June 27  2015, Saturday
eMedinewS
editorial
Relaxation Therapy
Dr KK Aggarwal
  • Relaxation techniques share two components: the repetitive focus (on a word, sound, prayer, phrase, body sensation, or muscular activity) and adoption of a passive attitude (towards intrusive thoughts.)
  • They induce relaxation response characterized by decreased arousal and diminished sympathetic activity (decreased heart rate and lower blood pressure) and increased EEG slow wave activity.
  • Relaxation techniques may be subdivided into two methods, deep and brief, or by the specific strategy used to induce the relaxed state, including progressive muscle relaxation, autogenic training and breath training.
  • Adverse reactions are intrusive thoughts, fear of losing control, upsetting sensory experiences, muscle cramps, sexual arousal and psychotic symptoms
  • Adverse reactions are relaxation–induced anxiety or relaxation-induced panic.
  • Relaxation–induced anxiety is a gradual increase in behavioral, physiologic, and psychological anxiety, whereas relaxation–induced panic is severe anxiety of rapid onset.
  • Patients with a history of generalized anxiety disorder or panic disorder and those with a history of hyperventilation are more likely to experience these adverse effects.
  • Patients should also be introduced to deep breathing techniques that often accompany relaxation in a gradual manner and not more than couple of minutes at a time.
  • Relaxation techniques can relieve pain in cancer.
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70 doctors attend IMA Rise & Shine's CME in Cochin, Kerala to discuss the various health threats faced by the Indian population due to Vitamin D deficiency
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News
  • Exercise can help diabetic patients reduce waist circumference and body fat and improve HbA1c levels, even if cardiorespiratory fitness does not improve, suggests new research published online in Diabetes Care.
  • A new study published in the Journal of Clinical Oncology suggests that for many women with operable breast cancer, four cycles of chemotherapy followed by paclitaxel once per week (P1) offer better outcomes than docetaxel once every three weeks (D3).
  • Apremilast, a new oral option for the treatment of psoriatic arthritis, shows sustained and clinically meaningful improvement in key symptoms of the disease out to 104 weeks, suggests a pooled analysis presented at the European League Against Rheumatism Congress 2015.
  • A new study published in The BMJ suggests that women are up to four times more likely to experience stillbirth if they had a stillbirth in a previous pregnancy.
  • A new study has linked better memory performance in older age with patterns of neural compensation. The research highlights how memory can remain efficient in spite of common age-related neural decline. The findings are published in the journal Brain and Cognition.
Cardiology eMedinewS
  • Chronically elevated blood pressure from young adulthood to middle age is associated with systolic and diastolic dysfunction in a group of healthy middle-aged adults, reported a new analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study. The findings are published in the June 30 issue of the Journal of the American College of Cardiology.
  • A single-blind randomized multicenter trial published online June 24 in the New England Journal of Medicine suggests that one year after femoropopliteal-artery angioplasty for symptomatic disease, patients treated with a paclitaxel-coated balloon showed superior target-vessel patency, and their results were "noninferior" for a composite safety end point that included amputation and limb-related death, in comparison with a standard balloon.
Pediatrics eMedinewS
  • A new study supports the efficacy of the 9-valent human papillomavirus (HPV) vaccine in girls and boys ages 9 to 15. The immunogenicity of the vaccine in boys and girls was found to be noninferior to that in young women ages 16 to 26. The findings were published in Pediatrics.
  • A study published in the Journal of Pediatrics suggests that girls are at a much higher risk than boys to suffer overuse injuries in high school sports.
Dr KK Spiritual Blog
An empty mind is the devil’s house

It is an old saying that "Khali dimag shaitan ka ghar".

Empty mind means when you are doing nothing and Shaitan means negative thoughts. In terms of Vedic Sciences, negative thoughts mean absence of positive thoughts and they are often equated to darkness which is absence of light.

Positive thoughts always need efforts and exertions while negative thoughts are spontaneous and without exertion. It is recommended that one should think differently and positive otherwise there will be spontaneous appearance of negative thoughts.

Darkness is spontaneous and naturally present and to bring light one has to make efforts by switching on the light or the nature has to ask the Sun to come and give the light.
Make Sure
Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.
Dr Good Dr Bad
Situation: A patient came with black stools.
Dr. Bad: It is lower GI bleeding.
Dr. Good: This is upper GI bleeding.
Lesson: Black stools usually indicate upper GI bleeding.

(Copyright IJCP)
eMedi Quiz
Mummification refers to:

1. Hardening of muscles after death.
2. Colliquative putrifaction.
3. Saponification ofsubcutaneous fat.
4. Dessication of a dead body.

Yesterday’s Mind Teaser: Acantholysis is characteristic of:

1. Pemphigus vulgaris.
2. Pemphigoid.
3. Erythema multiforme.
4. Dermatitis herpetiformis.

Answer for yesterday’s Mind Teaser: 1. Pemphigus vulgaris.
Correct Answers received from: Dr Shangarpawar, Virendra Kharpate, Tukaram Pagad, Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 25th June Mind Teaser: 1. The gain in weight of young animals per unit weight of protein-consumed.
Correct Answers received: Dr Avtar Krishan, Dr Pandit Hantodkar, Dr Shangarpawar.
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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
Press Release
Do not ignore early morning chest pain

Do not ignore early morning chest pain as most fatal heart attacks occur early in the morning. In a message, 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 said that most heart attacks occur in the first three hours of getting up, more during full moon period and during winter.

A heart attack can present with chest pain, discomfort, heaviness or burning in the center of the chest, which is diffuse in nature and never localized and lasts for more than 30 minutes.

A discomfort, which lasts less than 30 seconds and which can be pinpointed with a finger, can be ignored as a non-cardiac chest pain. A burning in the chest occurring at 2 O’clock in the night may be due to acidity but any acidity occurring for the first time in life after the age of 40 years, should be considered cardiac in origin unless proved otherwise. Similarly, any breathlessness appearing for the first time in life after the age of 40 years is cardiac in origin unless proved otherwise.

Chewing a tablet of aspirin at the onset of cardiac chest pain can reduce chances of cardiac death by 22%.

All patients with chest pain should be promptly taken to the nearest cardiac hospital as timely clot dissolving therapy or clot removing angioplasty can practically cure a patient. The life saving window is to reach hospital within 3 hours.

Elaborating further, Dr Aggarwal said that the three investigations required for evaluation of a chest pain should be available in the set up of every doctor who handle such patients and these include an audio-visual auscultation device, ECG machine to diagnose an acute heart attack and echocardiography machine for early detection of heart attack.

ECG can often detect abnormal sounds in first six hours of heart attack but it is always possible to detect abnormal sounds during chest pain with an audio-visual auscultation device. Angiography is the gold-standard investigation if a patient with chest pain comes within three hours as it can help removing the clot by primary angioplasty.
eIMA News
WMA Appeals to Israeli Prime Minister to Reconsider Force Feeding Bill
(26.06.2015) The World Medical Association has appealed to Israel’s Prime Minister Benjamin Netanyahu to reconsider Government legislation before the Knesset which would explicitly allow the force-feeding of detainees on hunger strike. In a letter to the Prime Minister, the WMA President Dr. Xavier Deau and Chair Dr. Ardis Hoven say that doctors should not be involved in any way in torture or inhumane and degrading treatments.

They add: ‘Force-feeding is violent, very painful and absolutely in opposition to the principle of individual autonomy. It is a degrading, inhumane treatment, amounting to torture. But worse, it can be dangerous and is the most unsuitable approach to save lives.

‘The evidence from many cases around the world that our colleagues have been working on over the past four decades, shows that the best results are obtained when the patient/physician relationship is maintained, even under the difficult circumstance of a hunger strike. This includes patient confidentiality, proper medical care and advice by the physician, but also respecting the free will of the patient. Force-feeding is completely incompatible with this and destroys any patient/physician trust.’

The WMA leaders say that there are far better results in handling hunger strikes than by force-feeding and they supported the initiatives for medical care put forward by the Israeli Medical Association. Israeli physicians had treated dozens of hunger strikers very successfully over the past two decades and were able to deal with the situation, if only they were only allowed to establish a real patient/physician relationship without threats and interference from prison authorities.

‘For the sake of the people involved and the safety and reputation of your country, please reconsider this step which is already broadly criticised internationally, but worse, which will not help the problem you wish to solve.’
World Medical Association celebrates landmark declaration on torture
The 40th anniversary of a landmark declaration by the medical profession against physicians' involvement in torture is being celebrated on the eve of the United Nations International Day in Support of Victims of Torture (June 26).

World Medical Association President Dr. Xavier Deau said it was 40 years since the WMA first adopted its Declaration of Tokyo on Guidelines for Physicians Concerning Torture. This set out clear guidance that “the physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife.”

Dr. Deau said: ‘I am proud to celebrate the work done by the WMA in supporting physicians across the world in their opposition to torture and on the guidance in our Declaration of Malta that forcible feeding is never ethically acceptable. With these two Declarations I have no doubt that we have made a significant difference to the world. When it was adopted in 1975, the Declaration of Tokyo was the first clear statement by the medical profession against physician involvement in torture and it has become a milestone in human rights. It is now an essential tool in medical ethics and education and a major global reference in the prevention of torture, inspiring others to engage in the fight against torture.

‘Regrettably there is still widespread evidence of torture being used around the world. Physicians are helping victims, often despite threats to their own life, and the WMA is committed under its Declaration of Hamburg to support physicians facing pressure to become involved in any inhuman procedures. Equally we encourage our member associations to investigate accusations of physician involvement in torture and we support them in resisting such violations, and standing firm in their ethical convictions'.
Harvard seven ways to set your sensitive gut
  1. Avoid foods that trigger your symptoms.
  2. Eat small portions and don't overeat; try eating smaller, more frequent meals and be sure to chew food slowly and completely.
  3. Avoid activities that result in swallowing excess air, such as smoking, eating quickly, chewing gum, and drinking carbonated beverages.
  4. Reduce your stress. Try relaxation therapies, cognitive behavioral therapy, or exercise. An aerobic workout 3-5 times per week can help, but don't exercise right after eating.
  5. Get enough rest.
  6. Don't lie down within two hours of eating.
  7. Keep your weight under control.
NEWS
  • Angioplasty with a paclitaxel-coated balloon kept femoropopliteal stenoses open at 1 year better than a standard uncoated balloon, the LEVANT 2 trial showed.
  • A clinical trial investigating a potential treatment for alcohol use disorder (AUD) was announced by the National Institute of Alcohol Abuse and Alcoholism (NIAAA). The study will assess the safety and efficacy of gabapentin enacarbil (HORIZANT) in extended-release tablets for treating moderate to severe AUD. NIAAA is part of the National Institutes of Health.
Media
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Inspirational Story
Most Popular Vs the Right Decision

A group of children were playing near two railway tracks, one still in use while the other disused. Only one child played on the disused track, the rest on the operational track.

The train is coming, and you are just beside the track interchange. You can make the train change its course to the disused track and save most of the kids. However, that would also mean the lone child playing by the disused track would be sacrificed. Or would you rather let the train go its way?

Let’s take a pause to think what kind of decision we could make………

Most people might choose to divert the course of the train, and sacrifice only one child. You might think the same way, I guess. Exactly, I thought the same way initially because to save most of the children at the expense of only one child was rational decision most people would make, morally and emotionally. But, have you ever thought that the child choosing to play on the disused track had in fact made the right decision to play at a safe place?

Nevertheless, he had to be sacrificed because of his ignorant friends who chose to play where the danger was. This kind of dilemma happens around us every day. In the office, community, in politics and especially in a democratic society, the minority is often sacrificed for the interest of the majority, no matter how foolish or ignorant the majority are, and how farsighted and knowledgeable the minority are. The child who chose not to play with the rest on the operational track was sidelined. And in the case he was sacrificed, no one would shed a tear for him.

The great critic Leo Velski Julian who told the story said he would not try to change the course of the train because he believed that the kids playing on the operational track should have known very well that track was still in use, and that they should have run away if they heard the train's sirens.

If the train was diverted, that lone child would definitely die because he never thought the train could come over to that track! Moreover, that track was not in use probably because it was not safe. If the train was diverted to the track, we could put the lives of all passengers on board at stake! And in your attempt to save a few kids by sacrificing one child, you might end up sacrificing hundreds of people to save these few kids.

While we are all aware that life is full of tough decisions that need to be made, we may not realize that hasty decisions may not always be the right one.

"Remember that what’s right isn’t always popular… and what’s popular isn’t always right." Everybody makes mistakes; that’s why they put erasers on pencils.
Quote of the Day
If you have a positive attitude and constantly strive to give your best effort, eventually you will overcome your immediate problems and find you are ready for greater challenges. Pat Riley
CME
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Reader Response
Dear Sir, Thanks for the information. Regards- Dr Kanchan
Wellness Blog
About Thyroid gland
  • Low functioning thyroid is a new epidemic of the society affecting more than 3% of people. If thyroid function is low, it causes weight gain, loss of energy, cold intolerance and menstrual irregularities in women.
  • All people who are aged 50 and above should have their thyroid profile (TSH test) done to look for thyroid deficiency.
  • In younger people, or in cases of infertility, menstrual irregularity, pregnancy, weight gain, thyroid deficiency should be looked for.
  • Iodized salt should be used to prevent thyroid deficiency.
  • Non–iodized salt is only used in two conditions: firstly in patient with thyroid inflammation and secondly, while doing Jalneti in naturopathy, a yoga–related nasal wash technique.
  • In pregnancy, even mild thyroid deficiency can affect the growth of fetus hence dose requirement of thyroid medicine is much higher in pregnancy than in non–pregnancy.
  • In the elderly, the dose of thyroid medicine to be started is always low as compared to one in the adults.
  • If thyroid deficiency is untreated, osteoporosis (thickening of bone) and/or atrial fibrillation (irregular and fast heart rate) may result. Osteoporosis can cause recurrent fractures and atrial fibrillation may cause brain paralysis.
  • In Allopathic medicine, thyroid deficiency is treated by synthetic T4 hormone replacement.
  • In Ayurveda, thyroid stimulant drugs are available but they are effective only if some amount of thyroid gland is available.
  • As per Ayurveda, eating soya and drinking water from copper vessel is good for thyroid.
IMA Humor
A group of expectant fathers sat nervously in the hall. A nurse beckoned to one of them and said, "Congratulations, you have a son!" Another man dropped his magazine, jumped up and said, "Hey, what’s the idea? I got here two hours before he did!"
Rabies News (Dr A K Gupta)
Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.
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