July 30  2015, Thursday
eMedinewS
editorial
Serum Calcium to diagnose diabetes
Dr KK AggarwalAn analysis from the PREDIMED study published in the November 2014 issue of Diabetes Care has suggested that increased serum calcium levels can independently predict the risk of type 2 diabetes.

Calcium plays an important role in both insulin secretion and insulin action. Previous studies have shown that elevated calcium levels are linked with insulin resistance.

The study included individuals who did not have diabetes at baseline. In a follow–up of 5 years, in 10% of them who were diagnosed with diabetes, the following parameters were found.
  • The mean baseline albumin adjusted serum calcium was significantly higher for those who developed diabetes than those who did not.
  • Patients who developed diabetes within 6 months were excluded from the study.
  • The risk of developing diabetes for those in the highest serum calcium tertile i.e. 10.2 mg/dL was more than 3 times greater than for the lowest tertile (9.0 mg/dL).
  • For every 1 mg/dL increase in albumin-adjusted serum calcium, the risk of diabetes was 3.52 times higher.
If the study is to be believed, albumin–adjusted serum calcium will be a new test to predict diabetes along with HbA1c.
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eMedipics
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In cardiac arrest call 102 or 100
News
Rheumatology
According to the results of a large prospective cohort study published July 14 in Rheumatology, patients with fibromyalgic rheumatoid arthritis (FRA) and isolated rheumatoid arthritis (RA) will have similar responses to treatment, but FRA patients may miss remission goals and are less likely to have low-disease activity.

Oncology
Gastroenterology
Adequate lymph node staging is critical to the appropriate management of gastric cancer, and radiotherapy appears to improve outcomes of patients even when lymph node staging is inadequate, suggest findings from the National Cancer Data Base (NCDB) published online in the Annals of Surgery.

Neurology
Female collegiate athletes with a history of concussion may experience greater and more severe symptoms and poorer cognitive performance at preseason testing than their male counterparts, suggests a new study presented at the Sports Concussion Conference hosted by the American Academy of Neurology.

Orthopedics
Some placebos are more effective than others in the treatment of osteoarthritis, and these differences can influence the apparent outcomes of clinical trials, suggested a systematic review and meta-analysis of osteoarthritis trials. In particular, intra-articular placebo was more effective than the active drug Tylenol. The findings were published online July 28 in Annals of Internal Medicine.

Obstetrics and Gynecology
Psychiatry
Novel research has identified a relationship between the genetic and epigenetic markers in oxytocin, which increases the risk of postpartum depression. The findings were published in the journal Frontiers in Genetics.
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Cardiology eMedinewS
  • A new study published in the August 4 issue of the Journal of the American College of Cardiology suggests that within a few years of defibrillator implantation, one in four patients experienced improvements in heart function substantial enough to put them over the clinical threshold that qualified them to get a defibrillator in the first place.
  • Dr. Thomas Nyström at the Karolinska Institutet in Stockholm, Sweden and his associates reported July 27 in the Journal of the American College of Cardiology that patients with type 1 diabetes whose HbA1c levels exceeded 9.1% before coronary artery bypass grafting were significantly more likely to die or suffer major coronary adverse events over the next 5 years vs those with better glycemic control. Patients with the worst glycemic control had more than double the risk of death or major coronary adverse events (MACE) as those who were adequately controlled before surgery.
Pediatrics eMedinewS
Pediatrics
Infectious diseases

When approved, a new hexavalent childhood vaccine could reduce, by as many as four, the number of injections in the current series recommended for infants. The investigational vaccine contains diphtheria, tetanus, acellular pertussis, inactivated polio, Hemophilus influenzae type b, and hepatitis B vaccines. Furthermore, immunogenicity did not differ significantly between the hexavalent vaccine and pentavalent vaccine with separate hepatitis B vaccine groups, reported a July 27 Pediatrics online report.

Pediatrics
Gastroenterology
A new study suggests that exogenous glucagon-like peptide 2 (GLP-2) treatment may help fight neonatal parenteral nutrition-associated liver disease (PNALD). The findings are published in the OnlineFirst version of the Journal of Parenteral and Enteral Nutrition (JPEN).
Dr KK Spiritual Blog
Why Spirituality is wellbeing–friendly
  • What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  • Positive thinking produces nearly a 30 percent drop in perception of pain.
  • Spirituality and the practice of religion are associated with a slower progression of Alzheimer’s disease.
  • Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12 percent a year.
  • People who undergo cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  • Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  • Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  • Spirituality can affect immune–system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  • Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  • Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.
Events
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Wellness Blog
Fish Medicine for asthma

The Bathini Goud family, living in Hyderabad, claim that they can cure asthma by making people swallow a 2–inch live fish filled with medicine. They claim that they have been using this treatment for over 160 years.

As per their claim the medicine is stuffed inside the mouth of a live murrel fish, 5–6 cm in size. This fish with the medicine is slipped into the mouth of the asthmatic patient, which can easily be swallowed as the fish is slippery. This needs to be taken for three consecutive years.

The medicine is administered on a specific day Mrigashira Kanthi Nakshatra, which normally coincides with arrival of monsoon rains in the first or second week of June. Three doses are given to the patients after every 15 days.

The Goud family never discloses ingredients of their drug. They provide the medicine free of cost. Some people went to the Court of the Andhra Pradesh on 27.01.2013 but the court declined to interfere and pass any orders regarding the administration of substances popularly known as Fish Medicine. They reasoned that although the treatment had no medicinal value, analysis had shown the samples to not be harmful. They said that "if people flock to have a substance out of faith the courts cannot interfere".

My opinion

Asthma is classified as mild intermittent asthma, moderate persistent asthma and severe persistent asthma. The distinction between intermittent and mild persistent asthma is important because current guidelines for moderate persistent asthma call for initiation of daily control medicine. For moderate persistent asthma, the preferred long-term controller is low–dose inhaled steroid.

Mild intermittent asthma is the largest segment of asthmatic patients and they do not require long term treatment. These are the people who may never require steroid inhalers. Over a period of time, these asthmatics may show improvement. Many mild intermittent asthmatics who are allergic to a particular protein may improve over a period of time.

Homeopaths, Ayurveda physicians, naturopaths and others who claim that they can cure asthma work only on patients with mild intermittent asthma. If their results can be demonstrated in severe asthma, then their methods can be believed to be of use.

The very fact that anybody has claimed does not mean that it is not scientific or scientifically validated. If they can prove their claim, there is no reason why they should not get Noble Prize. We have seen a similar claim by a person who gives a medicine for jaundice in Chandni Chowk and another person in Agra who claims that the can cure any type of cancer with a herb mixed with goat milk.
Make Sure
Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lesson: Make sure to remember that there is a higher incidence of hepatitis with cholestatic jaundice in pregnancy with erythromycin estolate.
Dr Good Dr Bad
Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in the ventricles or cisterns.

(Copyright IJCP)
eMedinewS Humor
Hotel Security

A friend and I stayed at a Chicago hotel while attending a convention. Since we weren’t used to the big city, we were overly concerned about security. The first night we placed a chair against the door and stacked our luggage on it. To complete the barricade, we put the trash can on top. If an intruder tried to break in, we’d be sure to hear him.

Around 1 a.m. there was a knock on the door. "Who is it?" my friend asked nervously.

"Honey," a woman on the other side yelled, "you left your key in the door."
eMedi Quiz
At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1. Pancuronium.
2. Gallamine.
3. Atracurium.
4. Vecuronium.

Yesterday’s Mind Teaser: Granulocytopenia, gingival hyperplasia and facial hirsutism are all possible side effects of one of the following anticonvulsant drugs.

1. Phenytoin.
2. Valproate.
3. Carbamazepine.
4. Phenobarbitone.

Answer for yesterday’s Mind Teaser: 1. Phenytoin.
Correct Answers received from: Siva Kumar, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella, Dr Pravar Passi, Dr G Madhusudhan, Dr Avtar Krishan.
Answer for 28th July Mind Teaser: 2. MEN II.
Correct Answers received: Dr Poonam Chablani, Dr K V Sarma, Dr Shangarpawar, Dr Bitaan Sen & Dr Jayashree Sen, Dr K Raju.
Reader Response
This is in reference to the article- One voice burning issues of IMA. You have suggested CGHS rates to be applicable to private providers. I would request you to have a re look at the CGHS rates, which are so low that it will not be possible for any standard health care provider to comply. For this the rates have to be redrawn by a committee with the private stake holders being a part of it. Presently the CGHS rates are decided arbitrarily by the GOI without considering the capital costs incurred by a private hospital, which is not a concern of the Govt. Dr P Lall
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Rabies News (Dr A K Gupta)
Are there any survivors of human rabies?

Till date only seven survivors have been recorded. These patients survived not due to any specific antirabies therapy but following intensive life support and excellent nursing care. These patients survived for variable periods with residual neurological deficits. All the survivors had paralytic form of rabies and majority had history of some anti–rabies vaccination in the past.
IJCP Book of Medical Records
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CPR 10
Total CPR since 1st November 2012 – 110490 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
                             Government of India
               Ministry of Health and Family Welfare

                                  PUBLIC NOTICE

Rational prescription of drugs and use of "Generic Names" as against brand names has been an issue in medical profession for some time. Accordingly, a clause is in Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 which reads as under:-

1.5 Use of Generic names of drugs: "Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs."

The matter was considered in consultation with Medical Council of India (MCI) as well as Indian Medical Association (IMA) and the following formulation has been proposed:

"Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs. "

General Public is hereby requested to send suggestions/feedback in respect of proposed form ulation. Suggestions may be furnished to ali.rizvi@nic.in by 1 7.08.2015. '

                                                                        (Ali R. Rizvi)
                                      Joint Secretary, Medical Education
Centre considers separate loos for transgender patients in hospitals
Sushmi Dey, TNN | Jul 28, 2015, 06.36AM IST

New Delhi: Hospitals may soon have to build separate toilets for transgender (TG) people and provide 'TG' as an option in their admission forms. The government is considering a proposal making it mandatory for hospitals to fulfill this provision, in line with the Supreme Court directive seeking separate toilets and special medical care for transgender population.

In April last year, the apex court had created the "third gender" status for transgenders in a landmark judgment. Among many other things, the SC also asked the Centre and states to devise social welfare schemes for the community and directed them to construct special public toilets and departments to look into their special medical issues.

The Indian Medical Association, which represents over 2,50,000 doctors from across the country, have also passed a resolution recently to this effect. IMA has asked all its members and medical establishments, under the Hospital Board of India, to abide by the SC directive.

"We have asked all doctors to henceforth provide three columns for gender -Male/Female/Transgender - while enrolling patients. Abiding by the SC rule, the TG column shall be introduced in day to day practice. We have also asked hospitals to create separate toilet facilities for such people," IMA secretary general Dr K K Aggarwal said. He added, IMA is also planning to write to the health ministry to expedite its directive to hospitals.

Experts say the move is important because transgenders have different medical problems and without a basic declaration by themselves their medical needs cannot be adequately addressed. Moreover, by providing them with separate infrastructure according to their sex, transgenders can be acknowledged as a third gender and boost their confidence, which is very important for medical treatment, says Dr Aggarwal.

The government's move comes at a time when the Rights of Transgender Persons Bill is waiting to be taken up for debate in the Lok Sabha during the ongoing monsoon session. The private members' bill, which was passed by Rajya Sabha during the budget session of Parliament, is aimed at ending discrimination against transgenders by bring in stringent punishment. The proposed legislation also talks of provisions to involve transgenders in the social mainstream by facilitating their education, employment as well as health needs, in line with the SC order.
IMA Stand
IMA White Paper on Transgender people

10th March 2015

Dr A Marthanda Pillai, National President IMA; Dr K K Aggarwal Honorary Secretary General IMA; Dr Jugal Kishore Professor of Community Medicine Maulana Azad Medical College; D A P Dubey Director Professor of Pediatrics Maulana Azad Medical College; Dr Rajeev Sood, Professor and Head Urology RML Hospital; Dr Rashmi Sharma Senior Gynecologist and Aswita President IMA Students Wing Delhi Chapter.

Supreme Court of India, WP, 400 of 2012, National Legal Services Authority vs Union of India and others and WP 604 of 2013 has come out with some guidelines regarding third gender. These are not applicable for the aforesaid wider meaning of the expression transgender.
  1. Transgender is the term used as an umbrella term for persons whose gender identity, gender expression or behavior does not conform to their biological sex.
  2. TG may also take in persons who do not identify with their sex assigned at birth, which include Hijras/Eunuchs who describe themselves as “third gender” and they do not identify as either male or female. Hijras can be emasculated (castrated, nirvana) men, non-emasculated men (not castrated/akva/akka) and inter-sexed persons (hermaphrodites).
  3. TG also includes persons who intend to undergo Sex Reassignment Surgery (SRS) or have undergone SRS to align their biological sex with their gender identity in order to become male or female. They are generally called transsexual persons.
  4. TG also includes persons who like to cross-dress in clothing of opposite gender, i.e transvestites.
  5. The gender symbols used should be M/F/TG (some countries write 0 in place of TG)
  6. Transgender persons have a legal right to decide their self-identified gender. In situations where a TG person wants to choose the gender as male or female then it should be written in bracket (declared sex).
  7. TG are in the category of socially and educationally backward classes of citizens and will be under reserved category for educational admissions and other government appointments.
  8. Governments should operate separate HIV sero-surveillance Centres since Hijras/ Transgenders face several sexual health issues.
  9. Medical professionals should seriously address the problems being faced by Hijras / Transgenders such as fear, shame, gender dysphoria (earlier called gender identity disorder), social pressure, depression, suicidal tendencies, social stigma, etc. and any insistence for SRS (Sex Reassignment Surgery)for declaring one’s gender is immoral and illegal.
  10. Medical establishments should take proper measures to provide medical care to TGs in the hospitals and also provide separate public toilets and other facilities for them.
  11. Medical profession should also take steps for framing various social welfare schemes for their betterment.
  12. Medical profession should take steps to create public awareness so that TGs will feel that they are also part and parcel of the social life and be not treated as untouchables.
  13. Medical profession should also take measures to regain their respect and place in the society, which they once enjoyed in our cultural and social life.
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs
unless we do it public will not listen to us

Team IMA
Textbook row: NCERT letter to PM bitter dose for IMA
Shimona Kanwar, TNN | Jul 29, 2015, 03.21 AM IST

Chandigarh: The negative characterization of private doctors in an NCERT textbook is all set to become an ugly fight with the authors of the book writing to Prime Minister Narendra Modi, requesting him not to withdraw the chapter as demanded by the Indian Medical Association (IMA).

Weeks after the IMA demanded withdrawal of the chapter in Class VII social science textbook that labeled private doctors as greedy, the National Council of Educational Research and Training's (NCERT) textbook team on Tuesday claimed in the letter that there is enough evidence to show that private doctors accept kickbacks.

A chapter in the book describes private doctors as "encouraging practices that are incorrect" to make profit. The book was published in 2007 and reprinted in December last year. It also has a comic strip that brings out the difference of treatment at public and private hospitals. The private doctor is shown as prescribing many medicines, while a government doctor just gives a pill for a viral infection. The private doctor's bill is Rs 3,500, while the government doctor charges Rs 150.

According to the NCERT team, children of Class VII can grapple with concrete experiences and cannot be "brainwashed" by merely reading the chapter as alleged by the IMA. TOI had first reported July 9 about the IMA's protest against the way private doctors were projected in the textbook.

The textbook team of nine academicians has gained support from 200 people who endorsed their views about IMA which has also been forwarded to the PM. The team feels that IMA's allegations are based on selective reading of the chapter.

Countering IMA's allegations that such statements on private practitioners "brainwash" students, Arvind Sardana, member of the textbook team, said, "The IMA's thinking about education is outdated. Students of Class VII and onwards are smart. They are able to grapple concrete experiences of health care."

"The chapter provides enough questions in the text to enable students to engage in a discussion based on their health care experiences thereby allowing them to agree or contend and to understand that there are implications for society that faces such inequality in access, including costs for a basic need, especially given the current environment that is encouraging privatization of health sector," he added.

Not affected by all this, the IMA has drafted a legal notice which will be sent to the ministry of human resources and development and the NCERT soon. "We are drafting the legal note and serve it to the ministry and the NCERT. How can all private doctors be termed as following incorrect practices to make money," said IMA's secretary general Dr K K Aggarwal.

Dr Raman Abrol, secretary of IMA's Chandigarh chapter, had complained to the NCERT on July 9. "We are only against the generalization of the entire class of private doctors. There are black sheep in every sector and we are not denying that. The NCERT has misunderstood our contention," said Dr Abrol.

Controversial Text

In the book's chapter 2, "Role of government in health" the controversial description is given under the sub head "Private health facilities". It says, "In order to earn more money, these private services encourage practices that are incorrect. At times cheaper methods, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicines can suffice."
Shri Sudhanshu Ranjan, an eminent TV Journalist awarded by IMA
A renowned TV Journalist & Author, Shri Sudhanshu Ranjan was awarded by IMA with “Dr AKN Sinha Journalism Award and Oration”.

The Award was given by Padma Shri Awardee, Dr. A. Marthanda Pillai, National President, IMA during the recently held International Conference of IMA College of General Practitioners. The award carrying a citation and memento.

Shir Sudhansu Ranjan is known for his investigative reporting that earned him the sobriquet of 'Stormy Petrel of Doordarsdhan" in 1990s itself and enlivening debates on Doordarshan. He is also an accomplished author who has written famous books like Jayaprakash Narayan: Prophet of People's Power, published by the NBT, and Justice, Judocracy and Democracy in India, published by Routlege. Besides, he is a regular contributor of articles to leading dailies and learned journals of India and abroad.
NEWS
  • Two studies published online July 21 in the BMJ suggest that the combination of low birth weight and unhealthy lifestyle has a significant impact on risk of type 2 diabetes, as does consumption of sugar-sweetened drinks independent of obesity status.
  • European Union (EU) regulators have approved the world's first malaria vaccine for use outside the EU among children aged 6 weeks to 17 months.
  • Low- to intermediate-risk patients who arrived at a hospital emergency department with chest pain and had a coronary CT angiography (CCTA) scan were discharged in about 8 hours if the scan failed to detect significant CAD; otherwise they were discharged after about 3 days, Medscape
  • Blood pressure variability across physician's office visits among hypertensive patients is strongly linked to an increased risk for stroke, heart and death, according to a secondary analysis of the ALLHAT hypertension treatment study.
  • The US FDA has approved a gastric balloon to treat obesity, adding to a fat-busting device arsenal that includes gastric banding and a vagal nerve stimulator. The ReShape dual balloon system is indicated for obese adults who have a body mass index (BMI) of 30 to 40, and at least one other obesity-related comorbidity such as hypertension, high cholesterol, or diabetes. It's placed into the stomach using an endoscope. The outpatient procedure takes less than 30 minutes. Temporary device should be removed 6 months after insertion. In a 326-patient clinical trial, patients on the device lost an average of 14.3 pounds over 6 months, compared with 7.2 pounds for those in the control group. Those on the device managed to keep 10 of those pounds off 6 months after the device was removed. (Source: Medpage)
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Inspirational Story
A story to live by

There was a blind girl who hated herself because she was blind. She hated everyone, except her loving friend. He was always there for her. She told her friend, ‘If I could only see the world, I will marry you.’ One day, someone donated a pair of eyes to her. When the bandages came off, she was able to see everything, including her friend.

He asked her, "Now that you can see the world, will you marry me?" The girl looked at her friend and saw that he was blind. The sight of his closed eyelids shocked her. She hadn’t expected that. The thought of looking at them the rest of her life led her to refuse to marry him.

Her friend left in tears and days later wrote a note to her saying: ‘Take good care of your eyes, my dear, for before they were yours, they were mine.’

This is how the human brain often works when our status changes. Only a very few remember what life was like before, and who was always by their side in the most painful situations.

Life is a divine gift
Quote of the Day
Honesty is something you can’t wear out. Waylon Jennings
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Press Release
Emergency guide to saving a patient who has been electrocuted

The maximum deaths due to electric shocks are noted in the ongoing monsoon season

The Monsoon season is welcomed in our country due to the respite it brings to the dreaded Delhi summer heat. However what people need to be cautious about while enjoying the rains is the high risk of electrocution. With the technological advancement of the 21st century, electronic equipment surrounds us. During the monsoon season it is very important to ensure that every individual takes adequate precautionary measures to avoid electrocution and is aware of how to help a victim in case of an emergency.

Heart Care Foundation of India jointly with the Indian Medical Association, Delhi Red Cross Society and Delhi Police has taken up the challenge of training 100% of the Delhi Police PCR van staff on the life-saving technique of hands only CPR 10 by Independence Day 2015. In today’s training session, a special focus was laid on how to help and revive electrocution patients in the monsoon.

Addressing the PCR van staff, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA said, “Electrocution is extremely common in the monsoon months due to carelessness on part of the public. They are not aware of or do not take seriously simple rules that one must not touch any electrical switch or gadget barefoot or with wet hands. The Delhi police are the first to reach such an emergency situation and can help revive the patient by the simple and effective technique of hands only CPR 10. When approaching an electrocution victim the first instinct is to go and pull him or her out. However this can be extremely dangerous since electricity can get passed on from one person to another putting both the people at risk. What one must do instead is first switch off the electric current from the source. Then separate the victim using a non-conducting material such as wood, glass, plastic and paper. Then lay the victim on the floor and check if he is breathing. If not, begin the process of hands only CPR 10 immediately.”

Adding to this, Padma Shri Awardee Dr A Marthanda Pillai National President IMA said, “CPR, is a technique that involves chest compressions without artificial respiration to help save the life of a victim who has collapsed due to a sudden cardiac arrest. It must only be performed on a person who has no pulse rate and is not breathing. Chest compressions must be stopped only when the person starts breathing again or an ambulance arrives. If administered immediately, Hands only CPR can double a person's chances of survival”.

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heartbeats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing.A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.