October 2   2015, Friday
Dr KK AggarwalDr KK Aggarwal Should Video Cameras be installed in ORs?

Operating rooms in the US may soon have video cameras installed in them. The idea is to document possible adverse events and so prevent future such events. But the downside will be compromising of doctor-patient privacy and more malpractice lawsuits. Currently, recreating mistakes in the OR, relies on frequently unreliable sources such as the recollections of those present and whatever notes have been taken during or shortly post procedure. In most cases the data will protect doctors in court. In 2005, the American Medical Association (AMA) adopted a policy on filming patients in healthcare settings for educational purposes, but stated that such filming should be strictly limited to patients who have given their consent beforehand. (Medscape)
Breaking news
Scientists create world’s largest catalog of human genomic variation

An international team of scientists from the 1000 Genomes Project Consortium has created the world’s largest catalog of genomic differences among humans, providing researchers with powerful clues to help them establish why some people are susceptible to various diseases. While most differences in peoples’ genomes — called variants — are harmless, some are beneficial, while others contribute to diseases and conditions, ranging from cognitive disabilities to susceptibilities to cancer, obesity, diabetes, heart disease and other disorders. Understanding how genomic variants contribute to disease may help clinicians develop improved diagnostics and treatments, in addition to new methods of prevention. In two studies published online on Sept. 30, 2015, in Nature, investigators examined the genomes of 2,504 people from 26 populations across Africa, East and South Asia, Europe and the Americas. (NIH)
Dr Good Dr Bad
Situation: An infant was found to have high blood sugar.

Dr Bad: Such a young child cannot have diabetes.

Dr Good: It can be diabetes.

Lesson: Diabetes can occur in infants as well as in older children.
Specialty Updates
  • Research suggests that the risks of developing type 2 diabetes for South Asians, a group long known to suffer from substantially higher rates of both diabetes and heart disease, begins immediately at birth. Researchers say that South Asian pregnant women should be considered high risk for gestational diabetes and routinely screened in pregnancy. (TOI)
  • A a new test, called ViroCap can detect virtually any virus that infects people and animals, including the Ebola virus. It detects viruses not found by standard testing based on genome sequencing. The new test could be used to detect outbreaks of deadly viruses such as Ebola, Marburg and severe acute respiratory syndrome (SARS), as well as more routine viruses, including rotavirus and norovirus, both of which cause severe gastrointestinal infections. (Source: Financial Express/PTI)
  • For patients with first-time unprovoked venous thromboembolism (VTE), oral sulodexide may help stave off future flare-ups without causing serious safety risks, suggests the Sulodexide in Secondary Prevention of Recurrent Deep Vein Thrombosis (SURVET) study published online in Circulation.
  • Severe obesity in children and young adults is associated with a high prevalence of abnormal levels of cardiometabolic risk factors, and the overall risk increases with greater levels of obesity, suggests new research published in the October 1 issue of the New England Journal of Medicine.
  • Early results from a study investigating intravenous busulfan plus melphalan as enhanced conditioning therapy before autologous stem cell transplantation (ASCT) in patients newly diagnosed with multiple myeloma are encouraging and show good safety. The results were presented at the International Myeloma Workshop (IMW) 2015.
  • The bone density and fracture risk of older individuals do not improve with increased calcium intake, suggest two new studies published in The BMJ.
  • Men aged 18 to 24 years are significantly more likely to commit suicide than women of that age group, according to recent Health E-Stat data released by the National Center for Health Statistics (NCHS), published online September 30.
  • Women who have severe menopausal symptoms after being treated for ovarian cancer can safely take adjuvant hormone therapy (AHT) without compromising their survival, and may even have enhanced survival benefits, suggested long-term results from the Adjuvant Hormone Therapy (AHT) trial published in the Journal of Clinical Oncology.
  • A new study of patients with autoimmune cerebellar ataxia has found that the condition is not always untreatable and that many patients respond well to immunotherapy, particularly if started early. The findings were published online in JAMA Neurology.
  • The interleukin (IL)-17A inhibitor secukinumab was significantly more effective than placebo in the treatment of psoriatic arthritis in a phase III study, published in the New England Journal of Medicine.
How to remove negative thoughts
Darkness is the absence of light and similarly, negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring back positive thoughts. An idle mind is the devil’s workshop and so will always think negative. Here are some ways by which you can get rid your negative thoughts.
  • Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.
  • Think opposite as taught by Patanjali. For example, if you are having a thought to steal, silently start thinking of charity.
  • Think positive as taught by Buddha. Make a list of positive actions to be done today as the first thing in the morning and concentrate on that list. Divert your mind to your list of pending jobs. This is a type of behavioral therapy.
Components of financial Planning Process
  • Review of your objectives and risk/reward attitudes: Short-term, medium range and long-term goals as well as perceptions of risks and expected rewards.
  • Asset structure: Review of current holdings, present value, cost basis, growth and expected purchases.
  • Liabilities: Present and anticipated debt obligations.
  • Income tax analysis: Projections for 10 years, with review of personal tax returns for last two years.
  • Cash flow management: Projections for 10 years, determine effective use of anticipated surplus, managing deficits.
Industry News
  • Ecosystem for startups launched: A Startup Entrepreneurial Ecosystem (SEE) has been launched by the Madras Chamber of Commerce. Its focus will be focus more on manufacturing and service startups and the panel of experienced mentors will provide them guidance, mentorship and endorsement. (Source: The Times of India- Aparna Desikan)
  • A new app to manage health: A new app, Diabeto, can now keep all your records safe. The Bluetooth-enabled device created by Shreekant Pawar can be connected to any glucometer and synced with a smartphone to record the patient’s diabetic condition. “The idea is to sync your glucometer data with the downloaded app. This forms a cloud and records your diabetic condition throughout the day. This way, your data will never get lost,” he said. (Source: Daily News & Analysis- Pooja Patel)
  • Entrepreneurship Awareness Drive 2015 on October 7: Hyderabad: Entrepreneurship Awareness Drive (EAD) 2015, Hyderabad will be held in Guru Nanak Institute of Technology on October 7. The EAD consists of a series of guest lectures and workshops in 23 cities in 23 days in the month of October. Students will be counselled by eminent entrepreneurs and industry leaders and how entrepreneurship differs from a routine job. (Source: Thehansindia.com)
  • A $150 million impact fund dedicated to health, agriculture and renewable energy sector: ‘Bharat’, a $150 million impact fund dedicated to health, agriculture and renewable energy sector was announced by the Prime Minister Narendra Modi during his visit to the US. (Source: ET Bureau - Surabhi Agarwal & Jayadevan PK)
  • More safety measures needed for Digital India: Carl Bildt, former prime minister of Sweden said that while India is taking the right steps with its Digital India project, more safeguards are needed and any surveillance on such digital information has to be ethical. Carl Bildt is now the chair of The Global Commission on Internet Governance, which informs policy recommendations for the future of internet governance. (Source: The Times of India- Arun Dev)
A CME was organized by IMA HQs on World Heart Day 'Cardiology - Yesterday, Today & Tomorrow' at IMA House, New Delhi
Inspirational Story
Going the Extra Mile

I was 20 and had just finished my first degree when I asked my father’s advice on how to approach the world of work. He had a long and distinguished career in the Indian Army and rose to become commander–in–chief of a million men. He was a soldier’s soldier and his men adored him. His manner was strict and firm, but he was very friendly. He appreciated and trusted people and gave then freedom.

"Come and see me in my office if you want to talk to me about work" he said. So I made an appointment with his ADC and went to see him. He had a huge office and I felt very small.

"You are starting out and you will be given a lot of tasks to fulfill" he said. "The first thing is always to do something to the best of your ability. Then the second time you do it, give it that little bit extra". What he was saying was: "Take the initiative; be innovative; be creative. Always go the extra mile."
Customer: My keyboard is not working anymore.

Tech support: Are you sure it’s plugged into the computer?

Customer: No. I can’t get behind the computer.

Tech support: Pick up your keyboard and walk 10 paces back.

Customer: OK Tech support: Did the keyboard come with you?

Customer: Yes

Tech support: That means the keyboard is not plugged in. Is there another keyboard?

Customer: Yes, there’s another one here. Ah...that one does work.
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 your views and solutions.

Here are the responses received
  • I will go for a) Ignore the issue, as sharing information is culturally acceptable in India unless someone specifically asks for not sharing a small part of information. Saranya Devanathan, Psychiatrist
  • I think we cannot see 2 or 3 patients in one room. The patient’s right of privacy cannot be compromised for any reason. Each patient should be interviewed in a single room, and the patient and the family members should also be seen separately at least once and as and when needed. Infrastructural issues cannot be the excuse for inefficient treatment. Prof. Anil Agarwal, Psychiatrist
  • Lack of infrastructure is not an excuse for not observing privacy and confidentiality Patients should be seen alone as well as with family members. Prof. Satish Malik
  • Explain that the other person too is a doctor like me and assure that she would maintain confidentiality. Sudhakar Bhat, Psychiatrist
  • It is very difficult to provide a separate place and extending work hours may not be possible for doctors. They can talk in low voices and make the patient as comfortable as possible. If the issue really demands confidentiality like HIV or any other which patient is not at all confident to discuss in overcrowded situations, then extra time can be given after the crowding hours. Respecting the privacy of the patient is very important. Triptish Bhatia, Principal Investigator, GRIP-NIH, USA Project, Dept. of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi
  • Firstly, we can have cabins or space with glass partitions, which prevent the sound from reaching other places. Secondly, if we are to be economical then probably the patients, of course depending upon their problem and certainly alongside giving him assurance and confidence about confidentiality, can be asked to record their voices in their phones and then ear phones can be used as a medium to listen to the voice recorded by the patient. These ear phones shall be inserted/worn by both - the patient as well as the client so that they are on the same track of conversation. But, this can be done only at the time of case history taking. If the client is educated, he can write and the doctor can ask and clarify. Enquiry questionnaires could be used. Structuring the room accordingly can help. I don't know how much do we support online counselling and case history taking. However, people (doctors and patients) who are ready for the online case history-taking, shall be taken separately by doctors at say a particular day and they must be given facility and services of the same with helpers available around in a particular room Or can be done in a booth placed to be able to communicate with the doctors in any given area within the compound. Parul
Breaking news
Govt. proposes to change the definition of food

In the aftermath of the controversies involving the Food Safety and Standards Authority of India (FSSAI), the central government now proposes to change the definition of food to widen its scope and close loopholes. Nutraceuticals, health supplements, functional food and dietary supplements will be excluded in the new definition. The Food Safety and Standards Act, 2006, has defined foods as “any substance, whether processed, partially processed or unprocessed, which is intended for human consumption and includes primary food.” Drugs and medicinal products, cosmetics, narcotic or psychotropic substances are excluded from this definition. (Source: Shambhavi Anand, ET Bureau)
Make sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why did you ignore the blood pressure of 90/80?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.
GP Tip: Crossover test can detect temperature differences

It is a bedside test that can help reveal subtle differences in temperature between two body parts. Place one hand on the body part to be tested for warmth and the other hand on the contralateral body part. After 30-60 seconds, cross each hand over to the opposite side. Even subtle temperature differences can be differentiated in this manner. This test is especially useful for examining patients with suspected inflammatory arthritis. Remember if there is an equal amount of warmth bilaterally, there will be no discernible difference in temperature.
(Source: IJCP)
AAP/ACOG revise joint policy statement on Apgar score
  • Apgar score does not predict individual neonatal mortality or neurological outcomes, and so should not be used for this purpose.
  • The Apgar score alone should not be used to diagnose asphyxia.
  • Umbilical arterial blood gas samples from a clamped section of the umbilical cord should be obtained for infants with an Apgar score of 5 or less at 5 minutes.
  • Perinatal healthcare professionals should be consistent in assigning an Apgar score during resuscitation. Because there is currently no accepted standard for reporting an Apgar score in infants undergoing resuscitation after birth, to correctly describe such infants and provide accurate documentation and data collection, an expanded Apgar score reporting form is encouraged (Source: Medscape)
Smoking, tobacco use main reason for cancer: ICMR scientist

ICMR scientist Dr. Prabhdeep Kaur on Sunday said that high prevalence of smoking and tobacco use are the main cause of cancer in the northeastern region. "Smoking and use of tobacco and tobacco products are the main cause of cancer in India's northeastern region, there are some other reasons for the increase of the dreaded disease in the region," said Dr. Kaur. (ANI)
WHO changes global HIV Policy

For the first time ever, the World Health Organisation wants everyone who has HIV to be offered the life-saving drugs as soon as they are diagnosed. The new recommendations also say that all those who are at risk of HIV should also be made to pop the antiretroviral therapy to help prevent the infection taking hold. Antiretroviral Therapy (ART) is free in India under its National AIDS Control Programme but the treatment is not provided to every HIV patient. ART is initiated depending upon the stage of infection. HIV patients with less than 200 CD4 (while blood cells) require treatment irrespective of the clinical stage. Those with 200-350 CD4, ART is offered to symptomatic patients. Among those with CD4 of more than 350, treatment is deferred for asymptomatic persons. WHO estimates that these new policies could help avert more than 21 million deaths and 28 million new infections by 2030. (TOI)
In 2014, 155 deceased organ donors gave new life to more than 500 people in Tamil Nadu. This was the highest number of such donations the state saw since the cadaver transplant programme was initiated in 2008. It also saw the highest number of deceased organ donors on a single day when on February 15, the families of 19 people declared brain dead agreed to donate the organs of their kin. (TOI)
The health status of Assam chief minister Tarun Gogoi has been stated to have deteriorated on Wednesday morning. He suddenly fell ill while delivering a speech at a meeting of party workers at Tinsukia on Tuesday evening. He was immediately taken off the dais and taken to the circuit house by his security personnel. The chief minister's office said that the chief minister has been suffering from dysentery and he fell weak following dehydration. "He is taking rest," was all the chief minister's office said. Doctors from Assam Medical College in Dibrugarh are attending on Gogoi since last night. (TOI)
Safety Alerts List of Drugs, Medical Devices and Cosmetics declared as Not of Standard Quality/Spurious/Adulterated/Misbranded for the Month of August 2015
"Flavored tobacco products are enticing a new generation of America's youth into nicotine addiction, condemning many of them to tobacco-related disease and early death," said CDC director Dr. Tom Frieden.
Honey excellent for cough
A spoonful of honey can quieten night time cough in children and help them and their parents sleep better. When compared to the cough syrup ingredient dextromethorphan or no treatment, honey comes out on top. As per a study from Archives of Paediatrics and Adolescent Medicine, the results are so strong that one is able to say that honey is better than no treatment and dextromethorphan was not. There is currently no proven effective treatment for cough due to an upper respiratory infection like the common cold. While dextromethorphan is widely used, there is no evidence that it works and it carries risks. Honey is used around the world as a home remedy for cough, and might provide a safe, effective alternative to cough medicine. To investigate, the researchers compared buckwheat honey, a honey-flavored dextromethorphan preparation, and no treatment in 105 children who had sought treatment for night time coughs due to colds. Among the three groups, children given honey had the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality may be soothing to the throat, while its high antioxidant content could also be a factor. Honey also has antimicrobial effects. Honey is not recommended for infants younger below one year of age because of the risk of botulism spores.
Normal Aging Changes
  • Heart rate shows less variability.
  • The circadian pattern (24–hour cycle of the body) is altered.
  • There is a delayed response of bone marrow to loss of blood or hypoxia (reduced oxygen).
  • The function of the white blood cells is impaired.
  • Advancing age is a procoagulant stage. This means that the blood gets clotted easily.
  • Reflux of the stomach acid in the esophagus (food pipe) is common.
  • Tendency to constipation is common.
  • Painkillers can quite easily cause ulcers in the stomach.
  • Renal functions decline with age.
  • Older kidney is more prone to be damaged with painkillers.
  • Calcification of heart valves may occur.
  • The maximum heart rate may not reach the level as that in the young age in response to exercise.
  • About one–third of the lung volume may be lost.
  • Aging slows the rate of fracture repair.
  • Skin may become atrophic (thin) and elasticity is reduced.
  • A person may not be able to read small print.
  • There may be impaired speech recognition in noisy environment.
  • There may be loss of taste.
  • There may be loss of smell.
  • There may be high frequency hearing loss.
  • Immunity may be reduced.
  • With age, one is more prone to get urinary tract infection.
  • With age, ejaculation may get impaired.
The commonest variation in the arteries arising from the arch of aorta is:

1. Absence of brachiocephalic trunk.
2. Left vertebral artery arising from the arch.
3. Left common carotid artery arising from brachiocephalic trunk.
4. Presence of retroesophageal subclavian artery.

Yesterday’s Mind Teaser: Interscalene approach to brachial plexus block does not provide optimal surgical anaesthesia in the area of distribution of which of the following nerve:

1. Musculocutaneous.
2. Ulnar
3. Radial
4. Median.

Answer for Yesterday’s Mind Teaser: 2. Ulnar
Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.K.V.Sarma, Dr.K.Raju, Dr Avtar Krishan, Daivadheenam Jella
Answer for 30th September Mind Teaser: 4. Pre-existing neurological deficits.
Correct Answers received from: Amit Desai, Dr Ridu Kumar Sharma, Dr Jainendra Upadhyay, Dr Poonam Chablani.
Press Release
A World Vegetarian Day Initiative

A Vegetarian diet is a key to a healthier and disease-free lifestyle

Helps reduce systolic blood pressure by 5mmHg, which in turn may decrease the blood pressure and the risk of developing heart diseases by 21 percent

Akin to the saying, being close to nature has always helped man, is the fact that a vegetarian diet is key to a healthy lifestyle. Nowadays, people are increasingly being drawn to vegetarianism; some because they believe in the ‘eat healthy, live longer’ motto and others because they wish to reduce the ever-increasing environmental pollution. More and more people are becoming aware of how an estimated 70 percent of major diseases, including one-third of all cancers, are related to their diet. A vegetarian diet is inherently healthy and proven to reduce the risk of developing degenerative lifestyle diseases like coronary heart disease, obesity, high blood pressure, diabetes as well as prostate, breast, stomach, lung and esophageal cancer. There are a variety of features that make vegetarian diets preferable. The first one being the amount of dietary fiber it contains that positively affects a person’s blood pressure levels. Vegetarians, in general, have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. This is because a typical vegetarian diet contains high levels of potassium, complex carbohydrates, polyunsaturated fats, fiber, calcium, magnesium, vitamin C and vitamin A, all of which may have a favorable influence on blood pressure. Another reason is its low-calorie content that helps to keep obesity under check. The low levels of cholesterol and fat in a vegetarian diet also help reduce the risks of hypertension.

Speaking on the issue, Padma Shri Awardees, Dr A Marthanda Pillai National President, Indian Medical Association & Dr K K Aggarwal Honorary Secretary General IMA and President HCFI said, “Vegetarian diets help in preventing, treating and managing heart disease. The low-fat and cholesterol quality of a vegetarian meal significantly lower and eliminate the chances of developing coronary heart disease factors such as hypertension, diabetes, and obesity. Low glycemic foods like high-fiber whole grains and legumes shield your heart as they can be digested easily, and they keep blood sugar levels stable and steady as well. The soluble fiber-rich diet helps reduce cholesterol levels. Eating ample fruits, vegetables, nuts and whole grains is key to maintaining necessary energy levels of the body and a healthy heart.“

Studies show that a plant-based diet can significantly decrease the risk of developing type 2 diabetes when compared to the individuals who consume non-vegetarian diet. The Harvard-based Women’s Health Study found a similar correlation between eating red meat (especially processed meats, such as bacon and hot dogs) and an increased diabetes risk, after evaluating BMI, total calorie intake, and exercise. The inherently healthy vegetarian meals are rich in oxidant-rich produce and fibers unlike meat meals, which are processed for consumption. These processed and high-calorie meals end up making us fat and inactive. A vegetarian meal will suffice only when it is well planned. If you are a vegetarian or have been thinking of adopting a healthy vegetarian diet, you should know what you should eat. Your vegetarian platter should be apt in proportion and variety so, that you get the desired health and lifestyle benefits from it.

An ideal diet comprises of
  1. One fruit-only meal
  2. One meal that has a mix of besan products, fruits, salads and a portion of mix vegetables
  3. The third meal should be a regular meal comprising of two mixed grain chapattis/brown rice with vegetables and dal
  4. In between meals, one can consume fruits, salads, black tea/coffee and dark chocolates without added sugar or milk
Digital IMA