. David Brinkley
Reader Response
Dear Dr KK, well done by publishing so many important information in this bulletin. congratulations-kudos. Dr Vinod Agarwal
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
Rabies News (Dr A K Gupta)
If the skin test is positive to ERIG, what should be done?

If skin test is positive, it is better to switch over to HRIG.

eIMA News
• India committed to achieve universal health coverage - Nadda: Health Minister J P Nadda has said that India is committed to achieve universal health coverage for all age groups. Addressing the 68th World Health Assembly 2015, at Geneva, yesterday Mr Nadda said, India has charted a path that depends largely on provision of affordable, quality health care through the public health system.

• Cleanliness Drive: The doctors associated with Indian Medical Association (IMA) and other members of medical fraternity joined Swachh Bharat Abhiyan on the campus of Banaras Hindu University (BHU).

• Report released in the May issue of the Journal of the American Society of Hypertension and discussed at a symposium at the society's annual meeting here came from discussions held before the announcement that the pivotal U.S. trial SYMPLICITY HTN-3 for Medtronic's catheter was stopping for futility and then St. Jude also halted its device's pivotal trial.

• Ahmedabad: In the backdrop of the Maharashtra Food and Drugs Administration (FDA) taking action against e-commerce major for selling prescription drugs online, Gujarat Food and Drug Control Administration (FDCA) has decided to take strict action against defaulters from Gujarat.

• Peeling skin syndrome (PSS) is a heterogeneous group of rare autosomal recessive disorders characterized by superficial painless peeling and blistering of the skin without mucosal fragility. The two major forms of PSS are acral PSS (APSS) and generalized PSS. The latter is subclassified into noninflammatory or type A PSS and inflammatory or type B PSS

• In 2015, an estimated 5.3 million Americans will be diagnosed with Alzheimer's disease. This number is expected grow each year as the proportion of the US population above age 65 continues to rise. The global cost of dementia is now $600 billion per year and is expected to soar even further.

• The World Health Organization predicts that by 2050, the number of people who make it past their 80th birthday will almost quadruple to 395 million—and one in six will be living with dementia.
Vitamin D Facts
• The recommended vitamin D intake by different societies is 600-1000 IU daily for low-risk adults under 50 years of age and 800-2000 IU for high-risk and older adults.

• Considering that typical 25(OH)D levels in most Indian studies have been found to be between 4-15 ng/mL, for Indians, the upper end of the above recommended intake may be appropriate.

• Doses up to 4000 IU daily are considered safe and do not require monitoring.

• Toxicity has not been reported below intakes of 10000 IU/day.

• The expert group felt that optimum serum 25(OH)D level for patients with bone disorders like osteoporosis is 30 ng/dL (IOF 2010, Endocrine Society 2011)

• A serum 25(OH)D level of 30 ng/ml is also preferable for older adults (>50 years), who are at risk for osteoporosis (IOF)

• For other patient groups or population, 25(OH)D values of 20 ng/ml may be considered adequate.

• Many Indians may require supplementation to achieve this level (IOF 2010)

• We do not believe current evidence provides sufficient support that levels above 40 ng/mL provide any additional benefit.

• Therefore, 25(OH)D levels between 20-40 ng/ml are optimum for most of the population

• Vitamin D toxicity is most commonly caused by overdose of vitamin D supplements.

• Clinical manifestations are secondary to hypercalcemia.

• 25(OH)D levels are almost always above 150ng/ml, however, much higher levels may not result in any symptoms if serum calcium is normal.

• There is no specific antidote for vitamin D toxicity. Hydration, judicious use of loop diuretics, calcitonin, bisphosphonates and glucocorticoids are mainstay of management.

• Hypercalcemia due to parenteral vitamin D overdose can be prolonged due to slow release of vitamin D from fat deposits.

• Therefore regular follow up with monitoring of serum calcium is needed for at least a year.

Dementia Prevention
• Avoid sugar and refined fructose.

• Avoid gluten and casein (primarily wheat and pasteurized dairy, but not dairy fat, such as butter).

• Optimize your gut flora by regularly eating fermented foods.

• Increase consumption of healthy fats, including animal-based omega-3 fats.

• Reduce your overall calorie consumption, and/or fast intermittently.

• Improve your magnesium level.

• Eat a nutritious diet, rich in folate and zinc.

• Avoid environmental toxins and chemicals as much as possible.

NHRC asks govt to probe death after sterilization

Bhubaneswar, May 23: The National Human Rights Commission (NHRC) Saturday directed the principal secretary of the state’s health department to constitute a team of doctors and administrators to conduct an inquiry in a case in which a woman died few hours after sterilization under the family planning programme.

Chandrakanti was subjected to sterilisation by doctor Ashok Das and his team at Padmapur sub-divisional hospital July 28, 2014. After completion of the sterilization, she returned to her village. However, that night she suffered severe pain.

Earlier, in compliance of the order of the commission, special secretary to Orissa government, health and family welfare department, had submitted a report November 3, 2014, stating that the matter was inquired into and it was found that the deceased had no past history of any disease. The operating surgeon had after clinical examination found the patient fit for undergoing the sterilisation operation. The patient was normal at the time of operation July 28, 14, after which the tubectomy operation was done.

The report further said all possible treatment was given to the patient at the hospital but unfortunately she died.

The report also asserted that there was no negligence on part of the doctor who conducted the operation and that the allegations leveled by the family members of the deceased are baseless.

However, the NHRC said it is not clear as to on what basis the Orissa government has come to a conclusion that there was no negligence on the part of Dr Ashok Das and his team. (Metro by Arindam Ganguly On May 23, 2015.)
World No Tobacco Day
Inspirational Story

Morality may consist solely in the courage of making a choice. Wickedness is always easier than virtue, for it takes a short cut to everything. But over time you learn, you can’t make wrong work. There are always two choices, two paths to take. One is easy. And your only reward is that it’s easy. You cannot do wrong without suffering wrong.

Work joyfully and peacefully, knowing that right thoughts and right efforts will inevitably bring about right results. You can never lose anything that really belongs to you, and you can’t keep that which belongs to someone else.

You always experience the consequences of your own acts. If your acts are right, you’ll get good consequences; if not, you’ll suffer for it. Sooner or later everyone sits down to a banquet of consequences.
Can I participate as a speaker in a scientific meeting organized by a pharmaceutical company?

Yes. As per Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations 2010 a) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers as treating doctors or in any other professional capacity.

If the amount involved is more than Rs1000/-, there has to be a written agreement or MoU.
Wellness Blog
Pacing Without Leads

The first leadless pacemaker, less than one-tenth the size of a conventional pacemaker, has been approved for use in Europe. It can be delivered via a catheter into the heart.

There will be elimination of the visible lump and scar at a conventional pacemaker’s implant site. Also there is removal of patient activity restrictions that may prevent the dislodgement or damage to a conventional lead.

Initial results from the first–in–man LEADLESS study showed successful implantation in 32 of 33 patients and performance comparable with traditional pacemakers with leads.
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IMA Humor

The man passed out in a dead faint as he came out of his front door onto the porch. Someone called 911.

When the paramedics arrived, they helped him regain consciousness and asked if he knew what caused him to faint.

"It was enough to make anybody faint," he said. "My son asked me for the keys to the garage, and instead of driving the car out, he came out with the lawn mower!"
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Press Release
Women should quit smoking to lower their risk of heart disease

Smoking is still the leading preventable cause of death. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases. As per WHO, an estimated 3 million people in industrialized countries will have died as a result of tobacco use by 2030, and an additional 7 million people in developing countries face the same fate.

The harms of smoking are reversible and can decline to the level of nonsmokers, as per a report in Journal of the American Medical Association, said Padma Shri, Dr BC Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

Women who quit smoking have a 21 percent lower risk of dying from coronary heart disease within five years of quitting their last cigarette. The risk of dying from other conditions also declines after quitting, although the time frame varies depending on the disease. For chronic obstructive pulmonary disease, it may take up to 20 years. It's never too early to stop, and it's never too late to stop.

Women who are current smokers have almost triple their risk of overall death compared with nonsmoker women. Current smokers also have a 63 percent increased risk for colon cancer compared with never-smokers, while former smokers have a 23 percent increased risk. There was no significant association between smoking and ovarian cancer.

Women who started smoking early in life are at a higher risk for overall mortality i.e. of dying from respiratory disease and from any smoking-related disease. However, a smoker's overall risk of dying returns to the level of a never-smoker 20 years after quitting. The overall risk declines by 13 percent within the first five years of abstaining. Most of the excess risk of dying from coronary heart disease vanishes within five years of quitting.

For chronic obstructive pulmonary disease, the return to normal takes 20 years, although there is an 18 percent reduction in the risk of death seen within five to 10 years after quitting. And the risk for lung cancer does not return to normal for 30 years after quitting, although there is a 21 percent reduction in risk within the first five years.