July 31  2015, Friday
eMedinewS
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 September 2012 issue of 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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eMedipics
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ICON 2015
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Cardiology eMedinewS
  • Two new studies add to previous research showing that early "bystander" interventions can improve outcomes after a witnessed out-of-hospital cardiac arrest, especially when compared with EMS-provided interventions. Both studies were published in the Journal of the American Medical Association.
  • A new study published in JAMA suggests that 2013 guidelines compared with 2004 guidelines, provide greater accuracy and efficiency in identifying cardiovascular disease (CVD) risks. More participants were eligible overall for treatment with statin drugs when applying the new clinical guidance compared with the old - 39% versus 14%.
Pediatrics eMedinewS
Pediatrics
Cardiology
Most congenital heart defects that need surgery in the first six months of life go undetected before birth; however, opportunities do exist to improve prenatal congenital heart disease screening, suggests new study online July 27 in Pediatrics.

Pediatrics
Psychiatry
Physical activity may be a strong antidote to ward off sadness and suicidal thoughts in bullied adolescents, suggests a study published online in the Journal of the American Academy of Child and Adolescent Psychiatry.
Dr KK Spiritual Blog
Low Self Esteem

Low self-esteem is the opposite of ego. Supportive psychotherapy is often used to treat depression by improving self esteem.

Low self–esteem always develops when one compares their skill or knowledge with somebody else. We often forget that for passing marks, we only need 50%. One who passes with 50% is a good student.

But the same person, when compares himself or herself with a student who has got 90%, he or she feels that his education was inferior as he was not as competent as others.

Remember that one is required to possess average degree of knowledge and skill and not the maximum degree of skill and knowledge. In the society, one needs to possess only average degree of skill and knowledge.

For example, if a person has passed MBBS with 50% marks, he or she is allowed to practice medicine with full powers and respect. There may be chances when a person who is 90 percentile may be able to take some better decisions but the same does not make him a superior doctor.

The fundamental principle in self–esteem is to make a person proud of his personal knowledge and skills and also to bring out his or her uniqueness.

Passion and profession are two different things. We should judge an individual from is passion and not profession.
Events
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Make Sure
Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.
Dr Good Dr Bad
Situation: A patient came with black stools.
Dr. Bad: It is lower GI bleeding.
Dr. Good: This is upper GI bleeding.
Lesson: Black stools usually indicate upper GI bleeding.

(Copyright IJCP)
eMedi Quiz
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 of 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.

Yesterday’s Mind Teaser: At the end of a balanced anesthesia 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.
Answer for yesterday’s Mind Teaser: 3. Atracurium.
Correct Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr G Madhusudhan, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 30th July Mind Teaser: 1. Phenytoin.
Correct Answers received: Dr Poonam Chablani, Dr K V Sarma, Dr Shangarpawar, Dr Bitaan Sen & Dr Jayashree Sen, Dr K Raju.
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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
NEWS
  • A nasal spray formulation of midazolam may diminish repeated seizures and lower the risk of generalized tonic-clonic seizures in hospitalized epilepsy patients (Medpage)
  • Forty surgeons, anesthesiologists, nurses, and other clinicians at Children's Hospital of Philadelphia (CHOP) operated for 10 hours on an 8-year-boy earlier this month to achieve the world's first pediatric bilateral hand transplant.
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Topic: Breast Feeding & Neonatal Skin Care
News
Infectious diseases
Tenofovir alafenamide maintains viral suppression at least as well as standard tenofovir, has potential bone- and renal-sparing effects, and is not associated with additional adverse events, suggested the largest switch study of its kind conducted in virologically suppressed HIV-infected patients, presented at the 8th International AIDS Society Conference.

Dermatology
In adults with chronic plaque psoriasis, adalimumab is generally well tolerated and effective during five years of therapy, suggested a new analysis from ESPRIT, a 10-year multinational post-marketing registry. The findings were published in the Journal of the American Academy of Dermatology.

Orthopedics
Early mobilization should be the standard of care for simple elbow dislocations, suggests new research published online in the British Journal of Sports Medicine.

Gastroenterology
Four in 10 patients with celiac disease have abnormal liver function tests (LFTs) at diagnosis, but they generally normalize with treatment, suggests new research published in the American Journal of Gastroenterology.

Neurology
Individuals who have agreed to be screened for dementia and who turn out to have a positive result are more likely to refuse additional diagnostic assessment if they live alone, suggests a new study. This refusal could be due to the individual's belief that there is a stigma associated with having cognitive impairment. The findings are published in the Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring.
IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs
unless we do it public will not listen to us

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Inspirational Story
Brotherhood

Ram received an automobile from his brother as birthday present. One day when Ram came out of his office, he saw a street urchin was walking around the shiny new car, admiring it.

"Is this your car?" He asked. Ram nodded, "My brother presented me on my birthday." The boy was astounded. "You mean your brother gave it to you and it didn’t cost you nothing? Boy, I wish…" He hesitated.

Of course Ram knew what he was going to wish for. He was going to wish he had a brother like his brother but what the lad said jarred Ram all the way down to his heels.

"I wish," the boy went on, "that I could be a brother like that." Ram looked at the boy in astonishment, and then impulsively he added, "Would you like to take a ride in my automobile?"

"Oh yes, I’d love that." After a short ride, the boy turned and with his eyes aglow, said, "Would you mind driving in front of my house?" Ram smiled a little. He thought he knew what the lad wanted. He wanted to show his neighbors that he could ride home in a big automobile. But Ram was wrong again.

"Will you stop where those two steps are?" The boy asked. He ran up the steps. Then in a little while Ram heard him coming back, but he was not coming fast. He was carrying his little crippled brother. He sat him down on the bottom step, then sort of squeezed up against him and pointed to the car.

"There he is, brother. Like I told you upstairs, his brother gave it to him and it didn’t cost him a penny. Some day I’m going to give you one just like it then you can see for yourself all the pretty things in the shop windows that I’ve been trying to tell you about."

Ram got out and lifted the crippled boy to the front seat of his car. The shining–eyed older brother climbed in beside him and the three of them began a memorable ride.
Quote of the Day
Nothing ever comes to one that is worth having, except as a result of hard work. Booker T. Washington
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Reader Response
Dear Sir, very informative news. Regards: Dr Karan
Wellness Blog
Do not ignore transient brain dysfunction

Transient ischemic attack or TIA or mini paralysis is a brief episode of neurologic dysfunction caused by lack of blood supply in the focal brain or eye, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction or brain attack

It is a neurological emergency and early recognition can identify patients who may benefit from preventive therapy or from surgery of large vessels such as the carotid artery.

The initial evaluation of suspected TIA and minor non disabling ischemic paralysis includes brain imaging, neurovascular imaging, and a cardiac evaluation. Laboratory testing is helpful in ruling out metabolic and hematologic causes of neurologic symptoms.

TIA or minor non disabling ischemic paralysis is associated with a high early risk of recurrent paralysis. The risk of paralysis in the first two days after TIA is approximately 4 to 10 percent.

Immediate evaluation and intervention after a TIA or minor ischemic reduces the risk of recurrent stroke. Risk factor management is appropriate for all patients. Currently viable strategies include blood pressure reduction, statins, antiplatelet therapy and lifestyle modification, including smoking cessation.

For patients with TIA or ischemic stroke of atherothrombotic, lacunar (small vessel occlusive), or cryptogenic type, antiplatelet agents should be given. For patients with atrial fibrillation and a recent ischemic stroke or TIA, the treatment is blood thinners. For patients with carotid blockages, surgery is needed.
IMA Humor
A man wakes up in a hospital bed after a terrible accident and cries, "DOC, DOC…I can’t feel my legs, I can’t feel my legs!!!

"Well of course you can’t silly!" replies the Doc… "I’ve cut off both of your arms."
Rabies News (Dr A K Gupta)
How is RIG life saving?

Administration of anti–rabies vaccine stimulates production of neutralizing antibodies by the patient’s immune system. Protective levels of antibodies (more than 0.5 IU/ml of serum) are seen 7 to 14 days after the initial dose of vaccine (window period). Moreover when the bites are on the head, neck, face & hands, the incubation period will be shorter.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.
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News on Maps
Press Release
The Indian Medical Association announces a one of its kind training course on Emergency Medical Services

To provide practical training to students who wish to become Emergency Medical technicians or Home Healthcare Assistants

The Indian Medical Association has taken up the challenge of making emergency medical care more accessible and robust in our country. Towards this endeavor, the Association has launched a one of its kind training course for people who aspire to establish their career as Emergency Medical Technicians or Home Healthcare Assistants. In addition to this, IMA in association with the Heart Care Foundation of India, Delhi Red Cross Society and Delhi Police has been training the Delhi Police PCR Van staff in the life-saving technique of hands only CPR 10. By the upcoming Independence Day, Delhi will be only city in India where each and every police PCR van staff will be able to assist sudden cardiac arrest patients until the ambulance arrives.

Sharing details about the same, Padma Shri Awardee Dr. A. Marthanda Pillai, National President, IMA and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA in a joint statement said, “The biggest challenge that we face in India is the lack of focus on emergency medical care as compared to other developed nations. The number of medical emergencies in the country continues to increase and yet the quality of training received by most healthcare assistants remains negligible. Given this scenario, we have launched this course, which will provide both theoretical and practical training to aspirants. IMA in association with HCFI, Delhi Police and the Delhi Red Cross Society will also be training 100% of the PCR van staff in the life-saving technique of hands- only CPR 10 by Independence Day this year. We believe that by working in this endeavor, we can help save the lives of many people who die due to the unavailability of quality medical care in the A person who wishes to become an Emergency Medical Attendant, General Duty Attendant or a Home Healthcare Attendant requires a minimum of 120 hours of training. The Indian Medical Association will conduct training as per the guidelines of the National Skill Corporation in association with Skill Tree Consulting. This will be done under Pradhan Mantri Kaushal Vikas Yojana. Students, who have passed 10th or 12th, can apply for the training.

In addition to training the students, IMA will also help them get jobs. Once trained, these Assistants and Attendants will be able to join healthcare settings owned by a medical doctor and become an integral part of the healthcare delivery system of the country. Each student, once trained will not only be able to assist in providing emergency and medical care but also learn technique of hands

To know more please contact Mr. Piyush : piyush@allianceinfra.com