November 30   2015, Monday
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Dr KK AggarwalDr KK Aggarwal Updates in Medicine

• Four weeks of triple or quadruple combination therapy using new drugs for hepatitis C virus (HCV) results in only limited cure rates in patients with early-stage liver fibrosis, according to a study published online November 23 in the Annals of Internal Medicine.

• The US Food and Drug Administration (FDA) has declined approval of the New Drug Application for an intranasal naloxone spray for the emergency treatment of known or suspected opioid overdose.

• A pilot study in Frontiers in Neurology reports that although performing direct funduscopy during a patient's initial assessment is considered a "basic competency," most clinicians did not perform the eye exam, potentially missing "valuable clinical information".

• The US FDA has repurposed a 45-year-old vaccine against anthrax for postexposure protection. It added a new indication to prevent anthrax after suspected or confirmed exposure to Bacillus anthracis in individuals aged 18-65 years. The vaccine should be given in conjunction with recommended antibiotic treatment. Anthrax vaccine adsorbed (BioThrax, Emergency BioDefense Operations) was approved in 1970 to prevent the disease in individuals at high risk for exposure.

• Results of a multicenter prospective study in JAMA Surgery show that patients with acute complicated appendicitis who received 5 days of postoperative antibiotic treatment after laparoscopic appendectomy surgery did not have a reduction in infectious complications relative to patients receiving only 3 days of postoperative antibiotic treatment (Snapshot Appendicitis Collaborative Study Group).

• In rheumatoid arthritis patients who fail to achieve an adequate response to their first anti-tumor necrosis factor (TNF) agent, a non-TNF targeted biologic provides significantly better disease control than a second anti-TNF agent (Rotation of Anti-TNF or Change of Class of Biologic trial) (American College of Rheumatology 2015 Annual Meeting).
Amit Sharma and Nilesh Aggarwal

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Breaking News
Transplant facility in med colleges soon

The government will work towards creating a transplant facility in every medical college in the country to bridge the gap between demand and availability of human organs for transplantation. Speaking at the launch of the nationwide registry for organ and tissue donation at the 6th Indian Organ Donation Day, union health minister J P Nadda said, “At present all transplant facilities are available in metropolitan cities and 95% are in private sector. There is a need to increase the facilities in other parts of the country. The ministry will work to create a transplant facility in every medical college in the country in a phased manner.” The health ministry had decided to impart training in organ and tissue transplantation at all government hospitals. He also suggested that organ and tissue donation should be included in the syllabus of undergraduates (MBBS), postgraduates (MS and MD) and nursing degrees &hellip&hellip(ET Healthworld - PTI)

New guidelines to improve inpatient care for kids with autism

General psychiatric facilities can achieve a level of care for children with autism spectrum disorder (ASD) or intellectual disabilities that is comparable with care provided in specialist units, say US experts who have developed best practice guidelines for inpatient psychiatric care, published in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Developed from a consensus process involving experts in treating children with ASD or intellectual disability, the recommendations set out the information that should be obtained from children on admission and emphasize the importance of screening for co-occurring medical and psychiatric conditions. The guidelines also highlight the need to adapt the inpatient environment and provide activities appropriate for children with ASD or intellectual disability and, crucially, the need for staff training. (Medscape)
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Specialty Updates
• Improvements in respiratory measures and quality-of-life outcomes following hypoglossal nerve stimulation in patients with moderate to severe obstructive sleep apnea (OSA) are maintained for up to 3 years, suggested a new study published online in Otolargyngology – Head and Neck Surgery.

• Triple antithrombotic therapy, that is an oral anticoagulant added to dual-antiplatelet therapy (DAPT), appeared to be associated with an increased 1-year risk of bleeding complications versus DAPT alone in octogenarians with atrial fibrillation (AF) who had received PCI, reported a small Japanese study presented at the American Heart Association (AHA) 2015 Scientific Sessions.

• The National Institute for Health & Care Excellence (NICE) has announced its positive recommendation for the use of vortioxetine in patients with major depressive episodes (MDE). The drug is recommended for patients with MDE who have not adequately responded to two other antidepressants within the current episode.

• A computer-based algorithm based on a survey of diabetes thought leaders could serve as a decision-aid tool to help in determining the appropriate HbA1c target for individual patients with type 2 diabetes, suggested a new study published in Diabetes Care.

• In a new study published in the journal Nutrients, researchers noted that both obese children and those with non-alcoholic fatty liver disease (NAFLD) are not meeting the UK recommendations for a variety of vitamins and minerals. These children are also not meeting the recommended physical activity levels for children, which currently is 60 minutes five times a week.

• Dabigatran has received FDA approval for prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing hip replacement surgery.

• Children exposed to marijuana in the womb show a significant improvement in their ability to track moving objects at age four, suggested new vision research published in the journal Scientific Reports. However, researchers are warning that the results do not mean marijuana has a beneficial effect on fetal development.

• One hour's football training a few times a week counters many of the negative effects of prostate cancer treatment and strengthens the bones, suggests new research published in Osteoporosis International and European Journal of Applied Physiology.
Importance of silence

True silence is the silence between thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. Meditation is the process of achieving this silence. Observing silence is another way of getting benefits of meditation. Many yogis in the past have recommended and observed silence now and then. Mahatma Gandhi used to spend one day of each week in silence. He believed that abstaining from speech brought him inner peace and happiness. On these days, he communicated with others only by writing on paper.

Hindu principles also talks about a correlation between mauna (silence) and shanti (harmony). Mauna Ekadashi is a ritual followed traditionally in our country. On this day the person is not supposed to speak at all and keep complete silence throughout day and night. It gives immense peace to the mind and strength to the body. In Jainism this ritual has a lot of importance. Nimith was a great Jain saint, who long ago, asked all Jains to observe this vrata. Some people recommend that on every ekadashi one should observe silence for few hours in a day if not the whole day.

Deepak Chopra in his book 7 Laws of Spiritual Success talks in great detail about the importance of observing silence in day to day life. He recommends that everyone should observe silence for 20 minutes every day. Silence helps to redirect our imagination towards self from the outer atmosphere. Even Swami Sivananda in his teachings has recommended daily observation of mauna for 2 hours for ekadashi, milk and fruits every day, studying one chapter of Bhagwad Gita daily, regular charity and donating one–tenth of the income in the welfare of the society. Ekadashi is the 11th day of Hindu lunar fortnight. Ekadashi is the day of celebration occurring twice a month, meant for meditation and increasing soul consciousness.

Vinoba Bhave was a great sage of our country who is known for this bhoodaan movement. He was a great advocator and practical preacher of mauna vrata. Mauna means silence and vrata means vow; hence, mauna vrata means vow of silence. Mauna was practiced by saints to end enmity. Prolonged silence as a form of silence is observed by rishi munis.

Silence is a source of all that exists. Silence is where conscious dwells. There is no religious tradition that does not talk about silence. It breaks outward communication and forces a dialogue towards inner communication. This is one reason why all prayers, meditation and worship or any other practice whether we attune our mind to the spiritual consciousness within are done in silence. After the death of a person it is a practice to observe silence for two minutes. The immediate benefit is that it saves a tremendous amount of energy. Silence is cessation of both sensory and mental activity. It is like having a still mind and listening to the inner mind. Behind this screen of our internal dialogue is the silence of spirit. Meditation is the combination of observing silence and the art of observation.

Legal Quote

Samira Kohli vs Dr. Prabha Manchanda and Anr, SCI, Civil Appeal No. 1949 of 2004, 16.01.2008

“When a doctor dealing with a sick man strongly believed that the only hope of cure was submission to a particular therapy, he could not be criticized if, believing the danger involved in the treatment to be minimal, did not stress them to the patient.”
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Retirement Tax Suggestions

Some people retire by choice. Others do so involuntarily due to events like corporate restructuring. But planning for retirement should begin now. The sooner it is initiated, the easier it will be, regardless of whom decides when it is time to retire. Although it is difficult to determine exactly how much money will be needed in 30 or more years, estimate how much this lifestyle will cost.

One way to do this is to base it on current spending and the lifestyle, and adjusting for long-term inflation. The less money that is needed to live on, the easier it will be to retire early. Do not make plans so ambitious that they will never be achievable. Use the following guidelines: Most people manage on 65-80% of pre-retirement income. Spend less on home, clothing, savings, etc. Remember that most will probably spend more on healthcare and travel after retirement. There will be more time to travel and unfortunately, the aging process will probably increase medical outlay.

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Eating fast food can cause liver damage

Eating at least two fast foods meals every day and restricting levels of physical activity to no more than 5,000 steps a day can lead to signs of liver damage or weight gain as per a Swedish study. At the end of the 4 weeks, the fast food eaters had put on an average of 6.5 kilograms (14.3 pounds). After just 1 week on the fast food diet, blood tests showed sharp increases in a liver enzyme called SGPT. SGPT levels were more than quadrupled over the 4-week study period. Increased SGPT levels are used to diagnose liver disease before symptoms develop. In 11 fast food dieters, SGPT rose to levels suggestive of liver damage. The SGPT increases were linked to weight gain and higher sugar and Carbohydrate intake.
Bioethical issues in medical practice
Duty as a parent

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

Rina is mother to Chini, an 11 year old girl with mental retardation. Chini can barely look after herself. Her mother is constantly worried as to how she will look after herself when her periods start. At present Chini has barely learnt to bather herself, speak intelligible sentences and move around by herself. However Chini has no idea about her own disability and loves watching romantic scenes on TV. Rina is worried that in these insecure times, Chini may end up being abused or taken advantage of due to her lack of understating. They approach you as a doctor to provide a certificate so that the parents can ask for a hysterectomy. You tell them that this is against human rights and in fact, there is a court judgment against this practice but they keep insisting, because they see you both as a doctor as well as a friend. What should you do?

a) Go all out to help them for the operation because you feel that times are actually bad and chances of (possible) rape and pregnancy are high?
b) Go by the book and say there is nothing you can do?
c) Suggest alternative treatments?

Any other suggestions and solutions? Do write in!
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Inspirational Story
The Alphabet of Happiness (Contd.)

M – MANAGE: Manage your time and your expenses wisely, and you’ll suffer less stress and worry. Then you’ll be able to focus on the important things in life.

N – NOTICE: Never ignore the poor, infirm, helpless, weak, or suffering. Offer your assistance when possible, and always your kindness and understanding.

O – OPEN: Open your eyes and take in all the beauty around you. Even during the worst of times, there’s still much to be thankful for.

P – PLAY: Never forget to have fun along the way. Success means nothing without happiness.

Q – QUESTION: Ask many questions, because you’re here to learn.

R – RELAX: Refuse to let worry and stress rule your life, and remember that things always have a way of working out in the end.

S – SHARE: Share your talent, skills, knowledge, and time with others. Everything that you invest in others will return to you many times over.

T – TRY: Even when your dreams seem impossible to reach, try anyway. You’ll be amazed by what you can accomplish.

U – USE: Use your gifts to your best ability. Talent that’s wasted has no value. Talent that’s used will bring unexpected rewards.

V – VALUE: Value the friends and family members who’ve supported and encouraged you, and be there for them as well.

W – WORK: Work hard every day to be the best person you can be, but never feel guilty if you fall short of your goals. Every sunrise offers a second chance.

X – X-RAY: Look deep inside the hearts of those around you and you’ll see the goodness and beauty within.

Y – YIELD: Yield to commitment. If you stay on track and remain dedicated, you’ll find success at the end of the road.

Z – ZOOM: Zoom to a happy place when bad memories or sorrow rears its ugly head. Let nothing interfere with your goals. Instead, focus on your abilities, your dreams, and a brighter tomorrow
eMedi Quiz
Flu will have:

1. Fever (temperature of 100ºF [37.8ºC] or greater)
2. Cough or sore throat
3. Absence of a known cause other than influenza.
4. All of the above

Yesterday’s Mind Teaser: Following are true about gluten except
a) Gluten-rich foods are wheat, rye, and barley.
b) Soybean or tapioca flours, rice, corn, buckwheat, and potatoes have no gluten.
c) Stabilizers or emulsifiers never contain gluten.
d) Distilled alcoholic beverages and vinegars, as well as wine, are gluten free.
e) Beers, ales, lagers, and malt vinegars are often made from gluten-containing grains

Answer for Yesterday’s Mind Teaser: Celiac disease is a large bowel disorder

Answers received from: Dr poonam chablani,  Amit Patel, kailash sharma

Answer for 28th November Mind Teaser: 4. Superior vena caval obstruction.

Answers received from: Dr poonam,  Amit Patel
This lady was talking in to an envelope. I asked her what she was doing, she said ‘sending voice mail’.
Readers column
College Writing
A visitor to a certain college paused to admire the new Hemingway Hall that had been built on campus. "It’s a pleasure to see a building named for Ernest Hemingway, "he said.

"Actually," said his guide, "it’s named for Joshua Hemingway. No relation." The visitor was astonished. "Was Joshua Hemingway a writer, also?"

"Yes, indeed," said his guide. "He wrote a check."