March 27 2015, Friday
editorial
How to recognize cardiac arrest
Dr KK Aggarwal
  • Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.
  • As per the guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: "are you all right?"
  • If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.
  • Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.
  • Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.
  • After assessing responsiveness, health care providers should quickly check the patient’s pulse.
  • While doing so, it is reasonable to visually assess the patient’s respirations.
  • It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.
  • The key point is not to delay CPR.
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XIIth Jivan Pani Memorial Festival
News
  • Higher consumption of green tea seems to be associated with a lower risk for dementia or mild cognitive impairment, even after possible confounding factors are considered, suggests a new study presented at AD/PD 2015: International Conference on Alzheimer's and Parkinson‘s Diseases.
  • Patients undergoing knee cartilage repair fare slightly better if the procedure includes autologous chondrocyte implantation, suggests the ACTIVE trial presented recently at the American Academy of Orthopaedic Surgeons 2015 Annual Meeting.
  • The US Food and Drug Administration (FDA) has approved anthrax immune globulin intravenous for treatment of inhalational anthrax in combination with appropriate antibacterial drugs.
  • A new study suggests that a 15–minute walk is enough to quell even the most desperate desires for chocolate. The report is published in the journal Plos One.
  • Thyrotropin suppression does more harm than good in thyroid-cancer patients who aren't at high risk for tumor recurrence following thyroidectomy, suggests a new study published in the March issue of Thyroid.
Dr KK Spiritual Blog
On 7th Navratri enjoy a mind devoid of inner darkness


Kalaratri is worshipped on the Seventh Day of Navratri. She is dark and black like night. Her hairs are unlocked. SHE has three eyes and four hands.

She holds a sharp Sword in her right hand and blesses her devotees with her lower hand. HER vahana is a donkey, destroyer of darkness and ignorance (or shava). She spills out fire from her nostrils. She has put on necklaces shining like lightening. In Yoga Shastra, she represents the Sasahara Chakra.

Spiritual mantra on the 7th Navratri

By the time chanting of Bija mantras LAM, VAM, RAM, YAM, HAM and AUM is over, the inner darkness goes over.
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Cardiology eMedinewS
  • A European panel of experts has released a new consensus statement to advise physicians on how to deal with patients who develop muscle symptoms while taking statins, but they stress statins must continue to be tried in these difficult-to-manage patients. The statement was published in the European Heart Journal.
  • In the first larger–scale randomized controlled trial to assess long–term efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) in patients with chronic heart failure (CHF) presented at the American College of Cardiology (ACC) 2015 Scientific Sessions, there were no significant differences in clinical outcomes between escitalopram and placebo. The Mortality, Morbidity and Mood in Depressed Heart Failure Patients (MOOD–HF) study revealed that 60% of those who received escitalopram and 61% of those receiving matching placebo had an unplanned hospitalization for any reason or all–cause death over the following 24 months.
Pediatrics eMedinewS
  • Conscientious children are less likely to smoke in later life and the personality trait could help explain health inequalities, suggests a study published in the Journal of Epidemiology & Community Health.
  • Young children who received the 4CMenB vaccine as infants to protect against serogroup B meningococcal disease had waning immunity by age 5, even after receiving a booster at age 3½, suggested new research published in the Canadian Medical Association Journal.
IMA,IJCP,HCFI
Make Sure
Situation:  A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue
Events
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Dr Good Dr Bad
Situation: A 40–year–old male developed dyspnea for the first time in life. 
Dr. Bad: It is an attack of asthma.
Dr. Good: Get an ECG done.
Lesson: First onset of breathlessness after the age of 40, unless proved otherwise, is cardiac in nature.

(Copyright IJCP)
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Quote of the Day
If we wait until our lives are free from sorrow or difficulty, then we wait forever. And miss the entire point. Dirk Benedict.
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
Sonal Namaste
Preventive measures for acute diarrhea among children in resource– limited settings include breastfeeding, consumption of safefood and water, adherence to hygienic practices, and vaccination against rotavirus infection.
WMA supports opposition to Korean government medical plans
Plans by the South Korean Government to allow traditional oriental medicine doctors to use modern medical equipment have been condemned by the World Medical Association as costly and a danger to patient safety.

The WMA has spoken out following proposals by the South Korean Government to bring in a series of measures recommended by business–related organisations to revitalise the economy and create more jobs. Under these plans doctors licensed only for traditional oriental medicine would be allowed to use modern diagnostic equipment, health insurance coverage would be expanded for these practices and chiropractic and tattoo practitioners would be legally recognised.

The moves have been strongly opposed by the Korean Medical Association on the grounds that they would undermine the entire medical system in the country and bring confusion and unnecessary conflict to medical practice in Korea. The Association has argued that modern medicine and traditional medicine are strictly separated in Korea, are based on different principles and have different training.

Now the WMA has supported the Korean Medical Association. In a letter to Dr. Choo Moojin, President of KMA, the WMA's President Dr. Xavier Deau writes: ‘The high levels of quality, safety and effective and personal care Koreans enjoy today is at risk with these suggested changes – driven more my commerce than scientific and medical reasoning.’

He adds: ‘It is very clear that this move by the Korean government is nothing else but an attempt to de-value the health system and diminish the quality care enjoyed by Koreans today. These actions will not only commercialize health care but debase it with a longer term expense to Koreans and government as such short sighted reduction of standards, in the name of commercialization or competition, will diminish the service experienced by people with increased morbidity and mortality’.

Dr. Mukesh Haikerwal, Chair of the WMA, said the plans would lead to a massive increase in the use of costly technology, much of which would be wrongly interpreted. He warned: ‘As a number of those technologies are potentially dangerous in their application, injuries, suffering and damages are likely to occur.’
Facts about Tuberculosis (TB)
How are TB and HIV related?
 
  • HIV is the strongest risk factor for tuberculosis among adults as it debilitates the immune system.
  • An HIV positive person is 20–40 times more likely to develop TB disease once infected with TB bacilli as compared to an HIV negative person.
Inspirational Story
Do Believe

To believe... is to know that every day is a new beginning. It is to trust that miracles happen, and dreams really do come true.

 To believe... is to see Angels dancing among the clouds, to know the wonder of a stardust sky, and the wisdom of the man in the moon.

 To believe... is to know the value of a nurturing heart, the innocence of a child's eyes and the beauty of an aging hand, for it is through their teachings we learn to love.

 To believe... is to find the strength and courage that lies within us. When it is time to pick up the pieces and begin again.

 To believe... is to know we are not alone, that life is a gift and this is our time to cherish it.

 To believe... is to know that wonderful surprises are just waiting to happen, and all our hopes and dreams are within reach. If only we believe.
Reader Response
  1. It would be interesting for these so–called upholders of justice to ponder what punishment is meted for those with malpractice amongst the judiciary, police and politicians while they target weaker section of professionals! Sad! Dr Binoy John
Wellness Blog
Can blood pressure be higher in one arm?

A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have the doctor check both your arms for blood pressure and whichever is higher, use that arm for future blood pressure readings.
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What’s for Dinner?

I have my changed my system for labeling homemade freezer meals. I used to carefully note in large clear letters, "Meatloaf" or "Pot Roast" or "Steak and Vegetables or "Chicken and Dumplings" or "Beef Pot Pie."

However, I used to get frustrated when I asked my husband what he wanted for dinner because he never asked for any of those things. So, I decided to stock the freezer with what he really likes.

If you look in my freezer now you’ll see a whole new set of labels. You’ll find dinners with neat little tags that say: "Whatever," "Anything," "I Don’t Know," "I Don’t Care," "Something Good," or "Food." My frustration is now reduced because no matter what my husband replies when I ask him what he wants for dinner, I know that it is there waiting.
Rabies News (Dr A K Gupta)
What is the importance of pre–exposure vaccination?

Pre–exposure vaccination simplifies post–exposure vaccination because after the bite, those who have received full pre–exposure vaccination require only two doses of vaccine at Days 0 & 3. RIG is not required (WHO 2007).
Press Release of the Day
IMA to sensitize 2.5 lakh doctors on Food Safety, Dengue and Malaria

7th April is World Health Day and will be dedicated to ‘Food Safety’ this year.

20th April is World Malaria Day and will be dedicated to ‘Invest in the future. Defeat malaria’

To earmark both the days, IMA will sensitize 2.5 lakh doctors in the country through SMSs and emails, about food safety and prevention of vector–borne diseases.

Giving the details, Padma Shri Awardee Dr A Marthanda Pillai, National President IMA & Padma Shri Awardee, Dr K K Aggarwal, Honorary Secretary General IMA said that more than 3 lakh children in the age group 0 to 5 years of age die every year because of food and water-related diseases.

The core messages of the Five Keys to Safer Food are: (1) keep clean (2) Separate raw and cooked (3) cook thoroughly (4) Keep food at safe temperatures and (5) Use safe water and raw materials.

One should not keep food in room temperature for more than 2 hours.

Vector–borne diseases especially dengue are likely to increase this year. Therefore, mass sensitization of doctors is required to check the disease. IMA has decided to enter into an understanding with the NVBDCP, Govt. of India to work in this area.

The malaria mosquito is a night biter and a noise–causing mosquito.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

What is the medicolegal importance of age up to 14 years?
  • 7 years age: In accordance with Section 82 of Indian Penal Code, any act that is done by a child under seven years of age is not an offence.
  • 7–12 years of age: In accordance with Section 83 of Indian Penal Code, a child between 7–12 years of age is presumed to be capable of committing an offence, if he attained sufficient maturity of understanding to judge the nature and consequences of his conduct on that occasion. This maturity is presumed in a child of 7–12 years age until the contrary is proved.
  • 10 years age: In accordance with Section 369 of Indian Penal Code kidnapping or abducting child less than 10 years of age with intention to steal from its person is a criminal punishable offence.
  • 14 years age: A child below 14 years of age cannot be employed to work in any factory or mine under Indian Factory Act 1948. A person completing 15 and up to 18 years is allowed to work as adolescent employee in a factory if a fitness certificate is issued by a competent registered doctor.
eMedi Quiz
An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of hemoglobin.

Yesterday’s Mind Teaser:The parameters of sensitivity and specificity are used to assess:

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

Answer for yesterday’s Mind Teaser: 1.Criterion validity.

Correct Answers received from: Dr G Madhusudhan, Dr Avtar Krishan, Daivadheenam Jella

Answer for 25th March Mind Teaser: 4. X-ray diffraction.

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