March 30  2015, Monday
editorial
ABO Blood Type is a Risk Factor for Coronary Heart Disease
Dr KK AggarwalTwo prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5–23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non–O individuals, plasma levels of factor VIII–von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions.
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IMA Kancheepuram : SWINE FLU – H1N1 AWARENESS RALLY 26.03.2015
News
  • Short-term vitamin D supplementation has no effect on the expression of interferon alpha-inducible genes in patients with stable systemic lupus erythematosus (SLE), suggests multicenter, randomized, double-blind, placebo-controlled phase II trial published in Arthritis and Rheumatology.
  • Staying well hydrated is an effective way to reduce the chances of forming kidney stones, suggests new research presented at the National Kidney Foundation's 2015 Spring Clinical Meetings. Researchers noted that people who produced 2-2.5 liters of urine reduced their risk of forming kidney stones by approximately 50% compared to those who produced less.
  • New data suggest that patients who underwent minimally invasive colon resection procedures were able to leave the hospital faster, visit their doctors less for follow-up care and take fewer medicines as compared to those who underwent open surgery. The findings were published in the March 25 online edition of JAMA Surgery.
  • The European Commission has granted marketing authorization for naltrexone HCl/bupropion HCl prolonged release for the treatment of obesity.
  • Bathing ICU patients with cloths impregnated with chlorhexidine gluconate may be more effective for preventing health care-associated infections, especially those caused by gram-negative bacteria, than soap and water, suggests new research published online in the American Journal of Infection Control.
Dr KK Spiritual Blog
Allopathic Medical Vrat

There was a time when everybody in India, especially women, observed fast on a regular basis. In my childhood, I saw my mother not only observe fast herself but also insisting upon my sisters to observe fast once in a week, an extra fast once in a month and observe the two Navratras in a year of 9 days each. Together, this comes out to be around 80 fasts in a year.

When I go back to my childhood, I remember the fast used to be one day of avoiding cereals altogether. We were allowed to eat Roti made of Kuttu flour, singharha flour, samak rice and dal made of chaulai (all fruits).

In our childhood, we could never understand the meaning of fast. Today India is becoming a hub of diabetes, heart diseases and insulin resistance and all of them are linked with not observing fasts or eating high carb diets every day.

The culprit is eating carbohydrates, especially, refined carbohydrates. When we recall our mythology, only one king Raja Dashrath died of heart attack. This only signifies that our mythological lifestyle was preventing heart diseases in India. The western culture which is now spreading rapidly in India involves eating carbohydrates, especially, refined carbohydrates (white sugar, white rice white maida) every day.

I recently did a survey and found that women who do weekly vrats had a lower incidence of metabolic syndrome.

Today’s girls and women do not want to listen to the word ‘vrata’ or ‘spiritual vrata’.

Therefore, they must be made to understand the same in the language of a ‘medical vrata’. The simpler version of ‘vrata’ can be – not eating carbohydrates at all once in a week and replacing them with fruits and vegetables.

I normally suggest that once in a week, one should eat only fruits and vegetables and at the most can have milk, curd. If still someone has desires, they can have besan ka chila.
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Cardiology eMedinewS
  • Establishing age- and sex-specific 10-year risk thresholds to identify adults to be considered for statins might improve the treatment's number-needed-to-treat balance and enhance the overall performance of the treatment guidelines, suggests new research presented at the American College of Cardiology (ACC) 2015 Scientific Sessions.
  • In patients with coronary artery disease undergoing coronary angiography, measuring high-sensitivity C-reactive protein (hs-CRP) and lipoprotein(a) (Lp(a)) may help stratify patients into different categories of risk, with investigators reporting that those with higher levels of both biomarkers seem to be at a significantly increased risk of major adverse cardiovascular events (MACE), suggests a new study presented at the European Atherosclerosis Society (EAS) 2015 Annual Congress.
Pediatrics eMedinewS
  • More schooling -- and the more mentally challenging problems tackled in those schools -- may be the best explanation for the dramatic rise in IQ scores during the past century, often referred to as the Flynn Effect. These findings also suggest that environment may have a stronger influence on intelligence than many genetic determinists once thought. According to the researchers, who report their findings in the current issue of Intelligence, it is not just increasing attendance, but also the more challenging learning environment that are reasons behind the IQ score rise.
  • Lifestyle-related cardiometabolic risk factors cluster already in children in the same way as in adults, suggests new research from the University of Eastern Finland. The results revealed that risk factor levels even lower than those generally accepted as risk factor thresholds for type 2 diabetes and atherosclerotic vascular disease are harmful when several risk factors cluster.
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Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.
Medicolegal
(Contributed by Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. A friend of mine has the following qualifications: BHMS, PG Diploma in Clinical Pathology, MSc Clinical Pathology from a recognized University. Can he run a Pathology Lab?

A. Running a pathology lab amounts to practicing pathology, which is a specialty of Allopathy/modern medicine. Nobody who is not a graduate in modern medicine can be a specialist in an Allopathic/modern medicine specialty. Your friend is not legally competent to run a pathology lab.

Corrigendum
In the eMedinewS issue dated 19-3-2015 under Medicolegal section the Contributing author name was wrongly carried as (Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS). The original Contributing author is (Dr MC Gupta, Advocate & Medico-legal Consultant). Full apology, to readers and especially Dr MC Gupta. It was a mistake at editorial staff level. We apologize for this.
Dr Good Dr Bad
Situation: A patient with Mediclaim was advised to get admitted in a 5–bedded hospital.
Dr. Bad: It does not matter.
Dr. Good: Go to 15 bedded hospital.
Lesson: Mediclaim requires admission in hospital with minimum 15 beds (in C–Towns, it can be 10 bedded).

(Copyright IJCP)
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
eMedi Quiz
A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Propriception on the ipsilateral side.

Yesterday’s Mind Teaser: A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm Hg followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2. Hypovolemia.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr Amit Desai, Dr Avtar Krishan, Daivadheenam Jella.
Answer for 28th March Mind Teaser: 3.Atracurium.
Correct Answers receives: Viswanatha Sarma, Raju Kuppusamy, Dr Ravindra Kumar
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
Rabies News (Dr A K Gupta)
Can the IM and ID routes of vaccination be used interchangeably?

Many internationally reputed experts recommend that the phenomenon of mixing of IM and ID schedules is not to be practiced and must be avoided as far as possible.
IMA NEWS
IMA launches new campaign against TB

The Hindu: By Bindu Shajan Perapadan: The Indian Medical Association (IMA) has launched an aggressive campaign to identify TB patients and put them on treatment immediately. The Association – the largest non-government organisation of doctors in India – has come out with “Have I notified a TB patient today? Do it today” and on Monday it held its first workshop which was attended by 100 general practitioners.

“We have also appealed to all our members to ask themselves this important question about TB notification at the end of each working day,” said IMA secretary general Dr. K. K. Aggarwal.

Not notifying TB patient is not only a public hazard but also a violation of MCI Act and can lead to suspension of licence of a doctor.

Dr. Aggarwal further said it is not only important to notify TB patients, but equally important to follow the patient till he/she is cured.

The Association has maintained that most symptoms will disappear within a few weeks of treatment and there is a tendency for patients to stop treatment. Incomplete treatment can end up in drug resistance, which may not only be lethal to the patient, but also a health hazard to the community.

“We appreciate actor Amitabh Bachhan openly speaking about the fact that he had suffered from abdominal TB in the past. All pregnant ladies and lactating mothers suffering from TB should be given full treatment. Every patient of HIV should be followed for possible development of TB in future,” noted a release issued by the Association.

IMA also trained a group of Municipal Corporation teachers about respiratory hygiene and cough etiquettes. “We sensitised over 100 MCD teachers to help prevent the spread of swine flu and TB. Both swine flu and TB have cough but if the cough lasts for more than two weeks, TB should be ruled out,” noted the IMA release.

‘Lifestyle changes can reduce heart disease’

The Hindu: By Bindu Shajan Perapadan: Lifestyle counselling and healthy change can reduce heart disease, noted non-government organisation Heart Care Foundation of India president K. K. Aggarwal.

He noted that an intensive effort to change lifestyle by controlling high blood pressure, cholesterol and smoking can substantially reduce the risk of heart disease.

Dr. Aggarwal noted that a trial called the EuroAction study, published in The Lancet compared the results of added counselling on lifestyle issues such as diet, physical activity and smoking to the usual care.

The study includes more than 3,000 people with coronary heart disease and 2,300 high risk people.

Half received counselling from a team of nurses, dieticians, physiotherapists and treating doctors. The counselling was given to families as well as individuals.

The trial included two groups of patients — one who had already developed coronary heart disease, and the other who were asymptomatic but at high risk due to a combination of risk factors with a high chance of developing heart disease in over 10 years.

“The study found that 55 per cent of those getting the counselling reduced their intake of saturated fat, compared to 40 per cent of those not getting the advice. Increased consumption of fruits and vegetables was seen in 72 per cent of the counselled group. Seventeen per cent increased consumption of heart-friendly oily fish, compared to 35 per cent and 8 per cent in the other group,” noted Dr. Aggarwal.

The doctor has advocated increased consumption of fruits and vegetables, heart-friendly oily fish and sustained daily physical activity.

Doing their bit for tuberculosis control, doctors associated with the Indian Medical Association (IMA) have jointly signed and released a message — “TB Haarega , Desh Jeetaga ” and “ Swachh Bharat,Swasth Bharat —TB Mukt Bharat” .

The IMA has demanded that all doctors registered with the Medical Council of India, through their respective State Medical Councils, must notify each and every case of TB in the interest of the nation.
Sonal Namaste
Over 200 diseases are caused by unsafe food containing harmful bacteria, parasites, viruses, chemical substances.
Facts about Tuberculosis (TB)
How is MDR TB diagnosed?
  • MDR TB is diagnosed through a special test called culture and drug susceptibility testing (C & DST), which can be performed by some specialized laboratories.
  • Conventional C & DST (also called solid C & DST) takes 3-4 months to diagnose MDR TB.
  • Newer rapid diagnostics for MDR TB are now available, like liquid C & DST and molecular tests (Line probe assay) which give results much earlier.
Media
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Inspirational Story
Don’t Let Fear Hold You Back

A man once went to a fortune teller, curious to know what she would say about his future. The fortune teller looked into her magic ball and then her facial expression said it all. The man would die, she said, involved in a bus accident. This would happen within two to three months time, but she couldn’t say exactly when. The man went home, depressed and worried telling himself how he never really believed in fortune tellers. Why should he now?

When two months passed, he had thought about what she said, day in and day out. Now he decided to lock himself in his house where he wouldn’t come close to any buses for the next month.

Another 3 weeks went by when the man came down the stairs from his bedroom to make some coffee. His little son had left his toys on the floor of which one was a little toy bus. The man stepped on the bus, after his last step down the stairs, slipped and knocked his head against the stairway railing and died instantly.

Moral of the story: "Live life on the edge, don't lock yourself away."
Wellness Blog
3 simple ways for a restful sleep
  1. Cut down on caffeine: Caffeine drinkers may find it harder to fall asleep. Even a single cup of coffee in the morning may lead to a sleepless night. Caffeine blocks the effects of adenosine, a neurotransmitter thought to promote sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night. Because caffeine withdrawal can cause headaches, irritability, and extreme fatigue, it may be easier to cut back gradually rather than to go cold turkey. Those who can’t or don’t want to give up caffeine should avoid it after 2 p.m., or noon if they are especially caffeine–sensitive.
  2. Stop smoking or chewing tobacco: Nicotine is a central nervous system stimulant that can cause insomnia. If you continue to use tobacco, avoid smoking or chewing it for at least one to two hours before bedtime.
  3. Limit alcohol intake: Alcohol depresses the nervous system, so a nightcap may seem to help some people fall asleep. Alcohol suppresses REM sleep, and the soporific effects disappear after a few hours. Alcohol also worsens snoring and other sleep breathing problems.
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The Vicious Circle

The boss calls his secretary and says, "Get ready for the weekend. We are going on a business trip."

The secretary calls husband and says, "Me and my boss are going on a business trip for 2 days, so take care of yourself."

The husband calls his mistress and says, "My wife is going on a business trip. Come home we can have fun."

The mistress calls the boy to whom she gives tuition, "No tuition this weekend."

The boy calls his grandfather, "Grandpa at last we can spend this weekend together."

Grandpa (The boss) calls his secretary and says, "Business trip is canceled. I'm going to spend weekend with my grandson."

The secretary calls husband, "I won’t be going"

The husband calls his mistress, "I am sorry, my wife is not going."

The mistress calls boy, "You have tuition."

Boy calls his grandpa and says, "Sorry grandpa I’ve classes."

The grandpa calls secretary and…
Quote of the Day
A total commitment is paramount to reaching the ultimate in performance. Tom Flores
Reader Response
Tomatoes and prostate cancer is not a new news .I have known about it for some years. I think the prostate cancer prevalence in Italy is lower because of higher tomato consumption. Regards, Vijay Anthwal

Dear Sir, Emedinews is very informative news. Regards: Dr Shravan
IMA hails smokeless tobacco ban in Delhi
Will lead to fewer heart attacks
The IMA welcomes the recent decision of the Delhi Govt. to ban sale, purchase and storage of all forms of chewable tobacco, said Padma Shri Awardee Dr A Marthanda Pillai National President IMA and Padma Shri, Dr B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA. Complimenting the Govt. on this long-awaited decision, they said that this is an encouraging step in preventive health care.

Smokeless tobacco comes in the form of chewable tobacco or snuff. Electronic cigarettes (e-cigarettes) use a liquid nicotine cartridge, rather than tobacco. In addition to cigarettes, tobacco is smoked in the form of cigars, pipes, and waterpipes.

Nicotine is the main alkaloid found in smokeless tobacco products. The amount of total and free nicotine varies considerably. Oral snuff and cigarette tobacco have similar nicotine concentrations (mg per gm of tobacco), while the concentration of nicotine is somewhat lower in chewable tobacco.

Most smokeless tobacco products are held in the mouth, cheek, or lip or chewed to allow absorption of nicotine across the buccal mucosa. Oral snuff is held in the cheek between the gum and tooth area.
  • Snuff is associated with a small but significant increase in the relative risk for hypertension.
  • Some smokeless tobacco products, such as loose snuff and chewing tobacco, contain large amounts of sodium, part of the sodium bicarbonate alkaline buffer, enhancing nicotine absorption. The sodium load (30 to 40 excess mEq per day) could potentially aggravate hypertension and heart failure
  • Some smokeless tobacco products contain significant amounts of licorice. Glycyrrhizinic acid, an active chemical in licorice, has mineralocorticoid activity, which may potentiate hypertension and potassium wasting
  • Among “one-time” users of snuff or chewing tobacco transient (30 to 60 minutes), increases in blood pressure and heart rate have been observed due to effects of nicotine
  • The acute effects of smokeless tobacco products include an increase in heart rate and no change or transient increases in blood pressure.
  • Data from INTERHEART study showed that chewing tobacco alone was associated with significantly increased risk for heart attack
  • Most people are unaware about the dangers of smokeless tobacco, and some believe that it is a safe substitute for smoking cigarettes.
  • The health effects of smokeless tobacco include oral, pharyngeal, and esophageal cancer, oral leukoplakia, small white patches in the mouth, which are precancerous lesions and periodontal (gum) disease Use of smokeless tobacco produces nicotine levels that are similar to those produced by smoking, and are also addictive.
  • Smokeless tobacco use is associated with higher levels of current and subsequent cigarette smoking and lower rates of smoking cessation.