September 28   2015, Monday
All about Diabetes
Dr KK Aggarwal
• Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications

• India may soon be the diabetic capital of the world.

• People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications. Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.

• World Diabetes Day is on November 14.

• In type 1 diabetes, the body does not make insulin. In type 2 diabetes the body makes insufficient insulin or does not use insulin well.

• Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chances of getting type 2 diabetes later in life.

• Type 2 diabetes has begun to affect young people.

• Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually reduce your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.

• In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.

• Choose healthy foods to share.

• Take a brisk walk together every day.

• Talk with your family about your health and your family’s risk of diabetes and heart disease.

• If you smoke, seek help to quit.

• Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.
Hygiene and Health awareness Programme conducted by Sathy IMA at BAVN ( Bannari Amman Vidhya Nikethan ) school, Sathyamangalam, Erode ( Dt ), Tamil Nadu. on 29 / 08 / 15
Metformin-related vitamin B12 deficiency might contribute to clinically significant peripheral neuropathy in diabetes patients, suggests new research presented at the European Association for the Study of Diabetes 2015 Meeting.

Women who have the hormone disorder polycystic ovary syndrome may be able to improve their fertility through weight loss and exercise, suggests a new study published in the Journal of Clinical Endocrinology & Metabolism.

Frequent feelings of dizziness several minutes after getting up may signal a serious underlying health problem, suggests new research published in Neurology.

Patients with cancers of the mid- and lower throat may have higher survival rates if their initial treatment includes surgery, suggests new research presented at the 2015 European Cancer Congress.

The investigational oral JAK-1 inhibitor ABT-494 was found effective for refractory moderate-to-severe rheumatoid arthritis in two phase II studies, BALANCE-I and II. Researchers speculate that ABT-494 has the potential to become a best-in-class therapy.
Cardiology News
The American College of Cardiology, American Heart Association, and the Heart Rhythm Society (ACC/AHA/HRS) have published new guidelines for the management of patients with supraventricular tachycardia (SVT). The recommendations are published September 23 in Circulation.

Dosing antihypertensives before sleep instead of upon waking decreases the risk of incident diabetes, reported a randomized trial published in Diabetologia. It was also reported that sleeping BP -- but not daytime or 48-hour ambulatory BP -- was a significant predictor of new-onset diabetes and may be a novel target for prevention.
Pediatric News
New research published in PLOS Pathogens suggests that malaria in pregnancy leads to neurocognitive impairment of offspring.

A study published in the Annals of Allergy, Asthma and Immunology suggests that the risk for hospitalization doubles for kids with asthma who are exposed to secondhand smoke.
Dr KK Spiritual Blog
Is it necessary to take a dip in Ganga to remove your sins?

Ganga, Jamuna and Saraswati, the sangam of the three rivers in Allahabad is believed to be the holiest place in the country where if one takes a dip, one washes away his or her past sins.

After death, ashes are also submerged in the Ganga with an assumption that the past sins will be removed.

In Vedic era, what was the intention of the rishis and munis while making this ritual?

In mythology, moon represents cool mind and Ganga represents the positive flow of thoughts. And sea turmoil indicates the disturbed state of mind.

Hanuman’s samudra yatra indicates the meditative journey through the flow of thoughts. Samudra manthan represents the journey of the mind during meditation.

Taking a dip can be equated to shifting your mind towards your consciousness. This may occur when you introspect in a relaxed state of mind or when you practice meditation. Meditation is defined as a journey from sympathetic and parasympathetic state of mind or a journey from disturbed state of consciousness to undisturbed state of consciousness.

Every time you meditate, you dip into your consciousness and clean your guilt and negative thoughts. It is something like reformatting your hard disk and removing the bad sectors and viruses in your software.

It is, therefore, possible for you to do Ganga snan (bath) at your house in the morning while meditating or during pooja by drifting away from disturbed state of mind to non disturbed relaxed state of mind clearing your guilt and negative thoughts.
Scientific awareness on personal hygiene and prevention from obesity among school going children
Make Sure
Situation: A patient of pulmonary Koch on ATT complained of numbness in fingers and toes.

Reaction: Oh my God! I forgot to prescribe vitamin B complex.

Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.
Dr Good Dr Bad
Situation: A patient with severe migraine wanted to know if xylocaine drops would help.

Dr. Bad: They have no role.

Dr. Good: You can try them.

Lesson: As an intranasal spray, 2% xylocaine drops can help migraine patients.
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CPR 10
Successfully trained 119370 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 the memory of Sameer Malik to ensure that no person dies of a heart disease just because they cannot afford treatment. Any person can apply for 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
  1. A surgical revascularization strategy that uses multiple arterial coronary artery bypass grafts (MA-CABG) in patients with multivessel coronary artery disease results in lower mortality and less need for repeat revascularization compared with PCI with bare-metal stents or drug-eluting stents (DES) (JACC)
  2. A new meta-analysis has found that current smokers and people exposed to secondhand smoke have a significantly increased risk of developing type 2 diabetes, and this risk decreases in quitters over time. [September 18, Lancet Diabetes & Endocrinology)
  3. An extensive literature review presented at the recently concluded European Association for the Study of Diabetes 2015 Meeting found that exposure to pesticides significantly increases the risk of type 2 diabetes by nearly 60%.
  4. Scientists from MIT and the National Institute of Allergy and Infectious Diseases (NIAID) have discovered that the soft palate plays a key role in the flu viruses’ ability to travel through the air from one person to another. (Health Site)
  5. According to the State of Obesity report, the prevalence of obesity among adults and children living in the United States continues to be alarming, but there are signs that weight is stabilizing among adults in many states, and even among children in areas where greater efforts are being made to keep kids healthy.
  6. New evidence suggesting that carotid occlusion is not actually associated with a high risk for stroke with the inference that many carotid stenting or endarterectomy procedures for asymptomatic patients therefore may do more harm than good. (JAMA Neurology on September 21)
  7. The US Food and Drug Administration (FDA) has cleared the cobas Influenza A/B test for use on the cobas Liat System. It is the first Clinical Laboratory Improvement Amendments (CLIA)-waived, real-time polymerase chain reaction (PCR) test to detect and differentiate influenza A virus and influenza B virus in RNA in nasopharyngeal swab specimens in about 20 minutes or less.
  8. According to research presented at the American Academy of Pain Management (AAPM) 2015 Annual Meeting, obesity-related proteins adiponectin and resistin, both adipokines, show potential as novel biomarkers for acute pain associated with migraine severity, as well as treatment response.
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Bioethical issues in medical practice
Achieving Privacy and confidentiality in day to day practice- an ethical dilemma

Pragya Sharma,
Lecturer, Dept. of Clinical Psychology &
Smita N. Deshpande,
Head, Dept. of Psychiatry, De-addiction Services
PGIMER- Dr. Ram Manohar Lohia Hospital, New Delhi

Doctors in busy settings face an ethical dilemma. Maintenance of confidentiality and privacy becomes problematic due to the use of shared rooms. At times, the patient hesitates to share medical information due to this fact.  More funds and better infrastructure may not always be possible. What is your preferred solution in such circumstances?

a) Ignore the issue as sharing information is culturally acceptable in India
b)  Acknowledge overcrowding, try to make the patient comfortable within the shared setting
c)  Extend work hours, push back appointments to ensure one patient per room at a time
d)  Whisper/ talk in low voices

Do write in with views and your solutions!

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Quote of the Day
Winners compare their achievements with their goals, while losers compare their achievements with those of other people. Nido Qubein
Wellness Blog
Smoking makes you 5 years older

Men have a greater chance of dying then women, and smoking increases risk of death for adults just as if five years were suddenly added to their age.
  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.
Reader Response
Dear Sir, very informative news. Regards: Dr Kripa
eIMA Humor
Mr. Smith is Dead

A law firm receptionist answered the phone the morning after the firm's senior partner had passed away unexpectedly.

"Is Mr. Smith there?” asked the client on the phone. "I'm very sorry, but Mr. Smith passed away last night," the receptionist answered.

"Is Mr. Smith there?” repeated the client. The receptionist was perplexed. "Perhaps you didn't understand me I'm afraid Mr. Smith passed away last night."

"Is Mr. Smith there?” asked the client again. "Ma'am, do you understand what I'm saying?” said the exasperated receptionist.

"Mr. Smith is DEAD!" "I understand you perfectly," the client sighed. "I just can't hear it often enough."
Inspirational Story
10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren’t caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free

Don’t take things so personally: Most people, even your friends and colleagues, aren’t talking about you, thinking about you, or concerned with you at all for 99% of the time. The ups and downs of life, the warmth and coldness of others, aren’t personal at all. Pretending that they are will only make you more miserable than is needed.

Don’t assume your emotions are trustworthy: How you feel isn’t always a good indicator of how things are. Just because you feel it, that doesn’t make it true. Sometimes that emotion comes from nothing more profound than being tired, hungry, annoyed, or about to get a head–cold. The future won’t change because you feel bad—nor because you feel great. Feelings may be true, but they aren’t the truth.
Rabies News (Dr A K Gupta)

What are the initial (prodromal) symptoms of rabies?

  • Pain or paresthesiae at the site of the bite is well–known as a diagnostically useful prodromal symptom occurring in one–third to two–thirds of cases.
  • In Thailand, however, a specific type of paresthesiae – itching – was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesiae may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in three of the four patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.
eIMA Quiz
A 5-year-old boy suffering from Duchenne muscular dystrophy has to undergo tendon-lengthening procedure. The most appropriate anaesthetic would be:

1. Induction with intravenous thiopentone and N2O; and halothane for maintenance.

2. Induction with intravenous protocol and N2O; and oxygen for maintenance.

3. Induction with intravenous suxamethonium and N2O; and halothane for maintenance.

4. Inhalation induction with inhalation halothane and N2O; oxygen for maintenance.

Yesterday’s Mind Teaser: During rapid sequence induction of anesthesia:
1. Slick’s maneuver is not required.
2. Pre-oxygenation is mandatory.
3. Suxamethonium is contraindicated.
4. Patient is mechanically ventilated before end tracheal incubation.

Answer for Yesterday’s Mind Teaser: 2.Pre-oxygenation is mandatory.

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr Rajesh S Joshi, Dr.B.R.Bhatnagar, Dr.K.Raju, Dr Avtar Krishan

Answer for 26th September Mind Teaser: C. About 30 percent of your daily calories

Correct Answers received from: Dr Poonam Chablani, Viswanatha Sarma,
Press Release
Depression, severe mental illness and loneliness not heart friendly

Depression, severe mental illness and loneliness are linked to heart disease and dementia,  said Padma Shri Awardees Dr A Marthanda Pillai National President Indian Medical Association (IMA) and Dr K K Aggarwal, Honorary Secretary General IMA and President Heart Care Foundation of India

A 3-year study by Dr Jesse Stewart, formerly of the University of Pittsburgh School of Medicine found a correlation between depression and hardening of the arteries. The arteries of those who are most depressed were narrowed twice as much as those who were least depressed, in the study. Hardening of the arteries is a precursor to a heart attack or stroke.

Depression may also upset the body’s regulation of glands that release chemicals governing energy level and growth, and alter the functioning of cells responsible for blood clotting.

Hardening of the arteries leads to an overreaction of the immune system and the resulting inflammation is known to release chemicals that can cause the disease.

Quoting a British study, they said that severely mentally ill people are more than three times as likely to die from coronary heart disease and stroke as those not suffering from mental illness. Mental illness more than doubled the risk of dying from heart disease for people up to the age 75. The risk of dying from heart disease was even higher among those taking antipsychotic medications.

A persistent feeling of loneliness among the elderly doubles the risk of developing Alzheimer's-like symptoms compared to those who felt connected to others.