June 3  2015, Wednesday
eMedinewS
editorial
Low cholesterol linked to anxiety, depression, suicide, hemorrhagic stroke and cancers
Dr KK AggarwalPeople with very low cholesterol levels are at increased risk of developing stomach cancer, according to a study published in the International Journal of Cancer.

The study involved 2,600 residents of Hisayama, Japan, who were followed for 14 years. Gastric cancers developed in 97 subjects. After accounting for age and gender, stomach cancer rates rose significantly with descending cholesterol level. For example, among subjects with the highest cholesterol levels, the gastric cancer rate was the equivalent of 2.1 cases per 1000 persons per year; among those with the lowest cholesterol, the rate was 3.9 per 1000 persons per year.

Patients with low serum cholesterol should consider periodic gastrointestinal examination for the prevention of stomach cancer.

Low cholesterol has been earlier linked to depression, anxiety and suicide in both men and women. Another earlier report has also shown that people with cholesterol level below 180 had twice the risk of brain hemorrhage as compared to those with cholesterol levels of 230.
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IMA-USV Vitamin D Deficiency CME held on 24-5-2015 at IMA House, New Delhi
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News
  • Evidence is mounting that people with gout—particularly women—have an increased risk of vascular disease. These findings suggest that gout patients may need early screening for heart disease and that they should be managed aggressively to prevent vascular damage. (MedPage Today)
  • CT angiography (CTA) appears to be much better than nuclear bleeding scans for localizing lower gastrointestinal hemorrhage (LGIH), suggested a before-and-after study published online in JAMA Surgery.
  • Gorakhpur: Five infants died at a women's hospital within 36 hours, triggering protest by family members who alleged negligence by the hospital. While three infants died in the hospital on Sunday evening, two others had died earlier, hospital officials said.
  • A flat buyer will get Rs.52 lakh as cost from a builder in Kochi, Kerala, for not handing over on schedule the possession of a flat that the man had booked and had paid Rs.71 lakh as its price. The decks were cleared for Jayan to get Rs.52 lakh as the Supreme Court's vacation bench of Justice Prafulla C Pant and Justice Amitava Roy dismissed the builder's plea against the National Consumer Dispute Redressal Commission's order directing him to pay a punitive cost of Rs.52 lakh at the rate of 12 percent per annum from March 2009
  • The National consumer disputes redressal commission (NCDRC) has held that stilt parking is part of common areas and facilities of the apartments and the builder has no right to sell them or raise any construction on the same. The builder can, however, recover its cost of construction from flat owners in proportion to the carpet area of their flats, the commission ruled.
Dr KK Spiritual Blog
Prayer for Inner Happiness

Stress is defined as the physical and mental reaction to the interpretation of a known situation. In absence of a known situation there cannot be a stress. One cannot be stressful for a person who has just died in New York in an accident unless he or she is a known person.

There has to be a right, conscious–based interpretation of the situation as the same situation can bring happiness to one and stress to the other.

The most important consequence of stress, physical or mental, therefore, depends on the right interpretation of the situation.

The interpretation or judgment in the body is governed by chemical reactions and is controlled by the balance of autonomic balance system, which in turn is governed by the interaction of parasympathetic and sympathetic nervous systems.

During the phase of acute stress, when the sympathetic system is predominant, the heart rate and blood pressure increase and a person cannot take correct and decisive decision.

He or she is likely to make mistakes, which can often be detrimental to living. Sympathetic mode is basically the mode of flight or fight reactions of the body.

Right conscious–based decisions can only be taken in a state of relaxed mind when the intention is inserted in the field of consciousness. The relaxed state of the body is the parasympathetic mode, which is healing and is evident by reduction in heart rate, blood pressure and increase in the skin resistance. Most conscious-based decisions will be based on truthfulness, will be necessary and will bring happiness to both the persons and the surroundings.

The yogic lifestyle by which a person learns the dos and don’ts of living, does regular practice of correct postures, daily pranayama and practices regular withdrawal from the outer atmosphere, helps in preparing a state of physical and mental body state, which is more receptive for conscious-based decisions. Yoga Sutras of Patanajali included them in his Ashtanga yoga as the processes of Yama, Niyama, Asanas, Pranayama and Pratihyar.

Prayers have no value when the mind is not at rest. All of us have participated in hundreds of mourning prayers with two minutes of silence. This prayer has no value if the two minutes of silence is not observed. If prayer is done without it the mind will remain restless and we will keep on thinking these two minutes are not over yet.

The process of silence does shift our awareness towards test and parasympathetic state and temporarily we get to be in contact with the memories of the departed soul and we pay homage to him or her. Today a large number of organizations are teaching the process of meditation but the same cannot be taught unless a person practices procedures by which the mind gets relaxed.

The eight limbs of Patanjali focus in detail about premeditation preparations and once that is learned one can go to the other three limbs which are Dharna, Dhyana and Samadhi.

Yoga asanas are different from exercises. They stimulate and stretch all or one of the seven charkas, autonomic plexuses, and ganglion and there located ductless endocrine glands. Also during a yogasana the mind is in the exercise and not wandering here and there.

While yogic exercises at rest are termed yoga asanas and the same yogic meditative exercises with activity are called traditional Indian dances. Western exercises and dances do not follow the principles of yoga. Many international studies have shown that over one–third of the people during their lifetime pray either for their own illness or for somebody else.

All hospitals should have spirituals areas. The prayer and meditation rooms in a hospital setting invariably will provide an arena which will improve patient-doctor relationship and will reduce the rising disputes amongst them in the country.
Cardiology eMedinewS
  • New research, based on data from the Treating to New Targets (TNT) trial, demonstrated that higher levels of triglyceride-rich-lipoprotein cholesterol (calculated by subtracting non-HDL cholesterol from LDL cholesterol) were associated with an increased 5-year risk of a major cardiovascular event—coronary heart disease death, nonfatal MI, resuscitated cardiac arrest, or stroke—independent of LDL cholesterol. The findings were presented at the International Symposium on Atherosclerosis 2015.
  • Preliminary research presented at the Heart Failure Congress 2015 of the European Society of Cardiology Heart Failure Association suggested that percutaneous annuloplasty, a mitral-valve-repair (MVR) procedure, may be an effective alternative to surgery for patients with mitral regurgitation (MR) and severe heart failure.
Pediatrics eMedinewS
  • New research suggests that areas of the brain involved in the regulation of emotion develop differently in adolescents with bipolar disorder, and that these adolescents showed greater gray matter reduction over time and less white matter expansion compared with healthy adolescents. The findings were published online in Biological Psychiatry.
  • Migraine surgery is effective for selected adolescent patients with severe migraine headaches that do not respond to standard treatments, suggests a study published in the June issue of Plastic and Reconstructive Surgery.
Make Sure
Situation: : A patient was brought to the ICU in cardiogenic shock.

Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?

Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of National Registry of Myocardial Infarction 2 (NRMI–2) trial suggest that this intervention is much better than thrombolytic therapy in such patients.
Dr Good Dr Bad
Situation: A sportswoman developed acute low back pain

Dr. Bad: Take ibuprofen.

Dr. Good: You should take nimesulide.

Lesson: Nimesulide is an effective and well-tolerated agent for use in general practices to treat acute low back pain. In a comparative trial vs ibuprofen, the patients' capacity for daily tasks, showed improvement in both groups (P < 0. 001), but a statistically significant difference was found between the two groups in favor of the nimesulide group (P < 0.05) after 10 days. Nimesulide was more effective than ibuprofen in improved lateral bending measurements (P = 0.026). More gastrointestinal side effects were reported with ibuprofen than nimesulide. Spine (Phila Pa 1976). 2000 Jun 15;25(12):1579-85.

(Copyright IJCP)
eMedinewS Humor
Can’t find printer

Customer: Hi, good afternoon, this is Martha, I can’t print. Every time I try, it says ‘Can’t find printer’.
I’ve even lifted the printer and placed it in front of the monitor, but the computer still says he can’t find it…
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Rabies News (Dr A K Gupta)
What is the cause of death in a rabid animal?

Death in rabid animal is due to progressive paralysis.
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
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  • When they applied AUC recommendations to all PCIs performed in the state from 2010 to 2013, they found a 43% decline in revascularizations performed for elective indications, with the largest drop seen after initiation of a statewide PCI appropriateness assessment in 2010 (P=0.03), reported Steven M. Bradley, MD, of the VA Eastern Colorado Health Care System in Denver, and colleagues.
  • The proportion of elective PCIs classified as appropriate increased from 26% to 38% between 2010 to 2013, while the proportion of inappropriate PCIs decreased from 16% to 13% (P<0.001), they wrote in Circulation. (Medpage Today)
IMA End Polio Campaign
The Global Poliomyelitis Eradication Initiative strategic plan through 2018 includes:
  • Cessation of circulating wild-type poliovirus and type 2 circulating vaccine-derived polioviruses (cVDPV)
  • Coordinated replacement of trivalent oral poliovirus vaccine (tOPV) with bivalent oral poliovirus vaccine (bOPV) for an interim period
  • Eventual discontinuation of all oral poliovirus vaccine (OPV) once complete eradication of all types is certified by the World Health Organization (WHO)
It is anticipated that most countries will continue the use of one or more inactivated poliovirus vaccine (IPV) doses for routine infant immunization after total OPV withdrawal.

Because the risk of cVDPV reemergence from residual OPV type 2 circulation will be substantial in the first one to three years after OPV2 cessation, the WHO Strategic Advisory Group of Experts on immunization has recommended that all countries that use OPV add at least one IPV dose to routine immunization of infants in advance of the tOPV-bOPV switch, planned for 2016.

This recommendation is based on affordability, the ability of a single vaccine dose to prime the immune system to respond to another dose administered during an outbreak, and reduction in the risk of disease among vaccinated children in the event of type 2 cVDPV exposure (one-dose seroconversion would be expected in less than 50 percent of recipients). This strategy enhances immunity to types 1 and 3 in two ways: by improving the immunogenicity of OPV with the removal of type 2 vaccine virus, and by enhancing immunity in children who receive bOPV and IPV during routine infant immunization. (Source: Uptodate)

Sonal Namaste
Respiratory hygiene/cough etiquettes apply to all patients and accompanying family or friends who have signs of respiratory illness such as cough, congestion, rhinorrhea or increased volumes of respiratory secretions.
Such individuals should cover their nose or mouth when coughing, promptly dispose used tissues and practice hand hygiene after contact with respiratory secretions. Use of a mask and spatial separation of such patients in waiting or patient care areas is also recommended.
IMA Swachch Bharat Swastha Bharat
Observe IMA Hygiene Hour every Friday between 4-5 PM. Do one hour cleanliness awareness drive.
Key Resolutions and Decisions: 68th World Health Assembly – 26th May
Item 17.1 Emergency and essential surgical care and anaesthesia as a component of UHC: The Assembly noted the report contained in document A68/31, and adopted resolution EB136.R7. Member States committed to identify and prioritise a core set of emergency and essential surgery and anaesthesia services at the primary health care and first referral hospital level, and to develop methods and financing systems for making quality, safe, effective and affordable emergency and essential surgical care and anaesthesia services accessible to all who need it, as part of an integrated surgical care network in order to achieve universal health coverage. They also recognised the need to ensure access to anaesthetics, with a particular focus on ketamine, for patient wellbeing in all surgical settings. Member States explicitly included emergency situations and in fragile states within this.
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Inspirational Story
A Million Dollar Lesson

A cab driver taught me a million dollar lesson in customer satisfaction and expectation. Motivational speakers charge thousands of dollars to impart his kind of training to corporate executives and staff. It cost me a $12 taxi ride.

I had flown into Dallas for the sole purpose of calling on a client. Time was of the essence and my plan included a quick turnaround trip from and back to the airport. A spotless cab pulled up. The driver rushed to open the passenger door for me and made sure I was comfortably seated before he closed the door. As he got in the driver’s seat, he mentioned that the neatly folded Wall Street Journal next to me was for my use. He then showed me several tapes and asked me what type of music I would enjoy. Well! I looked around for a "Candid Camera!" Wouldn’t you? I could not believe the service I was receiving! I took the opportunity to say, "Obviously you take great pride in your work. You must have a story to tell."

"You bet," he replied, "I used to be in Corporate America. But I got tired of thinking my best would never be good enough. I decided to find my niche in life where I could feel proud of being the best I could be. I knew I would never be a rocket scientist, but I love driving cars, being of service and feeling like I have done a full day’s work and done it well. I evaluate my personal assets and… wham! I became a cab driver. One thing I know for sure, to be good in my business I could simply just meet the expectations of my passengers. But, to be GREAT in my business, I have to EXCEED the customer’s expectations! I like both the sound and the return of being ‘great’ better than just getting by on ‘average’"
Wellness Blog
Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management along with empirical treatment is unsuccessful or who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity.

Symptoms that may suggest complicated disease include loss of appetite, loss of weight and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. The examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

Hurry, worry and curry are the three main factors that cause acidity apart from alcohol and smoking.

People with acidity should consume less of fermented, sour, salty and pungent foods.
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eMedi Quiz
The exaggerated lepromin test seen in cases of Lucio phenomenon is called as:

a. Mitsuda's reaction
b. Medina-Ramirez reaction
c. Fischer's test
d. Fernandez reaction

Yesterday’s Mind Teaser: IRIS commonly occurs after how many weeks of ART initiation?

a. 1-4 week
b. 2-12 weeks
c. 12-24 weeks
d. After 6 months

Answer for yesterday’s Mind Teaser:b.2-12 weeks
Correct Answers received from: Tukaram Pagad, Dr.K.V.Sarma, Dr.MadhuSudhan G, Dr Avtar Krishan, Daivadheenam Jella
Answer for 1st June Mind Teaser: b. Combination of store and forward and video conference
Correct Answers received: : Dr K C Sharma, Dr K C Sharma, Dr Poonam Chablani, Daivadheenam Jella, Dr.K.V.Sarma,
Quote of the Day
I hear and I forget. I see and I remember. I do and I understand. Confucius
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Reader Response
Dear Sir, Very informative news. Regards: Dr Kunal
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Press Release
Wear Green dress on World Environment Day

Indian Medical Association (IMA) has appealed to all its 2.5 lac members to wear green dress on Friday the 5th June on Word Environment Day.

Giving the details Padma Shri Awardee Prof. Dr. A. Marthanda Pillai, National President & Padma Shri Awardee Dr KK Aggarwal, Hony. Secretary General, IMA in a joint statement said that the rising air pollution is concern to the society. Uptill now air pollution was linked with asthma and related respiratory diseases. But now, it is linked with heart attack, Blood Pressure and Paralysis.

Now Noise population also has been added in the list of pollution. People who live near airport or near main roads have high blood pressures then others.

Indian Medical Association has asked all the doctors to promote the concept of Green IMA.