May 29  2015, Friday
eMedinewS
editorial
Low Vitamin D Levels Linked to Fatal CVD
Dr KK Aggarwal Vitamin D deficiency is much more strongly linked to fatal than nonfatal CV events (27% increased risk), as suggested by a large prospective study published in the Journal of Clinical Endocrinology and Metabolism.

The population–based cohort study enrolled 9949 adults aged 50 to 74 years recruited during regular health check–ups at primary–care practices in 2000 to 2002. There were more women than men (59% vs 41%); most participants (59%) had inadequate vitamin D levels (<50 nmol/L). Blood samples were collected at baseline, five, and eight years.

Mean follow–up was 9.2 years for mortality and 6.5 years for the end points of CVD, CHD, and stroke. A total of 854 patients had a nonfatal CVD event, 176 had a fatal CVD event, 460 had a nonfatal CHD event, 79 had a fatal CHD event, 313 had a nonfatal stroke, and 41 had a fatal stroke. Overall, the proportion of individuals who had no events was significantly lower among those with vitamin D deficiency.

Even after adjustment for other potential confounders, including smoking and physical activity, vitamin D deficiency still conferred a significant 27% increased risk for total CVD, and a 62% increased risk for fatal CVD.

There was no association between vitamin D deficiency and nonfatal CVD events. Individuals with low vitamin D levels also had a significant 36% increased risk of total CHD and a nonsignificant 33% increased risk of total stroke. (Source: Medscape Cardiology)
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IMA-USV Vitamin D Deficiency CME held on 24-5-2015 at IMA House, New Delhi
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News
  • Low levels of vitamin D are significantly and independently associated with low levels of testosterone in otherwise healthy middle-aged men, suggests a study presented at the American Urological Association 2015 Annual Meeting.
  • Regular aspirin use is associated with a slowing of the progression of subclinical emphysema, reported an observational study presented at the American Thoracic Society 2015 International Conference.
  • All contraceptive pills carry an increased risk for venous thromboembolism (VTE), but the newer ones are actually riskier, suggested a combined population-based, nested case-control study published online May 26 in the BMJ.
  • The US Food and Drug Administration (FDA) has approved eluxadoline and rifaximin to give relief to adults with irritable bowel syndrome and diarrhea (IBS-D).
  • Disturbed eating behaviors and eating disorders are common in girls and women with type 1 diabetes, suggests a recent study published online in Diabetes Care.
Dr KK Spiritual Blog
Shiksha and Sabhyata

Suno, Samjho, Jaano and Karo is the mantra for education and involves not only hearing but listening and understanding and converting understanding into wisdom by doing it practically.

One of the components of education is etiquettes or manners, which can be at every level of education. In older era, Rajkumars or princes were sent to Gurukuls for formal education including that of warriorship. They were also sent to Gharanas/Kothas to learn tehzeeb the Lucknawi way where they were taught how to talk to each other and respect others. Their language in typically Lucknawi style used to be ‘we’ oriented and not ‘I’ oriented. Today’s education is more oriented towards ‘I–ness’ or ego and not towards the soul or respect.

When we were students, we were taught that a senior is a senior and needs to be respected. Even today, when we meet our teachers, we take their blessings by touching their feet but today’s students believe in shaking hands or saying ‘hi’. There is more and more commercial touch in the teacher–student relationship of today.

Ego makes one rude and arrogant with a mentality full of Rajas and Tamas. Road rage, gang rapes, murders, violence, terrorism are all examples of not learning etiquettes at the right time.
Cardiology eMedinewS
  • Coronary artery calcium (CAC) density was inversely related to 10-year risk of cardiovascular disease and coronary heart disease in an extended analysis of individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, suggested new research presented at the International Symposium on Atherosclerosis 2015.
  • Early analysis of 154 participants in the ongoing Observational Study to Predict Readmission for Heart Failure Patients (OPERA-HF) trial showed that within a year after hospital discharge, those with moderate to severe depression scores were more than five times more likely to die than those with lower scores, and the risk remained high even after controlling for demographics, health factors, and comorbidities. The findings were presented at the Heart Failure Congress 2015 of the European Society of Cardiology Heart Failure Association.
Pediatrics eMedinewS
  • A large, cross-sectional study of almost 7000 children aged 7 to 9 years has confirmed that visual impairment is rarely the cause of pediatric reading problems. Hence, the common practice of vision-based interventions is unlikely to help in treating youngsters with severe reading impairment. The findings were published online May 25 in Pediatrics.
  • Infants who live at higher altitudes may be at greater risk of sudden infant death syndrome (SIDS), suggested a new study published in Pediatrics. Researchers noted that infants who resided at an altitude of 8,000 ft or higher were at 2.3 times greater risk of SIDS, compared with infants who lived at an altitude below 6,000 ft.
Inspirational Story
Positive thinking

Jerry was the kind of guy you love to hate. He was always in a good mood and always had something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!"

He was a unique manager because he had several waiters who had followed him around from restaurant to restaurant. The reason the waiters followed Jerry was because of his attitude. He was a natural motivator. If an employee was having a bad day, Jerry was there telling the employee how to look on the positive side of the situation.

Seeing this style really made me curious, so one day I went up to Jerry and asked him, "I don’t get it! You can’t be a positive person all of the time. How do you do it?" Jerry replied, "Each morning I wake up and say to myself, Jerry, you have two choices today. You can choose to be in a good mood or you can choose to be in a bad mood.’ I choose to be in a good mood. Each time something bad happens, I can choose to be a victim or I can choose to learn from it. I choose to learn from it. Every time someone comes to me complaining, I can choose to accept their complaining or I can point out the positive side of life. I choose the positive side of life." "Yeah, right, it’s not that easy," I protested.

"Yes it is," Jerry said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people will affect your mood. You choose to be in a good mood or bad mood. The bottom line: It’s your choice how you live life."

I reflected on what Jerry said. Soon thereafter, I left the restaurant industry to start my own business. We lost touch, but often thought about him when I made a choice about life instead of reacting to it. Several years later, I heard that Jerry did something you are never supposed to do in a restaurant business: he left the back door open one morning and was held up at gunpoint by three armed robbers. While trying to open the safe, his hand, shaking from nervousness, slipped off the combination. The robbers panicked and shot him. Luckily, Jerry was found relatively quickly and rushed to the local trauma center. After 18 hours of surgery and weeks of intensive care, Jerry was released from the hospital with fragments of the bullets still in his body. I saw Jerry about six months after the accident. When I asked him how he was, he replied, "If I were any better, I’d be twins. Wanna see my scars?"

I declined to see his wounds, but did ask him what had gone through his mind as the robbery took place. "The first thing that went through my mind was that I should have locked the back door," Jerry replied. "Then, as I lay on the floor, I remembered that I had two choices: I could choose to live, or I could choose to die. I chose to live."

"Weren’t you scared? Did you lose consciousness?" I asked. Jerry continued, "The paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the emergency room and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read, ‘He’s a dead man.’ I knew I needed to take action."

"What did you do?" I asked.

"Well, there was a big, burly nurse shouting questions at me," said Jerry. "She asked if I was allergic to anything. ‘Yes,’ I replied. The doctors and nurses stopped working as they waited for my reply… I took a deep breath and yelled, ‘Bullets!’ Over their laughter, I told them, ‘I am choosing to live. Operate on me as if I am alive, not dead."

Jerry lived thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything.
Make Sure
Situation: A neonate in an ICU being administered IV calcium exhibited signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully?
Lesson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe cutaneous necrosis.
Dr Good Dr Bad
Situation: A patient wanted to know his risk of MI
Dr. Bad: What is your BMI?
Dr. Good: What is your waist–to–hip ratio?
Lesson: In the INTERHEART Study, elevated waist–to–hip ratio had a three times stronger association with risk of MI than BMI.

(Copyright IJCP)
eMedinewS Humor
Old age secret

Grandpa was celebrating his 100th birthday and everybody complimented him on how athletic and well–preserved he appeared.

"Gentlemen, I will tell you the secret of my success," he cackled. "I have been in the open air day after day for some 75 years now."

The celebrants were impressed and asked how he managed to keep up his rigorous fitness regime.

"Well, you see my wife and I were married 75 years ago. On our wedding night, we made a solemn pledge. Whenever we had a fight, the one who was proved wrong would go outside and take a walk."
eMedi Quiz
Epidermodysplasia veruniciformis is caused by which of the following HPV serotypes:

a.1
b.3
c.5
d.11

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 4. Oxygen affinity of hemoglobin.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan.
Answer for 27th May Mind Teaser: 1. Criterion validity.
Correct Answers received: Dr Shangarpawar, Dr K Raju, Dr Poonam Chablani, Daivadheenam Jella.
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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
Snorers at risk of sudden death

The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep, said Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community.

A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

In another study, researchers from the University of Wisconsin have shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.
eIMA News
IMA Swachch Bharat Swastha Bharat
Observe IMA Hygiene Hour Every Friday 4-5 PM. Do one hour cleanliness awareness drive.
Key Resolutions and Decisions: 68th World Health Assembly – 26th May
Item 14.2 Health in Post-2015: Numerous Member States flagged the importance of health in the post-2015 development agenda. The Assembly noted the report A68/14.

The Union for International Cancer Control and the NCD Alliance delivered a joint statement.

Statement by the Union for International Cancer Control on behalf of the NCD Alliance 68th World Health Assembly

Statement on Agenda Item 14.2


Chairperson, Honourable Ministers, distinguished delegates,

Thank you for the opportunity to deliver this statement on behalf of the Union for International Cancer Control and the NCD Alliance – a global civil society network working to elevate the profile of NCDs on the global development agenda.

The finalization and adoption of the post-2015 development agenda, the upcoming conference on Financing for Development in Addis, and momentum around universal health coverage are leading us to a new era for global health and development. Achieving health for all in post-2015 will require that NCDs remain at the top of political and technical agendas. We call on Member States to:
  1. Ensure strong references to health, including NCDs and mental health and wellbeing in all elements of the post-2015 agenda;
  2. Make strong, specific commitments at the Third International Conference on Financing for Development to maximise the human and financial resources allocated to health and NCDs. Achieving the target to reduce NCD mortality demands adequate resources are provided in order to strengthen health systems to deliver cost-effective NCD interventions, increase access to affordable medicines and vaccines, improve health workforce capacity, and improve health data. Tobacco taxes should be affirmed as a key mechanism for increasing domestic revenue.
  3. Define and promote a clear role for civil society in all levels of post-2015 follow-up and review mechanisms, and ensure comprehensive and cohesive reporting with the WHA.
  4. Prioritize reduction of NCDs within national development planning and programmes, as part of national efforts to implement the post-2015 agenda starting in 2016. Realizing the vision for sustainable human development in post-2015 is ambitious, but not impossible.
We look forward to bold commitments and strong actions by all. Please be assured that the NCD Alliance stands ready to support Member States and WHO as we work towards a healthy future that leaves no one behind.
Indian Medical Association (IMA) in association with Heart Care Foundation of India (HCFI) and Udyog Development Foundation (UDF) on 20th May 2015 donated medicines worth Rs.25 lacs to Nepal
Donate generously for the victims of Nepal Earthquake

 List of members contributed for Nepal Relief Fund
 
Date
Name of Doner
Place
Amount (Rs.)
22-5-2015
IMA Bilaspur Branch
Chattishgarh
189200
27-5-2015
IMA Tamil Nadu State Branch
Tamil Nadu
100000
25-5-2015
IMA Gadag Branch
Karnataka
73000
25-5-2015
IMA Tinsukia Branch
Assam
60700
25-5-2015
IMA Idar Branch
Gujarat
40600
14-5-2015
IMA Barpeta Road Branch
Assam
25000
25-5-2015
IMA Dhule Branch
Maharashtra
25000
14-5-2015
IMA Talcher Branch
Orissa
24000
13-5-2015
Dr. S.S.Sukumar
Tamil Nadu
20000
14-5-2015
IMA Puri Branch
Orissa
20000
25-5-2015
IMA Rajpipla Branch
Gujarat
20000
25-5-2015
IMA Siliguri Branch
Bengal
20000
22-5-2015
IMA Palanpur Branch
Himachal Pradesh
16000
13-5-2015
IMA Vadodara Branch
Gujarat
15000
25-5-2015
Dr. Milind Naik
Nagpur
11000
28-05-2015
Dr. KK Aggarwal
Delhi
10441
14-5-2015
IMA Bangalore North East Branch
Karnataka
10000
14-5-2015
Dr. Pramila Ramteke
Nagpur
10000
25-5-2015
IMA Kendujhar Dist Branch
Orissa
10000
25-5-2015
Dr. Kiran Belsare
Nagpur
10000
14-5-2015
Dr. Sarita Bokde
Nagpur
6100
27-5-2015
IMA Morinda Branch
Punjab
5100
13-5-2015
Dr. A.K.Punetha
Pithoragarh
5000
14-5-2015
Dr.Vipul Gupta
Delhi
5000
14-5-2015
Dr. Madhu Gupta
Delhi
5000
14-5-2015
Dr. B.R.Gupta
Delhi
5000
15-5-2015
Dr. Pravin Lad
Nagpur
5000
25-5-2015
Dr. Usha Garg
Delhi
5000
25-5-2015
Dr. Shailesh Pitale
Nagpur
5000
27-5-2015
IMA Berhampur Branch
Orissa
5000
28-05-2015
Dr. Chetan N. Patel
Vadodara
4386
27-5-2015
Dr. Jayant Lanjewar
Nagpur
2000
13-5-2015
IMA Phagwara Branch
Punjab
1000
13-5-2015
IMA Sirhind Branch
Punjab
1000
13-5-2015
IMA Rajpura Branch
Punjab
1000
13-5-2015
IMA Dasuya Branch
Punjab
1000
13-5-2015
IMA Amritsar Branch
Punjab
1000
21-5-2015
Dr. Ashish Diswal
Nagpur
1000
22-5-2015
IMA Tanda Branch
Punjab
1000
22-5-2015
IMA Jagraon Branch
Punjab
1000
25-5-2015
Dr. Bijan K. Dey
Delhi
1000
27-5-2015
IMA Patiala Branch
Punjab
1000
Total contribution received as on 28-05-2015
777,527.00
Health must be given higher priority in climate summit say physician leaders
(28.05.2015) Physician leaders are pressing for health issues to be given a greater priority in the United Nations climate change talks.

On the eve of next week’s preparatory discussions in Bonn for the climate change summit to be held in Paris in December, the World Medical Association has urged its 111 national medical associations to make their voices heard.

The WMA, representing 10 million physicians worldwide, has written to its members urging them to write to their national negotiating representatives to emphasise that climate change is the greatest global health challenge of the 21st century.

Physician leaders have serious concerns about the adverse effects of climate change on health, such as disease and injury, increased malnutrition, and premature deaths, particularly among the most vulnerable populations.

In its letter, the WMA says: ‘The coming 21st Conference of the United Nations Framework Convention on Climate Change next December constitutes a decisive opportunity to address these challenges through an effective universal agreement bringing health to the forefront of the global warming debate and mitigating the severe health risks facing the world.’

WMA President Dr. Xavier Deau said he was very concerned that crucial health issues were being ignored in the build up to the summit and time was running out for the voice of the health community to be heard.

He said the negotiations needed to transform energy systems from fossil fuels to renewables. ‘Reducing fossil fuel consumption improves air quality and public health, as well as mitigating climate change. Last week’s resolution by the World Health Assembly on air pollution is a clear and positive step towards the improvement of the lives and health of millions of people who suffer from poor air quality. However, we believe that much more needs to be done globally and domestically to take fully into account the health impact of climate change and to engage the health sector in the process.

‘Improving insulation in homes and buildings can protect people from extreme temperatures and reduce energy consumption. We need to get people to adopt a more active lifestyle. So we need to see an expansion of public transport systems to improve health through increased physical activity and reduced air pollution.

‘All these changes would provide significant economic savings. Climate action that recognises these benefits can improve health, support sustainable development, and advance global equity.

‘National medical associations have a vital part to play in persuading the world that the impact of climate change on health is one of the most significant measures of harm associated with our warming planet.’
IMA signed MoU with UNESCO Chair in Bioethics HAIFA
By EP News Bureau-Mumbai on May 28, 2015

Under this Initiative, IMA will develop standardised modules in bio-ethics for upgrading the knowledge of medical practitioners

Dr A Marthanda Pillai, National President and Dr KK Aggarwal, Secretary General, IMA signed a Memorandum of Understanding with UNESCO Chair in Bioethics HAIFA represented by Prof Dr Russell D’Souza, Head Asia Pacific Bioethics Programme, UNESCO Chair in Bioethics HAIFA.

Under this Initiative, IMA will develop standardised modules in bio-ethics for upgrading the knowledge of medical practitioners. IMA will also have “IMA Bio-Ethics Chair” and “IMA-UNESCO Chair in Bio Ethics HAIFA” at national as well as at every state level.

34 such Chairs will be formed as a first step. In a joint statement, Dr A Marthanda Pillai, National President and Dr KK Aggarwal, Secretary General, IMA said as a part of this initiative, IMA will:

Sensitise 2.5 lakh of its members the principles of bio-ethic

Include bio-ethics as a part of every CME lecture. The last three slides of every lecture will include what is ethical, what is unethical and what not ethical

Come out with a white paper on what is not unethical and also what makes a doctor indulge in unethical jobs
World No Tobacco Day
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Quote of the Day
Difficulties increase the nearer we get to the goal. Johann Wolfgang von Goethe
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Reader Response
Dear Sir, very informative news. Regards: Dr Shravan
Wellness Blog
50% of adverse drug reactions can be prevented

Over 50% of all adverse drug reactions treated in hospitals and emergency care are preventable.

Many preventable drug reactions like drug overdoses and internal bleeding associated with the improper use of blood thinners and painkillers are life-threatening, especially in the elderly. There are many reasons for these reactions and may include poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education, according to Swedish researchers, who conducted a meta-analysis of 22 studies. Human error is inevitable, and therefore systems must be made to reduce the error. The study concluded that:
  • In outpatient setting, the frequency of preventable adverse drug reactions resulting in hospitalization or emergency treatment is 2%; of these, 51% are preventable.
  • In the elderly, 71% of drug reactions are preventable.
  • In admitted patients, the frequency of harmful drug reactions is 1.6% and 45% of them are preventable.
  • A third of preventable adverse drug reactions are life-threatening.
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Rabies News (Dr A K Gupta)
An unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog. What should be done?

If an unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog, wounds should be thoroughly washed with water and an antiseptic such as povidone iodine should be applied.

If the stray dog is suspected to be rabid, then the pet dog should be put to sleep (Euthanasia). But if the owner is not ready or the rabid status of the stray dog is not known, post–exposure vaccination of the pet with cell culture vaccine and simultaneous careful observation of the pet are recommended for up to 2 months (up to six months is desirable) for possible signs of rabies in the pet. During this period, if the dog becomes sick, the owner should take the dog to the veterinarian to get rabies ruled out at the first instance. It should be noted that post–exposure vaccination is not very successful in dogs. Simultaneously, pre–exposure vaccination of all household members is necessary.