May 30  2015, Saturday
eMedinewS
editorial
High fat diet, prostate cancer prone
Dr KK Aggarwal Diets high in saturated fat increase the risk of prostate cancer. A study from University of Texas M. D. Anderson Cancer Center in Houston published in the International Journal of Cancer observed that men who eat high saturated animal fat diet are two times more likely to experience disease progression after prostate cancer surgery than men with lower saturated fat intake. Obese men who eat high saturated fat diet also have a shorter "disease–free" survival time vs non–obese men consuming diets low in saturated fat.

Men with a high saturated fat intake had the shortest survival time free of prostate cancer (19 months). Non–obese men with low fat intake survived the longest time free of the disease (46 months). Non–obese men with high intake and obese men with low intake had "disease–free" survival of 29 and 42 months, respectively.

Take home messages
  • High saturated fat diet has been linked to cancer of the prostate
  • Reducing saturated fat in the diet after prostate cancer surgery can help reduce the cancer progression.
  • Cancer prostate has the same risk factors as that of heart blockages and both are linked to high saturated fat intake.
  • With an increase in number of heart patients, a corresponding increase in prostate cancer patients is also seen in the society.
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
IMA & HCFI for increase in size of pictorial health warnings on tobacco products
IMA,IJCP,HCFI
News
  • Depression may be a very early prodromal symptom of Parkinson’s disease, suggests a large Swedish study published online May 26 in Neurology.
  • Subclinical hyperthyroidism may increase the risk of hip, spine and other fractures, especially among those with low thyroid-stimulating-hormone (TSH) levels, suggests a study published in the May 26 issue of the Journal of the American Medical Association.
  • Acupuncture seems to thicken the cortex of patients with idiopathic hand pain while alleviating their pain, reported a new study presented at the American Pain Society (APS) 54th Annual Scientific Meeting.
  • Injections of onabotulinum toxin A increase skin pliability and elastic recoil, suggests new research published online in JAMA Facial and Plastic Surgery. Botulinum toxin A could thus have direct anti-aging effects on the skin, and may be useful for scar treatment.
  • Bridge therapy with heparin during warfarin interruption for invasive procedures is associated with increased bleeding rates in the 30 days that follow, suggested a retrospective study published online May 26 in JAMA Internal Medicine.
Dr KK Spiritual Blog
Spiritual Prescriptions – Controlling the Inner Noise

Yoga Sutras of Patanjali define yoga as restraint of the mental states (Chapter 1.2). In the state of total restraint, the mind is devoid of any external object and is in its true self or the consciousness. Many Vedic scholars have given their own formulae to control the mind.

Being in touch with one’s own consciousness requires restraining of the mind, intellect and ego on one hand and the triad of rajas, tamas and satwa on the other hand. Every action leads to a memory, which in turn leads to a desire and with this a vicious cycle starts.

The mental turmoil of thoughts can be equated to the internal noise and the external desires and objects to an external noise.

The process of withdrawing from the external noise with an aim to start a journey inwards the silent field of awareness bypassing the internal noise is called pratihara by Yoga Sutras of Patanjali. It involves living in a satwik atmosphere based on the dos and don’ts learnt over a period of time or as told by the scriptures. To control inner noise-based thoughts, we either need to neutralize negative thoughts by cultivating opposite thoughts or kill the origin of negative thoughts.

Not allowing thoughts to occur has been one of the strategies mentioned by the scholars. One of them has been neti–neti by Yagnayakya.

The other method is to pass through these inner thoughts and not get disturbed by it and that is what the process of meditation is. This can be equated to a situation where two people are talking in an atmosphere of loud external noise. For proper communication one will have to concentrate on each other’s voice for long till the external noise ceases to disturb. In meditation, one concentrates on the object of concentration to such an extent that the noisy thoughts cease to bother or exist.

One of the ways mentioned by Adi Shankaracharya in Bhaja Govindam and by Yoga Sutras of Patanjali (Chapter 2.35) is that whenever one is surrounded by evil or negative thoughts one should meditate open the contrary thoughts. For example, if one is feeling greedy, one can think of donating something to somebody. Deepak Chopra in his book Seven Laws of Spiritual Success talks in detail about the importance of giving and sharing. He says you should never visit friends or relations empty handed. You should always carry some gift of nature, which if nothing is available can be a simple smile, compliment or a flower. By repeatedly indulging into positive behavior and thoughts, you can reduce the internal noise, which helps in making the process of meditation or conscious living a simpler one.

Washing out negative thoughts is another way mentioned by many Vedic scholars. Writing for 3 min is one such exercise which anybody can do. Just before sleeping, take 3 min and write down all your emotions and then discard the paper. Another exercise is to reward or punish oneself at bed time for the activities done during the day by either patting or slapping yourself.
Cardiology eMedinewS
  • In older men, statins might not prevent major cardiovascular events, reported a large retrospective study presented at the American Geriatrics Society 2015 Annual Scientific Meeting. In men older than 70 years with no previous cardiovascular disease who used statins, the 10% reduction in myocardial infarction, stroke, and revascularization was not significant.
  • Subgroup analysis from the Echo-CRT trial showed no benefits and possible harm from cardiac resynchronization therapy (CRT) for patients with heart failure and narrow-QRS duration. The findings were presented at the Heart Failure Congress 2015 of the European Society of Cardiology Heart Failure Association.
Pediatrics eMedinewS
  • New research suggests that measuring the circumference of the mid-upper arm was the most accurate predictor of under-nutrition in children with diarrhea, and that children with diarrhea are misdiagnosed more often if weight is sole criterion. The research was published in the Journal of Nutrition.
  • Alan R. Schroeder, MD, from the Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, and colleagues report in the June issue of Pediatrics that urinalysis in young infants with bacteremic urinary tract infection (UTI) is more sensitive than previous research suggested it was in infants with UTI in general.
Inspirational Story
Joy of Giving

A woman who was traveling alone in the mountains found a precious stone in a stream. The next day she met another traveler who was hungry; the woman opened her bag to share her food.

The hungry traveler saw the precious stone and asked the woman to give it to him. She did so without hesitation. The traveler left, rejoicing in his great fortune. He knew the stone was worth enough to give him security for a lifetime. But a few days later he came back to return the stone to the woman.

"I’ve been thinking," he said, "I know how valuable the stone is, but I give it back in the hope that you can give me something even more precious. Give me what you have within you that enabled you to give me the stone."

The woman smiled, "The joy of giving!"
Make Sure
Situation: A patient went into acute cardiac arrest within 3 hour of developing chest pain.

Reaction: Oh my God! Why was water–soluble aspirin not given at the time of chest pain?

Lesson: Make sure that all patients with suspected MI are given water–soluble aspirin to reduce chances of death.
Dr Good Dr Bad
Situation: A patient’s fever was not controlled with paracetamol.

Dr. Bad: Add nimesulide.

Dr. Good: No, give nimesulide in place of paracetamol.

Lesson: Nimesulide alone is more antipyretic than paracetamol, more anti-inflammatory than aspirin, and equivalent in analgesia to any of the NSAIDS alone, so efficacy gains are unlikely with added paracetamol. Br J Clin Pharmacol. 2008 May;65(5):795-6.

(Copyright IJCP)
Wellness Blog
Is caffeine good for the health?
  • Caffeine is the most consumed stimulant in the world. It is consumed in the form of coffee and tea.
  • At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  • Short term benefits include mental alertness and improved athletic performance.
  • Short–term adverse effects including headache, anxiety, tremors and insomnia.
  • Long–term adverse affects include generalized anxiety disorder and substance abuse disorders.
  • Long–term benefits are dose–dependent. Caffeine is associated with a reduced risk of Parkinson’s disease, Alzheimer’s disease, alcoholic cirrhosis and gout. Coffee, both caffeinated and decaffeinated, is also associated with a lower risk of type 2 diabetes.
  • Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long–term risk factor for myocardial disease.
  • Most studies show a modest inverse relationship between coffee consumption and all–cause mortality.
  • Caffeine withdrawal is a well–documented clinical syndrome with headache being the most common symptom. (Source: Uptodate)
eMedinewS Humor
Threatening Letters

The fellow stormed into the postmaster’s office in a fury. "I’ve been getting threatening letters in the mail for months and I want them stopped."

"Of course," said the postmaster. "Sending threatening letters through the mail is a federal offense. Do you know who’s sending them?"

"Yes," shouted the man. "It’s those idiots down at the Internal Revenue Service."
eMedi Quiz
Patient empowered teledermatology is well documented with which of the following teledermatology conditions?

a. Acne
b. Psoriasis
c. Leg ulcer
d. All of above

Yesterday’s Mind Teaser: Epidermodysplasia veruniciformis is caused by which of the following HPV serotypes:

a.1
b.3
c.5
d.11

Answer for yesterday’s Mind Teaser: c.5

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K V Sarma, Dr G Madhusudhan, Dr K C Sharma, Dr Avtar Krishan.

Answer for 28th May Mind Teaser: 4. Oxygen affinity of hemoglobin.

Correct Answers received: Satish Gulati.
Rabies News (Dr A K Gupta)
Is hydrophobia a sign of rabies in dogs?

Hydrophobia is not a sign of rabies in dogs. Rabid dogs can drink water and even swim in water. If a rabid dog is not able to drink water, it is because of paralysis of jaw muscles and not due to hydrophobia.
IMA,IJCP,HCFI
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
India to switch from trivalent OPV (tOPV) to bivalent OPV (bOPV) in the immunization programme

The 65th World Health Assembly (WHA) adopted a landmark resolution in May 2012 declaring the completion of polio eradication a ‘programmatic emergency for global public health’, which included the endorsement of the eventual cessation of use of oral poliovirus vaccine (OPV) in routine immunization programmes.

A Polio Eradication and Endgame Strategic Plan 2013-2018 has been developed by the Global Polio Eradication Initiative with the objective of simultaneously eradicating wild polioviruses and eliminating vaccine derived polioviruses.

One of the objectives of the plan is a globally coordinated withdrawal of the OPV from the programme in a phased manner. It will begin with the withdrawal of the type 2 component (OPV2), by switching from trivalent OPV (tOPV) to bivalent OPV (bOPV) in the immunization programme. The current target date for the globally synchronized switch from tOPV to bOPV is April 2016.

To meet this timeline, all OPV-using countries will begin the planning process for the tOPV to bOPV switch and develop a national switch plan by 1 September 2015. Meticulous planning and preparation for the switch is essential and has to begin immediately.

The debriefing on the “dry run” for the tOPV to bOPV switch shall take place on Monday, 01 June from 10 a.m.- 12 noon. The details of the venue are given below:

Kind regards,

World Health Organization
Regional Office for South-East Asia

World Health House
Indraprastha Estate
Mahatma Gandhi Marg New Delhi, India 110 002
IMA Swachch Bharat Swastha Bharat
Observe IMA Hygiene Hour Every Friday 4-5 PM. Do one hour cleanliness awareness drive.
Key Resolutions and Decisions: 68th World Health Assembly – 26th May
Item 13.1 Outcomes from ICN2: The WHA approved the draft resolution contained in document A68/8. The Assembly endorsed the Rome Declaration on Nutrition, as well as the Framework for Action, which provides a set of voluntary policy options and strategies for use by governments; called on Member States to implement commitments of the Rome Declaration through a set of voluntary policy options within the Framework for Action; and requested the WHO Director-General to prepare a biennial report to the World Health Assembly on the status of implementation of commitments, in collaboration with the Director-General of FAO and others.
To
Sh Arvind Kejriwal
Hon'ble CM
Government of Delhi

Dear Sir

Congratulations for directing all city hospitals not to deny admission to people suffering from heat stroke. And also directing all hospitals to attend to such patients on an emergency basis. The searing heat wave has killed over 1,400 people across the country. In Delhi, two deaths have been reported so far.

Your health department has also directed all directors and medical superintendents of government owned/funded, private hospitals and nursing homes to ensure necessary arrangements in their emergency departments in the form of cooled areas, manpower, medicines and IV fluids, ice packs.

Sir, the medical fraternity is with you. But your ministry has forgotten to mention about reimbursements to the private sector.

All emergency care should be reimbursed by Delhi Govt as per Delhi Govt reimbursable rates to the private sector.

Kind regards,

Dr A Marthanda Pillai         Dr K K Aggarwal
National President,              Honorary Secretary General,
IMA                                       IMA
IMA Kent Safe Water Initiative
Is Delhi Jal Board Water safe for drinking?

In a study done by MCD in March 2011, it was shown that tap water consumed at the point of care is not health friendly.

The survey tested water samples from 600 locations spread across the capital. Twenty percent of samples were found to be unfit for human consumption and that too by Indian standards, which are 10 times higher than the Western standards. A total of 111 out of 616 samples showed presence of coliform bacteria with a count of more than 10 CFU per 100 ml (chlorine forming units). Indian Standards allow up to 10 CFU per 100 ml but the US standards is 1 CFU per 100 ml.

Is presence of high arsenic content in ground water a concern?

As per the report presented in 16th Lok Sabha by Minister of Water Resources, Rural Development and Ganga Rejuvenation, it was submitted that in India around 80% of the rural population and 50% of the urban population uses ground water for domestic purposes.

Ganga water contains arsenic, selenium, nitrate, iron, fluoride and heavy metals. High arsenic contents in the water of the Ganga affects the human, animal, soil and plant systems. As many as 98 districts in 13 states have been affected by high arsenic contamination in the river water. About 7.4 million people in 35 districts alone have been exposed to this arsenic contamination. It has been reported that over 1 lakh deaths and 223 confirmed cases of illnesses have been caused by arsenic in the waters of Ganga.

Under Article 47, it is the duty of the State to improve the public health facilities for the general public.
IMA stand on LGBT Community
Being Lesbian, Gay, Bisexual and Trans Gender is not an illness.

Amongst the LGBT community, 60 to 70% are bisexual. These people can be Ego-dystonic or ego-syntonic.

Ego-syntonic people are comfortable with their sexual preferences. The role of medical practitioners is only to look after their needs and not advice them about change of a particular behavior.

Ego-dystonic people are not comfortable with their sexual behavior and invariably will require a referral to a specialist for counseling for medical or surgical treatment as the case may be.

It is now common for a medical practitioner to ask the following two questions to their patients:
  • Are you sexually attract to women, men or both?
  • Do you feel comfortable with your sexuality?
It is also taught in medical college today to ask the following non-judgmental questions to every adult:
  • Have you been sexually active in the past years?
  • Do you have sex with men, women and both?
  • Are you sexually attracted to men, women and both?
  • Do you feel comfortable with your sexuality?
The job of a medical doctor is to not coerce people from one behavior to other.

However in special situation, MSM relationship (forced relation), relationship in prison, in professional industry etc. it is justifiable for a doctor to interfere.
World No Tobacco Day
IMA,IJCP,HCFI
Indian, Nepali doctors to conduct mobile health camps in Nepal
IANS | 28 May 2015, 6:40 PM IST Kathmandu: Indian doctors will assist Nepal's own physicians in organising mobile health camps to tackle any likelihood of outbreak of epidemics following the devastating temblor last month and ahead of the impending monsoon, a top official said.

The Nepal Medical Association (NMA) and the Indian Medical Association (IMA) will jointly conduct mobile health camps to prevent potential outbreak of epidemics in the districts that were badly affected by the April 25 earthquake and subsequent aftershocks, it was announced here on Thursday.

Pointing out that thousands of quake survivors, taking refuge in makeshift shelters, were vulnerable to epidemics in the aftermath of the natural disaster, IMA, the professional organisation of medical and dental doctors of India, said they were set to conduct mobile health camps in association with their Nepali counterparts to provide healthcare to disaster survivors.

"We cannot remain mute spectators to Nepali people's plight at such time of national crisis and tragedy. Indian medical teams were dispatched to Nepal to respond to the post-quake needs," IMA president A. Marthanda Pillai said at a press meet organised in the capital.

He said IMA had already contributed medical supplies worth around Rs.4 million (nearly $62,700) to quake victims.

"It is crucial to make necessary arrangements for special health camps on time, bearing in mind the potential outbreak of epidemics," said Pillai.

Meanwhile, IMA has signed a seven-point agreement with NMA for providing medicines and expert services to the people living in makeshift camps, formulating a special strategy to prevent epidemics before the onset of monsoon, and extending all kinds of medical assistance as necessary.

NMA president Anjani Kumar Jha said the professional organisation of medical and dental doctors has been actively engaged in ensuring people's access to medical services since the earthquake hit the Himalayan nation.

"Still, we have much more to do and we will be organising mobile health camps to cover all quake-affected areas," he informed.
Politics of “Putrajeevak Beej”
  • Minister of State for AYUSH Shripad Naik has stated that the Ayurvedic medicine “Putrajeevak Beej” promoted by Baba Ramdev was named after a herb of similar name.
  • Imagine a qualified gynecologist naming her nursing home as “Putrajeevak Hospital” after the ancient herb. If she had an ultrasound machine, she would have been behind the bars
  • Swamiji’s company which has been promoting ayurvedic drugs on primetime is neither booked under Drugs and Magic Remedies Act for claiming to cure infertility nor under Indian Medicine Central Council Act 1970 for violating Section 17 subsection 2 clause (b) of the said Act.
  • The subsection 4 of section 17 of the Indian Medicine Central Council Act provides punishment of 1 year jail term for practicing Ayurved without having any qualification mentioned under Second , third and fourth schedule and registered in any State register.
  • Claiming to treat sterility or women’s diseases in general is mentioned at serial no 18 & 48 in the schedule attached with Drugs and Magic Remedies Act as Diseases or ailments (by whatever name described) which a drug may not purport to prevent or cure or make claims to prevent or cure. The “Putrajeevak Beej” is according to the media reports is used for female infertility/sterility.
(Source: Writings of Dr Neeraj Nagpal)
Media
IMA,IJCP,HCFI
IMA started IMA CLEAN INDIA MISSION today 4pm -5pm. Over 30 IMA staff of IMA participated in cleanliness drive.
IMA,IJCP,HCFI
Quote of the Day
High achievers spot rich opportunities swiftly, make big decisions quickly and move into action immediately. Follow these principles and you can make your dreams come true. Robert H. Schuller
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Reader Response
Dear Sir, very informative news. Regards: Dr Shravan
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Press Release
IMA & HCFI for increase in size of pictorial health warnings on tobacco products

A survey conducted by the Indian Medical Association (IMA) and Heart Care Foundation of India (HCFI) amongst the youth found that the two most important facts, which youth fear about tobacco usage are: “Tobacco products can lead to erectile dysfunction in men” and “Tobacco consumption can lead to early aging of skin in women leading to wrinkles.”

Addressing a Press Conference in Delhi, Padma Shri Awardee Dr A Marthanda Pillai, National President IMA and Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr KK Aggarwal, Hony Secretary General, IMA and President HCFI said that IMA is for increasing the size of the pictorial health warnings on tobacco products, covering up to 60 to 80% of the front part of the product. According to the IMA, besides the cancer warnings, the government should also include pictorial warning messages about early aging and erectile dysfunction.

Dr Aggarwal further said that they support increase in taxes on tobacco products and hailed the order of Punjab Government, Haryana Government and Chandigarh Administration that banned complete use of nicotine under the Provisions of Poison Act 1919 and their Sale Rule 2015. These three States have placed nicotine in the category of poison. IMA wants this to be implemented in all other States and Union Territories too. IMA has written to the Health Minister demanding this ban at a National level also.

IMA will also be training all General Practitioners in tobacco cessation so that tobacco quit facilities are available to those who want to quit. IMA has already advised their 2.5 lakh members to ask every patient at every visit whether he or she smokes and if yes, offer help for quitting.

IMA has also sent communication to all its 1700 branches and 2.5 lakh members not to allow smoking in their organizational meetings and their clinics and hospitals should be strictly no smoking zones. No doctor shall smoke in public place and in public view.

Following points, as IMA Stand, were released.
  • Beedi and Hukkah smoking is in fact more dangerous than cigarette smoking.
  • Secondhand smoke is equally dangerous to health as tobacco smoking.
  • Quitting means 3 years of not consuming tobacco
  • Electronic cigarettes are not safe option to quit smoking.
  • Putting nicotine water over herbal products and selling them for a kick, needs to be banned.
  • There should be complete ban of smoking in films. The caption below the scene that smoking is injurious to health does not stop people emulating the smoking character depicted in the film. There is enough data available to prove the point.

    IMA & HCFI support banning oral tobacco products all over the country. Selective ban in few States is encouraging the illicit trade of tobacco products from non ban states to ban states e.g. from UP to Delhi.

    The Press Conference was co-addressed by Dr NV Kamat and Dr RP Vashist, Principal Advisors, IMA.