June 4  2015, Thursday
Supplements may Cut LDL in Older Women
Dr KK AggarwalPostmenopausal women taking calcium and vitamin D supplements had improved lipid profiles with those taking placebo as reported in 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.
Flagging off of truck containing IMA medical supplies for Nepal quake relief work
  • Longer-term data indicate that the effects of alemtuzumab, a novel monoclonal antibody, are long-lasting in patients with relapsing-remitting multiple sclerosis. Patients treated with this drug remained free of new MRI disease activity for up to 4 years. The findings were presented at the Consortium of Multiple Sclerosis Centers (CMSC) 2015 Annual Meeting.
  • Employees in predominantly desk-based occupations should stand and accumulate 2 hours a day of standing and strolling walking during working hours that should progress to 4 hours daily, suggests a consensus statement published online June 1 in the British Journal of Sports Medicine.
  • Depression can recur when postmenopausal women discontinue their estrogen therapy, suggest the results from a randomized clinical trial published online in JAMA Psychiatry.
  • Platinum-based chemotherapy followed by delayed surgery appears to be an effective and safe alternative to primary surgical debulking followed by chemotherapy in women newly diagnosed with advanced ovarian carcinoma, suggested results from the CHORUS noninferiority trial published online in The Lancet.
  • New research reveals that zinc levels may contribute to kidney stone formation, thus opening avenues for the identification of new preventive and therapeutic approaches. The results were published in PLos One.
Dr KK Spiritual Blog
Is time and place of death pre-defined?

Some gurus teach that the time and place of death is predefined and some do not. I personally feel that life and respiration are predefined and not day and time of death.

It is something like - water in a sponge will become empty when every drop of water drains out but it does not matter how much time it takes to come out. It is therefore possible to postpone or prolong the fulfillment of Prarabhdha Karma and postpone death.

As per the Karma theory, unless our Prarabdha Karmas (decided at the time of death and birth) are enjoyed and fulfilled, one cannot die.  But once the Prarabhdha Karmas are fulfilled, death is inevitable.

Another unanswered question is ‘can Prarabdha karmas be modified’? Fate or destiny may not change, which means one may not be able to prolong the quantity of life but can definitely change the quality of life. The quality of life can be changed by modifying Agami (present) Karmas.

Sanchit Karmas can be burnt with the file of knowledge about self. Prarabdha Karmas have to be experienced and Agami Karmas can be neutralized by positive and negative Karmas to Zero in the present life.

The last few Prarabdha Karmas experienced can thus be slowed down by the net positive result of the Agami karmas.
Cardiology eMedinewS
  • Periodic administration of the intravenous inodilator levosimendan is safe and tolerable for patients with advanced, chronic heart failure and may also improve clinical outcomes, suggests the Levosimendan Intermittent Administration in Outpatients: Effects on Natriuretic Peptides in Advanced Chronic Heart Failure (LION-HEART) trial, presented at the Heart Failure Congress 2015.
  • The first-in-class, structurally enhanced omega-3 fatty acid icosabutate safely lowered triglyceride levels in individuals with hypertriglyceridemia, reported a small proof-of-concept study, presented at the International Symposium on Atherosclerosis 2015.
Pediatrics eMedinewS
  • Persistent pulmonary hypertension of the newborn (PPHN) was present in slightly more births among women who had taken selective serotonin reuptake inhibitors (SSRIs) in late pregnancy compared with women who had a diagnosis of depression but were not prescribed antidepressants, reported a cohort study published in the June 2 issue of JAMA. However, after adjustments for confounding factors, the association diminished.
  • Breastfeeding for at least 6 months was linked with a reduced risk for childhood leukemia compared with breast-feeding for a short time or not at all, suggested an article published online June 1 in JAMA Pediatrics.
Make Sure
Situation: A patient on penicillin antibiotic developed a relapse of fever while still on antibiotic.
Reaction: Oh my God! Why was the antibiotic continued for so long?
Lesson: Make sure that drug fever is always excluded in such situations. Antibiotics are the most common cause of drug fever, accounting for approximately one–third of episodes. This especially applies to beta–lactams, sulfonamides and nitrofurantoin (Am J Med Sci 1987;294:275).
Dr Good Dr Bad
Situation:A patient with psoriatic arthritis complained of pain and morning stiffness.
Dr. Bad: Take high dose paracetamol.
Dr. Good:No, take nimesulide 200mg twice a day.
Lesson: Nimesulide 200 mg and 400 mg/day are effective and safe in psoriatic arthritis. Nimesulide in both doses reduced pain severity on a visual analogue scale (VAS) and morning stiffness compared to placebo (Clin Exp Rheumatol. 2001;19(1 Suppl 22):S17-20).

(Copyright IJCP)
Wellness Blog
How to recognize cardiac arrest

Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: "are you all right?"

If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

After assessing responsiveness, health care providers should quickly check the patient’s pulse.

While doing so, it is reasonable to visually assess the patient’s respirations.

It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

The key point is not to delay CPR.
eMedinewS Humor
Foiled Carjacking

An elderly lady did her shopping and upon return found 4 males in her car. She dropped her shopping bags and drew her handgun, proceeding to scream at them at the top of her lungs that she "knows how to use it and will shoot if required… so get out of MY car!"

The 4 men didn’t wait around for a second invitation. They got out and ran like mad, where upon the lady proceeded to load her shopping bags into the back of the car and got into the driver’s seat.

Small problem: Her key wouldn’t fit the ignition. Her car was identical and parked four or five spaces further down.

She loaded her bags into her car and drove to the police station. The sergeant that she told the story to nearly tore himself in two with laughter and pointed to the other end of the counter where 4 pale white males were reporting a carjacking by a mad, elderly, white woman.

No charges were filed.
eMedi Quiz
Olfleck's phenomenon is seen due to which component?

a. Joint psoriasis
b. Mucosal psoriasis
c. Nail psoriasis
d. Pustular psoriasis

Yesterday’s Mind Teaser: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

Answer for yesterday’s Mind Teaser: b. Medina-Ramirez reaction
Correct Answers received from: Dr Shangarpawar, Daivadheenam Jella, Dr PAM Kunju, Dr KC Sharma, Dr Avtar Krishan.
Answer for 2nd June Mind Teaser: b.2-12 weeks
Correct Answers received: Tukaram Pagad, Dr KV Sarma, Dr Madhusudhan G, Dr Avtar Krishan, Daivadheenam Jella.
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
  • In patients with ACS treated with statin therapy, elevated fasting triglyceride levels were significantly associated with an increased risk of cardiovascular events in the short- and long-term follow-up of two major clinical trials, Myocardial Ischemia Reduction with Acute Cholesterol Lowering (MIRACL) study and the dal-OUTCOMES trial. The risk of cardiovascular events was significantly greater among those with higher baseline triglyceride levels.
  • Because psychotropic drugs are immensely harmful when used long term, they should almost exclusively be used in acute situations and always with a firm plan for tapering off, which can be difficult for many patients (Peter C. Gøtzsche, MD, Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark).
Views invited

Last date: June 15th, 2015.
IMA relief work at Nepal
Members of the Indian Medical Association (IMA), Punjab, and the Indian Doctors for Peace and Development donated 200 shelter tents for the people of Nepal. The truck with relief material was flagged off on Monday evening. Parveen Kumar Bansal, BJP district president, flagged off the shelter tents worth Rs 4 lakh and medicine worth Rs 2 lakh. A team of doctors consisting of surgeons and orthopedics is already on way to Nepal.
Inspirational Story
Learn and Earn

Chuan and Jing joined a wholesale company together just after graduation. Both worked very hard.

After several years, the boss promoted Jing to sales executive but Chuan remained a sales rep. One day Chuan could not take it anymore, tender resignation to the boss and complained the boss did not value hard working staff, but only promoted those who flattered him.

The boss knew that Chuan worked very hard for the years, but in order to help Chuan realize the difference between him and Jing, the boss asked Chuan to do the following. Go and find out anyone selling water melon in the market? Chuan returned and said yes. The boss asked how much per kg? Chuan went back to the market to ask and returned to inform boss the $12 per kg.

Boss told Chuan, I will ask Jing the same question? Jing went, returned and said, boss, only one person selling water melon. $12 per kg, $100 for 10 kg, he has inventory of 340 melons. On the table 58 melons, every melon weighs about 15 kg, bought from the South two days ago, they are fresh and red, good quality.

Chuan was very impressed and realised the difference between himself and Jing. He decided not to resign but to learn from Jing.

My dear friends, a more successful person is more observant, thinks more and understands in depth. For the same matter, a more successful person sees several years ahead, while you see only tomorrow. The difference between a year and a day is 365 times, how could you win?

Think! How far have you seen ahead in your life? How thoughtful in depth are you?
Quote of the Day
You have to learn the rules of the game. And then you have to play better than anyone else.

Albert Einstein
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Reader Response
Dear Dr KK Aggarwal, whose idea is it to have an exit exam after passing MBBS. This person should be called to the IMA HQ and given a lecture on how to run the show. Regards: Ashok Ahooja Sqn Ldr
IMA Videos
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Press Release
5th June is World Environment Day

Rising noise pollution emerging as a major public health problem: IMA

Air pollution and its harmful effects on health have been in the news recently. But another environmental issue that also needs equal, if not more, attention is noise pollution, which has adverse health and social effects, both directly and indirectly. The rising noise levels have become a major public health problem, said Dr A Marthanda Pillai, National President Indian Medical Association (IMA) and Dr KK Aggarwal, Hony Secretary General, IMA and President HCFI.

Traffic is the major source of noise pollution. Poor urban planning, social events (loudspeakers), construction activities, gadgets like gadgets like TV, mobiles, earphones, household appliances are other contributors to noise pollution.

Long-term exposure to noise may cause hearing problems. Noise-induced hearing loss is the most common and obvious outcome of noise pollution. It is also an important occupational health concern due to high workplace noise levels.

However, noise pollution has also been associated with other health problems such as stress, anxiety, high blood pressure, increases heart rate, heart disease. It may manifest as disturbed sleep/ insomnia, headache, fatigue, loss of concentration and decreased work efficiency. Noise pollution also causes irritability, which may at times trigger road rage.

Some facts on noise levels
  • Continuous exposure to sounds above 85 db can cause progressive hearing loss. Anyone exposed to sounds above 85 db of noise requires hearing protection.
  • he special limit for people who are exposed to noise above 90 db is 8 hours; for 95 db is 4 hours and 2 hours for 100 db.
  • A short blast of loud sound also can cause severe to profound sensory neural hearing loss and pain. This usually involves exposure to noise above 120-155 db. Hearing protection in the form of muffins or ear plugs is highly recommended anytime a person is exposed to loud noise
Rabies News (Dr A K Gupta)
What does humanizing your dog mean?

1. Talking to your dog like he/she is a person.

2. Treating your dog like he/she is a person.

3. Allowing dogs to do what they want because it will hurt their "feelings."

4. 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.