April 30  2015, Thursday
Tips on family history of high cholesterol
Dr KK AggarwalPremature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL "bad cholesterol") levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.
Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
  • The American Thyroid Association (ATA) recommends routine screening beginning at age 35 and then every 5 years. The American Association of Clinical Endocrinologists (AACE) recommends an aggressive case-finding approach with screening of several high-risk groups. These groups include:
    • Men and women aged 60 years or older, because thyroid disease is common in those groups and because such individuals are often asymptomatic or have minimal or atypical symptoms
    • Adults with a history of other autoimmune disorders, such as type 1 diabetes or pernicious anemia
    • Adults with a history of thyroid surgery, previous thyroid disease, an abnormal thyroid examination, or who are taking medication that may affect thyroid metabolism, including glucocorticoids and sex hormones such as estrogen replacement therapy, which can affect thyroid-binding globulin and thus the amount of thyroid hormone required
    • Adults with a family history of thyroid disease, because of their higher risk of developing thyroid disease
    • Women who are planning to become pregnant or who are already pregnant, because of the very high risk of undiagnosed thyroid disease in terms of fetal well-being.
  • Kidneys donors may be at slightly higher risk for developing gout, new findings in the American Journal of Kidney Disease show. Overall the risk is slight, it’s about a 1.4% increase in risk after eight years. According to the researchers, high serum uric acid can contribute to gout.
  • For women with a personal history of breast cancer, surveillance is better with mammography than with MRI since more cancers are detected with mammography in these patients, suggests new research presented at the American Roentgen Ray Society 2015 Annual Meeting.
  • A report presented at the Society of General Internal Medicine 2015 Annual Meeting suggests that nearly 38% of the upper endoscopies performed in outpatients with gastroesophageal reflux disease and low-risk dyspepsia do not adhere to current best-practice guidelines.
  • Patients receiving dialysis have higher rates of cardiopulmonary resuscitation (CPR) and worse long-term survival after discharge than other patients, suggests a national cohort study published online April 27 in JAMA Internal Medicine.
Dr KK Spiritual Blog
Wahans (Vehicles) In Mythology

In mythological era, the negative tendency of a man is symbolized with the animal nature. Gods in Indian mythology are symbolized by living a positive behavior. Every God has been given a vehicle or Wahan. Both God and the Wahan symbolized how to live a positive life and how to control the animal tendencies.

Following are a few examples:
  1. Lord Ganesha rides a Mouse. Mouse in mythology is symbolized with greed and Ganesha with one who removes obstacles. The spiritual meaning behind both is – one should learn to control greed to tackle obstacles in life.
  2. Lord Shiva riding Nandi (Bull is symbolized with uncontrolled sexual desires) and the duo signifies that for learning meditation, one needs to control sexual desires first.
  3. Saraswati (the goddesses of knowledge) sitting on Swan symbolizes that to acquire knowledge one must learn to control the power of discrimination or Vivek. Swan can drink milk and leave water from a mixture of milk and water.
  4. Indra (the one who has a complete control over the intellect) riding on the elephant Airavat symbolizes that intellect (Indra) for its development requires control over Masti and madness (elephant).
  5. Durga (the perfect woman) riding a lion symbolizes that to become a perfect woman, one must learn to control her agitation or aggression (lion).
  6. Lakshmi (wealth) riding an owl symbolizes that to earn righteously, one must learn to control Owl like properties within us, which is not to get befooled.
  7. Lord Vishnu (the doer) riding eagle or Garuda (Eagles are opportunistic predators which means they eat almost anything they can find) means controlling your desires to eat the unbalanced food.
  8. Krishna riding five horses means one need to control our five senses.
  9. Kartikeya riding on Peacock symbolizes that one should learn to control one’s pride (vanity) or ego.
  10. The vehicle of Goddess Kali is a black goat. Agni rides Mesha – a ram. Kubera, the God of wealth, also has a ram as his vehicle. A ram is an uncastrated adult male sheep. Goat also signifies uncontrolled sexual desires but lesser than the bull.
  11. Yamraj rides a buffalo, which is known for its rampant destruction. Lord Yama or Yamraja is referred to as the God of death, twin brother, lord of justice, Dharma Raja. One can do justice only if one has a control over anger and aggressive behavior.
In mythology, apart from Wahans, animals are also shown to be sacrificed, which means to kill that animal tendency within ourselves. For example, during exams, you need to kill your goat behavior, which is known to possess excessive sexual desires. You may need to control them throughout the year but during exams you need to kill them. In Kali Pooja, a buffalo is sacrificed, which again means that in extreme situations, you may need to kill your ego or anger.
Cardiology eMedinewS
  • Digoxin, a cardiac glycoside, has inotropic effects in addition to effects on cardiac output. Digoxin is used to treat heart failure and atrial fibrillation and has other off-label uses. It has been shown to reduce hospitalization rates without affecting mortality rates in patients with heart failure. Digoxin is effective for rate control in patients with atrial fibrillation, but its influence on mortality rates is a source of controversy. The narrow therapeutic index limits its use and requires close monitoring. Digoxin can cause many adverse events, is involved in multiple drug interactions, and can result in toxicity. Despite its limitations, however, digoxin has a place in therapy. (Medscape)
  • If all 75- to 94-year-olds living in the US in 2014 received generic statins for 10 years for primary prevention of MIs and death from CHD, this would be cost-effective, but only when geriatric-specific side effects—that is, functional limitations (muscle pain and weakness) and mild cognitive impairment—were excluded, researchers conclude. (April 21, 2015 issue of the Annals of Internal Medicine)
Pediatrics eMedinewS
  • The American Academy of Pediatrics (AAP) has updated its child physical abuse guideline that includes new information on the long-lasting effects of abuse and on how pediatricians can protect children. The guideline, published online April 26 in Pediatrics, highlights risk factors for abuse and abusive injuries that are frequently overlooked.
  • Cerebral oxygen metabolism increases during neonatal seizures and decreases with phenobarbital administration, suggests a near-infrared spectroscopy (NIRS) study, published online in Pediatric Research.
Make Sure
Situation: In an STD clinic, a 23–year–old heterosexual male presenting with dysuria and urethral discharge was prescribed azithromycin to cover a suspected Chlamydia trachomatis infection.
Reaction: Oh my God! Why didn’t you advise the same treatment for his partner also?
Lesson: Make sure to remember that in such cases, it is essential that both the partners are treated.
Dr Good Dr Bad
Situation: A patient with positive malaria came with severe thrombocytopenia.
Dr Bad: This is classical malaria.
Dr Good: Also investigate for dengue.
Lesson: Malaria and dengue may co exist in the same patient.

(Copyright IJCP)
Beneficiaries of Sameer Malik Heart Care Foundation Fund
Inspirational Story
Girl and the Plants

A little girl was enjoying the beauty of the garden in her home. Her father had a good collection of rare and exotic plants. He grew them with tender care.

The girl was fascinated by a plant full of fine and fragrant flowers. She went near the plant and enjoyed its beauty and the fragrance of its fine flowers. Suddenly she noted that the plant was growing in a heap of filth. She could not tolerate the presence of dirt at the bottom of the plant with such fantastic flowers.

She conceived a plan to clean the plant. She pulled the plant with all her might and uprooted it. She then carried it to the tap and washed the shoot and roots in running tap-water till all traces of dirt were washed away. She then placed the plant on a clean stone and went away, thinking that she had done a great deed indeed.

Later her father came to the garden and saw the uprooted plant. Its flowers and leaves had wilted and the plant had almost died in the scorching sun. His little daughter ran to him to exhibit her achievement. ‘I have cleaned it, Daddy, she reported innocently. It was placed in dirty soil. Now it is clean.

The father showed her how her treatment had almost killed the plant. He told her that he had collected the filthy soil and placed it to cover the plant’s roots as it was the best medium to grow that plant. It could grow up healthily and produce fine flowers only if grown in filthy soil. She was sad that the plant had suffered and withered by her cleaning.

Pain, poverty and illness may cause agony in our life. Sight of successful persons may make us depressed and envious. A great gardener mixes the right soil for each plant. In the same way God provides each of us with the best environment required for optimum spiritual growth. But it may appear to be unpleasant to us and we may even complain to God about our plight.
Wellness Blog
Women above 65 should take extra care of their health
  • Women aged 65 and above should take low dose aspirin routinely to prevent heart attack and paralysis.
  • All women are urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate–intensity activity on most, or preferably all, days of the week.
  • A heart–healthy diet should be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
  • Saturated fat should be reduced to less than 7 percent of calories.
  • Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL.
  • Women aged 65 and over should consider taking low–dose aspirin on a routine basis, regardless of their risk.
  • Aspirin has been shown to prevent both heart attacks and stroke in this age group.
  • The upper dose of aspirin for high–risk women is 325 mg per day.
  • Hormone replacement therapy, selective estrogen receptor modulators nor antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
  • Folic acid should also not be used to prevent cardiovascular disease.
  • Women should eat oily fish or some other source of omega–3 fatty acids at least twice a week.
  • Women should not only quit smoking but should use counseling, nicotine replacement or other forms of smoking cessation therapy.
eMedi Quiz
Which factors may increase your risk of having a stroke?

A. Hypertension and aging.
B. Being female and Caucasian.
C. Being female and African-American.
D. Menopause.
E. B and C.

Yesterday’s Mind Teaser: The conversion of an optically pure isomer (enantiomer) into a mixture of equal amounts of both dextro and levo forms is called as:

1. Polymerization.
2. Stereoisomerization.
3. Racemization.
4. Fractionation.

Answer for yesterday’s Mind Teaser: Racemization.
Correct Answers received from: Dr G Madhusudhan, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Poonam Chablani, Tukaram Pagad, Daivadheenam Jella
Answer for 28th April Mind Teaser: 4. Protein folding
Correct Answers received: Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
eIMA News
Team IMA: Nepal Update
Ever since the news of earthquake came, IMA HQ became proactive.

Immediately line of action was developed and intimated to all Working committee members, State Branch Presidents and Secretaries, local branch Presidents and Secretaries and IMA Members.

A monitoring cell has been established at IMA HQ.

An appeal has sent to all members to volunteer to go to Nepal for help and for contribution for medicines and IMA President Disaster relief fund.

In response to this, many state branches also appealed to their members for help, like Bihar, Karnataka, Punjab, Maharashtra, Gujarat. (The information which we have received so far)

A request was done to Indigo airlines to provide free tickets to go to Kathmandu. We received a positive response.

IMA HQ Disaster Management Cell has received many request from our IMA Members to go to Nepal to help the needy.

Indian Medical Association along with Heart Care Foundation of India will send a team of specialist surgeons to Kathmandu. I.G. Police of Kathmandu will be giving full assistance for local hospitality.

The first team is ready to go on 30-4-2015.

IMA Blood Bank of Uttarakhand has donated 300 units of PRBC Component for needy patients.

The information regarding ‘How to deal with Disaster: Earthquake Dos and Don'ts’ has been given to all IMA Members.
Team IMA Nepal Update
List of equipment and logistic need for disaster victims

  1. Disposable gowns sterile with caps and masks
  2. Disposable draping sets
  3. Disposable dressing sets
  4. Disposable CVP sets
  5. Disposable C- arm covers
  6. Patients’ pajamas
  7. Patients’ shirts
  8. Blankets for the patients
  9. Injectable higher Antibiotics
  10. Antiseptic solutions
  11. Ethylene with container
  12. IV fluids
  13. IV sets
  14. IV cannula 16-21G
  15. Infusion pumps
  16. Fluid warmers
  17. Blood warmers
  18. Volume expanders
  19. Syringe pumps
  20. Central venous catheter systems (Triple lumen)
  21. Suctions catheters
  1. Ventilators
  2. Anesthesia machine
  3. Patient Monitors
  4. Cautery machines
  5. Manual suction (portable)
  6. Portable ultrasounds
  7. Mobile OT lamps
  8. Tracheostomy sets
  9. Portable pulse oximeters
  10. Laryngoscopes with different size blade
  11. Flexible intubating bronchoscopes
  12. Horizontal sterilizers (large size)
  13. Pneumatic power drills
  1. IM nail (for femur) size 9-11X 34-42
  2. IM nail (for tibia) size 7-11X 28-40
  3. Plates: Dynamic /reconstruction (Broad, narrow and small)
  4. Screws (cortical and cancellous)
  5. Drill bits (2.5-4.5)
  6. Tapings
  7. External fixators
  8. External fixators
  9. Flexible cystourethroscope set with camera /monitor and light source
Blood products
  1. FFP
  2. Con. WBC
  3. Platelets
  4. Albumin
  5. Coag. factor VIII and IX
Suture materials
  1. Polyglycon
  2. Silk
  3. Nylon monofilament
  4. Skin staple
  5. Surgicel/gelfoam
  6. Fibril glue
Team IMA Nepal Update
On 29.04.15: At 2 pm: The IMA Banaras Branch is moving out to Nepal in two Ambulances. One Blood Transport Vehicle with 200 Units of Blood/components. 100 Units of FFP. One lakh worth of antibiotics and 50000/- worth other drugs. Implants /nails/plates /screws. Team of orthopedicians. Paramedical staff, 2 Drivers, 2 attendants, All on its own. Dr Arvind Singh, Hony Secy IMA Banaras Branch
2 Doctors Convicted under section 338 IPC on 22.04.15
Dr Nelson Jesudasan MD Joseph Eye Hospital and Dr Ashok, both ophthalmologists were convicted for one year imprisonment in a case where 66 persons lost their eyes after Cataract surgery in a Government Sponsored camp conducted by Joseph Eye Hospital at Perambalur in Trichy in 2008. People’s civil liberty groups filed case in Madras High court in 2008. Compensation of one lakh by Govt and one lakh by Joseph eye hospital given at that time. Later on case was investigated by CBI and 7 accused, 5 doctors, one chief administrator and one Technician were charge sheeted. The CJM Trichy rejected Government enquiry and acquitted those surgeons who did the surgery and also the Technician. The managing director of Joseph Eye Hospital and the chief administrator of Joseph Eye hospital were convicted and 3 lakhs as compensation with 7.5% interest was ordered. They were found guilty under section 338 IPC. This is the first time doctors are punished for management lapses in Tamil Nadu state. IMA Tamil Nadu has submitted a memorandum containing Seven demands and will undertake one day token strike to be held on 02.05.15 (Emergency cases will be attended). Dr. RVS Surendran, IMA - State President - Tamil Nadu

The Indian Penal Code Section 3338: Causing grievous hurt by act endangering life or personal safety of others.—Whoever causes grievous hurt to any person by doing any act so rashly or negligently as to endanger human life, or the personal safety of others, shall be punished with impris¬onment of either description for a term which may extend to two years, or with fine which may extend to one thousand rupees, or with both.
Workplace violence
Workplace violence is any physical assault, threatening behavior or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee.

Doctors are facing violence in increasing numbers.

A cross-sectional study was conducted from January to June, 2011, at the Regional Institute of Medical Sciences, Imphal, Manipur. A self-administered questionnaire was used among the postgraduate students and findings expressed in the form of percentages. Of the total 286 PG students, 230 responded. 78.26% had experienced at least one form of violence, with the escorts of the patients committing 68.33% of the violence. Verbal threats were the commonest form. Maximum violence was committed at the emergency services (48.88%). Male doctors faced more workplace violence than females (P < 0.001). 78.26% of the respondents wanted work place violence to be a non-bailable offence. (Ori J, Devi NS, Singh AB, Thongam K, Padu J, Abhilesh R. Prevalence and attitude of workplace violence among the post graduate students in a tertiary hospital in Manipur. J Med Soc 2014;28:25-8)
Voluntary Doctors for Nepal with the team of IMA doctors
Nepal Relief Team 2015
Sr. No
Dr. Sadanand Raut
General Medicine MD
Dr. R B Joshi
Anesthesiologist and Gen Pract can do minor surgery
Dr. Jayant Navarange
Dr. Parvez Patel
Orthopaedic surgeon
Dr. Ajay Bojalwar
Orthopaedic surgeon
Dr. Mithilesh Tiwari
Mumbai West
General Practitioner
Dr. Usha A Johari
Eye Surgeon
Dr. S.B.Naval
Dr Devendra Paliwal
Orthopedic surgeon
Dr. Jayesh Shinde
Dr. Vikas Leelavati Balasaheb Jadhav
Dr. Harishchandra  Sakhare
Cardiac anaesthesia.
Dr. Gadewar Pralhad Vijaykumar
Dr. Ramnik Balubhai Chauhan
Family Physician
Dr. Munde Vinayak Chandrasen
MS surgery
Dr. Ingole Uttam Ramrao
MD Anaesthesia
Dr. Alurkar Surendra 
MD Paediatrician 
Dr. Tushar Masurkar
Dr. Pushkar Parag Bhide 
Orthopaedic Surgery
Dr. Ajit V Phadke
Orthopaedic Surgery
Dr. Nagin Nirmal
Family Physician & Hospital Practice
Dr. Dharmesh Gandhi
Dr. Mehul Bhatt
Family Physician
Dr. Varsha Reelkar
Dr. Abhay  Mohite
MS Orthopaedic
Dr.  Neelesh Wadnap
Dr. Prashant Meshram
MS Surgery
Dr. Ravindra Vora
9823279009,  9405858742
Gen. & Paed. Surgeon
Dr. Sanjay Purohit
Gen. & Uro Surgeon
Dr. Kiran Bhingarde
Dr. Ravindra Gosavi
Gen. Surgeon
Dr. Sudarshan Naval
Gynaecologist, Gen. Surg
Dr. Shital  Bane
Gen. Practitioner,  experience of assistance in OT at surg. camps
Dr. Ashok Patil
Ortho. Surg
Dr. Yogesh R. Jibhakate
DNB Ophthalmology
Dr. Mamnohan Kamat
Dr. Dilip Deshmukh
9420371741 7588876968
MBBS DTCD, General Physician
Dr. Sudarshan Kamble
M.S Ortho
Dr. Rajesh Khadse
MD Anaesthesia
Dr. Padma Iyer
This year is different
A call to action in support of 5 May 2015 SAVE LIVES: Clean Your Hands campaign, launched in 2009, and importantly to commemorate ten years of the WHO Clean Care is Safer Care programme 2005-2015
Sonal Namaste
Antibiotics are not indicated for most children with acute watery diarrhea; suspected cholera is an important exception in which antibiotic therapy is warranted.
IMA to send 13 doctors to Nepal
Indian Express: The Indian Medical Association (IMA) finalised a list of 13 doctors who would rush to Nepal Thursday, for treating serious patients affected by the earthquake. The survivors are suffering from injuries — ranging from broken bones, head trauma, spinal injuries and crush syndrome — which require intensive and rapid medical treatment. Some victims will also need to undergo surgeries.

“We have organised the trip in association with Heart Care Foundation of India. We have also tied up with the police in Nepal who is coordinating with a few hospitals where we can treat the critically injured patients,” said Dr KK Aggarwal, IMA’s honorary national secretary general.

The state health authorities have sent two teams of doctors to Nepal. The other experts who will be sent to the neighbouring country include plastic and orthopaedic surgeons.

Apart from doctors, other necessary aid is also being offered. Deputy Director of health, Pune circle, Dr H H Chava said dressing material, antibiotics, medicines and other drugs were being sent along with the team members.

Also in the private sector, Dr Parag Sancheti, head of the Sancheti Institute of Orthopaedics, said they were joining hands with Dr Peter Patel from Birmingham, UK, to send a team to Nepal. “A majority of the injuries will be head injuries, crush injuries, fractures and there will also be a need for psychological rehabilitation,” Sancheti said.

Meanwhile, the WHO is providing additional medical supplies and health workers to help the Government of Nepal.
Wellness Blog
Tomato reduces prostate cancer risk

Consumption of lycopene–containing foods, especially tomato and its products is prostate friendly. A prospective study of a cohort of over 50,000 men from the Health Professionals Follow–up Study in J Natl Cancer Inst 2014;106(2):djt430 suggests that dietary intake of lycopene is associated with a lower incidence of prostate cancer and a decreased risk of lethal prostate cancer. These effects may be mediated through inhibition of tumor angiogenesis.
Quote of the Day
The will to win, the desire to succeed, the urge to reach your full potential... these are the keys that will unlock the door to personal excellence. Confucius
IMA Humor
For crying out loud

With all the new technology regarding fertility, an 88–year–old woman was able to give birth to a baby recently. When she was discharged from the hospital and went home, various relatives came to visit.

"May we see the new baby?" one of them asked. "Not yet," said the mother. "I’ll make coffee and we can visit for a while first."

Another half hour passed before another relative asked, "May we see the new baby now?"

"No, not yet," said the mother. A while later and again the guests asked, "May we see the baby now?"

"No, not yet," replied the mother.

Growing impatient, they asked, "Well, when can we see the baby?"

"When it cries!" she told them.

"When it cries?" they gasped. "Why do we have to wait until it cries?"

"Because, I forgot where I put it."
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Reader Response
Dear KK. Agarwal sir, Already our IMA has an impleading petition against the judgement against AMRI HOSPITAL for the high compensation and capping for compensation in Consumer courts is there (filed while I was the National president & Saini as the secretary General) in the Supreme Court. Please strengthen our pleas with this case also after consulting advocates. Yours, Dr K. Vijaya kumar, Past National IMA President

eMedinewS: Please follow the case and consult legal advisor
IMA Videos
News on Maps
17th May is World Hypertension Day
Post Earthquake symptoms may include High Blood Pressure. Any stress, including earthquake can increase Blood Pressure leading to heart attack & paralysis said Padmashri Awardee, Dr. A. Marthanda Pillai, National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA.

Hypertension is a silent killer and may not have symptoms for decades.

17th May, all over the country is being observed as “Hypertension Day”.

IMA has issued an Advisory that all patients should have their BP check-up done on 17th May. Over 15% of the people may have high blood pressure and they may not be aware about it.

The first symptom of high blood pressure may be a bleeding from the nose or brain-hemorrhage. BP is higher 5 mm in winter, as compared to summer. In any given time, BP should be kept lower by 120/80.

Reducing salt intake and white sugar intake can reduce BP. All patients whose abdominal girth is more than 80 CM should make sure that their BP is kept normal.

IMA will be sensitizing over 2.5 lacs doctors to do a mass screening of BP on 17th May.
Rabies News (Dr A K Gupta)
What are monoclonal antibodies?

Monoclonal antibodies (mAb) are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.