June 29  2015, Monday
Sleep deprivation and sleep apnea both bad for the heart
Dr KK Aggarwal Both sleep deprivation and sleep apnea have been linked to a higher risk of heart disease.

Over time, inadequate or poor quality sleep can increase the risk of heart disease. 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)
World Elder Abuse Awareness Day 2015 was observed by Neolife foundation, Haridwar in association with Indian Medical Association UA on 15th June 2015
Cardiology eMedinewS
  • The first ESC recommendations for patients with cardiac arrhythmias and chronic kidney disease (CKD) were presented June 24 at EHRA EUROPACE - CARDIOSTIM 2015 and published in EP Europace. The paper outlines how to stage and monitor CKD; the association between CKD and hypertension, heart failure and atrial fibrillation; how CKD affects management of patients with arrhythmias or cardiac devices; risk of stroke and bleeding in patients with atrial fibrillation and CKD; and how arrhythmias and cardiac devices affect management of CKD.
  • Men with rheumatoid arthritis (RA) have double the rate of all-cause mortality and triple the rate of respiratory-related death compared with the general population without RA, with cardiovascular disease (CVD)-related mortality being the leading cause of death, suggests new research published online in Arthritis Care and Research.
Pediatrics eMedinewS
  • Cyberbullying among teenagers was significantly associated with depression, while association with suicidal thoughts or anxiety was inconsistent, reported the results of a meta-analysis published in JAMA Pediatrics.
  • A study published in the journal Pediatric Obesity suggests that emotional support from grandparents has a protective effect against child obesity, even with the presence of other risk factors.
Dr KK Spiritual Blog
Sword, Dragger and Discus in Mythology

Out of nine forms of Goddess Durga, Chandraghanta, Katyayani and Kalratri are depicted as carrying a sword; Kushmunda, Sidhadhatri as holding a discus and Kalratri as holding additional Dragger (Bhala). All have mythological significance.

The powers of Durga represent feminine powers in all of us. The mythological weapons represent our inherent mental powers to fight to live in this world.

The power of a sword power (non moving astra power) indicates sharp intelligence and relates to straight forward resistance. For example, if you are not happy with somebody’s answer and you stab him on the spot and prove him wrong, is like using your sword power.

On the contrary, the power of a discus (moving shastra power) is your indirect power to make the other person realize his mistake and come back and withdraw.

The dagger or Bhala is in between the two. It is both an astra and a shastra. It is much sharper and more powerful than the sword.

All three of them are three human qualities used by a person in three different situations. For example, there is a theft in your house and you suspect your servant. You can use the sword power and confront him directly till he says yes or you can keep mum for the time being, look for evidence and, if you find it, then you confront him with much more force using your dagger power and, lastly, you can create circumstances by using your discus power and make the servant realize his mistake and come back to you to admit his mistake and seek pardon.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
Make Sure
Situation: Doctor, this patient has developed acute renal failure.
Reaction: Oh my God, I forgot that he was on furosemide. I gave him full dose of amikacin.
Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that furosemide and other loop diuretics, which enhance its nephrotoxicity, are not being given.
Dr Good Dr Bad
Situation: A patient with migraine was put on the herb, Butterbur.
Dr. Bad: It is a drug of choice for preventing migraine.
Dr. Good: Its benefits still remain unproven.
Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproven. Neither treatment is recommended.
(Copyright IJCP)
eMedi Quiz
All of the following infections are often associated with acute intravascular hemolysis except:

1. Clostridium tetani.
2. Bartonella bacilliformis.
3. Plasmodium falciparum.
4. Babesia microti.

Yesterday’s Mind Teaser: A patient has been allegedly bitten by cobra snake. The venom in such a bite would be:

1. Musculotoxic.
2. Vasculotoxic.
3. Cardiotoxic.
4. Neurotoxic.

Answer for yesterday’s Mind Teaser: 4. Neurotoxic.
Correct Answers received from: Dr.Shangarpawar, Dr. Pravin H Patel, Dr. C.T. SALI, Dr Jainendra Upadhyay, Dr.K.Raju, Dr. G. Madhusudhan, Daivadheenam Jella, Dr Avtar Krishan
Answer for 26th June Mind Teaser: 1. Pemphigus vulgaris.
Correct Answers received: Dr Shangarpawar, Virendra Kharpate, Tukaram Pagad, Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella, Dr Avtar Krishan.
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
Inhaling diesel exhaust fumes causes heart attack or stroke

Inhaling diesel exhaust fumes causes changes in the body that may make people more prone to heart attack or stroke, said Padma Shri, Dr. B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Hony Secretary General Indian Medical Association.

European scientists have shown that blood clots are more likely to form in otherwise healthy people exposed to relatively high amounts of diesel engine exhaust fumes for a short time. This could cause a blocked vessel, heart attack or stroke.

Diesel engines spew many times more fine pollutant particles than gasoline engines. People with heart and artery disease should stay away from traffic congestion to avoid the effects of this pollution.

The study involved 20 healthy men, aged 21 to 44 years. They breathed filtered air and also diluted diesel exhaust at a level approximating curbside exposure on a busy road. Compared to breathing filtered air, breathing air with the diesel exhaust fumes increased clot formation by roughly 20 - 25 percent in the hours after exposure. The researchers also found an increase in platelet activation in the blood. Platelets play a major role in clotting.

The same group reported in the New England Journal of Medicine that heart attack victims showed clear differences when breathing diesel fumes. They found that the hearts of those who had survived a heart attack were far more likely to be starved of oxygen when exercising while breathing in such fumes than when exercising in clear air.
eIMA News
  • Proof-of-Concept: Reduce glucose variability without changing HbA1c: The FLAT-SUGAR trial provides proof of concept that glucose variability (GV) can be reduced while maintaining similar glycated hemoglobin (HbA1c) levels through use of a GLP-1 agonist, rather than prandial insulin. A larger trial is required to see whether targeting GV improves clinical outcomes in diabetes, say the researchers, led by Irl B Hirsch, MD, of the University of Washington, Seattle. HbA1c, while associated with diabetes complications, does not reflect GV, which may contribute to vascular disease by inducing inflammation, oxidative stress, and cardiac arrhythmias. (ADA Medscape)
  • Obstructive sleep apnea common in type 1 diabetes: Obstructive sleep apnea (OSA) is common in people with type 1 diabetes and is associated with abnormal glycemia and microvascular complications but not body mass index (BMI), reported Laurent Meyer, MD, an endocrinologist at Hôpitaux Universitaires de Strasbourg, France. The link between type 1 diabetes and OSA has been reported in three previous small trials, but this study of 90 adults with type 1 diabetes is the largest such trial to date and the first to use both continuous glucose monitoring and sleep studies. The message for clinicians is to "think of OSA" in type 1 patients with long disease duration, Dr Meyer said. "With the design of our study we can't say check at 10 or 15 years, but in my opinion if [A PATIENT HAS] a duration of more than 20 years, it's important to check for OSA." (ADA Medscape)
  • No mortality risk with sulfonylureas, meta-analysis shows: The use of sulfonylureas in patients with type 2 diabetes mellitus does not increase the risk of all-cause or CV mortality, suggest results of a new meta-analysis. There was also no increased risk of stroke or MI with the antidiabetic agents, reported Dr Dimitris Rados (Hospital de Clinic de Porto Alegro, Brazil). The results were similar when they included and excluded data from the UK Prospective Diabetes Study, the first study to suggest a potential mortality risk among patients treated with metformin plus a sulfonylurea. When analyzing the different sulfonylureas, investigators did observe a statistically significant increase in the risk of all-cause and CV mortality with glipizide, although they caution against making too much of the subgroup analysis given the small number of patients and clinical events. (ADA Medscape)
  • In sickness and in health: spouses have double diabetes risk: Spouses or live-in partners of people newly diagnosed with diabetes are twice as likely to develop diabetes themselves, compared with people in the general population, in the year following the initial diagnosis of their loved one, hint new data from a large Kaiser Permanente study. The findings are "quite striking," said study presenter Mohammed K Ali, MBChB, from Emory University, Atlanta, Georgia. "Not only are they provocative, but the implications are huge. It might be important to think about talking to the spouses or partners (of newly diagnosed patients) about their own risks. Even if you are not genetically related, if you are a residing spouse or domestic partner, just that shared environment is associated with an increased risk, that's what we saw. (ADA Medscape)
  • ADA moves to improve referrals for diabetes self-management: A group of US societies has issued new guidance to doctors on when they should refer patients for diabetes self-management education. "There is confusion as to why diabetes education is needed, when diabetes education should occur, what is needed in diabetes education, and how it should be provided," said Margaret Powers, PhD, ADA healthcare and education president-elect. "Our goal with this paper was to reduce this confusion and provide clear guidelines and expectations for clinicians and for patients," said Dr Powers. The joint position statement has been released by the ADA, the American Association of Diabetes Educators (AADE), and the Academy of Nutrition and Dietetics, in collaboration with the National Diabetes Education Program (NDEP). (ADA Medscape)
  • GLP-1 agonist alters brain response to seeing, eating food: Glucagonlike peptide-1 (GLP-1) may play a role in the brain regarding anticipation of tasty food and may reduce food cravings. Individuals who received injections of the GLP-1 receptor agonist exenatide (Bydureon) had dampened responses in the brain's reward system at the sight of chocolate milk and enhanced responses after drinking the chocolate milk, in a small functional-MRI study. The GLP-1 agonist also increased activation in the brain's reward system after consuming food, which may prevent overeating, Liselotte van Bloemendaal, MD, from VU University Medical Center, Amsterdam, the Netherlands, reported here. (ADA Medscape)
  • Low vitamin D levels common in painful diabetic neuropathy: Diabetic peripheral neuropathy is associated with significantly reduced vitamin D levels, independent of sunlight exposure, a new study finds. This suggests a possible role of vitamin D in the pathogenesis of painful diabetic peripheral neuropathy and therefore a potential role of supplementation in its treatment, pending the results of randomized clinical trials, said study author Dinesh Selvarajah, MD, of the University of Sheffield, United Kingdom. This is the first study to carefully control for seasonal differences in vitamin D and for activity variations that affect vitamin D exposure. "We've certainly got a smoking gun. We've got a proof of concept. Now we need to do an intervention study to show whether this is a significant finding, because if it is, it's a simple enough treatment," he said. (ADA Medscape)
  • A new National Heart, Lung, and Blood Institute (NHLBI)–sponsored study shows that a periprocedural bridging strategy with low-molecular-weight heparin (LMWH) offers no clinical advantages compared with simply stopping warfarin.
  • A "smart insulin patch" that could potentially dispel the need for painful insulin injections for millions of people worldwide with diabetes has been developed by a team at the University of North Carolina (UNC) and North Carolina State University. It employs painless microneedles to sense the low oxygen environment created when glucose levels rise and then delivers insulin as required. (Medscape)
  • A new study published in the journal Diabetes Care suggests that the order in which different types of food are consumed has a significant impact on post-meal glucose and insulin levels in obese people. Researchers noted that eating protein, vegetables and fat before carbohydrates in a meal may help keep glucose and insulin levels low.
  • A study published online in Neurology has revealed that abnormal levels of several proteins thought to play a role in Alzheimer's disease were detected in blood samples from individuals that were taken many years before they developed symptoms of the condition.
  • Topical cyclosporine is more effective than oral doxycycline for the treatment of ocular rosacea, suggests a new study published online in the International Journal of Ophthalmology.
  • The acidity of urine, as well as the presence of small molecules related to diet, may influence how well bacteria can grow in the urinary tract, suggests a new study. The findings may have implications for treating urinary tract infections. The report is published in the June 26 issue of the Journal of Biological Chemistry.
  • In the first 5 years after the onset of rheumatoid arthritis, the risk for major joint surgery is the same for patients with moderate disease activity and those with persistently high levels of disease activity, reports new research presented at the European League Against Rheumatism Congress 2015.
Inspirational Story
Let me put forward a story to you which I once read which should be borne on mind by every parent.

A little boy was playing ball when his father hurried out calling the secretary on the phone.

"Dad, do you have a minute to play ball with me?"

"Sorry son, I’m busy" was the response.

Years later, the father, now bald–headed and reclining in a chair in the lawn saw his son coming out to his car, keys twirling on his finger.

"Son, do you have a moment to have a cup of tea with me?" he asked.

"Sorry I’m busy," came the response.

A simple story and one which I am sure is not new to many of you in essence, but one which does call for some soul searching.

Of course, we have our busy schedules but it is important to make up for the time which you could not give your child when you were busy, with some quality time later.

But make sure that it happens before it is too late.
Quote of the Day
A crust eaten in peace is better than a banquet partaken in anxiety. Aesop
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Reader Response
Dear Sir, Thanks for the information. Regards: Dr Shantanu
Wellness Blog
OTC drug does not mean it can be taken without a doctor’s advice

An over–the–counter antacid is often used to relieve mild cases of heartburn orACID REFLUX. Though they are available without a doctor’s prescription they should be taken only under a doctor’s advice.

As per American Academy of Family Physicians
  • There are different types of antacids that work in different ways.
  • One should talk to the doctor before taking an antacid.
  • To manage an ulcer, an antacid may need to be taken in conjunction with an antibiotic.
  • If one needs more calcium to help strengthen bones, one should prefer an antacid that contains calcium carbonate.
  • In some, antacids may have minor side effects such as nausea, headache, diarrhea or constipation.
  • One should read the label carefully to make sure that one is not allergic to any of the ingredients.
  • People with kidney disease may not be able to take all types of antacids.
  • An antacid may interact with other medications.
IMA Humor

The guy approached a beautiful looking woman in a mall and asked, "You know, I’ve lost my wife here in the mall. Can you talk to me for a couple of minutes?"

"Why?" she asks.

"Because every time I talk to a beautiful woman, my wife appears out of nowhere."
Rabies News (Dr A K Gupta)
What are the initial (prodromal) symptoms of rabies?
  • Pain or paresthesia 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 paresthesia–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 paresthesia 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 3 of the 4 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.
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