September 2   2015, Wednesday
eMedinewS
editorial
Harvard’s 4 simple ways to boost your energy
Dr KK Aggarwal
  1. Pace yourself. If you’re a go–getter, you probably like to keep going — but don’t risk overtaxing yourself. You can pace yourself and still get things done. For example, instead of burning through all your "battery life" in two hours, spread it out among morning tasks, afternoon tasks, and evening activities — with rest and meals in between.
  2. Take a walk or a nap. There’s nothing more satisfying than a short power nap when you’re pooped out. However, if you have trouble sleeping at night, know that napping can make insomnia worse. If that’s the case for you, get moving instead. Get up and walk around the block, or just get up and move around. If you are not an insomniac, though, enjoy that 20– to 30–minute power nap.
  3. Skip most supplements. You may have heard about energy–boosting or "anti–aging" supplements. There is no evidence they work.
    • DHEA. There is no evidence that DHEA offers any real benefits, and the side effects remain a question mark. You especially shouldn’t be buying it from ads in the back of a magazine, because you don’t know what’s in it.
    • Iron. Iron only improves energy if you are clearly deficient, which a doctor can check with a blood test. Unless you are low in iron, you don’t need to take it — and getting too much iron can be harmful.
    • B vitamins. It is true that B vitamins (B1, B2, B6, B12) help the body convert food into the form of energy that cells can burn, but taking more B vitamins doesn’t supercharge your cells. That’s a myth.
  4. Fuel up wisely. A sugary roll from the bakery delivers plenty of calories, but your body tends to metabolize them faster, and then you can end up with sinking blood sugar and fatigue. You’ll maintain a steadier energy level by eating lean protein and unrefined carbohydrates. Try low–fat yogurt with a sprinkling of nuts, raisins, and honey. Your body will take in the carb–fiber–protein mix more gradually. Don’t skip meals, either. Your body needs a certain number of calories to get through the day’s work. It’s better to space your meals out so your body gets the nourishment it needs all through the day.
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Beneficiaries of Sameer Malik Heart Care Foundation Fund, tuesday meeting
News
Obesity
Workplaces that encourage healthy lifestyle practices are tied to fewer obese employees among millennials, suggested a new study published online in the Journal of Epidemiology and Community Health.

Psychiatry
Results from the BRIDGE-II-MIX study, presented at the 28th European College of Neuropsychopharmacology (ECNP) Congress, suggested that the use of current diagnostic criteria may lead clinicians to miss a substantial proportion of patients with a major depressive episode who have a mixed depressive state, as determined on the basis of less rigid diagnostic criteria.

Gastroenterology
Surgery

Frail patients with paraesophageal hernia may have more complications if they follow the watchful waiting approach than if they undergo elective repair, reported a study published online in JAMA Surgery.

Obstetrics and Gynecology
Neurology

About 35% of pregnant women with acute headache who came to the hospital emergency department and received a neurologic consultation had a secondary disorder, in many cases preeclampsia, suggested a new study published online in Neurology.

Orthopedics
For acute Achilles tendon rupture, early dynamic functional rehabilitation is just as safe as the traditional ankle mobilization, and with greater patient satisfaction, suggests a new meta-analysis published online in the British Journal of Sports Medicine.
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Cardiology eMedinewS
European Society of Cardiology (ESC) Congress 2015 Update
  • In a study of more than 35,000 patients in Scotland, Dr Bhautesh Jani (University of Glasgow, Scotland) and colleagues showed an 83% higher relative risk (RR) for CV events, such as MI, heart failure, or even death, in those with both depression and high systolic BP vs those without both conditions. Those with depression and very low systolic BP had a 36% higher RR for CV events. Interestingly, there were no associations found between CV-event risk and diastolic blood pressure plus depression.
  • CIRCUS (Cyclosporine and Prognosis in Acute Myocardial Infarction Patients): A bolus injection of cyclosporine administered before PCI in patients with anterior ST-segment-elevation MI (STEMI)—the intent being to reduce myocardial infarct size resulting from reperfusion injury and to prevent downstream events—did not result in better outcomes on any of the individual components of the primary end point vs patients who did not receive the intravenous injection.
  • ALBATROSS (Aldosterone Lethal Effects Blockade in Acute Myocardial Infarction Treated With or Without Reperfusion to Improve Outcome and Survival at Six Months' Follow-Up) trial: Early treatment with mineralocortoid-receptor antagonists does not improve clinical outcomes in patients without heart failure who had a recent MI (ALBATROSS.
  • ARTS-HF (Mineralocorticoid Receptor Antagonist Study in Heart Failure): Finerenone, a new nonsteroidal mineralocorticoid-receptor antagonist has shown some promise in patients with worsening heart failure who also have type 2 diabetes and/or chronic kidney disease. Although there was no difference in the primary end point — a relative decrease of N-terminal probrain natriuretic peptide (NT-proBNP) — with finerenone vs the comparator drug, the MRA eplerenone, the 10–20-mg dose of the novel agent showed a hint that it may be less likely to cause hyperkalemia.
Pediatrics eMedinewS
Pediatrics
Allergy and Immunology

Polymorphisms in vitamin D-binding protein (DBP) seem to modify the relationship between serum vitamin D and food allergy in young children, suggests new research published online in the Journal of Allergy and Clinical Immunology.

Pediatrics
Dermatology

Adolescents with moderate to severe psoriasis may respond to the human monoclonal antibody ustekinumab as well as adults, with no unexpected side effects, suggested a new study published online in the Journal of the American Academy of Dermatology.
Dr KK Spiritual Blog
You can reverse heart disease

Every cell in the body eventually dies and is replaced by a new cell. Every day is a new opportunity to build a new body. The entire body totally rebuilds itself in less than two years with 98% in less than one year.
  • Stomach lining rebuilds itself in 5 days.
  • Skin rebuilds itself in one month.
  • Liver rebuilds itself in 6 weeks.
  • DNA rebuilds itself every 2 months.
  • Bone rebuilds the whole new skeleton in 3 months
  • Blood rebuilds itself in 4 months.
  • Brain rebuilds itself in 1 year.
You cannot swim in the same river twice. With every breath, we inhale 1022 atoms coming from all cells present in the universe. We share everything with everybody with every breath. Quadruplet atoms in the last three weeks have gone through our breath. Billion atoms out of them may have been those of Christ or Mohammad.

The very fact that our body rebuilds itself, it is possible to change the Dharma of the new cells and even prevent or regress cancers and heart diseases.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
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.
Dr Good Dr Bad
Situation: A pregnant lady died.
Dr Bad: Declare her dead.
Dr Good: Deliver the infant within 5 minutes.
Lesson: "Five minute rule", the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within 5 min of maternal cardiac arrest.

(Copyright IJCP)
eIMA Quiz
In ulcerative colitis with toxic megacolon lowest rate of recurrence is seen in:

a) Complete proctocolectomy and Brook's ileostomy
b) Ileorectal anastomoses
c) Kock's pouch
d) Ileo anal pull-through procedure

Yesterday’s Mind Teaser: Which of the following is true about ulcerative colitis with malignancy?

a) It has a better prognosis.
b) It is related to disease activity.
c) It is related to duration of ulcerative colitis.
d) Malignancy is more in anorectal ulcerative colitis.

Answer for Yesterday’s Mind Teaser: c) It is related to duration of ulcerative colitis.
Answers received from: Dr Shangarpawar, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K Raju, Dr Avtar Krishan, Daivadheenam Jella.
Answer for 31st August Mind Teaser: c) Astrocytomas
Correct Answers received from: Dr Ridu Kumar Sharma,
Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Shangarpawar,
Dr B R Bhatnagar, Daivadheenam Jella, Dr Poonam Chablani, Dr K V Sarma.
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CPR 10
Successfully trained 113241 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 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
Dengue mosquitoes can also bite in the night if the lights are on

With the incidence of dengue being at its all-time high in the Capital, the best way to reduce chances of acquiring the illness is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, one must regularly clean water containers like pet and animal water containers, flower planter dishes and keep water storage barrels covered.

Other precautionary measures include keeping a lookout for standing water indoors such as in vases with fresh flowers and clean them at least once a week. One must remember that the adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect oneself, it is important to use mosquito repellents while indoors or out. When possible, people must wear long sleeve shirts and long pants for additional protection. Also, they must make sure that the window and door screens are secure and without holes. Sitting in air-conditioned rooms can reduce the incidence of the disease.

For people in whose houses someone is ill with dengue, extra precautions must be taken to prevent mosquitoes from biting the patient and then going on to bite others in the household. The dengue patients must sleep under a mosquito bed net to avoid spreading the illness. All hospitals must also provide mosquito nets to patients suffering from dengue.

Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA said, “What most people do not realize is that the dengue mosquito breeds in fresh clean water as opposed to dirty drains. Thus, people living in clean urban surroundings are more at risk of acquiring the disease. Prevention is always better than cure. In case of being diagnosed with dengue, people must not panic, consume ample amounts of fluids since the dangers of dengue lie in dehydration and must only get a platelet transfusion if their platelet counts are below 10,000 and there is active bleeding. Unnecessary transfusion can cause more harm than good."

Dengue fever is a disease caused by the dengue viruses that are transmitted by mosquitoes. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rashes. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks.

Tips to prevent mosquito bites
Using the right insect repellent and other preventive actions can discourage mosquitoes. Here are some places where mosquito breeding must be eliminated:

Remove Mosquito Habitats
  • Eliminate standing water in rain gutters, old tires, buckets, plastic covers, toys, or any other container where mosquitoes can breed.
  • Empty and change the water in birdbaths, fountains, wading pools, rain barrels, and potted plant trays at least once a week to destroy potential mosquito habitats.
  • Drain or fill temporary pools of water with dirt.
  • Keep swimming pool water treated and circulated.
Use Structural Barriers
  • Cover all gaps in walls, doors, and windows to prevent mosquitoes from entering.
  • Make sure window and door screens are in good working order.
  • Completely cover baby carriers and beds with netting.
Avoid Getting Bitten
  • Keep mosquitoes away from exposed skin by wearing long-sleeved shirts, long pants, and socks.
  • Tuck shirts into pants and pants into socks to cover gaps in your clothing where mosquitoes can get to your skin.
  • Stay indoors at sunrise, sunset, and early in the evening when mosquitoes are most active.
eIMA News
News
  • Awareness of memory impairment starts deteriorating about 2.6 years before a diagnosis of dementia and this deterioration is a manifestation of dementia-related pathology, such as tau tangles and gross cerebral infarcts. The findings of the study was published online August 26 in Neurology.
  • Richard Achiro, PhD, California School of Professional Psychology, at Alliant International University, Los Angeles suggests that almost one third of men who use over-the-counter workout supplements to augment gym training are concerned about their use of the supplements, and almost 1 in 10 have been cautioned by their physician on this. He also suggested that the findings may point to the emergence of a novel eating disorder.
  • Using a multistep Delphi consensus process, a large and diverse group of cerebrovascular specialists has developed a comprehensive scoring model for managing unruptured intracranial aneurysms (UIAs). The new model considers many factors that influence clinical decisions that weren't well studied in the past, for example, young age, modifiable risk factors, aneurysm morphology, reduced life expectancy due to comorbidities (such as cancer), and factors influencing the risk of treatment (such as patient age and aneurysm size or complexity).
  • Desiree van der Heijde, MD, PhD, Leiden University Medical Center in the Netherlands suggests that a combined rule of five -- the presence of at least five fatty lesions/erosions in the sacroiliac (SI) joint, at least five fatty lesions in the spine, or at least five spinal inflammatory lesions on magnetic resonance imaging (MRI) -- is highly specific for axial spondyloarthritis in patients with chronic back pain. They found specificity for axial spondyloarthritis to be >95% when applying the cut-off of five or more inflammatory lesions and five or more fatty lesions (Annals of the Rheumatic Diseases).
  • In Illinois, authorized personnel at healthcare facilities can now access the state's mandated online registry to identify patients who have screened positive for the bacteria. And soon, they will be automatically alerted when a positive patient is being admitted. William Trick, MD, from the Cook County Health and Hospitals System in Chicago said, “The registry will allow personnel to enact appropriate precautions when an infected patient comes in, and will create "a community where people are engaged in the process with a shared objective of preventing the spread of infectious disease."
  • A Swedish cross-sectional study published online August 20 in Acta Obstetricia et Gynecologica Scandinavica shows that most pregnant women have insufficient iodine intake. Researchers found a median urinary iodine concentration of just 98 μg/L (interquartile range, 57 - 148 μg/L) among the women tested, which is considerably below the international recommendation for pregnancy of 150 to 249 μg/L.
  • A new study recently presented at the 28th European College of Neuropsychopharmacology (ECNP) Congress in Amsterdam, the Netherlands found that behavior patterns such as risky behavior, psychomotor agitation and impulsivity occur before 50% of suicide attempts. Researchers analyzed more than 2000 individuals with depression who were a part of the Bridge-II-MIX study - an international study of depression and suicide.
  • Mumbai: With cases of birth defects in India rising, an awareness campaign has been launched to prevent their occurrence by promoting use of 'Folic Acid' among expectant mothers. According to experts, the incidences of severe birth defects are more than 25,000 to 40,000 per year in India. "Birth defects are responsible for a greater proportion of infant and childhood mortality in India. Also, the number of infants born with genetic disorders and birth defects in India is highest in the world," said Dr Santosh Karmarkar, Founder Trustee of Spina Bifida Foundation (a Mumbai-based not-for-profit organisation). (Source: The Economic Times)
  • Kerala’s Palakkad district will become the first total HIV/AIDS literate district in the country due mainly to joint initiatives of civic authorities and KESS-HAPPI, a voluntary organisation which helped win the status. Just as Kottayam became India’s first city to achieve 100 percent literacy in 1989, so is Palakkad is all set to be honoured with the status of being the first district that took care of its HIV/AIDS patients’ literacy. A project named Jyotirgamaya was implemented with the cooperation of 91 gram panchayats and four municipalities in the district, to spread awareness about HIV/AIDS, which is the first step to protection. (http://www.microfinancemonitor.com/)
Vitamin D deficiency increases vulnerability to diseases: IMA
The Indian Medical Association today cautioned about the health risks caused by Vitamin D deficiency and called for a mass awareness drive.

PTI | 31 August 2015, 3:19 PM IST

THIRUVANANTHAPURAM: The Indian Medical Association today cautioned about the health risks caused by Vitamin D deficiency and called for a mass awareness drive to sensitise public to the issue.

Vitamin D deficiency is a hidden ailment which can have a serious long-term impact on a person's health making them vulnerable to diseases such as heart attacks, diabetes, and cancer, a Continuing Medical Education (CME), organised by IMA here, observed.

The CME was an initiative under IMA's Rise and Shine campaign and was attended by over 50 leading doctors in the city to discuss the various health threats faced by the Indian population due to Vitamin D deficiency, a release said here.

The campaign is a National movement aimed at sensitizing IMA's 2.5 lakh members across 30 states and 1700 branches over the next two years about the need to raise awareness about Vitamin D deficiency.

Dr A Marthanda Pillai, the National President of IMA said most people in the country are unaware that they are Vitamin D deficient.

"The deficiency of Vitamin D has been identified as a risk factor for various cardiovascular ailments such as ischemic heart diseases, congestive heart failure, heart attacks and strokes," he said.

For the next two years, the IMA Rise & Shine campaign would raise awareness about Vitamin D deficiency, he said.

Consultant endocrinologist Dr Mathew John said, "There is abundance of sunshine in the country, but still around 80-90 per cent of people suffer from Vitamin D deficiency. The reason for this is the sun-shy behavior of Indians, a predominantly vegetarian diet, long stressful working hours in closed spaces and a genetic pre-disposition."

He also said in the long run a National policy on food fortification is a must and the government must study and evaluate the success seen in countries like the US and Canada in dealing with the Vitamin D epidemic.

Dr Ambrish Mittal, Chairman, Metabolic Disorders & Endocrinology, Medanta, however, cautioned that any intake of Vitamin D supplements should be under medical supervision as an overdose can induce Vitamin D toxicity that can be fatal for patients.

The IMA initiated Rise and Shine campaign in addition to conducting CMEs and soft skill training workshops across 128 cities.
(Source: http://health.economictimes.indiatimes.com
/news/industry/vitamin-d-deficiency-increases-
vulnerability-to-diseases-ima/48743372)
IMA NH Scheme at a glance...
  1. In IMA NHS there is no escalation of annual premium amount even if the age progresses to the next slab for that particular insured amount. For example a person joining the scheme at the age of 25 years, will be paying the same amount of Rs.3000/- as renewal fee per annum for an upper limit of 2 lakhs, even if his age passes on to the next all slabs.
  2. All pre-existing diseases are covered.
  3. No screening test required.
  4. You can join up till the age of 80 years.
  5. Immediate relatives of life members of IMA can join.
  6. Original bills are returned at request, and hence can be utilized for other insurance schemes.
  7. More than an insurance company IMA NHS is for the medical fraternity and its family.
Proper application of insect repellants
Guidelines regarding the safe and effective use of insect repellents in order to maximize effectiveness and minimize side effects were issued by the United States Environmental Protection Agency (EPA). These are particularly important when using DEET-based repellents:
  • Use just enough repellent to lightly cover but not saturate the skin.
  • Repellents should be applied to exposed skin, clothing, or both, but not under clothing.
  • A thin layer can be applied to the face by dispensing repellent into the palms, rubbing hands together, and then applying to the face.
  • Repellent should be washed from the palms after application to prevent contact with the eyes, mouth, and genitals.
  • Do not use repellents over cuts, wounds, inflamed, irritated, or eczematous skin.
  • Do not inhale aerosols, spray them in enclosed spaces or near food, or get them into the eyes.
  • Do not apply insect repellent to the hands of small children, as it will inevitably be rubbed into the eyes.
  • Frequent reapplication of repellent is unnecessary.
  • The areas treated with repellent should be washed with soap and water once the repellent is no longer needed.
Protection is shortened by swimming, washing, sweating, wiping, exercise, and rainfall (Source: Uptodate)
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
A mountain of dirt

It's always a great idea to keep the front lawn looking tidy and to repair any problems. With this thought in mind, we had delivered a dump truck full of topsoil in order to fill in two large holes created when two old tree stumps were removed.

The big, big mound of earth sat there dumped 200 feet away from these holes waiting for me to begin the process. What had started out as a great idea soon soured when I realized that this big, big mound of earth was not going to move itself and seemed overwhelming. All I could see, as I stood beside it with my shovel and wheelbarrow, was a dump truck full of topsoil; a mound of earth that looked more like a mini–mountain than a pile of earth that would be a simple Saturday afternoon chore. Oh my goodness, why did I ever think that this hole filling, lawn repair project, was something I would be able to tackle?

After staring at this pile of topsoil for 10 minutes wondering whether I should hire someone to do what I just couldn’t see myself doing, an old Chinese proverb came to mind, "A journey of a thousand miles begins with a single step." The translation of this proverb to the task at hand immediately became obvious. I needed to take one shovel at a time until a wheelbarrow was full, and then keep filling one wheelbarrow at a time and dumping it until one hole was full then simply repeating the process until both holes were finished.

You see, what I had to remind myself was that what might at first appear as an overwhelming task, or something I couldn't see myself doing, would be resolved by simply taking one step at a time, or one action at a time, over and over again.

Projects, problems, or one’s own need to learn a new job or career skill has the same application. Every difficult goal that, at first, may be viewed as an insurmountable obstacle can be resolved when you implement a strategy that requires only one–step at a time. Each action taken moves you forward, continuous progress is seen, and the final goal is closer and closer until it is accomplished.
Quote of the Day
Every new beginning comes from some other beginning's end. Seneca
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Reader Response
  • Dear Sir, Thanks for enriching our knowledge. Regards: Dr Shubham
  • Sir, we are really enjoying your E news. In the water safety article, you have written as Sodium hydrochloride. Should it be sodium hypo chlorate instead? Please verify. Thanks. Dr MS Ravindra, Karthik Netralaya, Bangalore

    eMedinewS: It was a typing mistake. Yes, the correct sentence should read as “Adding two drops of 5% sodium hypochlorite (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.”
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Rabies News (Dr A K Gupta)
Can RIGs be safely injected into already infected animal bite wounds?

RIGs can be safely injected into already infected animal bite wounds following proper wound cleansing and administration of appropriate antibiotics.
Wellness Blog
When is your doctor at fault while prescribing antibiotic?
  • Prescribing antibiotics when no bacterial infection exists.
  • Prescribing the wrong antibiotic or the wrong dose.
  • Prescribing antibiotics for longer than necessary.
  • Prescribing strong antibiotics, when a less strong would be as effective.
  • Prescribing an expensive antibiotic when a cheaper but equally effective antibiotic is available.
When are you at fault?
  • You demand antibiotics even when the doctor thinks it is unnecessary
  • You buy an antibiotic without prescription.
  • You buy an antibiotic without a bill
  • You stop antibiotics as soon as your symptoms start improving and you do not take a full course of antibiotics.
  • When you change brands without the doctor’s knowledge.
IMA Humor
Open the Can

A chemist, a physicist, and a mathematician are stranded on an island when a can of food rolls ashore. The chemist and the physicist come up with many ingenious ways to open the can.

Then suddenly the mathematician gets a bright idea: "Assume we have a can opener …"
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