March 26 2015, Thursday
editorial
Sodium in drugs can be dangerous
Dr KK Aggarwal Using effervescent, dispersible or soluble drugs on a regular basis leads to greater risk for heart attacks, strokes, and other cardiovascular events.
Regular use of prescribed effervescent and other sodium–containing drugs have a 16% greater risk for nonfatal stroke, nonfatal myocardial infarction (MI), and vascular death (P<0.01), compared with regular users of low or no–sodium versions of the same drug as per Dr Jacob George, at the University of Dundee in Scotland who write in BMJ.

Taking the maximum daily dose of drugs like effervescent aspirin or acetaminophen may exceed the recommended daily limit of sodium. Effervescent paracetamol 500 mg can contain 18.6 mmol of sodium in each tablet.

Sodium-loaded effervescent, soluble or dispersible tablets should be avoided in patients at risk of hypertension.

Current US guidelines recommend that people at low risk for CVD events limit their sodium intake to no more than 2,300 mg (1 teaspoon or 100 mmol/L) per day.

Certain populations, including people over 50, African Americans, diabetics and people with high blood pressure or chronic kidney disease, should limit their daily sodium intake to 1,500 mg.

The American Heart Association (AHA) recommends intake of less than 1,500 mg of sodium a day for everyone.

The World Health Organization (WHO) recommendations call for limiting daily sodium intake to no more than 2,000 mg per day.
eMedipics IMA,IJCP,HCFI
XIIth Jivan Pani Memorial Festival
News
  • The US Preventive Services Task Force (USPSTF) has concluded that there is insufficient evidence to recommend screening for thyroid dysfunction in adults who are not pregnant and who are asymptomatic, reports an article published online March 23 in the Annals of Internal Medicine.
  • A minimally invasive esthetic treatment that uses cold thermal injury to block the impulse control of motor nerves leading to temporary muscle relaxation and a reduction in dynamic wrinkles seems to be the potential new treatment for facial wrinkles, reported a study presented at the American Academy of Dermatology 73rd Annual Meeting.
  • When smokers quit, their metabolism improves, suggests new research presented at ENDO 2015, the annual meeting of the Endocrine Society.
  • Prostate artery embolization appears to be a safe and effective alternative to more traditional treatments for benign prostatic hyperplasia, suggest two new studies presented at the European Association of Urology 30th Annual Congress.
  • Urine concentrations of two tumor–specific proteins may have significant potential for detecting renal cell carcinoma (RCC) in some patients, reported a new study published online in JAMA Oncology.
Dr KK Spiritual Blog
On 6th Navratri chant AUM

Mata Katyayani is worshipped on the sixth day of Navratri. SHE has three eyes and four hands and rides on a Lion.

The top right hand is positioned in a gesture of providing courage and the other hand is positioned in a gesture of rendering a boon. The top left hand holds a sword and the other is holding a lotus.

In Yoga Shastra, she represents the Ajna Chakra and AUM bija mantra. AUM chanting helps to attain success in religion, wealth, passion and salvation and removing fear and sorrows.

Spiritual mantra on the 6th Navratri

AUM chanting is one of the most powerful chakra and should be done concentrating on the Ajna chakra.
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Compared with stopping dual antiplatelet therapy (DAPT) at 12 months, extending therapy to 30 months reduced the risk of stent thrombosis and MI but also increased the risk of mild to moderate bleeding in patients who had a coronary stent implanted, whether this followed an initial MI or stable angina, reported a new study published in the Journal of the American College of Cardiology.
  • A large meta-analysis investigating the effects of statin therapy on heart failure shows the lipid–lowering therapy used for more than 4 years significantly reduced the number of patients hospitalized for heart failure but did not reduce the risk of heart–failure mortality. The findings were published online March 23 in the European Heart Journal.
Pediatrics eMedinewS
  • Pimecrolimus 1% cream (PIM) or topical corticosteroids (TCS) are safe for the long–term management of mild to moderate atopic dermatitis (AD) in infants, suggests a new study published online March 23 in Pediatrics.
  • Most deaths in children with cerebral malaria may be due to increased brain volume leading to raised intracranial pressure, suggests new research published online in The New England Journal of Medicine.
IMA,IJCP,HCFI
Make Sure
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.
Media
IMA,IJCP,HCFI
Events
IMA,IJCP,HCFI
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

What is embalming?

Embalming is the process of chemically treating a dead body developed by the ancient Egyptians to preserve the body after death to delay the decomposition of the body, restore it to an acceptable physical appearance and reduce the presence and growth of bacteria to prevent foul smell as well as perfume or add fragrance to corpse. Embalming certificate is required by law in certain circumstances like air/rail transportation.
  • The process of embalming has a very long history, dating back to the Egyptian process of mummification. Though their techniques were quite different from those used today, the effect was the same — to preserve an individual’s body after death. The ancient Egyptians believed that the spirit would return to the body after death, so it must remain in good condition. To preserve the corpses, they covered bodies in a drying chemical called natron, and then wrapped them in linen sheets.
  • Today, embalming is done by injecting chemicals directly into the bloodstream to preserve the corpse’s appearance. The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time i.e. up to a week.
  • To keep the corpse in a good condition for a longer period i.e. up to a month, a solution made up almost entirely of formaldehyde is used.
  • There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.
  • One of the most famous embalmed corpses today is that of Russian communist leader Vladimir Lenin, whose embalmed corpse is on display at the Red Square mausoleum in Moscow. The corpse is very well–preserved, and should last for at least another hundred years.
Dr Good Dr Bad
Situation:A patient with Mediclaim needed chemotherapy. 
Dr. Bad: Get admitted for minimum 24 hours.
Dr. Good: Take it as day care.
Lesson: Admission limit of 24 hours is not applicable for chemotherapy, radiotherapy etc.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
Quote of the Day
However difficult life may seem, there is always something you can do and succeed at. Stephen Hawking
eMedi Quiz
The parameters of sensitivity and specificity are used to assess:

1. Criterion validity.
2. Construct validity.
3. Discriminant validity.
4. Content validity.


Yesterday’s Mind Teaser:: The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X-ray diffraction.

Answer for yesterday’s Mind Teaser: 4.X-ray diffraction

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr Amit Desai, Dr Avtar Krishan, Daivadheenam Jella

Answer for 23rd March Mind Teaser: 1.Glyceraldehyde–3–phosphate Dehydrogenase

Correct Answers receives:Dr Jainendra Upadhyay, Dr Sharad SJ, Dr Shangarpawar, Dr Avtar Krishan, Daivadheenam Jella, Dr Poonam Chablani, Dr Prabodh K Gupta
IMA,IJCP,HCFI
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.
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
IMA NEWS
Sonal Namaste
Diarrhea Prevention

Observe the following recommendations to reduce subsequent episodes of diarrhea, malnutrition and delays in physical and mental development.
  • Exclusive breastfeeding until 6 months of age
  • Continued breastfeeding with complementary foods until 2 years of age.
  • Complementary feeding may be considered in younger infants if growth is inadequate.
  • The consumption of safe food and water.
  • Water brought to a rolling boil for at least 5 min is optimal for preparing food and drinks for young children.
  • Handwashing after defecating, disposing of a child‘s stool and before preparing meals.
  • Latrines should be located more than 10 meters and downhill from drinking water sources.
Government of National Capital Territory of Delhi
(Health & Family Welfare Department)
9111 Level, A–Wing, Room No. 910, Delhi Sachivalaya,
I.P. Estate, New  Delhi (23392031),
osdpsh@gmail.com
No. F8(72)/Director(hosp.services)/HFW/2015/163-68   

Date: 16/ 03/15

CIRCULAR

It has been noticed that resident doctors are often assigned continuous duties across multiple shifts. In order  to improve the working environment and enhance productivity  and  outcomes,   it  has  been  decided   to  curb  this  practice  and  restrict clinical duties of resident doctors  to a single.

All Directors/Medical Superintendents and Heads of clinical departments of hospitals/institutions/departments are  advised   that  in  case, resident   doctors  are assigned continuous duties across multiple shifts in their hospitals institutions/departments, then  this  practice   must  stop  forthwith and  duty   rosters  for  resident doctors  are  prepared in a way  that  they  are  put  on clinical duties  not  exceeding  12 hours in a shift in a day.

Exceptionally, in cases of working/clinical needs for  more  than 12 hours  of continuous shift duty, only the Director/Medical Superintendent of the hospital  will have  the  power  to  approve assigning clinical  duty  shift  beyond  12  hours  but  not exceeding 17 hours. However, for   all   such   cases, MS/Director of hospitals/ institutions shall inform the Secretary (H&FW) at pshealth@nic.in.

This has approval of the competent authority.
 
(Dr. Sanjay Agrawal)
Addl. Secy. (PGR)/
Director (Hosp Services)
 H&FW Department
To,
  1. All Directors/MSs of Hospital/Institutions in H&FW Department
  2. All Heads of clinical departments of Hospitals/institutions through respective Directors/MSs.
Copy for information:
  1. Secretary to Min. of Health
  2. All Spl. Secretaries/Addl. Secretary, H&FW Department
  3. PS to Secretary  (H&FW)
One Health
The World Veterinary Association (WVA) and the World Medical Association (WMA) in collaboration with the Spanish Medical and Veterinary associations are inviting you to participate at the Global Conference on ‘One Health’ Concept to be held on 21st and 22nd of May in Madrid, Spain (Vía de los Poblados, 3, A.M.A Parque Empresarial Cristalia – Edificio 4).  

The Global Conference aims to bring together Veterinarians, Physicians, Students, Public Health Officials, NGOs and others from the different world regions to learn, discuss and to address critical aspects of the ‘One Health’ Concept.

The main objectives of the conference are to strengthen the links and communications and to achieve closer collaboration between Physicians, Veterinarians and all appropriate stakeholders to improve the different aspects of health and welfare of humans, animals and the environment
Facts about Tuberculosis (TB)
How can TB be prevented?
 
  • In the absence of an effective vaccine, the only way to prevent TB is by early detection and treatment of infectious TB patients.
  • Patients with sputum-positive pulmonary disease should cover their mouth while coughing, sneezing and talking to reduce the transmission of TB bacteria.
IMA asks doctors to notify tuberculosis patients
New Delhi: Indian Medical Association (IMA) on Monday organised a workshop to sensitise medical practitioners about the need to notify tuberculosis patients who visit them for treatment.

According to IMA, the workshop was attended by 100 General Practitioners (GPs). At the workshop, IMA appealed to all its members to ask themselves at the end of the day: “Have I notified a TB patient today?”

“Not notifying TB patients is not only a public hazard but also a violation of the MCI Act and can lead to suspension of license of a doctor,” said Dr K K Aggarwal, honorary secretary general, IMA.

Dr Aggarwal further said that it is not only important to notify TB patients, but equally important is to follow the patient till he or she is cured.

Most TB symptoms will disappear within a few weeks of treatment and there is a tendency for patients to stop treatment. Incomplete treatment can lead to a drug resistance case, which may not only be lethal to the patient, but also be a health hazard to the community, according to a statement by IMA.

The faculty who conducted the workshop included Dr Dinesh Negi, Dr Sukhendu Roy, Dr Parag Bajpai, Dr Manisha Bidyae, Dr B M Das and Dr Rajeshwar Rao, besides Dr Aggarwal.

At the workshop, the experts said that all pregnant ladies and lactating mothers suffering from TB should be given full treatment. Every patient of HIV should be followed for possible development of TB in the future.

According to IMA, if an elderly patient develops diabetes, doctors should think of TB and if a middle-aged person develops TB, they should think of diabetes.

IMA lauded the initiative by Amitabh Bachchan who recently said that he had suffered from abdominal TB in the past.
NIH statement on World TB Day 2015
World TB Day, March 24, marks the day in 1882 when German microbiologist Robert Koch announced his discovery of the bacterium that causes tuberculosis (TB). Despite the considerable progress made since that discovery, TB remains one of the world’s deadliest diseases. In 2013, an estimated 9 million people became ill with TB, and 1.5 million people died, according to the World Health Organization (WHO). This airborne disease is a leading killer of women and children worldwide. TB co-infection is the major cause of death among HIV-infected people killing roughly 1 in 4 who are co-infected. The growing problems of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB further intensify the TB crisis.

WHO’s theme for World TB Day 2015, Reach, Treat, Cure Everyone, highlights the continued need to effectively diagnose, treat, and cure those afflicted with the disease — many of whom live in the world’s poorest, most vulnerable communities. NIAID remains committed in its broad research efforts to gain a better understanding of the disease and to find new ways to diagnose, treat and prevent TB.

Through innovative approaches, such as mathematical modeling and genome mapping of complex biological structures, scientists are developing a greater understanding of how Mycobacterium tuberculosis (Mtb) causes disease, as well as the various stages of Mtb infection and TB disease. With NIAID’s support, scientists have sequenced the genomes of approximately 2,000 Mtb strains to gain a deeper knowledge of the bacterium’s genetic diversity and patterns of drug resistance — information that will contribute to the development of new diagnostics and other rapid tests for identifying patients with MDR–TB and XDR–TB.

New diagnostics and indicators, or markers, of disease to identify patients who harbor TB bacteria but do not have symptoms is a key research focus. In this regard, NIAID recently expanded its Tuberculosis Research Units program, which integrates epidemiology, immunology and microbiology to focus on TB latency and persistence and their connection to active TB disease. Additionally, the NIAID-supported TB Clinical Diagnostic Research Consortium is evaluating several investigational diagnostics and their impact on TB management in endemic countries. NIAID supports the development of the WHO-endorsed GeneXpert MTB/RIF TB diagnostic test, which detects Mtb and drug resistance in sputum samples within two hours. Development efforts are aimed at increasing the sensitivity of Mtb detection, expanding the drug resistance markers to detect XDR-TB, as well as using non-sputum samples to facilitate diagnosis of TB in children.

 Finding new TB treatments is also a major research focus at NIH. Adherence to current therapy can be difficult given that regimens require daily medications for at least six months and potentially up to two years. Moreover, with the growing threats of MDR–TB and XDR–TB, effective new medicines to overcome drug resistance are critically needed. NIAID support has contributed to more than two–thirds of the roughly 20 investigational TB drugs and drug combinations currently in clinical testing. Additionally, NIAID scientists working as part of an innovative, collaborative public–private partnership helped to identify 3,200 promising compounds for further development. In 2014, NIAID scientists and other researchers helped to identify a new type of TB treatment, called host-directed therapy, which involves manipulating the body’s response to TB bacteria rather than targeting the bacteria itself.

 Controlling TB infection ultimately depends on effective prevention strategies, including a vaccine. NIAID supports basic and preclinical research on new candidate TB vaccines to prevent infection or disease, as well as to help shorten the duration of TB drug treatment regimens. Several candidate vaccines have demonstrated protective effects in animal models and are now being tested in humans. Through its HIV/AIDS clinical trials networks, NIAID also evaluates preventive TB treatments for people infected with HIV.

 Last year, WHO announced the goal of completely eliminating TB by 2050. NIAID remains committed to supporting and conducting the necessary research and leveraging resources with other funding agencies and organizations to reach that target. Although the challenges ahead are daunting, our resolve to end the plague of this ancient disease is steady. With continued scientific progress, we look forward to the day when World TB Day becomes a thing of the past.
Inspirational Story
Don’t Sweat the Small Stuff

One day an expert in time management was speaking to a group of students and, to drive home a point, used an illustration those students will never forget.


As he stood in front of the group of high–powered overachievers, he said, "Okay, time for a quiz." Then he pulled out a one–gallon, wide mouthed Mason jar and set it on the table in front of him. Then he produced about a dozen fist–sized rocks and carefully placed them, one at a time, into the jar. When the jar was filled to the top and no more rocks would fit inside, he asked, "Is the jar full?"

Everyone in the class said, "Yes." Then he said, "Really?" He reached under the table and pulled out a bucket of gravel. Then he dumped some gravel in and shook the jar, causing pieces of gravel to work themselves down into the space between the big rocks.

Then he asked the group once more, "Is the jar full?" By this time the class was on to him. "Probably not," one of them answered. Good!" he replied. He reached under the table and brought out a bucket of sand. He started dumping the sand in the jar and it went into all the spaces left between the rocks and the gravel. Once more he asked the question, "Is the jar full?" No!" the class shouted. Once again he said, "Good!" Then he grabbed a pitcher of water and began to pour it in until the jar was filled to the brim. Then he looked at the class and asked, "What is the point of this illustration?" One eager student raised his hand and said, "The point is, no matter how full your schedule is, if you try really hard you can always fit some more things in!"

No," the speaker replied, "That’s not the point. The truth this illustration teaches us is: If you don’t put the big rocks in first, you’ll never get them in at all. What are the ‘big rocks’ in your life?

"Your children… Your loved ones… Your education… Your dreams… A worthy cause… Teaching or mentoring others… Doing things that you love… Time for yourself… Your health… Your significant other."

"Remember to put these BIG ROCKS in first or you’ll never get them in at all. If you sweat the little stuff (the gravel, the sand) then you’ll fill your life with little things to worry about that don’t really matter, and you’ll never have the real quality time you need to spend on the big, important stuff (the big rocks).

So, tonight or in the morning, when you are reflecting on this short story, ask yourself this question: What are the ‘big rocks’ in my life? Then, put those in your jar first."
Reader Response
  1. Dear Dr KK, your spiritual blog was informative and inspiring. I wish that our medical fraternity starts praying for the patients under their care. This way we would treat our patients with love and compassion. Looking forward for more inspiring blogs from you. Regards. Dr Pankaj Khora.
Wellness Blog
Nine Modifiable physical Triggers for Low Back Pain
 
  1. Heavy load
  2. Awkward positioning
  3. Handling of objects far from the body
  4. Handling people or animals
  5. Unstable loading
  6. A slip, trip or fall
  7. Heavy loads
  8. Engagement in moderate or vigorous physical activity
  9. Sexual activity
Possible psychosocial Triggers
  1. Alcohol consumption
  2. Fatigue
  3. Being distracted during an activity or task. 
IMA in Social Media
https://www.facebook.com/ima.national 28138 likes
https://www.facebook.com/imsaindia 45354 likes
https://www.facebook.com/imayoungdoctorswing 952 likes
Twitter @IndianMedAssn 833 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
IMA Videos
News on Maps
IMA Humor
Talking Clock

While proudly showing off his new apartment to friends late one night, the drunk led the way to his bedroom where there was a big brass gong.

"What’s that big brass gong for?" one of the guests asked.

"Why, that’s the talking clock" the man replied. "Watch", the man said, giving the gong an ear–shattering pound with a hammer.

Suddenly, someone on the other side of the wall screamed, "F’gosh sakes, you idiot, it is

2 am in the blankety–blank morning!"
Press Release of the Day
Lifestyle counseling can reduce heart disease

An intensive effort to change lifestyle in people at high risk of heart disease can help them reduce such risk factors as high blood pressure, raised cholesterol levels and smoking, 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.

A trial, called the Euroaction study, published in the journal The Lancet compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 high risk people. Half got the counseling from a team of nurses, dieticians, physiotherapists and the treating doctors. The counseling was given to families as well as individuals.

The trial included two groups of patients. One those who already had developed coronary heart disease, another those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years.
  • Fifty–five percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent of those not getting the advice.
  • Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart–friendly oily fish, compared to 35 percent and 8 percent in the other group.
  • Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking.