August 27   2015, Thursday
Sleep deprivation and sleep apnea both bad for the heart
Dr KK AggarwalBoth sleep deprivation and sleep apnea have been linked to a higher risk of heart disease.

Inadequate or poor quality sleep can increase the risk of heart disease in due course of time. Short–term sleep deprivation is linked with high cholesterol, high triglycerides, and high blood pressure

Sleep apnea makes people temporarily stop breathing many times during the night. Up to 83% of people with heart disease also have sleep apnea.

In sleep apnea oxygen levels dip and the brain sends an urgent "Breathe now!" signal. That signal briefly wakes the sleeper and makes him or her gasp for air. That signal also jolts the same stress hormone and nerve pathways that are stimulated when you are angry or frightened. As a result, the heart beats faster and blood pressure rises, along with other things that can threaten heart health such as inflammation and an increase in blood clotting ability. (Source Harvard)
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
The US Food and Drug Administration (FDA) has approved the first continuous glucose monitoring (CGM) system that sends data directly to a smartphone and does not require a separate receiver. The Dexcom G5 Mobile CGM System was approved on August 25 for adults and children as young as 2 years of age.


A combination of intralesional interleukin (IL)-2, imiquimod, and topical retinoid prompted a complete local response in patients with cutaneous metastatic melanoma, and might improve survival, suggested a small retrospective study published online in the Journal of the American Academy of Dermatology.

Infectious Diseases
Intravenous (IV) artesunate is safe and effective in patients with severe malaria, suggested a retrospective case series analysis published online August 25 in the Annals of Internal Medicine.

Obstetrics and Gynecology
For pregnant women who are at low risk for delivery complications, newborn and maternal outcomes are similar for obstetric deliveries by family physicians and obstetricians, suggested a retrospective, population-based cohort study published online August 24 in the Canadian Medical Association Journal.

More than a third of apolipoprotein E (APOE) e4 noncarriers diagnosed with mild to moderate Alzheimer's dementia have minimal amyloid plaque in the cerebral cortex, revealed autopsies performed on these patients. The findings were published online in JAMA Neurology.
Cardiology eMedinewS

A randomized trial of community-dwelling seniors >75 years old with hypertension and only mild cognitive deficits revealed that stopping antihypertensive therapy for 16 weeks did not improve their short-term cognitive, psychological, or general function. The findings were published online August 24 in JAMA Internal Medicine.

White race is associated with a significantly higher risk of incident atrial fibrillation (AF) compared with blacks, and systemic inflammation contributes to a significant proportion of that heightened risk, suggested the Health ABC (Health, Aging and Body Composition) study, published in the August 2015 issue of JACC: Clinical Electrophysiology.
Pediatrics eMedinewS

Children undergoing surgery for high-grade glioma have an increased chance of survival when tumors are fully removed, suggests a new study published in the September issue of Neurosurgery. Researchers noted that female patients survived almost 6 years longer than male patients who underwent the same procedure.


A new study links family problems and other early life adversity to variation in brain structure in late adolescence and an increased risk for depression and anxiety among boys. The findings are published in JAMA Pediatrics.
Dr KK Spiritual Blog
Sugary drinks versus sugary sweets (mithai)

When we talk about health, everybody talks against soft drinks. They say that one should not substitute water with soft drinks. One should take not more than one soft drink a day.

From medical point of view, soft drinks mean any drink, which contains more than 10% sugar. Oral rehydration solution that is medically recommended for dehydration and marketed as a replacement solution is not a sugary drink as it contains not more than 2–3% sugar. A 200 ml bottle of soft drink, on an average, contains 20 gm of sugar, which amounts to 10%.

Most mithais or the so-called Indian sweets contain more than 10% sugar; an average person consumes 100 gm of sweets per meal.

The traditional halwas such as moong ki daal ka halwa or gajar ka halwa or suji halwa contain 30% sugar. Suji Halwa is made of one cup of ghee, one cup of suji and two cups of sweet syrup and four cups of water. Kalakand is the least sweetened Indian sweet as it contains only 300 gm of sugar in 10kg of milk. Indian traditional Burfi is 3 kg sugar in 10 kg of khoya. Kaaju burfi is 50% sugar, gulab jamun is 40% sugar, rasgulla syrup contains 50% sugar (made of only cow milk and sugar).

The sugar syrup, or chashni as it is called, is 50% sugar. Most soft drinks have 10% sugar.

Most Indian sweets are prepared either in sugar syrup or vanaspati ghee (hydrogenated oils). A sweet cannot be made in artificial sweeteners as artificial sweetener cannot be converted into a sugar syrup or chashni. The sweets prepared in vanaspati ghee are gulab jamun, laddoo, patisa, balushahi, sohan halwa. Sohn halwa contains the maximum hydrogenated oil. Balushahi also contains 60% ghee.

The sweets that are prepared without any ghee are those prepared with sugar syrup; they are rasgulla, ras malai, chum chum etc.

Most salty snacks are made in soyabean oil which is the cheapest oil. Other oils, which can be used are sunflower oil, cottonseed oil. Samosa, kachori are made of maida but they are not cooked in transfat or hydrogenated oils but in soyabean oil.

The hydrogenated oils or vanaspati ghee is only present in items like laddoo, balushahi, besan ka laddoo, patisa etc.
Inspirational Story
One Bedroom Flat

As the dream of most parents I had acquired a degree in Engineering and joined a company based in USA, the land of braves and opportunity. When I arrived in the USA, it was as if a dream had come true.

Here at last I was in the place where I want to be. I decided I would be staying in this country for about five years in which time I would have earned enough money to settle down in India.

My father was a government employee and after his retirement, the only asset he could acquire was a decent one bedroom flat.

I wanted to do something more than him. I started feeling homesick and lonely as time passed. I used to call home and speak to my parents every week using cheap international phone cards. Two years passed, two years of Burgers at McDonald’s and pizzas and discos and 2 years watching the foreign exchange rate getting happy whenever the Rupee value went down.

Finally I decided to get married. Told my parents that I have only 10 days of holidays and everything must be done within these 10 days. I got my ticket booked in the cheapest flight. Was jubilant and was actually enjoying shopping for gifts for all my friends back home. If I missed anyone then there will be talks. After reaching home I spent home one week going through all the photographs of girls and as the time was getting shorter I was forced to select one candidate.

In-laws told me, to my surprise, that I would have to get married in 2–3 days, as I will not get anymore holidays. After the marriage, it was time to return to USA, after giving some money to my parents and telling the neighbors to look after them, we returned to USA.

My wife enjoyed this country for about two months and then she started feeling lonely. The frequency of calling India increased to twice in a week sometimes 3 times a week. Our savings started diminishing.

After two more years we had kids. Two lovely kids, a boy and a girl, were gifted to us by the almighty. Every time I spoke to my parents, they asked me to come to India so that they can see their grand-children.

Every year I decided to go to India. But part work, part monetary conditions prevented it. Years went by and visiting India was a distant dream. Then suddenly one day I got a message that my parents were seriously sick. I tried but I couldn’t get any holidays and thus could not go to India. The next message I got was my parents had passed away and as there was no one to do the last rites, the society members had done whatever they could. I was depressed. My parents had passed away without seeing their grandchildren.

After couple more years passed away, much to my children’s dislike and my wife’s joy we returned to India to settle down. I started to look for a suitable property, but to my dismay my savings were short and the property prices had gone up during all these years. I had to return to the USA…

My wife refused to come back with me and my children refused to stay in India… My two children and I returned to USA after promising my wife I would be back for good after two years.

Time passed by, my daughter decided to get married to an American and my son was happy living in USA… I decided that had enough and wound –up everything and returned to India… I had just enough money to buy a decent 2 bedroom flat in a well–developed locality.

Now I am 60 years old and the only time I go out of the flat is for the routine visit to the nearby temple. My faithful wife has also left me and gone to the holy abode.

Sometimes I wondered was it worth all this?

My father, even after staying in India had a house to his name and I too have the same nothing more.

I lost my parents and children for just ONE EXTRA BEDROOM.

Looking out from the window I see a lot of children dancing. This damned cable TV has spoiled our new generation and these children are losing their values and culture because of it. I get occasional cards from my children asking I am alright. Well at least they remember me.

Now perhaps after I die it will be the neighbors again who will be performing my last rites, God Bless them. But the question still remains ‘was all this worth it’?

I am still searching for an answer………!!!

Start thinking … Is it just for one extra bedroom??? Life is more than this…start living it… Live it as you want it to be
Scientific awareness on personal hygiene and prevention from obesity among school going children, Modern ERA Convent Sr. Sec. School-on 26th August 2015
Make Sure
Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make Sure to remember that the macrolide, clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.
Dr Good Dr Bad
Situation: An obese patient with visceral fat wanted dietary advice.
Dr Bad: You need a high fiber diet.
Dr Good: Go on a low calorie, high fiber diet.
Lesson: A low calorie-high fiber diet with balanced nutritive elements has a positive effect on fasting glucose, lipid profile, hypertension and visceral obesity, in obese people with impaired glucose tolerance with a consecutive lowering of cardio metabolic risk (Source: Med Pregl 2010 Jul-Aug; 63 (7-8):465-9).

(Copyright IJCP)
eMedinewS Humor
At Ninety-Nine

When a grandmother was in her late eighties, she decided to move to Israel. As part of the preparations, she went to see her doctor and get all her charts. The doctor asked her how she was doing, so she gave him a litany of complaints - this hurts, that's stiff, I'm tired and slower, etc.

He responded with, "You have to expect things to start deteriorating. After all, who wants to live to 100?"

The grandmother looked him straight in the eye and replied, "Anyone who's 99."
eIMA Quiz
All are precancerous for carcinoma colon except

a. Crohn's disease
b. Bile acids
c. Fats
d. Carotene

Yesterday’s Mind Teaser: What is not true for HNPCC?

a) It is the most common hereditary colorectal cancer syndrome in USA
b) It is associated with MMR gene mutation
c) It is associated with APC mutation
d) It is associated with carcinoma colon and extraintestinal cancers

Answer for Yesterday’s Mind Teaser: c) It is associated with APC mutation
Answers received from: Dr Shangarpawar, Dr B R Bhatnagar, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Raghu Chaks, Dr Avtar Krishan, Daivadheenam Jella, Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay.
Answer for 25th August Mind Teaser: c) Astrocytomas
Correct Answers received from: Dr Shangarpawar, Dr Ridu Kumar Sharma, Dr Poonam Chablani, Dr K V Sarma, Raghu Chaks, Dr G Madhusudhan, Dr K Raju, Dr Avtar Krishan.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
eIMA News
  • While some research suggests that a diet high in omega-3 fatty acids can protect brain health, a large clinical trial by researchers at the National Institutes of Health found that omega-3 supplements did not slow cognitive decline in older persons. With 4,000 patients followed over a five-year period, the study is one of the largest and longest of its kind and published in the Journal of the American Medical Association.
  • Timely use of epinephrine is associated with increased survival among hospitalized children in nonshockable rhythm cardiac arrest as per analysis of data from the American Heart Association's "Get With the Guidelines-Resuscitation" registry (GWTG-R). Delayed adrenaline administration was associated with worse survival and other outcomes in the pediatric in-hospital cardiac arrest setting (JAMA).
  • Patients with rheumatoid arthritis who began taking statins had significantly lower all-cause mortality than those who did not take statins (August 5 in the Annals of the Rheumatic Diseases).
  • The Dietary Guidelines Advisory Committee (DGAC) released a report stating that up to five cups of coffee per day, or up to 400 mg of caffeine, is not associated with long-term health risks. Not only that, they highlighted observational evidence that coffee consumption is associated with reduced risk for several diseases, including type 2 diabetes, cardiovascular disease (CVD), and neurodegenerative disorders. The body of data suggesting that moderate coffee—and, in all likelihood, tea—consumption is not only safe but beneficial in a variety of mental and medical conditions is growing fast. (Medscape)
  • The role of magnesium in the pathogenesis of vascular calcification has heretofore not been studied extensively. Magnesium is a natural calcium antagonist; both human and animal studies have shown that low circulating levels of magnesium are associated with enhanced vascular calcification. In vitro and animal studies have suggested that magnesium plays a protective role through multiple molecular mechanisms. Several in vitro studies have shown that magnesium can have an inhibitory effect on hydroxyapatite formation and precipitation, and thus on the calcification process
  • Prediabetes affects 1 in 3 Americans. Both intensive lifestyle intervention and metformin can prevent or delay progression to diabetes.
  • Reports of the successful use of ultrasound for the noninvasive diagnosis of giant cell arteritis have emerged over the past decade. A diagnostic program involves patient evaluation with color Doppler ultrasound within 24 hours of presentation, followed by immediate treatment with corticosteroids for positive findings. The ultrasound assessment included examination of the superficial temporal arteries, the frontal and parietal branches, and the axillary and common carotid arteries, with a hypoechoic ring (halo sign) surrounding a vessel in any of these arteries being considered a positive result.
  • The NITI Aayog has objected to increasing investments and focusing on the public health sector as well as providing free drugs and diagnostics, as suggested in the updated draft National Health Policy of the National Democratic Alliance (NDA) government. Asking for a revision, it has recommended that the private sector and insurance-based models be given a greater role in a public health system that would require people to pay for health services
Dengue: Facts and prevention measures
Tuesday, 25 August 2015 - 10:30pm IST | Agency: DNA webdesk

With dengue cases on the rise, here's all you need to know about the spread and prevention measures of the disease.

The number of dengue cases, caused by viruses transmitted by mosquitoes, have been on the rise, as the monsoon season is underway. Here are some important facts about dengue and a few preventive measures you need to be aware of.

Facts about the Aedes mosquitoes

The Dengue virus is primarily transmitted by Aedes mosquitoes. These mosquitoes do not lay eggs in drains, ditches, canals, wetlands, rivers or lakes. “What most people do not realise is that the dengue mosquito breeds in fresh clean water as opposed to dirty drains. Thus, people living in clean urban surroundings are more at risk of acquiring the disease,” says Dr KK Aggarwal, President HCFI & Honorary Secretary General IMA and a Padma Shri Awardee.

These mosquitoes can fly several hundred yards looking for water-filled containers, often found in a house and patio, to lay their eggs and it only takes a few mosquitoes in a household to produce a large dengue outbreak.

Humans are only bitten by the female mosquitoes who lay dozens of eggs, up to five times, during their life time. The eggs which can survive for months, hatch when submerged in water. The lifecycle of the mosquito is close to eight days - from egg to larvae, pupae and into an adult mosquito.

Tips to prevent dengue fever:
  • Do not let water accumulate in your house
  • Wear full-sleeve clothing
  • Use mosquito repellents, especially during the monsoon season
Since dengue is caused by a virus, it is the symptoms that are treated and the chronic phase of the illness with fever and myalgias lasts approximately one to two weeks.

The symptoms:
  • Severe joint and muscle pain
  • Swollen lymph nodes
  • Headache
  • Fever
  • Exhaustion - Rashes
While the risk of complications is in less than 1% of dengue cases, Dr Aggarwal has a few recommendations. The danger of dengue lies in dehydration, so it is vital to consume a lot of fluids and to only opt for a platelet transfusion if there is active bleeding or your platelet count is below 10,000.
Birthday wishes for National President IMA
  1. Respected Dr Pillai, Happy birthday, wish you a long fruitful and satisfying healthy life. You and KK are doing a good job. Dr Suresh Amin.
  2. Many happy returns of the day to National President Padma Shri Dr Marthanda Pillai sir: Prof Dr Ravi Wankhedkar
  3. Warm wishes Happy Birthday our beloved National president Dr Pillai. Prof. Dr. Akhilesh Verma
JIMA Responses
  • Kudos to IMA Leadership: Dr. Dilip Kumar Acharya
  • Krishan Singla: Great effort by Pillai / Aggarwal duo. We are perceiving a definite forward movement.
  • IMA members all over the country were missing their journal for a long time. Thank you Team IMA for your efforts. The draft of JIMA says it all ... great selection of topics, their placement, editorials and effort involved. Badhai all the way. Dr V K Monga.
  • Congratulations: Dr Neeraj Gupta, Dr Pawan Gupta.
  • Congratulations to Dr A Marthanda Pillai and Dr KK Aggarwal for facilitating JIMA to be published again. Kudos to the JIMA team for the new format. Dr Jayakrishnan AV.
  • What can we say, except a big congratulatory thanks to all the leaders for making this possible in such a wonderful fashion. With best regards: Dr C Srinivasa Raju.
  • Congratulations to our respected National President and Secretary General and entire team IMA for bringing out JIMA. Very happy to see the journal after a long time. All the best wishes. Dr Muhammed Shaffi.
  • World class JIMA, KK. This is long awaited. We salute Team IMA for this achievement. Dr Arul.
Kindly sign this petition: For allowing parliament to function

Tiny url to pass on to other members:

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
IMA Digital TV
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IMA IPMO Initiative
Kindly go to
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
Quote of the Day
Failing doesn’t make you a failure. Giving up, accepting your failure, refusing to try again does! Richard Exely.
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Wellness Blog
The Science of Hygiene

All of us are taught about hygienic living and this subject should be included as a chapter in the curriculum of every school. There are many different kinds of hygiene.

Respiratory hygiene: This is important to prevent cross infection, specifically, from flu and related respiratory illness. One should keep a distance of minimum 3 ft, from a person who is coughing, sneezing or singing. Most respiratory particles are more than 5 microns in size and do not travel a distance of more than 3 ft. This respiratory hygiene, however, will not prevent transmission of the tuberculosis bacteria, which are less than 5 microns and keep circulating in the area.

Hand hygiene: This is the fundamental principle for any disease prevention and the catch phrase is “before and after”, i.e. one should wash hands before and after eating food, touching any infected material, seeing a patient or after normal evacuation of stool in the morning.

Food hygiene: This means maintaining hygiene at home while cutting, serving and eating food. While cutting a vegetable, the surface or the cutting board should be clean and hygienic including the knife, hands, water, utensils etc. If that hygiene is not possible, follow the formula of ‘boil it, heat it, peel it, cook it or forget it’. This means that any food which has been boiled, heated or peeled is safe for eating. Peeling means removing the skin of a fruit such as banana or oranges.

Water hygiene: This involves drinking safe water, safe drinking glass, proper washing of glass, not washing multiple glasses in the same utensil and picking up glasses properly. People often try to pick up four glasses of water at the same time with one finger in each glass.

Sexual hygiene: This involves washing local areas before and after sexual contact.

Body hygiene: This involves 16 upchars, as mentioned in mythology. Out of these 16 basic steps, some are related to body hygiene and they involve washing feet first and then hands followed by mouth and finally the body. Washing of the feet is the most important as they are the ones which carry infections into one’s house.

Cleaning of mouth is cleaning the teeth with one finger, gums with two fingers, tongue with three fingers and palate with thumb.

Abhishekam or the snana of the body involves multiple steps. Ancient steps have been washing the body with milk water (rose water etc.) followed by rubbing with curd (soap), honey (moisturizers), ghee (oil), sugar (the drying agent) and finally with milk water again. This facilitates natural bathing and not dependent on soap.

Nail hygiene: This is also a very important hygiene, especially for food handlers, because they are responsible for causation of water and food disease. It is important that they be given typhoid vaccines and de-worming tablets every three months.

Another important hygiene to be observed at our homes is that of the servants or the help. They are often provided soap at the start of the month and they are supposed to use that bar of soap for a month. If by any chance, they lose that soap in 2-3 weeks’ time, they are apprehensive in asking the owners for soap. As a result, they may wash their hands without soap for the next 2-3 weeks, which includes washing of hands in morning.
Reader Response
Dear Sir, Very informatory news. Regards: Dr Tripta
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Rabies News (Dr A K Gupta)
What are the types of rabies?

There are mainly two types of rabies.
  • Two-third of rabies patients suffer from typical furious (encephalitic) type of rabies. The virus replicates in portions of the brain including the hippocampus, amygdala, anterior thalamic nuclei and limbic cortex. Furious rabies has three cardinal signs:
    • Fluctuating consciousness, episodes of excitement and hallucinations.
    • Phobic spasms – Aerophobia, hydrophobia and photophobia
    • Autonomic dysfunctions like increased salivation, excessive sweating, priapism and pupillary abnormalities.
It is typically believed that salivation and vomiting are linked, and contribute to the apparent hydrophobia (fear of water) in patients. These symptoms can last for few days, after which the patient may suffer from the second type of rabies, or may slip into a coma and die. It is when suffering from furious rabies that a person or animal is likely to attack those near them and spread the disease.

b) Dumb (paralytic) rabies, which is characterized by flaccid muscle weakness, constipation, urinary retention, stupor and coma. Hydrophobia is usually absent in these cases. This is a condition resembling Guillain Barre syndrome. Dumb rabies occurs as the result of the virus replicating in the brain’s neocortex. It is much harder for a doctor to diagnose rabies in its "dumb" form than it is in its "furious" form, because the symptoms are less indicative of a specific medical issue.

Both forms are progressive and will lead to death, usually within 7 days in patients with encephalitic rabies and 3 weeks in those with paralytic rabies.
Press Release
Best time to have a heart attack is a week day

The best time to have a heart attack is a week day, 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 Indian Medical Association (IMA).

Your chances for surviving a cardiac arrest are 13.4 percent worse if you are admitted to the hospital on the weekend versus a weekday, he further added. Even after taking into account factors such as hospital size and location and the person's age, gender and other illnesses, the lower survival rate remains the same.

According to Richard M. Dubinsky, of the University of Kansas Medical Center in Kansas City, a higher death rate among patients admitted on weekends may be due to lack of resources for treating cardiac arrest.

The findings come from researchers analyzing a national database containing a 20 percent sampling of all U.S. hospital admissions for cardiac arrest from 1990 to 2004. The analysis included 67,554 admissions. During cardiac arrest, the heart slows or stops working, and brain death can occur in just 4 to 6 minutes.