September 29   2015, Tuesday
eMedinewS
Can Blood Pressure Be Higher In One Arm?
Dr KK Aggarwal A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check both your arms for blood pressure and which of the two is higher, use that arm for future blood pressure readings.
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
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News
  • Major differences have been found in symptoms and prognoses between non-smokers and smokers with non-small cell lung cancer (NSCLC). Researchers noted that non-smokers were more likely to be women, with adenocarcinoma (the most common form of NSCLC), with less chronic obstructive pulmonary disease (COPD), heart disease, previous cancer of the larynx and weight loss and also had a longer survival after diagnosis. The findings were presented at the European Respiratory Society's International Congress 2015.
  • More than four in 10 patients having inflammatory back pain suggestive of early axial spondyloarthritis and followed for 2 years experienced bone loss in the lumbar spine and hip, suggested new findings published in Rheumatology
  • The serum aminotransferase ratio is associated with hepatosteatosis in patients with hepatitis C, suggests new research published online in BMJ Open. Researchers noted that patients with a higher ALT/AST ratio had a 1.9-fold greater risk of NAFLD and a 2.44-fold higher risk of a high degree of NAFLD.
  • Highly diluted acetic acid, an active ingredient of household vinegar, has been shown to be an effective alternative agent to prevent infection and kill bacteria found in burn wounds, suggested new research published in PLOS ONE. Low concentrations of acetic acid can be used to treat biofilms, and therefore could be used as alternatives to topical antimicrobials and traditional antimicrobial dressings, reported the researchers.
  • Birth control pills cause a small but significant increase in the risk of the most common type of stroke, suggested a comprehensive report published in the journal MedLink Neurology.
Cardiology News
  • A simple, low-cost automated program of semi-personalized mobile phone text messages supporting lifestyle change brought about improvement in low-density lipoprotein cholesterol (LDL-C) levels, blood pressure, body mass index, and smoking status in patients with coronary heart disease, reported a study published in JAMA.
  • Patients with persistent atrial fibrillation receiving anticoagulants have a greater risk for stroke, cardiovascular death, and embolism than those with sporadic episodes of the cardiac arrhythmia, irrespective of whether or not they also have pre-existing heart failure, suggests new post hoc analysis from the AMADEUS trial, published online in the journal Stroke.
Pediatric News
Contrary to previous research, a new study published in PLos One suggests that breastfeeding does not improve a child's intelligence.

The interaction between infections and the microbiota during infancy in the lungs could help provide clues to disease development later in life, suggests a new study presented at the European Respiratory Society (ERS) International Congress.
Dr KK Spiritual Blog
Shradhs in Hindu Mythology

Shradhs are observed by every family in Indian Hindu culture to seek forgiveness from the deceased person and our ancestors for their unfulfilled known or unknown desires.

Traditionally, people observe shradh either on the day of Amavasya every month or on the day of death anniversary of the deceased person or persons or during Shradh days observed in Chaturmas coinciding with the Hindi Tithi or the date on which the diseased person had died. Shradhs are observed till Mahashradh is observed which is usually at a place near Ganga in Gaya, Pushkar, Haridwar etc.

In mythology, mind is linked with ocean, river or water. Most Mahashradhs are held near sacred water as it requires the process of purification of the mind away from home so that one can relax and not only take a one holy bath but also take an internal bath of meditation and self-confession. Medically, Shradh is a type of an attachment disorder or guilt disorder where either you are attached to the thoughts of the diseased person which keep on disturbing in the day to day life and during dreams or you have a guilt that you have not been able to fulfill some of the desires of the diseased persons and that guilt keeps reminding you all the time in your day to day activity or in the dreams.

Shradh is a way or a reminder to you or your consciousness to fulfill and complete the incomplete jobs and finish up all the pending works. Sometimes doing this job may take time and that is the reason why Mahashradhs are done once or twice in a lifetime for a particular deceased person.

Whenever a good ritual or ceremony is held, we also seek blessings from our ancestors. For example, before marriage, it is a ritual to do pooja of ancestors and take blessings which only means that we want to get rid of in our mind the self confession and seek forgiveness from our ancestors that please don’t disturb our mind or in emotions at this juncture of our function and we are aware of the pending work which you asked us to do in future.

Typically, a Shradh ceremony involves self confession and pooja of black sesame seeds or consuming black sesame seeds. Black sesame seeds in Ayurveda are known for their quality of absorbing negative energies both external and internal. Once the pending job is over and in the mind of the family or the person all the assigned works are finished, then they usually go to one of the pilgrimages for Mahashradh which is like a Mahapind Daan. Remember people usually say – Ab to mera pind chhod do, which means please stop coming in my dreams and reminding me of my pending works.

Shradhs are also for unknown unfulfilled desires of our ancestors. When I say unknown desires, it means the desires which are unknown to the present family but maybe were known to the past family. This can only be understood by computer module where my soul is my internet server and spirit has the God as cloud internet. Both my internal server and cloud servers will have a social networking page of mine and will also have my page even if my physical body dies. Similarly, all the social pages of my ancestors will be present in the cloud internet. So, unfulfilled desires will always be posted there. People of my family or those who know me can get connected to that page and know that there were some unfulfilled desires which are yet to be fulfilled by my family and that keeps coming to us in the form of message from our friends that you are suffering due to unfulfilled desires which they might have read from that particular page and that is the reason why there is always a forgiveness seeking exercise during Shradh for those known and unknown unfulfilled desires of our ancestors.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N. P. Primary. School, Kaka Nagar, 28-9-15
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Make Sure
Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to avoid painkillers in renal failure as most painkillers (barring nimesulide, paracetamol) are not kidney–friendly drugs.
Dr Good Dr Bad
Situation: A patient came with black stools.
Dr. Bad: This is lower GI bleeding.
Dr. Good: This is upper GI bleeding.
Lesson: Black stools usually indicate upper GI bleeding.
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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
Press Release
No one deserves to die of heart disease, just because they cannot afford treatment

Heart Care Foundation of India strives to end preventable cardiac deaths in the country

Any person suffering from a heart disease in need of treatment can apply for financial and technical assistance by +9958771177.


While everyone is talking about the prevention and reversal of heart disease in the 21st century India, not much has been spoken about those who continue to die in the city because of the sheer inaccessibility of cardiac care.

Around one percent of children in India (1 in every 125 babies) are born with a congenital heart defect. There was a time when there was a no cure for this and parents were just informed of the inevitable fate of their child. However medical advancements over the past few decades have made it possible for most children suffering from congenital heart disease to live normal lives post timely surgical intervention. However the cost of surgery, which is a few lakhs, is out of reach for a large number of people living below the poverty line in India. For such families, the situation remains grim.

Recognizing the gap in the health care demand and supply in the country, and determined to ensure that no person dies of heart disease just because they cannot afford treatment, the Sameer Malik Heart Care Foundation was founded. An initiative of the Heart Care Foundation of India, a national non-profit organization, the project has seen over 400 success stories till date. As per the guidelines of the project, any person belonging to the economically weaker sections of the society in need of cardiac intervention can apply for the benefits of the fund by calling the helpline number +919958771177.

Take the case of Baby Siya for instance. Not having even turned one, she was diagnosed with holes in her heart because of which she developed frequent episodes of pneumonia and was underweight. Her father Manoj; was a driver with a monthly income of Rs 6000. Mother Krishna was a housewife. Diya needed a corrective surgery to close a hole in the ventricular septum, one in the arterial septum and closure of a tiny PDA. The cost for the same was quoted to be 2.5 lakh by a private hospital. Unable to put together funds, the family lost hope for her survival until they read about the fund. Dr. KK Aggarwal, President of Heart Care Foundation of India personally evaluated her case, and she was adopted by the fund and operated successfully at Medanta - the Medcity, Gurgaon. Siya has been cured completely, and her family looks forward to making her a doctor in the future.

Countries across the globe are witnessing the development of state-of-the-art heart care techniques, which have made the identification and the cure of cardiac diseases much easier. Nowadays, medical experts are coming up with minimally invasive surgical treatments for both congenital and rheumatic heart diseases patients. However, in a developing country like India many patients, especially from the economically backward sections of the society are still dying because of lack of medical assistance and affordability.

Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA said, “Through the right kind of awareness, timely intervention and financial support, a majority of the heart diseases can be prevented and cured. The time has come to look at a holistic approach to healthcare where prevention and accessibility are addressed simultaneously. We must not only work towards raising awareness about prevention of coronary heart disease, but also should look at making heart care accessible to that section of the society that continues to succumb to illness for no fault of their own. Children are the future of our country, and we must take all possible steps to ensuring that they live healthy lives. Additionally we must also work towards creating heart healthy environments for them at home, work and play."

“It is important to remember that Article 21 of the Indian Constitution states the right of each citizen to life. By depriving people of accessible quality health care, we are violating this fundamental right of the citizens and the public and private sector must work together to eliminate this issue. This World Heart Day let’s take a pledge to help eliminate curable heart deaths completely”, he added.

The helpline number of the Sameer Malik Heart Care Foundation Fund - +919958771177 is open from Monday to Saturday from 9 AM to 5 PM. Those who wish to apply online can download the application form from the website, http://heartcarefoundationfund.heartcarefoundation.org/.
eIMA News
News
  • The anti-interleukin 5 (IL-5) antibody reslizumab can reduce exacerbations by 75% compared with placebo, in patients with late-onset asthma who have elevated blood eosinophils, as per research presented by Guy Brusselle, MD, PhD, professor of medicine at Ghent University Hospital, in Belgium, at the European Respiratory Society (ERS) International Conference 2015.
  • Metabolic testing categorizes patients with Alzheimer's disease (AD) into three subcategories: inflammatory, noninflammatory and cortical, each with distinct pattern of metabolic disturbance and cognitive impairment.
  • The US Food and Drug Administration (FDA) has approved two long-lasting insulin drugs from Novo Nordisk to improve blood glucose control in adults with diabetes mellitus after having rejected them in 2013 for lack of cardiovascular outcomes data. The drugs, Tresiba and Ryzodeg 70/30, contain insulin degludec, which possesses a half-life of 25 hours and acts for least 42 hours.
  • The Juvenile Diabetes Research Foundation (JDRF) and the American Diabetes Association (ADA) have developed a new classification approach for the preclinical staging of type 1 diabetes based on the concept that there is a progressive process leading up to symptomatic type 1 diabetes. (October issue of Diabetes Care)
  • Presenting the findings of a study analyzing Dutch myeloma registry data by age group as well as frailty here at International Myeloma Workshop (IMW) 2015, Silvia Verelst, academic researcher in the Department of Haematology at Erasmus University Medical Center, Rotterdam, the Netherlands reported that functional status, as well as chronologic age, is significantly associated with survival in multiple myeloma.
  • Administering the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft, Pfizer Inc) at symptom onset may help relieve premenstrual dysphoric disorder (PMDD), particularly in women whose most pronounced symptom is irritability. (JAMA Psychiatry)
  • A new clinical trial published in The Lancet has demonstrated that combining an antidepressant with an antipsychotic drug could improve clinical depression in older adults who do not respond to regular treatment.
  • A position statement by the International Society for Nutritional Psychiatry Research (ISNPR), emphasizes that there is epidemiologic, basic scientific, and clinical evidence to show that diet both influences risk for and outcomes of mental health disorders.
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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!

More responses received for Case scenario 2 - A patient’s right to information
  • My father had cancer and I requested the treating doctors not to tell him. We told him he had bone disease. He did sense that there was something serious. But there was fear that he may go into depression. He was 72. He would tell he is living a bonus life well beyond the average life span. He would have refused painful treatment. Telling a patient he has a terminal illness is as much a pain to his family as it is to the treating physician. Hence it is not a question of rights. It is a question of what is right for a particular patient. It should be humanely discussed with the family before disclosing/not disclosing to the patient. Abdul Samad Burhan
  • The doctor should tell the person about his disease. Cancer is not a disease, which has good prognosis. By telling him about his disease he will complete all his incomplete work. But the doctor should tell him in phases that investigations are being done he may suffer from some incurable disease. Dr BR Bhatnagar
  • I think biomedical ethics would require the doctor to provide an honest reply. A professional’s allegiance to his professional ethics should surely be rated higher than family fealty. He must treat the father in the same way as any other patient. Also I think we tend to get overprotective of people and generally fail to realize when we are stepping on their rights. The son's intention is surely appreciable, but if the doctor chooses not to disclose, he is doing both the father and son and the profession a disservice. Upasana Saraf
  • I understand the conundrum that would follow if the patient is told about his diagnosis (especially after having his son hiding it from him) and the strain that would be added to familial ties. However, breaking the news to the patient and patiently dealing with the consequences seems best for all. Post the demise, would the son and the consultant physician be guilt-free if they went ahead and hid the truth or would they come to terms with it? On a medical ethics note, it's best to come clean and not add on more layers. Sharanya K, Gerontologist/Psychotherapist
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Happiness is the meaning and the purpose of life, the whole aim and end of human existence. Aristotle
Reader Response
Dear Sir, Very informative news. Regards: Dr Karan
Inspirational Story
A beautiful way of looking at things

A Father was reading a magazine and his little daughter every now and then distracted him. To keep her busy, he tore one page on which was printed the map of the world. He tore it into pieces and asked her to go to her room and put them together to make the map again.

He was sure she would take the whole day to get it done. But the little one came back within minutes with perfect map……When he asked how she could do it so quickly, she said, “Oh…. Dad, there is a man’s face on the other side of the paper….. I made the face perfect to get the map right." She ran outside to play leaving the father surprised.

Moral of the story: There is always the other side to whatever you experience in this world. Whenever we come across a challenge or a puzzling situation, look at the other side…. You will be surprised to see an easy way to tackle the problem.
Wellness Blog
Gaining weight, losing strength versus losing weight, gaining strength

When we gain weight, we must acquire more strength and when we lose weight, we must lose the strength. This is a fundamental medical principle.

If we gain weight and feel weak, it is a disease and when we lose weight and gain strength, this indicates recovery from the disease. One is not supposed to gain more than 5kg of weight after the age of 20 years. Any weight gain after that will only be due to accumulation of fat, which leads to insulin resistance.

Insulin resistance does not allow food to convert into energy. In the state of insulin resistance, whatever you eat is converted into fat. Because it is not converted into energy, you feel weak. When you reduce insulin resistance by drugs or walking the metabolism becomes normal and whatever you eat gets converted into energy and you start gaining strength.
Rabies News (Dr A K Gupta)

What does humanizing your dog means?

  • Talking to your dog like he⁄she is a person.
  • Treating your dog like he⁄she is a person.
  • Allowing dogs to do what they want because it will hurt their “feelings.”
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.
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eIMA Quiz
A 25-year-old male is undergoing incision and drainage of abscess under general anesthesia with spontaneous respiration. The most efficient anaesthetic circuit is:

1. Mapleson A.

2. Mapleson B.

3. Mapleson C.

4. Mapleson D.

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: 2. Induction with intravenous protocol and N2O; and oxygen for maintenance.

Answers received from: Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma.

Answer for 27th September Mind Teaser: 2.Pre-oxygenation is mandatory.

Correct Answers received from: Dr G Madhusudhan, Arvind Diwaker, Dr K Raju, Dr K V Sarma, Dr Poonam Chablani.
eIMA Humor
Trouble on the Roof

Mike and Rob were laying tile on a roof when a sudden gust of wind came and knocked down their ladder.

"I have an idea," said Mike. "We'll throw you down, and then you can pick up the ladder."

"What, do you think I'm stupid?" Rob replied." I have an idea. I'll shine my flashlight, and you can climb down on the beam of light."

"What, do you think I'm stupid?" Mike answers. "You'll just turn off the flashlight when I'm halfway there."