September 3   2015, Thursday
eMedinewS
editorial
Supplements May Cut LDL in Older Women
Dr KK Aggarwal Postmenopausal women taking calcium and vitamin D supplements had improved lipid profiles with those taking placebo according to a study published in the journal Menopause.

In an analysis of data from the Women’s Health Initiative, the level of LDL cholesterol was lower by an average of 4.46 mg/dL in the women on active treatment reported Peter F. Schnatz, DO, of Reading Hospital in Pennsylvania.

In addition, higher levels of 25–hydroxyvitamin D3 (25(OH)D3) were associated with higher levels of HDL cholesterol and lower levels of LDL cholesterol and triglycerides.
IMA,IJCP,HCFI
eMedipics
IMA,IJCP,HCFI
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Neurology
Psychiatry

Nine potentially modifiable risk factors may explain two thirds of Alzheimer's disease (AD) cases globally, suggested a comprehensive meta-analysis published online in the Journal of Neurology, Neurosurgery and Psychiatry. Risk factors include obesity, carotid artery narrowing, low educational achievement, hyperhomocysteine, depression, hypertension, frailty, current smoking, and type 2 diabetes (diabetes only in Asian populations).

Oncology
Surgery

Irreversible electroporation, a tissue ablation technique, appears to double median survival compared with historical controls for patients with locally advanced pancreatic cancer, suggested data published in the September issue of the Annals of Surgery.

Dermatology Genetic and environmental factors seem to have a similar and roughly equal influence on measures of rosacea, suggest findings from a twin-based study published online in JAMA Dermatology.

Sleep Medicine
A new study published in Sleep has demonstrated that not getting enough sleep could increase the risk of catching a cold.

Urology
Surgery

GreenLight Laser vaporization is as safe and effective as transurethral resection of the prostate (TURP) for benign prostatic obstruction, suggest two-year follow-up data from the GOLIATH trial, published online in European Urology.
IMA,IJCP,HCFI
Cardiology eMedinewS
European Society of Cardiology (ESC) Congress 2015 Update
  • SCOT (Standard care versus Celecoxib Outcome Trial): Among older patients with no history of heart disease, extended treatment with NSAIDs did not increase the risk of heart attack or stroke, researchers said here. The actual event rate was "much, much lower" than the rate anticipated by researchers when they designed the trial -- so much lower that they lost industry support when it became apparent that there would be no difference in outcome between patients assigned to a nonselective NSAID (ibuprofen or diclofenac) or celecoxib (Celebrex), the selective COX-2 inhibitor.
  • OPTIDUAL: Four years of dual antiplatelet therapy did not significantly reduce net adverse cardiac events, but it also did not increase bleeding risk nor did it drive higher mortality. Gérard Helft, MD, PhD, of the Institut de Cardiologie, Hôpital Pitié-Salpétrière in Paris said that extending DAPT beyond the currently recommended 12 months "should be considered for patients at low risk for bleeding who remain event-free 12 months after receiving a drug-eluting stent."
  • PARAMETER (Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin Receptor blocker MEasuring arterial sTiffness in the elderly): Valsartan/sacubitril, formerly known as LCZ696 — but now bearing the brand name Entresto since it won FDA approval for heart failure — may also be a potent treatment for isolated systolic hypertension, the number one driver of stroke.
  • TECOS (Trial Evaluating Cardiovascular Outcomes with Sitagliptin): In an analysis of the TECOS trial, researchers confirm that the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia, Merck) is not associated with any risk of developing heart failure in diabetic patients who received the drug.
Pediatrics eMedinewS
Pediatrics
Pulmonary Medicine


For children hospitalized with bronchiolitis, intermittent pulse oximetry did not shorten length of hospital stay, nor did it result in any difference in the rate of escalation of care or use of diagnostic or therapeutic measures compared with continuous monitoring, reported an article published online August 31 in JAMA Pediatrics.

Pediatrics
Dental Health

Pediatricians should make sure children's teeth are getting varnished with fluoride, recommends the American Academy of Pediatrics (AAP). The 2015 version of AAP’s Recommendations for Preventive Pediatric Health Care is published online August 31 and in the September issue of Pediatrics.
Dr KK Spiritual Blog
How to get rid of negative thoughts

Darkness is absence of light and similarly, negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring back positive thoughts. An idle mind is the devil’s workshop and so will always think negative. Here are some ways by which you can get rid your negative thoughts.
  • Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.
  • Think opposite as taught by Patanjali. For example, if you are having a thought to steal, silently start thinking of charity.
  • Think positive as taught by Buddha. Make a list of positive actions to be done today as the first thing in the morning and concentrate on that list. Divert your mind to your list of pending jobs. This is a type of behavioral therapy.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P Boys Sr. Sec. School, Mandir Marg, New Delhi-2-9-15
IMA,IJCP,HCFI
Make Sure
Situation: A patient developed severe hypoglycemia after receiving 40 units of insulin.
Reaction: Oh my God! The order was for 4 units.
Lesson: Make sure that 4 unit is not written as 4.0 units. This may result in medication error with often disastrous consequences.
Dr Good Dr Bad
Situation: A patient with diarrhea was found to have increased pulse rate.
Dr. Bad: Nothing to worry.
Dr. Good: You have fluid deficiency.
Lesson: Increased heart rate is the first sign of hemodynamic decompensation.

(Copyright IJCP)
eIMA Quiz
All are precancerous for carcinoma colon except

a. Crohn's disease
b. Bile acids
c. Fats
d. Carotene

Yesterday’s Mind Teaser: In ulcerative colitis with toxic megacolon, the lowest rate of recurrence is seen in:

a) Complete proctocolectomy and Brook's ileostomy
b) Ileorectal anastomoses
c) Kock's pouch
d) Ileo anal pull-through procedure

Answer for Yesterday’s Mind Teaser: a) Complete proctocolectomy and Brook's ileostomy
Answers received from: Dr Poonam Chablani, Viswanatha Sarma, Dr Ridu Kumar Sharma, Dr B R Bhatnagar, Dr K Raju, Dr Shangarpawar, Dr Jainendra Upadhyay, Dr Ridu Kumar Sharma, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 1st August Mind Teaser: c) It is related to duration of ulcerative colitis.
Correct Answers received from: Dr Shangarpawar, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K Raju, Dr Avtar Krishan, Daivadheenam Jella.
IMA,IJCP,HCFI
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Press Release
Reversal of heart disease

Heart disease is reversible if lifestyle modifications are made in a timely manner. Nine potentially modifiable risk factors of heart attacks have been identified, which include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, lack of adequate fruits and vegetables in the diet and a sedentary lifestyle. Over 90% of Indians suffer their first heart attack due to one or several of these lifestyle irregularities. Modifying one’s bad habits can go a long way in helping prevent the onset of heart diseases.

Speaking on this topic, Padma Shri Awardee, Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA said, “Majority of the known risk factors of heart disease are modifiable. The reasons for the rising incidence of premature heart disease amongst today’s generation are their unhealthy life choices. The lifestyle of today's youth is characterized by a diet comprising of mostly consume junk food, high-stress jobs, lack of exercise and sleep, and an overdependence on alcohol and cigarettes. If the youth are made aware of the dangers, these carry, and if timely modifications are made, many heart attacks can be prevented."

Smoking cessation reduces the risk of both heart attack and stroke. The risks of heart attack and death in a smoker reduce by half after the first year of quitting itself. Once a person permanently quits smoking, over the course of time his chances of heart disease begin to approach that of nonsmokers.

Some observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of cardiovascular disease. Given this fact, Heart Care Foundation of India (HCFI) recommends walking 80 minutes in a day and with a speed of 80 steps per minute.

Along with lifestyle modifications, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

To prevent heart attacks one must remember the simple HCFI Formula of 80
  1. Keep lower BP, bad cholesterol level, resting heart rate, fasting sugar and abdominal girth levels all less than 80.
  2. Keep kidney and lung functions more than 80%.
  3. Exercise regularly (minimum 80 minutes of moderately strenuous exercise per week). Our recommendation is to walk 80 minutes a day and for 80 minutes per week at a speed of 80 steps per minute.
  4. Do not eat more than 80 gm or ml of caloric food in each meal. Follow a healthy diet (high in fiber, low in saturated fats, containing zero trans fat, low in refined carbohydrate and salt).
  5. Observe cereal fast 80 days a year.
  6. Do 80 cycles of pranayama in a day.
  7. Spend 80 minutes to yourself every day (relaxation, meditation, helping others, etc.)
  8. Do not smoke or be ready to payRs. 80,000/-for treatment.
  9. For those who drink and do not wish to quit, limit alcohol intake to no more than 80 ml per day for men (50% for women) or 80 grams per week. 10 grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor.
  10. Take 80 mg of aspirin if prescribed for prevention.
  11. Take 80 mg atorvastatin for prevention when prescribed.
eIMA News
Rural Health Service
Dear Leaders

Union Health ministry had convened a meeting on rural health service on 27th August 2015 at Nirman Bhavan in which IMA was also invited.

The discussion was on
  1. How to encourage doctors to fill the vacant posts in primary health centres
  2. Alternatively appoint AYUSH doctors at PHC and SCs and
  3. Introduction of Nurse practitioners at SCs and PHCs
The following suggestions were made from our side

Agenda 1
  1. To identify difficult areas (primary health centres where doctors are not available for more than 3 years)
  2. To develop a package to attract doctors to these areas by offering higher salary, accommodation preferably at headquarters with transportation, weightage for PG admission for those serving in difficult rural areas (up to 30% weightage), admission of children to central schools
  3. To post minimum of three MBBS doctors in PHCs instead of the present system of posting one MBBS doctor
  4. To utilise the service of private practitioners in the locality on a retainership /contract basis in the pattern of ‘Mohalla Clinics’ which has become popular in Delhi
  5. To utilise the services of foreign degree holders (Russia/China Indian graduates) as trainees under the supervision of PHC doctors up to three years or till they get registered
  6. Population covered by PHC to be revised at the PHC from existing 30,000 to 20,000 whereas presently up to 1.5 lakhs population is covered by one PHC
  7. To get orientation of rural health problems, and to motivate them to work in rural areas; at least 3 to 6 months should be spend by both undergraduates and post graduates in rural set up, under graduates to get training in PHC during their Community medicine posting and also as part of vertical integration at clinical postings. The post graduates can work at least 3 to 6 months in CHCs along with or under the supervision of specialists. The period for preparation of thesis for this can be reduced to 6 months
Agenda 2

IMA strongly opposed any move to allow AYUSH doctors to work in modern medicine institutions including PHC and HSC. This is against the Medical Council of India Act and Drugs and Cosmetic Act and also has been disapproved through verdicts of the Supreme Court and the Consumer Commission.

Agenda 3

IMA strongly opposed the nurse practitioner system since the doctor-nurse ratio is already below the required number. When a minimum of 3 nurses per doctor is required, we hardly have 1.5 nurses per doctor. So the first priority of the government should be to correct the doctor-nurse-paramedics ratio. All the models in developing/developed countries show that the health parameters are better when the total health manpower is high.

I seek your comments on the above deliberations so that IMA’s policy on rural health service can be given a final shape.

Thanks and regards

Prof Dr A Marthanda Pillai
National President, IMA
News
  • Exercise has the power to keep you from developing high blood pressure, diabetes, stroke, and some forms of cancer. In fact, exercise can lower your risk of heart disease as effectively as medications!
  • The effect of antibiotic exposure on the infant gut microbiome is increasingly well recognized, and a growing body of evidence has linked this association with autoimmune conditions. A recently released retrospective study conducted in children with newly diagnosed juvenile idiopathic arthritis (JIA) provided yet more evidence, finding that antibiotics were associated with newly diagnosed JIA in a dose- and time-dependent fashion. (Medscape)
  • Britain's National Health Service recently approved a trial for dogs capable of sniffing out prostate cancer in the hope that it could show up inaccuracies in the current prostate specific antigen (PSA) test.
Measures to Check Vitamin D Deficiency Should be Undertaken'
Express News Service, Published: 02nd September 2015

Thiruvananthapuram: As part of its Rise and Shine campaign, the Indian Medical Association organised a training session, attended by about 50 doctors in the city, on the growth of Vitamin D deficiency in the country.

The session discussed various health threats due to Vitamin D deficiency. It can have a long-term impact on an individual’s health making them vulnerable to diseases like heart attacks, diabetes, and cancer. The campaign is a national movement initiated by IMA with educational grant from the pharmaceutical company USV. It aims at sensitising doctors across the country on the need to raise awareness about Vitamin D deficiency.

“Around 80-90 percent of the people suffer from Vitamin D deficiency. The reason is the sun-shy behaviour of Indians, a predominantly vegetarian diet, long stressful working hours in closed spaces and a genetic pre-disposition. It is important that doctors recognise common signs of this deficiency and provide appropriate lifestyle counselling and supplementation. The government should study and evaluate the success seen in countries like the US and Canada in dealing with the Vitamin D deficiency,” said consultant endocrinologist Dr Mathew John. Dr A Marthanda Pillai, national president and Dr K K Aggarwal, honorary secretary general of IMA said in a joint statement, “This has been identified as a risk factor for various cardiovascular ailments like ischemic heart diseases, congestive heart failure, heart attacks and strokes. People with low circulating 25-hydroxyvitamin D (25(OH)D) have a higher incidence of high blood pressure and diabetes, conditions that are associated with cardiovascular diseases. Apart from maintaining a regular healthy regime comprising of regular exercise, consumption of healthy food and quitting smoking, such patients should consume dairy products daily and spend at least 30 minutes in the sun.”

“Vitamin D, which can be synthesised in the body with adequate exposure to sunlight is essential to maintain calcium homeostasis in the body for good bone health and overall disease prevention. Doctors should check for Vit D deficiency if patients complain of unexplained tiredness, pains or vague aches.

It is important to note that an overdose can induce Vitamin D toxicity that can be fatal for patients,” said Dr Ambrish Mittal, chairman, Metabolic Disorders and Endocrinology, Medanta and Dr Muhammed Shaffi F, hon secretary, IMA Trivandrum branch.
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IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
Inspirational Story
The ...E... life !

In this world of E-mails, E-ticket, E-paper, E-recharge, E-transfer and the latest E-Governance...

Never Forget "E-shwar (God)"

who makes e-verything e-asy for e-veryone e-veryday.

"E" is the most Eminent letter of the English alphabet.

Men or Women don't exist without "E".

House or Home can't be made without "E".

Bread or Butter can't be found without "E".

"E" is the beginning of "existence" and the end of "trouble."

It's not at all in 'war'

but twice in 'peace'.

It's once in 'hell' but twice in 'heaven'.

E volution evolved from stone Age to all sorts of "E" Lif e

"E" represented in 'Emotions'

Hence, all emotional relations like Father, Mother, Brother, Sister,wife & friends have 'e' in them.

"E" also represents 'Effort' & 'Energy'

Hence to be 'Better' from good both "e" 's are added.

Without "E", we would have no love, life, wife, friends or hope

& 'see', 'hear', 'smell', or 'taste' as 'eye' 'ear', 'nose' & 'tongue' are incomplete without "e".

Hence GO with "E" but without E-GO.

Enjoy the life
Quote of the Day
Don't judge each day by the harvest you reap but by the seeds that you plant. Robert Louis Stevenson
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Reader Response
Respected Sir, even 67 years after independence there are so many villages without basic infrastructure. Also, in small villages and towns, doctors have to work under mercy of locals. The Govt provides free basic education till 10th standard. The pay scales are far behind that of other graduates. By the time doctors finish their basic graduation, they are aged 24 to 25 years; additional post-graduation degree takes another 2 years. Graduates in other disciplines will be drawing more than doctors when they start fresh. If one compares a village in any western country and India, there is a vast difference. The villages in India look like from stone age and no one in interested to develop the village and forget villages even small so-called towns taluks districts are far behind big cities like Bangalore, Mysore or Hubli etc. Can any rich person or big political people live in villages where basic infrastructure is extremely poor? Doctors are not interested to go to villages. If anything goes wrong, the villagers attack doctors and who will take responsibility. The same violence is seen occurring in all places. The Govt. has enforced strict action against the offenders but the attacks still continue because of poor law enforcement and fear among people is also less. Sir, I write this in response to the matter The Migration of Doctors and Nurses. Like every person, and everyone wants to have a decent life and not luxury life. Chitlur N Vishwanath
Media
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
What does humanizing your dog means?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.
Wellness Blog
Prescribe insurance to all patients in your prescription

When we do not take our car out on the road without insurance then why do we take our body out without insurance?
  • Everybody should be insured and for those who cannot, the government must pay for their insurance. Insurance should be added in the prescription of a doctor.
  • Even if a patient has a disease, he or she needs insurance so that he is covered for other illnesses.
  • The coverage amount is for one full year. Do not exhaust it in one admission.
  • The patients should choose their insurance so that even OPD treatment is added to the coverage.
  • A person can have more than one insurance policy.
  • Health is not mere absence of disease but a state of physical, mental, social, environmental, spiritual and financial well being.
  • The purpose of life should be to desire for inner happiness and for that to earn righteously.
  • One must plan for the old age; remember that today one can live above the age of 80 and old age treatments can be very costly.
  • Most disputes are due to property and one must write his or her will in time. Property dispute is number one cause of heart attack in the country.
  • All doctors should be insured against malpractice. To err is human and malpractice is not a criminal negligence.
  • The banks should come out with schemes so that patients can get loans for treatments on the spot.
IMA Humor
Stupid

A substitute teacher was trying to make use of her psychology background. She began her class by saying, "Everyone who thinks you’re stupid, please stand up."

Right away, Little Johnny stood up.

The teacher said, "Why do you think you’re stupid, Little Johnny?"

"I don’t, ma’am, but I hate to see you standing there all by yourself!"
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